Maxillary Overdentures Supported by Anteriorly or Posteriorly Placed Implants Opposed by a Natural Dentition in the Mandible: A 1‐Year Prospective Case Series Study

Background: For maxillary overdenture therapy, treatment guidelines are missing. There is a need for longitudinal studies. Purpose: The purpose of this 1‐year prospective case series study was to assess the treatment outcome of maxillary overdentures supported by six dental implants opposed by natural antagonistic teeth in the mandible. Materials and Methods: Fifty patients were treated with a maxillary overdenture supported by six dental implants, either placed in the anterior region (n = 25 patients) or in the posterior region (n = 25 patients). Items of evaluation were the following: survival of implants, condition of hard and soft peri‐implant tissues, and patients' satisfaction. Results: One‐year implant survival rate was 98% in the anterior group and 99.3% in the posterior group. Mean radiographic bone loss in the anterior and posterior groups after 1 year of loading was 0.22 and 0.50 mm, respectively. Mean scores for plaque, calculus, gingiva, bleeding, and pocket probing depth were low, and patients' satisfaction was high, with no differences between the groups. Conclusion: Six dental implants placed in either the anterior region or the posterior region of the edentulous maxilla, connected with a bar, and opposed by antagonistic teeth in the mandible supply a proper base for the support of an overdenture.     

One‐Year Results of a Clinical and Radiological Prospective Multicenter Study on NEOSS® Dental Implants

Background: NEOSS® (Neoss Ltd., Harrogate, UK) dental implant system was introduced on the clinical arena in 2003. It is important that novel implant systems are systematically evaluated in a multicenter setting. Purpose: The aim of this study was to follow a large number of consecutively treated patients, with NEOSS dental implant system, both clinically and radiographically. The current report constitutes the 1‐year data of a planned 5‐year study. Materials and Methods: The study included a total of 177 patients treated with 590 NEOSS implants at 13 clinics in Sweden. The material was composed of 72 males and 105 females treated for single, partial, and total edentulism. Clinical, radiographic, and subjective evaluations were performed. Results: Out of 590 implants, 13 early failures have been reported, corresponding to a 1‐year cumulative survival rate (CSR) of 97.8%. Evaluation of function and esthetics at the 1‐year visit resulted in 100% success for function and 98% success for the esthetic outcome. The mean marginal bone loss was 0.6 mm (SD 1.1) after 1 year in clinical function. No adverse effects of the NEOSS dental implants were reported, and complications were few and similar to those reported for implant treatment in general. Conclusion: The CSR in the present study was 97.8%. No adverse effects of the NEOSS implants were reported, and complications during the study period were few and similar to those reported to for other well‐documented implants system. Based on the present data, we conclude that NEOSS dental implant is a safe and predictable implant system. However, the high number of dropouts in the radiological evaluation must be considered when interpreting the data.     

Immediate Rehabilitation of the Extremely Atrophic Mandible with Fixed Full‐Prosthesis Supported by Four Implants

Purpose: To prospectively assess the outcome of immediate rehabilitation of extremely atrophic mandibles by a full‐arch fixed bridge anchored to four implants. Material and Methods: Twenty patients with edentulous mandibles were included in the study. Each patient received a full‐arch fixed bridge supported by two axial and two distal tilted implants. Prosthetic loading was applied within 48 hours of surgery. Patients were scheduled for follow‐up every 6 months up to 2 years and annually until 5 years. Radiographic evaluation of marginal bone level change was performed at 1 year. Results: All patients were followed for a minimum of 1 year (range 20–48 months, mean 30.1 months). No failures were recorded to date. The 1‐year implant survival rate and prosthesis success rate were 100%. Marginal bone loss around axial and tilted implants was similar at 12‐month evaluation, being, respectively, 0.6 ± 0.3 (standard deviation) mm and 0.7 ± 0.4 mm. High patient's level of satisfaction was recorded for function, phonetics, and aesthetics. Conclusion: This technique could be considered a viable treatment option for the rehabilitation of the atrophic mandible.     

