William C. Martin

Early Loading after 21 Days of Healing of Nonsubmerged Titanium Implants with a Chemically Modified Sandblasted and Acid-Etched Surface: Two-Year Results of a Prospective Two-Center Study

PURPOSE The aim of this two-center study was to evaluate screw-type titanium implants with a chemically modified, sandblasted and acid-etched surface when placed in the posterior maxilla or mandible, and loaded 21 days after placement. MATERIAL AND METHODS All 56 patients met strict inclusion criteria and provided informed consent. Each patient displayed either a single-tooth gap, an extended edentulous space, or a distal extension situation in the posterior mandible or maxilla. Eighty-nine dental implants (SLActive, Institut Straumann AG, Basel, Switzerland) were inserted according to an established nonsubmerged protocol and underwent undisturbed healing for a period of 21 days. Where appropriate, the implants were loaded after 21 days of healing with provisional restorations in full occlusion. Definitive metal ceramic restorations were fabricated and positioned on each implant after 6 months of healing. Clinical measurements regarding soft tissue parameters and radiographs were obtained at different time points up to 24 months after implant placement. RESULTS Of the 89 inserted implants, two (2.2%) implants failed to integrate and were removed during healing, and two (2.2%) additional implants required a prolonged healing time. A total of 85 (95.6%) implants were therefore loaded without incident after 21 days of healing. No additional implant was lost throughout the study period, whereas one implant was lost to follow-up and therefore left unaccounted for further analysis. The remaining 86 implants all exhibited favorable radiographic and clinical findings. Based on strict success criteria, these implants were considered successfully integrated 2 years after insertion, resulting in a 2-year success rate of 97.7%. CONCLUSION The results of this prospective two-center study demonstrate that titanium implants with a modified SLA surface can predictably achieve successful tissue integration when loaded in full occlusion 21 days after placement. Integration could be maintained without incident for at least 2 years of follow-up.

Consensus statements and recommended clinical procedures regarding optimizing esthetic outcomes in implant dentistry.

In the anterior maxilla, dental implant–supported prostheses need to replicate the dental hard and soft tissues in order to be esthetically acceptable. Three systematic reviews in Group 3 were prepared to address the topic of optimizing esthetic outcomes. Following tooth extraction, the clinician has the choice of various time points to place implants. Implant placement postextraction is often accompanied by bone augmentation procedures to manage residual bone defects and enhance esthetic results. Thus, the first systematic review by Chen and Buser analyzed the influence of the timing of implant placement and boneNo abstract available.

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.

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.

Use of prefabricated titanium abutments and customized anatomic lithium disilicate structures for cement-retained implant restorations in the esthetic zone.

This report describes the fabrication of customized abutments consisting of prefabricated 2-piece titanium abutments and customized anatomic lithium disilicate structures for cement-retained implant restorations in the esthetic zone. The heat-pressed lithium disilicate provides esthetic customized anatomic structures and crowns independently of the computer-aided design and computer-aided manufacturing process.

Comparing pink and white esthetic scores to layperson perception in the single-tooth implant patient.

PURPOSE The pink esthetic score (PES) and white esthetic score (WES) are tools utilized to objectively evaluate single-tooth implant restorations (STIR) in the esthetic zone.1 A questionnaire study was developed to address two objectives: (1) establish a total PES/WES score that is clinically acceptable based on layperson perception and (2) report outcomes in laypeoples perceptions of pink and white deficiencies. MATERIALS AND METHODS A presentation book of 27 color-calibrated photographs of a STIR in the esthetic zone (canine to canine) surrounded by virgin teeth and one photograph without a STIR (control) was presented to three prosthodontists (evaluators) to conduct a PES/WES evaluation. The same 27 photographs were presented to 101 laypeople. The laypeople were instructed to identify which tooth was the STIR. The laypeople were also instructed to record, based on pink or white esthetics, what factors influenced their decision on the selection of the STIR. RESULTS For the evaluators scores of the 27 cases, the mean PES score was 5.7 (range, 3 to 10). The mean WES score was 6.2 (range, 3 to 10). The mean total PES/WES score was 11.9 (range, 6 to 20). The mean percentage of laypeople unable to correctly identify the STIR was 59.1% (range, 13.9% to 89.2%). When the evaluators PES/WES score was greater than 12, 79% of the layperson population was not able to identify a STIR (ρ = -0.86). In addition, when the PES score was 6, 90% of the laypeople were not able to perceive a pink deficiency (ρ = -0.65), and when the WES score was 6, 83% of the laypeople were not able to perceive a white deficiency (ρ = -0.57). CONCLUSION Within the limitations of this study, in single-tooth implant restorations, a total PES/WES score greater than 12 would provide a STIR that would be clinically acceptable in the majority of situations. This study also concluded that laypeople identify white esthetic deficiencies more easily than pink esthetic deficiencies.

A novel surgical template design in staged dental implant rehabilitations.

ABSTRACT Background The philosophy of a gradual transition to an implant retained prosthesis in cases of full-mouth or extensive rehabilitation usually involves a staged treatment concept. In this therapeutic approach, the placement of implants may sometimes be divided into phases. During a subsequent surgical phase of treatment, the pre-existing implants can serve as anchors for the surgical template. Those modified surgical templates help in the precise transferring of restorative information into the surgical field and guide the optimal three-dimensional implant positioning. Methods This article highlights the rationale of implant-retained surgical templates and illustrates them through the presentation of two clinical cases. The templates are duplicates of the provisional restorations and are secured to the existing implants through the utilization of implant mounts. Results This template design in such staged procedures provided stability in the surgical field and enhanced the accuracy in implant positioning based upon the planned restoration, thus ensuring predictable treatment outcomes. Conclusions Successful rehabilitation lies in the correct sequence of surgical and prosthetic procedures. Whenever a staged approach of implant placement is planned, the clinician can effectively use the initially placed implants as anchors for the surgical template during the second phase of implant surgery.

Group 2 ITI Consensus Report: Prosthodontics and implant dentistry

OBJECTIVES Working Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full-arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs. MATERIALS AND METHODS Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached. RESULTS A total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements. CONCLUSIONS The literature supports the use of various implant numbers to support full-arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One-piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two-piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence.

Simplified custom impression post for implant-supported restorations.

The esthetic outcome of an implant-supported restoration is greatly influenced by the relationship between the contours of the definitive prosthesis and the periimplant tissues. In this clinical technique, an implant analog holder and autopolymerizing acrylic resin were used to accurately register the soft-tissue transition zone created by the interim restoration and transfer it to the impression post during the definitive impression.