Aims: We assess the cost‐effectiveness of dental implant first‐line strategy vs. fixed partial denture strategy in patients suffering from one single missing tooth.
Materials and methods: The model ...used a simulation decision framework over a 20‐year period. Potential treatment switches can occur every 5 years. Transition probabilities come from literature, epidemiological reports or expert opinions. They have been programmed using specific distribution ranges to simulate the patients' and practice variability, and to take into account parameter uncertainty. Direct medical costs have been assessed according to a cost survey. Probabilistic sensitivity analyses were conducted using 5000 Monte‐Carlo simulations, generating confidence intervals of model outcomes.
Results: We found that mean cost‐effectiveness of the bridge strategy is higher than the implant strategy.
Conclusion: Implant as the first‐line strategy appears to be the ‘dominant’ strategy, considering the lower overall costs and the higher success rate.
Objectives
To assess the potential trends for the year 2030 in dental implant dentistry in Europe using the Delphi methodology.
Material and methods
A steering committee and a management team of ...experts in implant dentistry were created and validated a questionnaire including 60 questions, divided in eight topics. The survey was conducted in two rounds using an anonymous questionnaire, which provided the participants in the second round with the results of the first. Each question had three possible answers, and the results were expressed as percentages.
Results
A total of 138 experts were invited to participate in the survey. From all the invited experts, 52 answered in both the first and second rounds. Three different consensus categories were established based on the percentage of agreement: no consensus (<65%); moderate consensus (65%–85%); and high consensus (≥86%). Within the topic categories, a consensus was reached (mainly moderate consensus) for the majority of questions discussed among experts during a face to face consensus meeting. However, consensus was not reached for a small number of questions/topics.
Conclusions
About 82% of the questions reached consensus. The consensus points towards a lower number of implants to replace chewing units, with implants surfaces made of bioactive materials with reduced micro‐roughness using mainly customized abutments with polished surfaces and an internal implant–abutment connection (85%). CBCT‐3D technologies will be the main tool for pre‐surgical implant placement diagnosis together with direct digital restorative workflows. There will be an increase in the incidence of peri‐implantitis, although there will be more efficient interventions its treatment and prevention.
Background
Compared with knowledge on patient and implant component factors, little knowledge is available on surgeons' role in early implant failures.
Purpose
To report incidence of early implant ...failures related to total number of operations performed by individual surgeons.
Materials and Methods
Early implant failures (≤1 year of implant prosthesis function) were reported after a total of 11,074 implant operations at one specialist clinic during 28 years of surgery. Altogether, 8,808 individual patients were treated by 23 different dentists, of whom 21 surgeons were specialists in oral surgery or periodontology. Recorded failures were related to total numbers of performed operations per surgeon, followed by statistical comparisons (χ2) between surgeons with regard to type of treated jaw and implant surface.
Results
Altogether, 616 operations were recorded with early implant failures (5.6%), most often observed in edentulous upper jaws after placing implants with a turned surface (p < .05). Significant differences between surgeons, gender of surgeon, type of treated jaws by the surgeon, and implant surface used by the surgeon could be observed (p < .05).
Conclusions
Early implant failures are complex, multifactorial problems associated with many aspects in the surgical procedure. A stochastic variation of failures for individual surgeons could be observed over the years. Different levels of failure rate could be observed between the surgeons, occasionally reaching significant levels as a total or for different jaw situations (p < .05). The surgeons reduced their failure rates when using implants with moderately rough surfaces (p < .5), but the relationship of failure rate between the surgeons was maintained.
ABSTRACT
Background:
Although the predictability of endosseous dental implants is well documented, the restoration of the posterior region of the maxilla remains a challenge. The placement of short ...implants is one therapeutic option that reduces the need for augmentation therapy.
Purpose:
The purpose of this retrospective study was to assess the survival rates of 6 to 8.5 mm‐long implants in the severely resorbed maxilla following a surgical protocol for optimized initial implant stability.
Materials and Methods:
The study included 85 patients with 96 short (6–8.5 mm) implants (Brånemark System®, Nobel Biocare AB, Göteborg, Sweden) supporting single‐tooth and partial reconstructions. The implants had a machined (54) or an oxidized (TiUnite™, Nobel Biocare AB) (42) surface. A one‐stage surgical protocol with delayed loading was used. The patients were followed for at least 2 years after loading (average follow‐up period 37.6 months). The marginal bone resorption was assessed by radiographic readings.
Results:
Five implants were lost during the first 9 months, and four implants were lost to follow‐up. The cumulative survival rate was 94.6%. Four of the failed implants had a machined surface, and one had an oxidized surface. The mean marginal bone resorption after 2 years in function was 0.44 ± 0.52 mm.
Conclusion:
This study demonstrates that the use of short implants maybe considered for prosthetic rehabilitation of the severely resorbed maxilla as an alternative to more complicated surgical techniques.
