Jeffrey Ganeles

Computer technology applications in surgical implant dentistry: a systematic review.

PURPOSE To assess the literature on accuracy and clinical performance of computer technology applications in surgical implant dentistry. MATERIALS AND METHODS Electronic and manual literature searches were conducted to collect information about (1) the accuracy and (2) clinical performance of computer-assisted implant systems. Meta-regression analysis was performed for summarizing the accuracy studies. Failure/complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 12-month proportions. RESULTS Twenty-nine different image guidance systems were included. From 2,827 articles, 13 clinical and 19 accuracy studies were included in this systematic review. The meta-analysis of the accuracy (19 clinical and preclinical studies) revealed a total mean error of 0.74 mm (maximum of 4.5 mm) at the entry point in the bone and 0.85 mm at the apex (maximum of 7.1 mm). For the 5 included clinical studies (total of 506 implants) using computer-assisted implant dentistry, the mean failure rate was 3.36% (0% to 8.45%) after an observation period of at least 12 months. In 4.6% of the treated cases, intraoperative complications were reported; these included limited interocclusal distances to perform guided implant placement, limited primary implant stability, or need for additional grafting procedures. CONCLUSION Differing levels and quantity of evidence were available for computer-assisted implant placement, revealing high implant survival rates after only 12 months of observation in different indications and a reasonable level of accuracy. However, future long-term clinical data are necessary to identify clinical indications and to justify additional radiation doses, effort, and costs associated with computer-assisted implant surgery.

Immediate and early loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: 1-year results from a prospective multicenter study

OBJECTIVE Immediate and early loading of implants can simplify treatment and increase patient satisfaction. This 3-year randomized-controlled trial will therefore evaluate survival rates and bone-level changes with immediately and early loaded Straumann implants with the SLActive surface. MATERIAL AND METHODS Partially edentulous patients >or=18 years of age were enrolled. Patients received a temporary restoration (single crown or two to four unit fixed partial denture) out of occlusal contact either immediately (immediate loading) or 28-34 days later (early loading group), with permanent restorations placed 20-23 weeks after surgery. The primary endpoint was change in crestal bone level from baseline (implant placement) to 12 months; the secondary variables were implant survival and success rates. RESULTS A total of 383 implants (197 immediate and 186 early) were placed in 266 patients; 41.8% were placed in type III and IV bone. The mean patient age was 46.3+/-12.8 years. Four implants failed in the immediate loading group and six in the early loading group, giving implant survival rates of 98% and 97%, respectively (P=NS). There were no implant failures in type IV bone. The overall mean bone level change from baseline to 12 months was 0.77+/-0.93 mm (0.90+/-0.90 and 0.63+/-0.95 mm in the immediate and early groups, respectively; P<0.001). However, a significant difference in implantation depth between the two groups (P<0.0001) was found. After adjusting for this slight difference in initial surgical placement depth, time to loading no longer had a significant influence on bone-level change. Significant influence was found for: center (P<0.0001), implant length (P<0.05) and implant position (P<0.0001). Bone gain was observed in approximately 16% of implants. CONCLUSIONS The results demonstrated that Straumann implants with the SLActive surface are safe and predictable when used in immediate and early loading procedures. Even in poor-quality bone, survival rates were comparable with those from conventional or delayed loading. The mean bone-level change was not deemed to be clinically significant and compared well with the typical bone resorption observed in conventional implant loading.

Immediate and early non-occlusal loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: interim results from a prospective multicenter randomized-controlled study

