Abstract Background Few large‐scale follow‐up studies are reported on routine implant treatment. Purpose To report retrospective data on peri‐implantitis and overall implant failures at one private referral clinic (effectiveness study). Materials and Methods A total of 1017 patients were consecutively provided with 3082 implants with an anodized surface during 1592 operations between 2000 and 2011. All patients with any of four events of problems were identified; “peri‐implantitis,” “surgery related to peri‐implantitis,” “overall implant failure,” and “late implant failures.” A logistic multivariate analysis was performed to identify possible factors with association to the four events. Results “Lower jaw surgery” (HR = 3.03) and “immediate gingival grafting” at implant surgery (HR = 3.34) were factors with the highest risk associated to the two peri‐implantitis events, respectively. Risk of peri‐implantitis increased by year of inclusion from year 2000 (HR = 1.28). “Overall implant failures” were associated to “smoking” (HR = 2.11), “surgical technique” (highest for direct placement; HR = 1.67), and “type of implant” (NobelActive CC; HR = 2.48). NobelActive CC was more used in upper jaws, using immediate or one‐stage surgery with bone and mucosa grafting procedures than other implants ( P < .05). Implants lost after first year only showed an association to “lower jaw” (HR = 2.63) and “early inflammation” (HR = 17.95). Conclusion Peri‐implantitis seem to be associated to surgical protocols more often in the posterior lower jaw in routine practice. The problems seem to increase during the inclusion period, possibly related to increased use of direct implant placement technique and grafting protocols. Early inflammatory problems have in the previous report on the present patient group been associated to the mid‐aged patient. Overall/late implant failures were shown to be associated to earlier inflammatory problems, smoking habits, surgical technique, and treatment in the posterior lower jaw.
This retrospective study evaluated the survival rate and the clinical outcome of an endosseous implant system, as well as the marginal bone level (MBL) and the impact of the machined collar neck position on crestal bone level changes up to 2 years later. A total of 96 implants were placed in 57 patients and loaded with a final restoration after at least 3 months of healing: 15 implants were immediately placed into fresh extraction sockets, and 81 were placed in healed ridges. Marginal bone loss around implants was determined radiographically at 12 to 24 months postloading. The effects on marginal bone loss of the site (mandible vs maxilla), location (anterior vs posterior), immediate vs delayed implant, smoking habit, sex, implant length and diameter, prosthesis type (screw-retained/cemented), and the machined collar position were evaluated. The implant survival rate was 98.96% at 1 year. The mean MBL decreased significantly (0.238 mm) between baseline and loading (P < .001; post hoc test) and decreased by 0.154 mm between loading and 1 year, but this was not significant (P = .085; post hoc tests). After 2 years, the mean MBL decreased significantly (0.263 mm) between baseline and loading (P < .001) and decreased by 0.111 mm between loading and 1 year and by 0.199 mm between loading and 2 years, but these were not significant (P > .05; post hoc tests). The mean bone loss after 1 and 2 years was not significantly associated with implant type or site, smoking habit, or type of implant surgery (P = .792). However, the mean bone loss was significantly associated with the type of prosthesis and was significantly greater for cemented prostheses compared to screw-retained prostheses. A supracrestal position of the machined collar (tissue level) was associated with no bone loss, while placing the collar below the alveolar crest led to bone loss over 2 years. Of the factors evaluated, marginal bone loss after 1 and 2 years was significantly associated with prosthesis type and the machined collar position.
Few large-scale follow-up studies are reported on routine implant treatment.To report retrospective data on early inflammatory and early implant failures in a large number of routine patients at one private referral clinic.A total of 1017 patients were consecutively provided with 3082 implants with an anodized surface (Nobel Biocare AB) at 1592 implant operations between 2000 and 2011. All patients reported with mucosa inflammation and bone loss and/or implant failures to the first annual examination were identified. A logistic multivariate data analysis was performed to identify possible factors with an association to the two events.Altogether 33 patients/operations presented early inflammation (2.1% operations). "History of periodontitis" (OR 3.91; 95% CI: 1.86-8.21), "numbers of implants" (OR1.33; 95% CI:1.07-1.67 per implant), "two stage surgical technique" (OR 3.70; 95% CI: 1.75-7.85), and "lower jaw" treatment (OR 4.73; 95% CI: 2.12-10.57) increased the risk for early mucositis with bone loss (P < .05). Highest risk for early inflammation was observed for patients at an age of 50-55 years at surgery (P < .05). "Smoking habits" (OR 2.08; 95% CI: 1.06-4.10) "Immediate implant placement" (OR 2.09; 95% CI: 1.23-3.54), and "immediate grafting procedures" (OR 2.09; 95% CI: 1.04-4.19) had a significant association to early implant failures (P < .05). Furthermore, risk for an early failure decreased with 22% per year of inclusion (2000 >2011; OR 1.22; 95% CI;1.08-1.39).History of periodontitis and two-stage surgery protocols with bone grafts in the (posterior) lower jaw increased the risk for early inflammatory problems after surgery (P < .05), with the highest risk for mid-aged patients (P < .05). Preventable factors related to the patient (smoking) and experience of surgeon showed to have a significant association to early implant failures in routine clinical practice (P < .05).
Le grand défi en implantologie est d'obtenir des résultats stables et satisfaisants tant sur le plan esthétique que fonctionnel. Afin d'atteindre ce but, la création d'un volume osseux suffisant avant ou durant la pose des implants est devenue une règle incontournable chaque fois que le chirurgien dentiste est face à un défaut osseux péri-implantaire. La technique de régénération osseuse guidée (ROG) est la plus documentée dans la littérature et ses résultats en termes d'augmentation du volume osseux tel qu'ils seront analysés dans notre article montrent une fiabilité et un succès à long terme. Toutefois, comme pour toute technique la ROG a certaines limites et peut être malmenée par certains échecs. Les différents types de membrane et de substituts osseux utilisés dans cette technique seront présentés dans cet article et illustrés par trois cas cliniques.
Purpose To investigate periimplant soft tissue response following flapless extraction and immediate implant placement and provisionalization (IIPP) associated with bovine hydroxyapatite bone and connective tissue grafting in the anterior maxilla. The study evaluated the effectiveness of this technique in terms of soft tissue contours in esthetic areas with the use of the pink esthetic score (PES). Materials and methods In this retrospective study, 39 consecutive patients were treated and followed by two experienced clinicians for single-tooth implant treatment in the esthetic zone. Treatment consisted of flapless extraction, immediate implant placement, inorganic bovine bone filling of the periimplant gap, and connective tissue grafting. A provisional crown was placed at the time of implant placement. The final crown was positioned 5 to 8 months after surgery. To assess the esthetic outcome of the technique, the soft tissue around the tooth to be extracted was scored according to the PES by seven evaluators before the surgery at visit 1 (v1), and at least 1 year after the final prosthesis placement at visit 2 (v2). Results After a mean follow-up of 4 years, the mean total PES score on a scale from 1 to 10 was 5.64 and 7.07 at v1 and v2, respectively. Statistical analysis revealed a significant difference between the PES scores before surgery and at the follow-up examination of the anterior single implants (P = 0.0008). Conclusion Within the limitations of this study, postextraction with immediate implant loading associated with bovine hydroxyapatite and connective tissue grafting is a predictable technique. The esthetic outcome is that soft tissue seems to be maintained or improved significantly according to PES assessment compared with baseline.
