Steven E. Eckert

Maxillary antral and nasal one-stage inlay composite bone graft: Preliminary report on 30 recipient sites

A one-stage antral and nasal inlay composite bone grafting procedure is described. Preliminary statistical data (1 to 6 years experience with the procedure) is presented for 30 recipient sites in 20 patients. A complete bone-supported fixed prosthesis was used and has provided continuous function in all patients to date. Implant survival has approached that of implants placed in uncompromised maxillary or mandibular bone.

Implant reconstruction in the posterior mandible: A long-term retrospective study

STATEMENT OF PROBLEM Because there is a lack of long-term data, it is unclear whether the determinants of implant and prosthesis survival include the location, angle, design, or number of implants and use of prosthesis cantilevers. PURPOSE This retrospective study evaluated the long-term outcome, determinants of outcome, and the type and prevalence of prosthetic complications in a series of patients treated consecutively with Brånemark implants in the partially edentulous posterior mandible. MATERIAL AND METHODS A total of 392 consecutively placed Brånemark implants were inserted in 152 partially edentulous patients and restored with 56 single-tooth and 168 fixed partial dentures restorations. RESULTS The cumulative success rates of implants and prostheses were 89.0% +/- 0.03% and 81.9% +/- 0.03%, respectively, at 6 years, with no further decrease in success noted during the remainder of the 10-year study. Significantly fewer major complications were found in prostheses supported by one or more implants, located exclusively in premolar sites, versus prostheses supported by either molar implant(s) or both premolar and molar implants. In single-tooth restorations, fewer major complications were seen in the cemented restorations, compared with the screw retained. CONCLUSION The results were strongly influenced by the phase of experience.

Endosseous implants in an irradiated tissue bed

Endosseous implants have been placed at the Mayo Clinic Department of Dental Specialties for over 12 years. On the basis of the clinical success of the osseointegration program, the use of implants has been expanded to include placement into tissue beds that have been exposed to therapeutic radiation. This article details preliminary data regarding implant survival in the previously radiated tissue beds. Presurgical evaluation and surgical technique are described and postprosthetic reconstruction complications are also related. Consideration is given to the relatively small number of patients in this review. It is suggested that the results should be shared among multiple institutions to create a meaningful data bank.

Consensus Statements and Clinical Recommendations for Implant Loading Protocols

No abstract available.

Validation of dental implant systems through a review of literature supplied by system manufacturers

STATEMENT OF PROBLEM The use of endosseous implants to support and retain dental prostheses has become a routine treatment option in many dental practices. Although physical, mechanical, and chemical differences exist among implant systems, survival claims are similar. PURPOSE OF STUDY This review solicited literature from six implant manufacturers that was thought, by their standards, to be pertinent to the validation of their implant system. METHODS The literature was reviewed and categorized. CONCLUSION On the basis of the literature supplied by the manufacturers, only one implant system demonstrated scientifically valid long-term success.

Implant-Supported Single Crowns Predictably Survive to Five Years with Limited Complications

SELECTION CRITERIA An electronic MEDLINE search was conducted to identify cohort studies, prospective or retrospective, describing clinical performance of implant-supported single crowns. Manual searches of bibliographies from full-text articles and related reviews were conducted using numerous scientific journals. Studies were included if the mean follow-up time was at least 5 years, if articles were published in the English or German language, if patients were physically examined, and if study details were sufficient for data extraction. Of the initial 3601 studies identified, only 26 were selected. No randomized control trials were identified. KEY STUDY FACTOR The 5-year survival and complications of implant-supported single crowns. MAIN OUTCOME MEASURES The primary outcome measure in this study was survival of endosseous implants when used to support single crowns. In addition, the clinical performance of soft tissue (peri-implantitis) and hard tissue (bone level) was documented. Clinical complications of a biomechanical nature were recorded relative to fracture of restorative materials. Poissons regression models were used to estimate failure and complication rates at 5 years. MAIN RESULTS A systematic review of the scientific literature identified 26 studies from which data were extracted (1558 placed implants). Meta-analysis identified survival of implants used to support and retain single crowns at 96.8% (95% confidence interval [CI]: 95.9%-97.6% after 5 years). The survival rate of the single crown restorations documented in 13 studies was 94.5% (95% CI: 92.5%-95.9%) with a significantly higher survival rate when metal ceramic crowns were used in comparison with all ceramic crowns (95.4% CI: 93.6%-96.7%; 91.2% CI: 86.8%-94.2%). Soft tissue complications, including peri-implantitis, were observed in 9.7% of the single crowns, whereas bone loss exceeding 2 mm was identified on 6.3% of the implants over the 5-year study. Prosthetic or abutment screw loosening was observed in 12.7%of the restoration and screw fracture occurred in 0.35%. Although only 7 of the 26 studies reported esthetic complications, the cumulative effects of esthetic complications approached 9% at 5 years. CONCLUSIONS From the presented data it may be concluded that 5-year survival of implant-supported single crowns is high, although biologic and mechanical complications are anticipated.