Overdentures in the Edentulous Mandible Supported by Implants and Retained by a Dolder Bar: A 5‐Year Prospective Study

Purpose: This prospective study was performed to evaluate the outcomes of XiVE® S plus implants (Dentsply Friadent, Mannheim, Germany) following conventional restoration with bar structures and overdentures in the edentulous mandible. Materials and Methods: A total of 39 patients were treated with four interforaminal implants (n = 156) splinted by a Dolder bar. Overdentures were attached to the bars after 3 months of healing. As primary outcome measures, clinical and radiological parameters were evaluated at the time of implant placement (baseline) and once a year (1, 2, 3, 4, 5 years) after functional loading. Secondary outcome measures included (i) primary stability and surgical complications, as well as (ii) Periotest® (Medizintechnik Gulden, Modautal, Germany) values, implant survival, and prosthetic complications at baseline and follow‐up. Results: A total of 156 implants were placed. The vast majority (n = 149) were tightened to >30 Ncm, while torques in the range of 20–30 Ncm were obtained in the remaining cases (n = 7). Mean crestal bone levels around the implants were 0.41 mm at baseline and 1.04/1.20/1.34/1.45/1.44 mm after 1/2/3/4/5 years respectively. The mean values of the plaque, calculus, bleeding, and mucosal indices remained low throughout this period. The reported follow‐up periods involved one implant loss after 3 months (survival rate: 99.4%) and one implant failure after 4 years (success rate: 98.4%). Prosthetic complications included factures of bars (n = 3) and denture teeth (n = 7). Prosthetic survival was 100%. Conclusions: Dolder bars to restore oral implants in the edentulous mandible appear to offer a high rate of implant survival, good stability of the peri‐implant tissue, and a low rate of prosthetic complications.     

Prospective Evaluation of 2,549 Morse Taper Connection Implants: 1‐ to 6‐Year Data

Background: The aim of this study is to evaluate the implant survival, the implant–crown success, and the prosthetic complications of 2,549 Morse taper interference–fit connection implants. Methods: A total of 2,549 Morse taper connection implants were inserted in 893 patients from January 2003 until December 2008. At each annual recall, clinical, radiographic, and prosthetic parameters were assessed. The implant–crown success criteria included the absence of pain, suppuration, and clinical mobility; an average distance between the implant shoulder and the first visible bone contact <2 mm from initial surgery; and the absence of prosthetic complications at the implant–abutment interface. Prosthetic restorations were fixed partial prostheses (462 units); fixed full‐arch prostheses (60 units); single crowns (531 units); and overdentures (93 units). Results: The cumulative implant survival rate was 98.23% (97.25% maxilla, 99.05% mandible). The implant–crown success was 92.49%. A few prosthetic complications at implant–abutment interface were reported (0.37%). After 6 years, distance between the implant shoulder and the first visible bone contact was 1.10 mm (± 0.30 mm). Conclusion: The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches.     

Immediate Loading of Mandibular Overdentures Supported by One‐Piece,Direct Metal Laser Sintering Mini‐Implants: A Short‐Term Prospective Clinical Study

Background: Only a few studies have dealt with immediately loaded, unsplinted mini‐implants supporting ball attachment–retained mandibular overdentures (ODs). The aim of this study is to evaluate treatment outcomes of ball attachment–retained mandibular ODs supported by one‐piece, unsplinted, immediately loaded, direct metal laser sintering (DMLS) mini‐implants. Methods: Over a 4‐year period (2009 to 2012), all patients referred to the Dental Clinic, University of Varese, and to a private practice for treatment with mandibular ODs were considered for inclusion in this study. Each patient received three or four DMLS mini‐implants. Immediately after implant placement, a mandibular OD was connected to the implants. At each annual follow‐up session, clinical and radiographic parameters were assessed, including the following outcome measures: 1) implant failures; 2) peri‐implant marginal bone loss; and 3) complications. Statistical analysis was conducted using a life‐table analysis. Results: A total of 231 one‐piece DMLS mini‐implants were inserted in 62 patients. After 4 years of loading, six implants failed, giving an overall cumulative survival rate of 96.9%. The mean distance between the implant shoulder and the first visible bone‐to‐implant contact was 0.38 ± 0.25 and 0.62 ± 0.20 mm at the 1‐ and 4‐year follow‐up examinations, respectively. An incidence of 6.0% of biologic complications was reported; prosthetic complications were more frequent (12.9%). Conclusions: Within the limits of this study, it can be concluded that the immediate loading of one‐piece, unsplinted, DMLS titanium mini‐implants by means of ball attachment–supported mandibular ODs is a successful treatment procedure. Long‐term follow‐up studies are needed to confirm these results.     

