Gerry M. Raghoebar

Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction

AIM This study evaluated, through a systematic review of the literature, the outcome of single-implant restorations in the aesthetic zone with natural adjacent teeth, thereby addressing immediate, early and conventional implant approaches. MATERIAL AND METHODS MEDLINE (1950-2008), EMBASE (1966-2008), and CENTRAL (1800-2008) were searched to identify eligible studies. Two reviewers independently assessed the methodological quality using specific study-design-related assessment forms. RESULTS Out of 86 primarily selected articles, 19 studies fulfilled the inclusion criteria. A meta-analysis showed an overall survival rate of 95.5% [95% confidence interval: (93.0-97.1)] after 1 year. A stratified meta-analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri-implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies. CONCLUSION The included literature suggested that promising short-term results could be achieved for immediate, early and conventional single-implants in the aesthetic zone. However, important parameters as aesthetic outcome, soft-tissue aspects, and patient satisfaction were clearly underexposed. The question whether immediate and early single-implant therapies would result in better treatment outcomes remained inconclusive due to lack of well-designed controlled clinical studies.

Morbidity from iliac crest bone harvesting

PURPOSE The iliac crest is the most common donor site for autogenous bone grafting in maxillofacial surgery. The aim of this study was to evaluate retrospectively the morbidity of bone harvesting from the inner table of the anterior iliac crest. PATIENTS AND METHODS Sixty-five patients were recalled 1 to 4 years after iliac crest bone harvesting. The morbidity as well as the patients satisfaction were evaluated by a survey of the medical record, a mail-in questionnaire, and a standardized physical examination. RESULTS There was good acceptance of this bone harvesting procedure, and the morbidity was low. CONCLUSION Bone harvesting from the inner table of the anterior iliac crest is a good option for reconstructing bone defects.

AUGMENTATION OF THE MAXILLARY SINUS FLOOR WITH AUTOGENOUS BONE FOR THE PLACEMENT OF ENDOSSEOUS IMPLANTS - A PRELIMINARY-REPORT

Placement of endosseous implants in the atrophic maxilla is often restricted because of lack of supporting bone. In this article, experience with augmentation of the maxillary sinus floor with autogenous bone grafts to enable insertion of endosseous implants is described. The technique is aimed at providing a cortical layer on top of the graft to ensure a reliable seal of the maxillary sinus and to achieve optimal stability of the bone graft in case of simultaneously placement of dental implants. The procedure was used in 25 patients, using iliac crest grafts (22 patients, 86 implants), symphyseal bone grafts (two patients, six implants), or a maxillary tuberosity bone graft (one patient, one implant). Ninety-three Brånemark implants (Nobelpharma, Götenburg, Sweden) were inserted in 47 grafted maxillary sinuses. The mean follow-up was 16 months (range, 6 to 36 months). No inflammation of the bone grafts nor of the maxillary sinus occurred. The sinus membrane was perforated accidentally in eight cases during the surgical procedure. Five implants (5.4%), all inserted in iliac crest grafts, were lost during the healing period. The patients received implant supported overdentures (16 patients) or bone-anchored bridges (nine patients). From this preliminary study it is concluded that augmentation of the maxillary sinus floor with bone grafts for the insertion of endosseous implants is a promising solution for patients with atrophic maxillae and functional problems with their partial or full dentures.

Augmentation of localized defects of the anterior maxillary ridge with autogenous bone before insertion of implants

PURPOSE This study evaluated the applicability of intraorally harvested autogenous bone grafts for the augmentation of the narrow maxillary alveolar ridge to enable insertion of implants for single tooth replacement. MATERIALS AND METHODS Local defects of the anterior maxilla were reconstructed in 27 patients with autogenous bone grafts from the mandibular symphysis (n = 12), maxillary tuberosity (n = 8), or mandibular retromolar area (n = 7). Three months after grafting, either Branemark (n = 23) or ITI Bonefit implants (n = 8) were inserted. RESULTS At the time of implantation, all grafted sites showed sufficient bone volume for insertion of the implants. Twenty-four to 68 months after insertion, all implants were functioning well. CONCLUSION Augmentation of local alveolar defects in the maxilla with intraorally harvested autogenous bone grafts appears to be a reliable method to enable implant placement.

Maxillary Sinus Function After Sinus Lifts for the Insertion of Dental Implants

PURPOSE The influence of bone augmentation of the floor of the maxillary sinus for the insertion of dental implants on sinus function has not been well investigated. In this study, the influence of the sinus lift on the development of maxillary sinus pathology was evaluated using generally accepted diagnostic criteria. MATERIAL AND METHODS A group of 45 patients in whom a sinus lift procedure had been performed were evaluated for sinus pathology 12 to 60 months after bone transplantation and implant insertion, using a questionnaire, conventional radiographic examination, and nasoendoscopy. RESULTS Postoperative maxillary sinusitis was detected in two of five patients with a predisposition for sinusitis, but in none of the other 40 patients. The occurrence of iatrogenic sinus membrane perforations during surgery was not related to the development of postoperative sinusitis in patients with healthy sinuses. CONCLUSION The occurrence of postoperative chronic sinusitis appears to be limited to patients with a predisposition for this condition. These predisposing factors need to be considered when evaluating patients for sinus lift procedures.

