Rudolf Fürhauser

Long-term implant success at the Academy for Oral Implantology: 8-year follow-up and risk factor analysis

Purpose Rehabilitation of the incomplete dentition by means of osseointegrated dental implants represents a highly predictable and widespread therapy; however, little is known about potential risk factors that may impair long-term implant success. Methods From 2004 to 2012, a total of 13,147 implants were placed in 4,316 patients at the Academy for Oral Implantology in Vienna. The survival rates after 8 years of follow-up were computed using the Kaplan-Meier method, and the impact of patient- and implant-related risk factors was assessed. Results Overall implant survival was 97% and was not associated with implant length (P=0.930), implant diameter (P=0.704), jaw location (P=0.545), implant position (P=0.450), local bone quality (P=0.398), previous bone augmentation surgery (P=0.617), or patient-related factors including osteoporosis (P=0.661), age (P=0.575), or diabetes mellitus (P=0.928). However, smoking increased the risk of implant failure by 3 folds (P<0.001) and a positive history of periodontal disease doubled the failure risk (P=0.001). Conclusions Summing up the long-term results of well over 10,000 implants at the Academy for Oral Implantology in Vienna it can be concluded that there is only a limited number of patients that do not qualify for implant therapy and may thus not benefit from improved quality of life associated with fixed implant-retained prostheses. Graphical Abstract

Esthetics of Flapless Single‐Tooth Implants in the Anterior Maxilla Using Guided Surgery: Association of Three‐Dimensional Accuracy and Pink Esthetic Score

BACKGROUND Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality. PURPOSE The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla. MATERIALS AND METHODS Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography (CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score (PES). RESULTS Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 (p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations  ≥  0.8  mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [IQR]: 8-11) compared with more accurate implant positions (median PES: 13, IQR: 12-13, p = .039). CONCLUSION Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla.Background Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality. Purpose The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla. Materials and Methods Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography (CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score (PES). Results Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 (p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations ≥ 0.8 mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [IQR]: 8–11) compared with more accurate implant positions (median PES: 13, IQR: 12–13, p = .039). Conclusion Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla.

Immediate Restoration of Immediate Implants in the Esthetic Zone of the Maxilla Via the Copy-Abutment Technique: 5-Year Follow-Up of Pink Esthetic Scores.

BACKGROUND Implant esthetics may benefit from individualized zirconia abutments copying the emergence profile of the natural tooth and delivered within days after immediate implant insertion. PURPOSE To investigate the esthetic outcome of the Copy-Abutment technique using the Pink Esthetic Score (PES). MATERIALS AND METHODS A total of 77 patients with single-tooth implants in the anterior maxilla restored at the day of immediate implant placement using Copy-Abutments and provisional crowns were followed-up after 1 week, 1 month, 4 months, 6 months, 1, 2, 3, 4, and 5 years to assess implant esthetics. RESULTS PES ranged between 7 and 14 (median: 13) and improved significantly between the 6 month and 1 year follow-up (p < .001), then remained stable up to the fifth year. Significant improvement was seen for the variables PES-6 soft tissue color (p = .002) and PES-7 soft tissue texture (p < .001) up to the 1 year follow-up, while PES-5 alveolar process deficiency deteriorated (p = .016). Mean mucosal recession was 0.26 ± 0.86 mm (range: 0-1.6) after 5 years and not related to gingival biotype. CONCLUSION Copy-Abutments for immediate restoration of implants in the esthetic zone show satisfactory long-term esthetic outcomes.

Denture-Related Biomechanical Factors for Fixed Partial Dentures Retained on Short Dental Implants.

Prosthodontically driven biomechanical considerations are essential for longterm successful outcomes in dental implant therapy. Correct protocols seek to preclude potential consequences associated with functional and parafunctional occlusal overload such as screw loosening, component fracture, compromised marginal bone maintenance, and the integrity of the induced osseointegration response. Other concerns also need to be addressed, more especially when other implants are selected, for example: bridge insertion torque (BIT) in cases of immediate loading, cantilever length-anteroposterior spread ratio (CL-AP), overall crown-to-implant ratio (oCIR), total bone-to-implant surface area (tBICA), and the status of the opposing dentition. In spite of promising clinical results, evidence-based clinical protocols demand that such biomechanical limits still need to be determined.