Evaluation of Clinical Outcomes and Bone Loss around Titanium Implants with Oxidized Surface: Six‐Year Follow‐Up Results from a Prospective Case Series Study

Purpose: The aim of this prospective study was to assess long‐term clinical outcomes and peri‐implant bone level changes around oxidized implants supporting partial fixed rehabilitations. Materials and Methods: Twenty‐two partially edentulous patients were included in the study. A total of 33 fixed rehabilitations were placed, supported by 54 titanium implants with oxidized microtextured surface. Prostheses were delivered after 3 and 6 months of implant placement in the mandible and maxilla, respectively. Patients were scheduled for follow‐up at 6 and 12 months and then yearly. At each follow‐up, plaque level and bleeding scores were assessed and periapical radiographs were taken. The main outcomes were prosthesis success, implant survival, implant success, and marginal bone level change. Results: Three patients were excluded from the study because they did not attend the 1‐year follow‐up. Nineteen patients, accounting for 49 implants, were followed for at least 6 years after prosthesis delivery. The mean follow‐up duration was 81.8 months (range 75–96 months). One mandibular single‐tooth implant failed after 1 year in a smoker woman. Cumulative implant survival and success at 6 years were 98.0% and 95.9%, respectively. Prosthesis success was 96.7%. The mean peri‐implant bone loss at 6 years was 0.76 ± 0.47 mm. Not significantly (p = .75) greater bone loss was found in the maxilla (0.78 ± 0.14 mm, n = 19) as compared with the mandible (0.74 ± 0.59 mm, n = 30). In the maxilla, bone loss was significantly greater around implants supporting partial prostheses as compared with single‐tooth implants (p = .03). Full patient satisfaction was reported. Conclusion: Implants with oxidized microtextured surface may achieve excellent long‐term clinical outcomes in the rehabilitation of partial edentulism.     

Soft Tissue Preservation and Pink Aesthetics around Single Immediate Implant Restorations: A 1‐Year Prospective Study

Purpose: (1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single‐tooth removal; (2) to evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed. Materials and Methods: Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15–25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate nonocclusal loading with a screw‐retained provisional crown, and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6, and 12 months. Cases demonstrating major alveolar process remodeling and/or advanced midfacial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns. Results: Twenty‐two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for nonperiodontal reasons using a novel bone condensing implant with variable‐thread design, conical connection, and platform switch (NobelActive®, Nobel Biocare, Göteborg, Sweden). One implant failed and mean marginal bone loss was 0.1 mm (p = .059). Temporary mesial papilla reduction occurred, whereas distal papilla reduction was permanent (mean 0.5 mm; p = .001). At 3 months, five cases demonstrated major alveolar process remodeling and two advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p = .053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p ≤ .037). At 12 months, pink aesthetics (mean PES 12.15) was comparable to the preoperative status (mean PES 11.86; p = .293). Distal papillae had significantly deteriorated (p = .020) in this time span, whereas midfacial contour had significantly improved (p = .005). Conclusions: Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one‐third of the patients. Major alveolar process remodeling is the main reason for additional treatment.     

Immediate Occlusal Loading of NanoTite™ Tapered Implants: A Prospective 1‐Year Clinical and Radiographic Study

Background: During the last decade, high success rates have been reported for implants placed with immediate loading procedures, especially when bone quality and quantity provide good implant stability. In many of these studies, straight‐walled implants with moderately rough surfaces were employed. Tapered implants are becoming increasingly more popular due to standardized drilling protocols and reports of high initial primary stability. Purpose: The aim of the present prospective, single center clinical study was to evaluate surface topographical analysis and the clinical and radiographic outcomes of the NanoTite? (BIOMET 3i, Palm Beach Gardens, FL, USA) Tapered Implant when used for immediate loading of fixed prostheses and single‐tooth restorations. Materials and Methods: Forty‐two patients who needed implant treatment and met admission criteria agreed to participate in the study and were consecutively enrolled. Surgical implant placement requirements consisted of a final torque of a least 30 Ncm prior to final seating and an implant stability quotient above 55. A total of 139 NanoTite Tapered implants (112 maxillary and 27 mandibular) were placed by one investigator, and the majority of these implants (n = 77/55%) were placed in posterior regions, and in soft bone (n = 90/65%). A total of 57 prosthetic constructions were evaluated consisting of 20 single‐tooth restorations, 30 fixed partial dentures, and 7 complete, fixed maxillary restorations. Radiographs were taken at baseline and at 12 months of follow‐up. Results: Of the 139 study implants, one implant failure was declared. The overall cumulative survival rate at 1 year is 99.4%. Mean marginal bone resorption is 1.01 mm (SD 0.85) during the first year of function. Conclusion: Although limited to the short follow‐up, immediate loading of NanoTite Tapered implants seems to be a viable option in implant rehabilitation, when insertion torque of at least 30 Ncm is achieved. Further studies are needed to authenticate the finding of this study.     