A systematic review of the prognosis of short (<10 mm) dental implants placed in the partially edentulous patient

AIM This study evaluated, through a systematic review of the literature, the estimated implant survival rate of short (<10 mm) dental implants installed in partially edentulous patients. MATERIALS AND METHODS A systematic search was conducted in the electronic databases of MEDLINE (1980-October 2009) and EMBASE (1980-October 2009) to identify eligible studies. Two reviewers independently assessed the methodological quality of the articles using specific study design-related quality assessment forms. RESULTS Twenty-nine methodologically acceptable studies were selected. A total of 2611 short implants (lengths 5-9.5 mm) were analysed. An increase in implant length was associated with an increase in implant survival (from 93.1% to 98.6%). Heterogeneity between studies was explored by subgroup analyses. The cumulative estimated failure rate of studies performed in the maxilla was 0.010 implants/year, compared with 0.003 found in the studies in the mandible. For studies that also included smokers, the failure rate was 0.008 compared with 0.004 found in studies that excluded smokers. Surface topography and augmentation procedure were not sources of heterogeneity. CONCLUSION There is fair evidence that short (<10 mm) implants can be placed successfully in the partially edentulous patient, although with a tendency towards an increasing survival rate per implant length, and the prognosis may be better in the mandible of non smoking patients.

Implantology and the Severely Resorbed Edentulous Mandible

Patients with a severely resorbed edentulous mandible often suffer from problems with the lower denture. These problems include: insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered facial appearance. These problems are a challenge for the prosthodontist and surgeon. Dental implants have been shown to provide a reliable basis for fixed and removable prostheses. This has resulted in a drastic change in the treatment concepts for management of the severely resorbed edentulous mandible. Reconstructive, pre-prosthetic surgery has changed from surgery aimed to provide a sufficient osseous and mucosal support for a conventional denture into surgery aimed to provide a sufficient bone volume enabling implants to be placed at the most optimal positions from a prosthetic point of view. The aim of this paper is to review critically the literature on procedures related to the severely resorbed edentulous mandible and dental implant treatment. The study includes the transmandibular implant, (short) endosseous implants, and reconstructive procedures such as distraction osteogenesis, augmentation of the mandibular ridge with autogenous bone, and bone substitutes followed by the placement of implants. The number of patients participating in a study, the follow-up period, the design of the study, the degree of mandibular resorption, and the survival rate of the dental implants all are considered evaluation parameters. Although numerous studies have described the outcome results of dental implants in the edentulous mandible, there have been few prospective studies designed as randomized clinical trials that compare different treatment modalities to restore the severely resorbed mandible. Therefore, it is not yet possible to select an evidence-based treatment modality. Future research has to be focused on long-term, detailed follow-up clinical trials before scientifically based decisions in treating these patients can be made. This will contribute to a higher level of care in this field.

Treatment outcome of bone-anchored craniofacial prostheses after tumor surgery

Percutaneous endosseous implants have acquired an important place in the prosthetic rehabilitation of patients with craniofacial defects. The objective of this study was to evaluate the clinical outcome of the use of endosseous implants in the orbital and auricular region as well as to assess the satisfaction of patients with implant‐retained craniofacial prostheses after tumor surgery.

Mandibular overdentures supported by two or four endosseous implants: a 10-year clinical trial

OBJECTIVE The aim of this 10-year clinical trial was to evaluate the treatment outcome (condition of hard and soft peri-implant tissues, patient satisfaction, surgical and prosthetic aftercare) of mandibular overdentures supported by two or four implants. MATERIALS AND METHODS Sixty edentulous patients with a mandibular height between 12 and 18 mm participated. Thirty patients were treated with an overdenture supported by two IMZ implants (group A) and 30 patients were treated with an overdenture supported by four IMZ implants (group B). Standardised clinical and radiographic parameters were evaluated 6 weeks after completion of the prosthetic treatment and after 1, 5 and 10 years of functional loading. Prosthetic and surgical aftercare was scored during the evaluation period, as well as patient satisfaction. RESULTS There were no statistically significant differences with regard to any of the studied clinical or radiographic parameters of the peri-implant tissues between the groups. In addition, no differences in satisfaction and aftercare were observed between the groups. CONCLUSION There is no difference in the clinical and radiographical state of patients treated with an overdenture on two or four implants during a 10-year evaluation period. Patients of both groups were evenly satisfied with their overdentures and received the same amount of aftercare. For reasons of cost-effectiveness, a two-implant overdenture is advised for patients with a Cawood classes IV-VI resorption of the mandible and complaints concerning retention and stability of the lower denture.

Mandibular overdentures supported by two or four endosteal implants. A prospective, comparative study.

The aim of this prospective study was to evaluate the effect of the number of implants supporting a mandibular overdenture on the condition of the peri-implant tissues. Sixty edentulous patients (Cawood class V VI) participated in this study. After randomization, thirty patients were treated with an overdenture supported by two IMZ implants (group A) and thirty patients with an overdenture on four IMZ implants (group B). The implants were inserted in the anterior region of the mandible. After three months overdentures were constructed, supported by round bar and clip attachments. A standardized clinical and radiographic evaluation was performed 0, 6 and 12 months after insertion of the denture. One implant was lost (group A) during the healing period. There were no significant differences with regard to any of the studied clinical or radiographic parameters of the peri-implant tissues, neither were significant differences found between the lateral and central implants in group B. None of the patients reported a sensory change in lip or chin region. From this study it is concluded that there seems to be no need to insert more than two endosteal implants to support an overdenture, however, long-term prospective studies are needed to support this notion.