BackgroundNowadays implant placement protocols are widespread among clinicians all over the world. However, available literature, only partially analyses what can be potential benefits for the clinicians and patients, often focusing just on specific aspects, such as accuracy. The purpose of this review is to compare computer guided implant placement with conventional treatment protocols.MethodsA search strategy according to the P-I-C-O format was developed and executed using an electronic MEDLINE plus manual search from 2000 up to December 2016. This review included only randomized controlled trials (RCTs) focusing on subjects treated with digital workflow for oral implant placement compared to conventional procedures. Data were extracted from eligible papers and analysed. All kinds of outcomes were considered, even patient-related and economical outcomes.ResultsThe search strategy revealed 16 articles; additional manual searches selected further 21 publications. Afterwards the evaluation of articles, only two studies could be selected for subsequent data extraction. The two identified RCTs analysed primary outcomes as prosthesis failure, implant failure, biological or prosthetic complications, and secondary outcomes as periimplant marginal bone loss. One RCT evaluated also the duration of treatment, post-surgical progress, additional treatment costs and patient satisfaction. The other RCT focused instead on evaluating eventual improvement of patient’s quality of life. In both selected studies, were not observed by the authors statistically significant differences between clinical cases treated with digital protocols and those treated with conventional ones. In one RCT, however post-surgical progress evaluation showed more patients’ self-reported pain and swelling in conventional group.ConclusionsWithin the limitation of this review, based on only two RCTs, the only evidence was that implant survival rate and effectiveness are similar for conventional and digital implant placement procedures. This is also confirmed by many other studies with however minor scientific evidence levels. Reduction of post-operative pain, surgical time and overall costs are discussed. Authors believe that scientific research should focus more in identifying which clinical situations can get greatest benefits from implant guided surgery. This should be done with research protocols such as RCT that assess comprehensively the advantages and disadvantages of fully digital surgical protocols.
Purpose: Scientific evidence is limited regarding the long-term (>10 years) outcomes of large enough numbers of implants (>500) to allow for reliable comparison of subgroups. The purpose of this study was to analyze the outcomes of dental implants placed in an active University Clinic setting and followed for up to 20 years. Materials and Methods:Data documenting the implant placement, prosthetic reconstruction, and annual follow-up of patients treated at Frankfurt University were extracted from a Structured Query Language database and patients' written records and evaluated statistically.Results: Between April of 1991 and May of 2011, 12,737 ANKYLOS® (DENTSPLY Implants Manufacturing GmbH, Mannheim, Germany) implants were placed in 4,206 patients for a variety of clinical indications. The Kaplan-Meier cumulative survival rate (CSR) was 93.3% after 204 months. Most of the failures (198/1.6%) occurred during the first year after implant placement and before prosthesis delivery. A significantly higher (p < .001) number of implants placed in the mandible and in hard quality bone failed than those placed in the maxilla or in weak and normal quality bone. Female patients had significantly higher CSRs (93.7% 204 months) than male patients (92.8% 204 months/p = .029). The implants showed low rates of peri-implant bone loss after 204 months (horizontal: 21 mm: 85.7%, vertical: 21 mm: 85.2%).Conclusion: ANKYLOS dental implants followed for up to 20 years have high CSRs and low rates of peri-implant bone loss.
In some PLS patients, periodontitis may be arrested by: combined mechanical and antibiotic periodontal treatment; extraction of severely diseased teeth; oral hygiene instructions; intensive maintenance therapy; and microbiological monitoring and treatment of the infection with Aggregatibacter actinomycetemcomitans. Implants in PLS patients who did not follow any maintenance programme have a high risk of peri-implantitis and implant loss. Treatment of PLS patients has always to be considered as high-risk cases.
PurposeTo evaluate the prevalence of peri‐implantitis (PI) and peri‐implant mucositis (PM) in a long‐term follow‐up with comparison among different PI and PM definitions, and to report on the incidence of PI.Materials and MethodsIn a retrospective clinical study five different PI and PM definitions were applied onto a population with 274 implants 17 to 23 years postimplant placement. Recommendations by the Eighth European Workshop on Periodontology (EWOP) were used as base reference. Clinical and radiological measurements were considered. Risk factors were evaluated in a regression analysis.ResultsAfter an average observation period of 18.9 years, 40.1% of the implants were diagnosed with PM and 15.0% with PI (Eighth EWOP). PI incidence reached 7.9% on implant level and 13.2% on patient level. Implants diagnosed with PI and progressive bone loss displayed exceptionally vertical bone defect configuration (BDC). Diabetes mellitus, smoking, regular maintenance, or a former periodontal infection did not show significant influence on the prevalence of peri‐implant diseases. Patients with bruxism displayed significantly less PM and PI.ConclusionsVertical BDC seems to correspond with active PI, wherefore we estimate such a defining factor of importance. Diagnosis of PM and evaluation of probing pocket depths might be only of descriptive interest as they could lead to false‐positive results.
In cases of an immediate insertion and loading of implants after a traumatic loss of the patient's own dentition or due to an inevitable extraction of an anterior tooth, it is essential to provide the patient with an adequate provisional crown. A soft-tissue recession must be avoided, whether it is due to a compression of the peri-implant soft-tissue caused by an over-dimensioned restoration in the cervical collar of the provisional crown or to a too small dimensioned sulcus former. A simulation of the exact dimension of the lost tooth - especially on the cervical part of the new provisional restoration - is expected to preserve all relevant information and allows the design of a naturally looking emergence profile. Based on theoretical considerations and a case report, the authors intend to demonstrate that a near-naturally dimensioned sealing of the dento-gingival soft-tissue collar may initiate a tissue-maintaining healing process, similar to a tooth replantation. The natural dental crown, connected to an implant instead of the root, is applied for a tight sealing of the wound. If due to traumatic impact the tooth is no longer available, a naturally dimensioned crown restoration will serve as an alternative wound sealant.
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