Marginal Bone Level Changes and Prosthetic Maintenance of Mandibular Overdentures Supported by 2 Implants: A 5‐Year Randomized Clinical Trial

Background: Documentation of early loading of mandibular overdentures supported by different implant systems is scarce. Purpose: This study aimed to compare the biologic and prosthetic outcome of mandibular overdentures supported by unsplinted early‐loaded one‐ and two‐stage oral implants after 5 years of function. Materials and Methods: Twenty‐eight consecutive patients were screened following an inclusion and exclusion criteria, and randomly allocated to treatment groups. Ball‐retained mandibular overdentures were fabricated on two unsplinted Straumann® (Institut Straumann AG, Basel, Switzerland) and Brånemark® (Nobel Biocare AB, Göteborg, Sweden) dental implants and subjected to an early‐loading protocol. During the 5‐year period, prosthetic complications were recorded. At 5‐years of function, plaque, peri‐implant inflammation, bleeding, and calculus index scores were recorded, and standard periapical radiographs were obtained from each implant for measurement of marginal bone loss. Results: All implants survived during the observation period. The peri‐implant inflammation, bleeding, and calculus index scores around Straumann and Brånemark implants were similar (p > .05). The marginal bone loss around Brånemark implants (1.21 ± 0.1) was higher than Straumann implants (0.73 ± 0.06) at 5 years of function (p = .002). Kaplan–Meier tests revealed that 1‐ and 5‐year survival of overdentures on Straumann and Brånemark implants were similar (p = .85). Wear of the ball abutment in the Brånemark group was higher than in the Straumann group (p < .05). Complications regarding the retainer and the need for occlusal adjustments were higher in the Straumann group (p < .05). Chi‐square test revealed that the frequency of retightening of the retainer was higher in the Straumann group than in the Brånemark group (p < .05). Conclusions: Mandibular overdentures supported by unsplinted early‐loaded Straumann and Brånemark implants lead to similar peri‐implant soft tissue and prosthetic outcomes, although higher marginal bone loss could be observed around Brånemark implants after 5 years.     

Osteotome Sinus Floor Elevation without Bone Grafts – A 3‐Year Retrospective Study with Astra Tech Implants

Background: The bone support for implants in the posterior part of the maxilla is often poor. This condition may be treated with augmentation of the maxillary sinus floor. The most common technique used is to elevate the sinus floor by inserting a bone graft through a window opened in the lateral antral wall. In 1994, a less‐invasive technique using osteotomes was suggested by Summers. Purpose: The aim of this study was to evaluate the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without grafting. Materials and Methods: The study population comprised 36 consecutive patients in whom 53 implants were inserted with the OSFE technique. The indication for sinus floor elevation was that the bone height below the maxillary sinus was considered to be 10 mm or less. Results: The mean height of the alveolar process in the intended implant sites was 6.3 ± 0.3 mm, and the mean elevation of the sinus floor was 4.4 ± 0.2 mm. Two implants in edentulous patients were lost at the 1‐year follow‐up, and one more at the 3‐year examination. The remaining 50 implants inserted were in function, giving a 3‐year cumulative survival rate of 94%. Implants used in single‐tooth replacements and in partially edentulous cases had a 100% survival rate. The marginal bone level at the time of loading of the implants was 0.1 ± 0.04 mm below the reference point. One year later, the corresponding value was 0.5 ± 0.06 mm. The mean bone loss between the two examinations was 0.4 ± 0.05 mm. At the final examination after 3 years, the mean bone level was situated 0.6 ± 0.09 mm below the reference point, indicating a nonsignificant change between 1 year and 3 years. Conclusions: The OSFE technique, without bone grafts, was found to produce predictable results in the treatment of 36 patients with restricted bone volume in the posterior part of the maxilla.