OBJECTIVE Immediate and early loading of dental implants can simplify treatment and increase overall patient satisfaction. The purpose of this 3-year prospective randomized-controlled multicenter study was to assess the differences in survival rates and bone level changes between immediately and early-loaded implants with a new chemically modified surface (SLActive). This investigation shows interim results obtained after 5 months. MATERIAL AND METHODS Patients > or =18 years of age missing at least one tooth in the posterior maxilla or mandible were enrolled in the study. Following implant placement, patients received a temporary restoration either on the day of surgery (immediate loading) or 28-34 days after surgery (early loading); restorations consisted of single crowns or two to four unit fixed dental prostheses. Permanent restorations were placed 20-23 weeks following surgery. The primary efficacy variable was change in bone level (assessed by standardized radiographs) from baseline to 5 months; secondary variables included implant survival and success rates. RESULTS A total of 266 patients were enrolled (118 males and 148 females), and a total of 383 implants were placed (197 and 186 in the immediate and early loading groups, respectively). Mean patient age was 46.3+/-12.8 years. After 5 months, implant survival rates were 98% in the immediate group and 97% in the early group. Mean bone level change from baseline was 0.81+/-0.89 mm in the immediate group and 0.56+/-0.73 mm in the early group (P<0.05). Statistical analysis revealed a significant center effect (P<0.0001) and a significant treatment x center interaction (P=0.008). CONCLUSIONS The results suggested that Straumann implants with an SLActive can be used predictably in time-critical (early or immediate) loading treatment protocols when appropriate patient selection criteria are observed. The mean bone level changes observed from baseline to 5 months (0.56 and 0.81 mm) corresponded to physiological observations from other studies, i.e., were not clinically significant. The presence of a significant center effect and treatment x center interaction indicated that the differences in bone level changes between the two groups were center dependent.

Submerged and transmucosal healing yield the same clinical outcomes with two‐piece implants in the anterior maxilla and mandible: interim 1‐year results of a randomized, controlled clinical trial

OBJECTIVES To test whether or not transmucosal healing at two-piece implants is as successful as submerged placement regarding crestal bone levels and patient satisfaction. MATERIAL AND METHODS Adults requiring implants in the anterior maxilla or mandible in regions 21-25, 11-15, 31-35 or 41-45 (WHO) were recruited for this randomized, controlled multi-center clinical trial of a 5-year duration. Randomization was performed at implantation allowing for either submerged or transmucosal healing. Final reconstructions were seated 6 months after implantation. Radiographic interproximal crestal bone levels and peri-implant soft tissue parameters were measured at implant placement (IP) (baseline), 6 and 12 months. Patient satisfaction was assessed by a questionnaire. A two-sided t-test (80% power, significance level α=0.05) was performed on bone-level changes at 6 and 12 months. RESULTS One hundred and twenty-seven subjects were included in the 12-month analysis (submerged [S]: 52.5%, transmucosal [TM]: 47.2%). From IP to 6 months, the change in the crestal bone level was -0.32 mm (P<0.001) for the S group and -0.29 mm (P<0.001) for the TM group. From IP to 12 months, bone-level changes were statistically significant in both groups (S -0.47 mm, P<0.001; TM -0.48 mm, P<0.001). The mean differences of change in the bone levels between the two groups were not statistically significant at either time point, indicating the equivalence of both procedures. For both groups, very good results were obtained for soft tissue parameters and for patient satisfaction. CONCLUSIONS Transmucosal healing of two-piece implants is as successful as the submerged healing mode with respect to tissue integration and patient satisfaction within the first 12 months after IP.

Immediate and Early Loading of Chemically Modified Implants in Posterior Jaws: 3-Year Results from a Prospective Randomized Multicenter Study

BACKGROUND There is a lack of well-designed prospective, randomized clinical trials evaluating the efficacy of immediate and early loading of implants placed in the partially edentulous posterior maxilla or mandible. PURPOSE The aim of this study was to evaluate crestal bone level changes over 3 years following immediate or early loading of Straumann implants with a chemically modified surface (SLActive®, Institut Straumann AG, Basel, Switzerland) placed in the posterior maxilla and mandible. MATERIALS AND METHODS Subjects received temporary restorations immediately or 28 to 34 days after surgery, with permanent restorations placed at 20 to 23 weeks. Bone level changes were measured by comparison of standardized radiographs taken on the day of implant placement and 5, 12, 24, and 36 months thereafter. RESULTS Two hundred thirty-nine of two hundred sixty-six patients (89.9%) completed the trial. Implant survival rates were 97.4% and 96.7% in the immediate and early loading groups, respectively (p = not significant). Over 36 months, the mean bone level change for immediately loaded implants was 0.88 ± 0.81 mm versus 0.57 ± 0.83 mm for the early-loaded group (p < .001). After adjusting for a slight difference in initial placement depth, the time of loading had no significant influence on bone level change. CONCLUSIONS Changes in crestal bone level occurred mostly during the first 5 months postloading. After this bone remodeling period, crestal bone level was stable up to 36 months. Implants with a chemically modified surface are safe and predictable for immediate and early loading in the posterior maxilla and mandible.