Long-term bone stability assessment around 1,187 immediately placed implants with 1- to 22-year follow-up.

PURPOSE To evaluate the retention of bone around implants placed immediately following tooth extraction and used to support dental prostheses. MATERIALS AND METHODS Patients from a previous study of implants placed immediately following tooth extraction were recalled to the original practice to obtain dental radiographs, which were then used to compare bone levels after 1 to 22 years of clinical function supporting dental prostheses. All radiographs were evaluated by measuring the bone within the implant threads. Implant bone maintenance was correlated with smoking history, type of implant surface, antibiotics used in conjunction with surgery, bisphosphonate use, presence of splinted restorations, anatomical location (mandible or maxilla and anterior or posterior), sex, and past periodontal disease status. Statistical analysis was performed using the Mann-Whitney test for statistical significance of differences in mean bone loss. RESULTS A total of 1,187 implants were identified, with mean bone loss of 0.52 ± 0.79 mm. Overall bone loss was less than 1.5 mm in 90% of the implants studied. Bone loss was greater in women (0.61 ± 0.91 mm vs 0.44 ± 0.69 mm in men; P = .002). There was a correlation between bone loss and patient age at the time of tooth loss, with patients below the age of 50 experiencing significantly more loss (mean loss, 0.76 ± 1.07 mm at age < 50 and 0.46 ± 0.71 mm at age > 50; P = .008). Other significant differences were seen with implant surface (machined surface, 0.57 ± 0.77 mm; roughened surface, 0.44 ± 0.84 mm; P = .0049), maxilla vs mandible in molar areas (maxilla, 0.68 ± 0.83 mm; mandible, 0.43 ± 0.80 mm; P = .0001), and platform width (regular, 0.46 ± 0.77; wide, 0.83 ± 0.94 mm; P ≤ .0001). None of the other factors demonstrated significant differences. CONCLUSIONS Bone loss of 1.5 mm or less was observed in 90% of the patients followed. Bone loss was correlated with age, sex, implant surface, anatomical location, and platform width. There was no statistical correlation between bone loss and any other factors evaluated.

Comparative assessments, meta-analysis, and recommended guidelines for reporting studies on histomorphometric bone-implant contact in humans.

PURPOSE To evaluate factors that have an influence on histomorphometric bone-to-implant contact (BIC) of dental implants in humans. MATERIALS AND METHODS Using inclusion/exclusion criteria, eligible studies were searched in five databases and handsearched in 11 journals. A total of 351 articles were assigned to full text analysis. The extracted data were assigned to comparative statistical assessments and meta-analysis. RESULTS A total of 55 articles were included in the analysis. The mean BIC found in comparative assessments and meta-analysis of implants in the mandible (70.97 and 69.744 ± 3.304, respectively) was higher than those in the maxilla (53.24 and 56.692 ± 3.598; P = .000 and P = .008, respectively). The mean BIC in the anterior mandible (79.42) and maxilla (74.19) were higher than the posterior mandible (69.14) and maxilla (36.68) (P < .05). Differences were detected in BIC of commercially available implants and experimental micro-implants (P < .05). Comparative assessments and meta-analysis showed that conventionally loaded implants (75.70 and 75.786 ± 4.889, respectively) had higher BIC than unloaded (54.07 and 53.24 ± 4.971, respectively) and immediately loaded implants (58.53 and 68.831 ± 4.972; P = .000 and P = .004, respectively). CONCLUSIONS Based upon a meta-analysis of the literature the following conclusions can be made: The BIC in the mandible is higher than the maxilla. The BIC is higher in the anterior than the posterior regions. The implant design coupled with the anatomical region affects the amount of BIC. Placement of experimental micro-implants with different surfaces in the posterior region always result in low and almost comparable BIC. The loading state and healing period seems to have an influence on BIC. Specific reporting guidelines are required to improve reporting of studies on human BIC.

How to evaluate a diagnostic test.

Tests are used in dentistry to establish, confirm, or reject the clinical impression of a diagnosis. Not all tests are equal in their ability to establish a diagnosis, with some tests demonstrating positive results when no disease is present (false positive) or negative results when disease is present (false negative). Using simple mathematical computations, it is possible to determine the extent to which a test can reliably establish the presence or absence of disease. This article describes the concepts of sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios through the evaluation of a clinically relevant paper on vital staining for oral carcinoma. This article also describes methods for literature evaluation to determine whether a test conveys meaningful diagnostic information.

Food and Drug Adminstration requirements for dental implants

The Food and Drug Administration (FDA) is a section of the Department of Health and Human Services of the United States Government, and its primary responsibility is to control the distribution of food, drugs, and medical devices within the country while ensuring public safety. The sale and distribution of dental implants is under the regulatory control of the FDA. Device classification, procedures for approval, and the current status of the approval process for endosseous implants are described in this article. The premarket approval procedure of the FDA is compared with the American Dental Association certification process. Issues related to the safety and effectiveness of dental implants are discussed.