Objectives: The aim of the present publication was to report on the EAO Workshop group-4 discussions and consensus statements on the five reviews previously prepared. These reviews provided the ...scientific evidence on the effect of crown-to-implant ratio, on reconstructions with cantilevers in fully and partially edentulous patients, on biological and technical complications of tilted in comparison with straight implants, and on the effects of osseointegrated implants functioning in a residual dentition. Material and Methods: The group discussed, evaluated, corrected where deemed appropriate, and made recommendations to the authors regarding the following five reviews submitted: (a) Is there an effect of crown-to-implant ratio on implant treatment outcomes?; (b) Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients; (c) and in partially edentulous patients; (d) Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses; (e) What are the adverse effects of osseointegrated implants functioning among natural teeth of a residual dentition? Based on the five manuscripts and the discussion among the group as well as the plenum members, the major findings were summarized, consensus statements were formulated, clinical recommendations were proposed, and areas of future research were identified. Results: Crown-to-implant ratios ranging from 0.9 to 2.2 did not influence the occurrence of biological or technical complications also in single-tooth restorations. Reconstructions with cantilevers for the rehabilitation of fully and partially edentulous jaws showed high implant and reconstruction survival rates. In contrast, the rate of complications-in particular associated with veneering material-was high during the observation period of 5-10 years. The data reported were primarily derived from studies with high risk of bias. The data for single-implant reconstructions were small. There was no evidence that distally tilted implants were associated with higher failure rates and increased amounts of marginal bone loss. The data supporting these findings, however, were at high risk of bias and frequently incompletely reported. Frequent positional changes occurred between the natural teeth and the implant-supported restorations. These changes were more pronounced in younger individuals, and even though they were reduced with age, they still occurred in adult patients. Even though these changes were frequent, potential implications for the patient are unclear. Conclusions: The use of single-tooth restorations with crown-to-implant ratio in between 0.9 and 2.2 may be considered a viable treatment option. Multiunit reconstructions with cantilevers are a viable treatment option in fully and partially edentulous patients. Clinicians and patients should be aware, however, that complications are frequent and primarily related to resin material used for veneering. There is some evidence that tilting an implant does affect stability of the implant and the surrounding bone. Treatment options to tilted implants should carefully be considered, as the effect on soft tissues and on prosthesis behavior is poorly reported for tilted implants. Positional changes in the dentition in relation to implant-supported restorations occur frequently. The patient should be informed about the possible need for a treatment related to these changes in the long term.
A total of 264 implants was placed in 143 patients using different immediate or delayed-immediate implant placement techniques in 12 different centers participating in a prospective multicenter ...study. The reason for tooth extraction was evaluated; bone quality and quantity were classified; socket depths were registered; and data on implant type, size, and position were collected. One hundred thirty-nine suprastructures were placed on 228 implants in 126 patients. A follow-up evaluation was done on 125 patients after 1 year of loading and on 107 patients after 3 years of loading. Clinical parameters (bleeding or not bleeding, pocket depth, and implant mobility) were evaluated after 1 and 3 years, and the marginal bone level after 1 year of loading was measured on radiographs. Clinical comparisons were performed to evaluate implant loss in relation to implant type, size, position, bone quality and quantity, socket depth, reason for tooth extraction, and placement method. In addition, life table analysis was done for cumulative implant survival rates. There was no clinical difference with respect to socket depth or when comparing the different placement methods. A higher failure rate was found for short implants in the posterior region of the maxilla and when periodontitis was cited as a reason for tooth extraction. Mean marginal bone resorption from the time of loading to the 1-year follow-up was 0.8 mm in the maxilla and 0.5 mm in the mandible. Over a period of 3 years, the implant survival rate was 92.4% in the maxilla and 94.7% in the mandible.
ABSTRACT
Background: As a complement to the earlier reported 3‐year results from a prospective multicenter study of immediate and delayed placement of implants into fresh extraction sockets, the ...5‐year results are reported.
Purpose: The purpose of this 5‐year report was to evaluate the immediate and long‐term success of implants placed into fresh extraction sockets, with respect to implant size and type, bone quality and quantity, implant position, initial socket depth, and reason for tooth extraction.
Materials and Methods: This paper presents the 5‐year results of the original 12 centers that participated with 143 consecutively included patients. A total of 264 implants were placed either immediately after tooth extraction or after a short soft‐tissue healing time (3–5 weeks). The patients were divided into five subgroups, depending on the type of insertion method used.
Results: The outcome demonstrated that the cumulative implant survival rate after 5 years of loading has not changed and remains 92.4% in the maxilla and 94.7% in the mandible. No difference in failure rates can be seen between the groups when relating the failures to insertion method.
Conclusion: This prospective study demonstrated that placing Brånemark implants into fresh extraction sites can be successful over a period of 5 years of loading. One of the outcomes of the study shows that there is a clinical correlation between implant failure and periodontitis as a reason for tooth extraction, even if it is difficult to give it a casual association. It can be hypothesized that periodontitis affected tissues might have a negative local influence because of the presence of infrabony defects that could possibly increase the gap between bone and implant or jeopardize achievement of primary stability.
In recent years, indications for endosseous dental implants have been extended to include partially edentulous jaws with areas of limited bone density and bone volume. Wide-diameter implants are ...particularly well suited for these situations. The purpose of this paper was to report on 98 consecutively placed 5-mm-diameter implants without smooth surface collars. Eight implants failed-6 at second-stage surgery, and 2 after 1 year of loading (91.8% survival rate). Sixty percent of the remaining implants had no thread above the bone level after 1 year of loading. The authors discuss the possible causes for failure and suggest guidelines to avoid failure.
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