Clinical and Radiologic Outcomes after Submerged and Transmucosal Implant Placement with Two‐Piece Implants in the Anterior Maxilla and Mandible: 3‐Year Results of a Randomized Controlled Clinical Trial

PURPOSE The aim of this investigation was to evaluate the 3-year outcomes regarding crestal bone level, clinical parameters, and patient satisfaction, following submerged and transmucosal implant placement for two-piece implants in the anterior maxilla and mandible. MATERIALS AND METHODS Patients requiring dental implants for single-tooth replacement in the anterior maxilla or mandible were enrolled in a randomized, controlled, multicenter clinical trial. The implants were randomized at placement to either submerged or transmucosal healing, with final restorations placed after 6 months. Radiographic and clinical parameters were recorded after 1, 2, and 3 years; a questionnaire was also used to assess patient satisfaction. A two-sided, unpaired T-test (significance level p ≤ .05) was used to statistically evaluate the differences between the two groups. RESULTS A total of 106 patients were included in the 3-year analysis. The mean change in crestal bone level from implant placement to 3 years was 0.68 ± 0.98 mm (p < .001) and 0.58 ± 0.77 mm (p < .001) in the submerged and transmucosal groups, respectively; the differences between the groups were not significant. Clinical parameters remained stable throughout the study, with no significant differences between the groups, and patient satisfaction was good or excellent for over 90% of subjects in both groups. CONCLUSIONS The results demonstrate excellent clinical and radiographic conditions after 3 years for implants supporting single-tooth restorations, regardless of whether a submerged or transmucosal surgical technique was used.

Implant‐supported single tooth restoration in the aesthetic zone: transmucosal and submerged healing provide similar outcome when simultaneous bone augmentation is needed

AIM The aim of this study was to compare the clinical outcomes after 2 years with bone level implants placed to restore a single missing teeth that needed simultaneous augmentation and were treated with a transmucosal or submerged approach. METHODS This study analyzed a subset of patients included in an ongoing prospective multicenter randomized clinical trial (RCT) involving12 centers where patients were to be followed-up to 5 years after loading. Of the 120 implants that were placed in the original study, and randomly assigned to submerged or non-submerged healing, 52 needed simultaneous augmentation (28 women patients and 24 men patients, between 23 and 78 years of age). Twenty-seven of them received implants with submerged healing (AuS), while in 25 patients the implants were inserted with a non-submerged protocol (AuNS). At the 2-year follow-up visit, radiographic crestal bone level changes were recorded as well as soft tissue parameters included Pocket probing depth (PPD), bleeding on probing (BoP) and clinical attachment level (CAL) at teeth adjacent to the implant site. RESULTS After 2 years a small amount of bone resorption was found in both groups (0.37 ± 0.49 mm in the AuS group and 0.54 ± 0.76 in the AuNS group; P < 0.001). There was no statistically significant difference between AuS Group and AuNS group for PPD (2.5 vs. 2.4 mm), BOP (BOP + sites: 8.8% vs. 11.5%) and CAL (2.8 vs. 2.4 mm) at the 2-year follow-up visit. CONCLUSIONS When a single implant is placed in the aesthetic zone in conjunction with bone augmentation for a moderate peri-implant defect, submerged and transmucosal healing determine similar outcome, hence there is no need to submerge an implant in this given clinical situation.

Single-Tooth Implant Restorations in Fresh Extraction Sockets of the Maxillary Esthetic Zone: Two-Year Results of a Prospective Cohort Study

In this prospective study, 15 patients received 15 variable-thread tapered implants placed in fresh extraction sites in the maxillary esthetic zone and immediately were provisionalized out of occlusion. Of the 15 patients, 11 completed their 2-year follow-up. At 2 years, the success and cumulative survival rates were both 100%, and the mean bone level gain was 0.83 mm. Soft tissue assessment showed no zero esthetic scores, improved papilla indices, and low bleeding on probing and plaque accumulation. Overall, the study implants showed excellent hard tissue, soft tissue, and esthetic outcomes, indicating a healthy tissue response in single-tooth extraction sites in the maxillary esthetic zone.