Single tooth implants in the esthetic zone following a two-stage all flapless approach: A retrospective analysis

BACKGROUND Due to chronic inflammation or trauma facial bone is frequently missing after tooth loss in the esthetic zone. As a consequence, procedures to augment or at least to preserve bone are frequently necessary prior to implant placement. PURPOSE The aim of this retrospective case series is to demonstrate the applicability of a staged all-flapless concept to establish satisfactory implant restorations following situations of partial missing facial bone in the esthetic zone. MATERIALS AND METHODS Radiological/clinical data of 25 patients were analyzed and an esthetic evaluation of 24 patients was performed. The staged concept included ridge preservation at time of tooth extraction and delayed guided implant placement. Marginal bone loss was measured radiologically and esthetic evaluation was performed based on standardized photographs using the Pink Esthetic Score as well as the Papilla Index. RESULTS Implant success rate revealed 100%. The mean radiological peri-implant marginal bone loss measured 1.16 mm (SD: 0.16). Regarding the esthetic outcome 71% of patients were evaluated with a Pink Esthetic Score higher or equal to 10 constituting satisfactory esthetics (median pink esthetic score: 10). The mean follow-up time for clinical and radiographic analysis was 1.3 years (SD: 0.6 years) and 1.2 years (SD: 0.6) for esthetic evaluation. CONCLUSION Although marginal bone loss cannot be avoided, the staged concept of flapless ridge preservation and subsequent delayed flapless guided implant placement carries the potential to improve esthetics of single-tooth implants in the anterior maxilla.

Periimplantitis Treatment: Long-term Comparison of Laser Decontamination and Implantoplasty Surgery

Purpose:Periimplantitis is the most frequent cause of late implant failure; however, little is known about the long-term success of periimplantitis treatment and the effectiveness of various therapeutic interventions. Materials and Methods:A total of 142 patients were referred to the Academy for Oral Implantology in Vienna for the treatment of recurrent periimplantitis around single-tooth implants. Of them, 72 patients (51%) were treated by laser decontamination, 47 patients (33%) by implantoplasty surgery, and 23 patients (16%) by a combination of both approaches. Results:Overall success of periimplantitis therapy was 89% after 9 years of follow-up, and it did not differ significantly between female and male patients (P = 0.426). The number of implant failures that could not be prevented by periimplantitis treatment was 6 after laser decontamination (8%), 6 after implantoplasty surgery (13%), and 4 after a combination of both therapies (17%). Implant loss occurred after 4.9 ± 1.9 years of therapy, on average. No significant difference between the 3 treatment groups could be observed (P = 0.393). Conclusion:The present results suggest that success rates of periimplantitis therapy with either laser decontamination or surgical implantoplasty are high. These success rates do not appear to be associated with patient gender or treatment strategy.

Graft Remodeling following Transcrestal Sinus Floor Elevation via the Gel-Pressure Technique (GPT) and Pasteous Nano-Crystalline Hydroxyapatite Bone Substitute

Bone grafting of the maxillary sinus is attempted to compensate for sinus pneumatization and permit reliable insertion of endosseous dental implants for prosthetic rehabilitation. The aim of the present clinical investigation was to study bone regeneration four months after transcrestal sinus floor elevation via the Gel-Pressure Technique (GPT) and application of pasteous nano-crystalline hydroxyapatite bone substitute. A total of 25 patients with deficient alveolar ridges in the posterior maxilla (mean residual bone height: 4.7 ± 1.8 mm) were subjected to 32 flapless transcrestal sinus floor augmentations and simultaneous insertion of 40 implants. Sinus membrane elevation height averaged 11.2 ± 2.7 mm and minimal vertical graft resorption of 0.1 mm was observed after four months. Radiographic bone density averaged 460 Hounsfield units in regions adjacent to the native jawbone (1 to 7 mm distance), while reduction of bone density by −7.2%, −11.3%, −14.8%, −19.6% and −22.7% was recorded in more apical regions of 8, 9, 10, 11, and ≥12 mm distance to the original sinus floor, respectively. The results suggest that graft remodeling is completed up to a distance of 7 mm within a healing period of four months after sinus augmentation using nano-crystalline hydroxyapatite bone substitute material.

Esthetics of Flapless Single-Tooth Implants in the Anterior Maxilla Using Guided Surgery: Association of Three-Dimensional Accuracy and Pink Esthetic Score: Esthetics of Guided Flapless Single-Tooth Implants

BACKGROUND Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality. PURPOSE The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla. MATERIALS AND METHODS Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography (CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score (PES). RESULTS Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 (p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations  ≥  0.8  mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [IQR]: 8-11) compared with more accurate implant positions (median PES: 13, IQR: 12-13, p = .039). CONCLUSION Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla.Background Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality. Purpose The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla. Materials and Methods Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography (CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score (PES). Results Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 (p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations ≥ 0.8 mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [IQR]: 8–11) compared with more accurate implant positions (median PES: 13, IQR: 12–13, p = .039). Conclusion Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla.