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Single Crowns (single + crown)

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Medical Sciences	100%

Selected Abstracts

Retrospective Clinical Evaluation of 86 Procera AllCeramÔ Anterior Single Crowns on Natural and Implant-Supported Abutments

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2005
Fernando Zarone MD
ABSTRACT Background: The Procera AllCeramÔ (Nobel Biocare AB, Göteborg, Sweden, and Procera Sandvik AB, Stockholm, Sweden) technique is one alternative to metal-ceramic restorations. However, few long-term evaluations of its use for single crowns on natural and implant-supported abutments are available. Purpose: The aim of the present study was to assess the clinical performance of Procera AllCeram single crowns when placed in aesthetic sites supported by either natural teeth or implants over a period of 48 months. Materials and Methods: Eighty-six single crowns were fabricated and used in 51 patients. The restorations were examined according to the California Dental Association's quality assessment system. Results: One crown was lost after 20 months of follow-up. Of the 85 restorations that completed the 48-month follow-up, only one crown (1.2%) showed a veneering porcelain chip. All crowns were ranked as either excellent or acceptable. The success rates of single crowns supported by natural tooth and implant-supported abutments were 100% and 98.3%, respectively; the total crown success rate was 98.8%. Conclusion: Within the limitations of the present study, Procera AllCeram crowns proved to be a reliable therapeutic choice for the restoration of anterior teeth on both natural and implant-supported abutments. The hybrid glass-ionomer cement used in the present study appeared to be a reliable luting agent. [source]

Tooth extraction decision model in periodontitis patients

CLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2010
A. Popelut
Abstract Objective: The purpose of this study was to build, around several types of input data, a decision analysis model for dental extraction strategy in periodontitis patients. Materials and methods: The decision analysis was based on the following scenario: a fictitious adult chronic periodontitis patient with no chief complaint, being referred to make a decision of extraction on one single tooth presenting a periodontal defect that may affect the decision-making process. A decision tree was used to identify the treatment options within the next 5 years. Scientific evidences were based on probabilities given by a literature analysis using a systematic approach. Clinical expertize was based on subjective utilities (SUs) assigned by an experts' panel. Expected utilities (EUs) were used to rank the following options: no treatment (EU1) or periodontal treatment (EU2); extraction followed by a tooth-supported fixed partial denture , FPD , (EU3) or an implant-supported single crown , ISC , (EU4). Results: The robustness analysis calculation indicates that the probability of tooth survival needed to be equal to 0.78 in order that the passive option becomes optimal. However, EU1 was impossible to calculate due to the lack of available probabilities. The EU intervals were 79,96, 86,89 and 94,95 for EU2, EU3 and EU4, respectively. Consequently, the FPD option is dominated by the ISC option, and it is not possible to conclude to a difference between the periodontal and the ISC therapy. Conclusions: Within the limits of this model, tooth extraction followed by FPD is the worst strategy compared with ISC or periodontal therapies. To cite this article: Popelut A, Rousval B, Fromentin O, Feghali M, Mora F, Bouchard P. Tooth extraction decision model in periodontitis patients. Clin Oral Impl Res. 21, 2010; 80,89. [source]

Analysis of load transfer and stress distribution by splinted and unsplinted implant-supported fixed cemented restorations

JOURNAL OF ORAL REHABILITATION, Issue 9 2010
J. NISSAN
Summary, Controversy remains over the rehabilitation of implant-supported restorations regarding the need to splint adjacent implant-supported crowns. This study compared the effects of simulated occlusal loading of three implants restored with cemented crowns, splinted versus unsplinted. Three adjacent screw-shaped implants were passively inserted into three holes drilled in a photo-elastic model. Two combinations of cemented restorations were fabricated; three adjacent unsplinted and three adjacent splinted crowns. Strain gauges were connected to the implant necks and to the margins of the overlaying crowns. Fifteen axial static loads of 20-kg loadings were carried out right after each other via a custom-built loading apparatus. Strain gauges located on the implant neck supporting splinted restoration demonstrated significantly (P < 0·001) more strain (sum of strains = 3348·54 microstrain) compared with the single crowns (sum of strains = 988·57 microstrain). In contrast, significantly (P < 0·001) more strain was recorded on the strain gauges located on the restoration margins of the single crowns (sum of strains = 756·32 microstrain) when compared with splinted restorations (sum of strains = 186·12 microstrain). The concept of splinting adjacent implants to decrease loading of the supporting structures may require re-evaluation. The clinical relevance of these findings needs further investigation. [source]

Two-Year Outcome with Nobel Direct® Implants: A Retrospective Radiographic and Microbiologic Study in 10 Patients

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2009
Tommie Van de Velde LA
ABSTRACT Introduction: The Nobel Direct® implant (Nobel Biocare AB, Göteborg, Sweden) was developed to minimize marginal bone resorption and to result in "soft tissue integration" for an optimized aesthetic outcome. However, conflicting results have been presented in the literature. The aim of this present study was to evaluate the clinical and microbiologic outcomes of Nobel Direct implants. Materials and Methods: Ten partially edentulous subjects without evidence of active periodontitis (mean age 55 years) received 12 Nobel Direct implants. Implants were loaded with single crowns after a healing period of 3 to 6 months. Treatment outcomes were assessed at month 24. Routine clinical assessments, intraoral radiographs, and microbiologic samplings were made. Histologic analysis of one failing implant and chemical spectroscopy around three unused implants was performed. Paired Wilcoxon signed-rank test was used for the evaluation of bone loss; otherwise, descriptive analysis was performed. Results: Implants were functionally loaded after 3 to 6 months. At 2 years, the mean bone loss of remaining implants was 2.0 mm (SD ± 1.1 mm; range: 0.0,3.4 mm). Three out of 12 implants with an early mean bone loss >3 mm were lost. The surviving implants showed increasing bone loss between 6 and 24 months (p = .028). Only 3 out of the 12 implants were considered successful and showed bone loss of <1.7 mm after 2 years. High rates of pathogens, including Aggregatibacter actinomycetemcomitans, Fusobacterium spp., Porphyromonas gingivalis, Pseudomonas aeruginosa, and Tanerella forsythia, were found. Chemical spectroscopy revealed, despite the normal signals from Ti, O, and C, also peaks of P, F, S, N, and Ca. A normal histologic image of osseointegration was observed in the apical part of the retrieved implant. Conclusion: Radiographic evidence and 25% implant failures are indications of a low success rate. High counts and prevalence of significant pathogens were found at surviving implants. Although extensive bone loss had occurred in the coronal part, the apical portion of the implant showed some bone to implant integration. [source]

Retrospective Clinical Evaluation of 86 Procera AllCeramÔ Anterior Single Crowns on Natural and Implant-Supported Abutments

Measurements of Buccal Tissue Volumes at Single-Implant Restorations after Local Bone Grafting in Maxillas: A 3-Year Clinical Prospective Study Case Series

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2003
Odont PhD, Torsten Jemt LDS
ABSTRACT Purpose: The purpose of this study was to measure changes in buccal and proximal tissue volumes after local bone grafting and single-implant treatment. Materials and Methods: Ten patients were provided with buccal bone grafts 6 months prior to implant treatment in central upper incisor regions. Following a healing time of 6 months, abutments and single-implant crowns were installed and followed up for 2 years. Clinical photographs and impressions were taken prior to the surgical intervention as well as after crown placement and at first and second annual checkups. The photographs and study models were analyzed with regard to papilla regeneration and changes in buccal crest volume during the study period by means of a clinical papilla index and optical scanning of study models. Results: All bone grafts healed without problems. A significant reduction of the buccal crest volume (-50%, p <.01) was observed in the grafted area before abutment connection. However, a significant increase of tissue volume (+100%, p <.05) was noticed at the subsequent crown placement, followed by a second but slow reduction of the volume during the following 2 years of function. The interdental papillae increased significantly (p <.05) in volume during the first year, almost completely filling up the embrasure areas after 2 years. Conclusions: It may be concluded that local bone grafting seems to be a valuable protocol to create sufficient bone volume for implant placement. However, significant resorption of the graft may be present, which reduces the impact of grafting on the esthetic outcome. Instead, placement of the abutment cylinder and the crown seems to play a more important role for reestablishing the tissue volume at the implant-supported single crowns. [source]

Complication and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2010
Kurt Schmidlin
Abstract Objectives: To assess the biological and technical complication rates of single crowns on vital teeth (SC-V), endodontically treated teeth without post and core (SC-E), with a cast post and core (SC-PC) and on implants (SC-I). Material and methods: From 392 patients with chronic periodontitis treated and documented by graduate students during the period from 1978 to 2002, 199 were reexamined during 2005 for this retrospective cohort study, and 64 of these patients were treated with SCs. Statistical analysis included Kaplan,Meier survival functions and event rates per 100 years of object-time. Poisson regression was used to compare the four groups of crowns with respect to the incidence rate ratio of failures, and failures and complications combined over 10 years and the entire observation period. Results: Forty-one (64%) female and 23 (36%) male patients participated in the reexamination. At the time of seating the crowns, the mean patient age was 46.8 (range 24,66.3) years. One hundred and sixty-eight single unit crowns were incorporated. Their mean follow-up time was 11.8 (range 0.8,26.4) years. During the time of observation, 22 biological and 11 technical complications occurred; 19 SC were lost. The chance for SC-V (56) to remain free of any failure or complication was 89.3% (95% confidence interval [CI] 76.1,95.4) after 10 years, 85.8% (95% CI 66,94.5) for SC-E (34), 75.9% for SC-PC (39), (95% CI 58.8,86.7) and 66.2% (95% CI 45.1,80.7) for SC-I (39). Over 10 years, 95% of SC-I remained free of failure and demonstrated a cumulative incidence of failure or complication of 34%. Compared with SC-E, SC-I were 3.5 times more likely to yield failures or complications and SC-PC failed 1.7 times more frequently than did SC-E. SC-V had the lowest rate of failures or complications over the 10 years. Conclusions: While SCs on vital teeth have the best prognosis, those on endodontically treated teeth have a slightly poorer prognosis over 10 years. Crowns on teeth with post and cores and implant-supported SCs displayed the highest incidence of failures and complications. To cite this article: Schmidlin K, Schnell N, Steiner S, Salvi GE, Pjetursson B, Matuliene G, Zwahlen M, Brägger U, Lang NP. Complication and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants Clin. Oral Impl. Res. 21, 2010; 550,557. doi: 10.1111/j.1600-0501.2009.01907.x [source]

Retrievability of implant-retained crowns following cementation

CLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2008
Christian Mehl
Abstract Objectives: The purpose of this study was to assess the retrievability of cemented implant crowns using two different removal devices. The influence of five cement types and two cement application techniques was evaluated. Methods: Forty copings were cast from a CoCr alloy for 40 tapered titanium abutments (5° taper, 4.3 mm diameter, 6 mm height, Camlog, Germany). Twenty copings were modeled as single crowns, whereas 20 copings were modeled with an extension to simulate fixed partial dentures (FPDs). Before cementation, the inner surfaces of the copings were air-abraded (50 ,m Al2O3 particles at 2.5 bars), while the abutments were used as delivered with machined surfaces. Copings were cemented with eugenol-free zinc oxide (Freegenol), zinc phosphate (Harvard), glass ionomer (Ketac Cem), polycarboxylate (Durelon) and so-called self-adhesive resin (RelyX Unicem) cement. Cement was applied in a thin film band of 1 or 3 mm to the cervical margin of the inner surface of the copings, respectively. After cementation, specimens were stored in saline solution for 24 h. The Coronaflex and a standardized custom-made removal device were used to remove the copings from the abutments. Results: Using the same cement, no statistically significant influence with regard to the type of restoration (crown/FDP), cement application mode and device was detected (P>0.05). Therefore, data of specimens cemented with the same cement were pooled. Median attempts to remove the copings were: zinc oxide: 3, self-adhesive resin: 3, zinc phosphate: 5, glass ionomer: 16 and polycarboxylate: 58. Four levels of significance (P<0.0001) were found: (1) zinc oxide/self-adhesive resin; (2) zinc phosphate; (3) glass ionomer; and (4) polycarboxylate. Conclusions: Zinc phosphate and glass ionomer cement might be suitable for a so-called ,semipermanent' (=retrievable) cementation, while polycarboxylate seems to provide the most durable cementation. [source]

Immediate and early non-occlusal loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: interim results from a prospective multicenter randomized-controlled study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2008
Axel Zöllner
Abstract Objective: Immediate and early loading of dental implants can simplify treatment and increase overall patient satisfaction. The purpose of this 3-year prospective randomized-controlled multicenter study was to assess the differences in survival rates and bone level changes between immediately and early-loaded implants with a new chemically modified surface (SLActive). This investigation shows interim results obtained after 5 months. Material and methods: Patients ,18 years of age missing at least one tooth in the posterior maxilla or mandible were enrolled in the study. Following implant placement, patients received a temporary restoration either on the day of surgery (immediate loading) or 28,34 days after surgery (early loading); restorations consisted of single crowns or two to four unit fixed dental prostheses. Permanent restorations were placed 20,23 weeks following surgery. The primary efficacy variable was change in bone level (assessed by standardized radiographs) from baseline to 5 months; secondary variables included implant survival and success rates. Results: A total of 266 patients were enrolled (118 males and 148 females), and a total of 383 implants were placed (197 and 186 in the immediate and early loading groups, respectively). Mean patient age was 46.3±12.8 years. After 5 months, implant survival rates were 98% in the immediate group and 97% in the early group. Mean bone level change from baseline was 0.81±0.89 mm in the immediate group and 0.56±0.73 mm in the early group (P<0.05). Statistical analysis revealed a significant center effect (P<0.0001) and a significant treatment × center interaction (P=0.008). Conclusions: The results suggested that Straumann implants with an SLActive can be used predictably in time-critical (early or immediate) loading treatment protocols when appropriate patient selection criteria are observed. The mean bone level changes observed from baseline to 5 months (0.56 and 0.81 mm) corresponded to physiological observations from other studies, i.e., were not clinically significant. The presence of a significant center effect and treatment × center interaction indicated that the differences in bone level changes between the two groups were center dependent. [source]

Factors influencing survival of reconstructions.

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2007
Consensus report of Working Group
Abstract: In order to evaluate the level of evidence of factors influencing the survival of reconstructions, systematic reviews of the relevant literature were prepared by a group of rapporteurs. The review papers were circulated to the members of the group before the conference and formed the basis for group and panel discussions. Subsequently, modifications were added to the review papers, and suggestions for consensus statements concerning the following topics were prepared and again critically reviewed in the group and in the plenum: Impact of (i) periodontal disease on the survival of tooth-supported reconstructions, (ii) post-surgical factors as supportive therapy on the survival of implant supported reconstructions, (iii) technical and/or biological complications on the survival of different types of reconstructions, (iiii) material choice for reconstructions on the survival of single crowns and fixed dental prostheses. [source]

A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues , the Implant Crown Aesthetic Index

CLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2005
A pilot study on validation of a new index
Abstract Objectives: The important item of aesthetics is rarely included in evaluation studies. The aim of this study was to develop and validate an index for rating aesthetics of implant-supported single crowns and adjacent soft tissues. Material and methods: Nine items were selected, which have an influence on the aesthetic result. The items are based on the anatomic form, colour and surface characteristics of the crown and on the anatomic form, colour and surface characteristics of the peri-implant soft tissues. Two oral-maxillofacial surgeons and two prosthodontists rated 24 implant-supported single-tooth restorations and adjacent soft tissues on a form with the nine items of the rating index. The rating was carried out twice by each of the examiners. Weighted Cohen's , was calculated to express the intra- and interobserver agreement. Results: Intraobserver results indicated that the agreement between the first and second rating of both the prosthodontists was good (both 0.7) and that the agreement of the oral-maxillofacial surgeons was moderate (0.49 and 0.56). The best interobserver agreement was found between the two prosthodontists (0.61, good agreement). Conclusions: The Implant Crown Aesthetic Index is an objective tool in rating aesthetics of implant-supported single crowns and adjacent soft tissues. The rating is best be carried out by one prosthodontist to have the highest reliability. Résumé L'aspect important qu'est l'esthétique est rarement inclus dans les études d'évaluation. Le but de cette étude était de développer et de valider un index pour évaluer l'esthétique d'implants avec une couronne unique et les tissus mous adjacents. Neuf points ayant une influence sur le résultat esthétique ont été sélectionnés. Ces points sont basés sur une forme anatomique, des caractéristiques de surface et de couleur de la couronne et de la forme anatomique, la couleur et les caractéristiques de surface des tissus mous paroïmplantaires. Deux chirurgiens maxillo-faciaux et deux spécialistes en prothèse ont évalué 24 restaurations de dents uniques sur implants et leurs tissus mous adjacents dans un formulaire avec les neuf points de l'indice d'évaluation. L'évaluation a été effectuée deux fois par chacun des examinateurs. Le kappa de Cohen a été calculé pour exprimer l'accord intra- et inter-observateurs. Les résultats intra-observateurs ont indiqué que l'accord entre la première et la deuxième évaluation étaient bonnes pour les spécialistes en prothèse (les deux 0,70) et l'accord pour les chirurgiens était moyen (0,49 et 0,56). Le meilleur accord inter-observateurs était trouvé entre les deux spécialistes de prothèse (0,61, bon accord). L'indice d'esthétique de la couronne sur implant est un outil objectif dans l'évaluation de l'esthétique des couronnes uniques sur implant et les tissus mous adjacents. L'évaluation est mieux effectuée par un spécialiste en prothèse pour obtenir la plus haute précision. Zusammenfassung Ziele: Der wichtige Faktor Aesthetik wird kaum in Untersuchungen miteinbezogen. Das Ziel dieser Studie war, einen Index zur Wertung der Aesthetik von implantatgetragenen Einzelkronen und der angrenzenden Weichgewebe zu entwickeln und zu werten. Material und Methoden: Neun Punkte wurden ausgewählt, welche einen Einfluss auf das Ästhetische Resultat haben. Die Punkte basierten auf der anatomischen Form, Farb- und Oberflächencharakteristiken der Krone und auf der anatomischen Form, Farb- und Formcharakteristiken der peri-implantären Weichgewebe. Zwei Kieferchirurgen und zwei Prothetikspezialisten bewerteten 24 implantatgetragene Einzelkronen und die angrenzenden Weichgewebe auf einem Formular mit 9 Punkten des Wertungsindex. Die Bewertung wurde von jedem Untersucher zweimal durchgeführt. Es wurden gewichtete Cohen`s Kappa berechnet, um die Uebereinstimmung innerhalb der Untersucher und zwischen den verschiednen Untersuchern auszudrücken. Resutate: Die Resultate innerhalb der Untersucher zeigten, dass die Uebereinstimmung zwischen der ersten und der zweiten Bewertung bei beiden Prothetikern gut war (beide 0.7) und dass die Uebereinstimmung bei den Kieferchirurgen mässig ausfiel (0.49 und 0.56). Die beste Uebereinstimmung zwischen zwei verschiedenen Untersuchern wurde zwischen den beiden Prothetikern gefunden (0.61, gut Uebereinstimmung). Schlussfolgerung: Der Implantat Kronen Aesthetik Index stellt ein objektives Werkzeug zur Bewertung der Aesthetik von implantatgetragenen Einzelkronen und der angrenzenden Weichgewebe dar. Die Bewertung wird am besten durch einen Prothetikspezialisten durchgeführt, um die höchste Zuverlässigkeit zu erhalten. Resumen Objetivos: El punto importante de la estética raramente se incluye en estudios de evaluación. La intención del presente estudio fue desarrollar y validar un índice para valorar la estética de las coronas unitarias implantosoportadas y los tejidos blandos adyacentes. Material y métodos: Se seleccionaron nueve puntos, que tienen influencia en el resultado estético. Los puntos se basan en la forma anatómica, color y características de la superficie de la corona y en la forma anatómica, color y características de la superficie de los tejidos blandos periimplantarios. Dos cirujanos maxilofaciales y dos prostodoncistas valoraron 24 restauraciones unitarias implantosoportadas y los tejidos blandos adyacentes en un formulario con nueve puntos del índice de valoración. La valoración se llevó a cabo dos veces por cada examinador. Se calculó el weighted kappa de Cohen para expresar la concordancia intra- e interobservador. Resultados: Los resultados intraobservador indicaron que el acuerdo entre la primera y la segunda valoración de ambos prostodoncistas fue buena (ambos 0.70) y que el acuerdo de los cirujanos maxilofaciales fue moderada (0.49 y 0.56). El mejor acuerdo interobservador se encontró entre los dos prostodoncistas (0.61, buen acuerdo). Conclusión: El Índice de Estética de Coronas de Implantes es una herramienta objetiva en la valoración de la estética de las coronas unitarias implantosoportadas y los tejidos blandos adyacentes. La valoración se llevó mejor a cabo por un prostodoncista que tuvo la mayor fiabilidad. [source]

Single-tooth replacement by immediate implant and connective tissue graft: a 1,9-year clinical evaluation

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2004
Andrea E. Bianchi
Abstract Objectives: The aim of the present study was to evaluate the long-lasting efficacy of a combined surgical protocol, using immediate implant and subepithelial connective tissue graft for single-tooth replacement. The advantages of this single-center, longitudinal, randomized, blind examiner research were the following: preservation of both keratinized mucosa amount and bone tissue, optimal peri-implant marginal sealing, satisfactory aesthetic results, reduction in treatment time. Materials and methods: In the time period from 1990 to 1998, 116 patients were consecutively admitted for treatment with a total of 116 solid screw ITI-implants supporting single crowns. Ninety-six patients underwent the proposed combined treatment (test group), while 20 received only single immediate implants (control group). The observation time extended from 1 up to 9 years. Results: The 9-year cumulative survival rate was 100% for both test and control groups. Comparative statistical analysis of soft and hard tissue peri-implant parameters demonstrated better results in the test group than in the control during every single 3-year analysis and especially in the last observation interval. The test group also showed very good results in terms of aesthetic parameters, which estimated the keratinized mucosa width, the alignment of crown emergence profile and the patient's satisfaction. Conclusion: Single-tooth replacement by immediate solid screw ITI implants in association with connective tissue autograft was demonstrated to be a predictable procedure. Moreover, this treatment can be considered as a sure system to reach an excellent functional and harmonious aesthetic restoration. Résumé Le but de l'étude présente a été d'évaluer l'efficacitéà long terme d'un protocole chirurgical combiné utilisant l'implant placé immédiatement et un greffon tissulaire de tissu conjonctif sous-épithélial pour le remplacement d'une dent unique. Les avantages de cette recherche randomisée longitudinale dans un seul centre et en aveugle étaient les suivants : préservation de la quantité de muqueuse kératinisée et du tissu osseux, une fermeture marginale paroïmplantaire optimale, des résultats esthétiques satisfaisants et une réduction du temps de traitement. Durant les années 1990 à 1998, 116 patients ont été admis pour le traitement de 116 implants ITI en vis pleines portant des couronnes uniques. Nonante-six patients ont recu le traitement proposé (groupe test) tandis que 20 autres n'ont reçu que des implants placés immédiatement en une étape (groupe contrôle). Le temps d'observation s'échelonnait de un à neuf ans. Le taux de survie cumulatif à neuf années était de 100% dans les deux groupes. L'analyse statistique comparative des tissus mous et durs paroïmplantaires a constaté des meilleurs résultats dans le groupe test que dans le groupe contrôle durant chaque analyse de trois ans et spécialement dans la dernière période d'observation. Le groupe test montrait également de très bons résultats esthétiques concernant la largeur de la muqueuse kératinisée, l'alignement du profil de l'émergence de la couronne et la satisfaction du patient. Le remplacement de dents uniques par des implants ITI en vis pleines placées immédiatement en association avec une greffe de tissu conjonctif est un processus prévisible. De plus, ce traitement peut être considéré comme un système sûr pouvant apporter une restauration fonctionnelle harmonieuse et esthétique. Zusammenfassung Ziele: Das Ziel dieser Studie war es, den Langzeiterfolg eines chirurgischen Protokolls zu untersuchen, das den Einzelzahnersatz mit einem Sofortimplantat in Kombination mit einem subepithelialen Bindegewebstransplantat vorsah. Die Vorteile dieser an einem Zentrum durchgeführten randomisierten, longitudinalen Blindstudie waren die folgenden: Erhaltung sowohl der gesamten keratinisierten Mukosa wie auch des Knochengewebes, der optimale perimplantäre marginale Abschluss, die befriedigenden ästhetischen Resultate und die Verkürzung der Behandlungszeit. Material und Methoden: In der Zeit von 1990 bis 1998 bekamen in der Folge 116 Patienten insgesamt 116 ITI-Vollschraubenimplantate, die mit Einzelkronen versorgt wurden. 96 Patienten wurden nach der vorgestellten kombinierten Methode behandelt (Testgruppe), währenddem die übrigen 20 Patienten einzig das Sofortimplantat erhielten (Kontrollgruppe). Die Beobachtungszeit reichte von 1 bis zu 9 Jahren. Resultate: Die kumulative Überlebensrate nach 9 Jahren betrug für Test- und Kontrollgruppe 100%. Eine statistische Vergleichsanalyse der Parameter von Weich- und Hartgeweben zeigte während jeder der dreijährigen Beobachtungsphasen (insbesondere in der letzten) in der Testgruppe bessere Resultate als in der Kontrollgruppe. Die Testgruppe zeigte auch bezüglich ästhetischen Parametern (Breite der keratinisierten Gingiva, Lokalisation der Durchtrittsstelle der Krone, Zufriedenheit des Patienten) sehr schöne Resultate. Zusammenfassung: Der Einzelzahnersatz mittels Sofortimplantation einer ITI-Vollschraube in Verbindung mit einem freien Bindegewebetransplantat erwies sich als gut beherrschbare Methode. Man kann diese Behandlung sogar als sicher für den Erhalt einer hervorragenden funktionellen, harmonischen und ästhetischen Rekonstruktion empfehlen. Resumen Objetivos: La intención del presente estudio fue evaluar la eficacia a largo plazo de un protocolo quirúrgico combinado, usando implantes inmediatos e injertos de tejido conectivo subepitelial para reemplazar dientes unitarios. Las ventajas de esta investigación unicentro, longitudinal, aleatoria, examinador ciego fueron las siguientes: preservación de tanto de la cantidad de mucosa queratinizada como del tejido óseo, sellado marginal periimplantario óptimo, resultados estéticos satisfactorios, reducción del tiempo del tratamiento. Material y métodos: En el periodo de tiempo desde 1990 a 1998, se admitieron 116 pacientes consecutivos para tratamiento con un total de 116 implantes macizos roscados ITI soportando coronas unitarias. Noventa y seis pacientes se sometieron al tratamiento propuesto (grupo de prueba), mientras 20 recibieron solo implantes inmediatos unitarios (grupo de control). El tiempo de observación se extendió de 1 9 años. Resultados: El índice acumulado de supervivencia a los 9 años fue del 100% tanto para el grupo de prueba como el de control. El análisis estadístico comparativo de los parámetros de los tejidos blandos y duros periimplantarios demostró mejores resultados en el grupo de prueba que en el de control, durante cada análisis de 3 años y especialmente en el último intervalo de observación. El grupo de prueba también mostró muy buenos resultados en términos de parámetros estéticos, que estimaron la anchura de la mucosa queratinizada, la alineación del perfil de emergencia de la corona y la satisfacción del paciente. Conclusión: La sustitución de un diente unitario por implantes macizos roscados inmediatos ITI en asociación con autoinjertos de tejido conectivo demostró ser un procedimiento predecible. Más aun, este tratamiento puede ser considerado como un sistema seguro para alcanzar una excelente restauración estética funcional y armónica. [source]

A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implants

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2004
Results from a private practice
Abstract: This paper reports on a 7-year life table analysis on ITI titanium plasma-sprayed (TPS) and sandblasted and etched (SLA) implants placed in a private practice and loaded for at least 1 year. In 236 patients, 528 (264 TPS and 264 SLA) implants were placed, 351 (66.5%) implants rehabilitated the posterior region and 71.1% implants were ,11 mm. In the posterior mandible and maxilla, the mean implant length was 9.90 and 9.74 mm respectively. Implant length was determined through standard radiographs only. Increase of the number of implants or reduction of the width or the length of the rehabilitations was not specifically sought for the shorter implants. One hundred and twenty-two SLA implants were loaded within 63 days. All early loaded SLA implants resisted the applied 35 N cm without rotation or pain. Three implants failed, one early and two late failures, all were SLA implants placed in the mandible. Shorter implants did not fail more than longer ones. The cumulative success rate was 99.40%. The predictable use of short implants supporting single crowns and small fixed partial dentures of 2,4 units supported by two to three implants permitted (1) restricting the need for sophisticated and expensive presurgical procedures aimed to determine precisely the available bone height by computerized radiographic methods, (2) the placement of prosthetically driven restoration instead of surgically driven ones, (3) reducing the indications span for complex invasive procedures like sinus lift and bone grafting procedures, (4) facilitating the surgery, without attempting to place the longest implant and (5) avoiding the occurrence of sensation disturbance. The safe use of short implants in a private practice should make implant therapy simpler and accessible to a higher number of patients and practitioners. Résumé Ce manuscript rapporte une analyse sur sept ans d'implants ITI® TPS et SLA placés dans un cabinet privé et chargés pendant au moins une année. Chez 236 patients, 528 implants (264 TPS et 264 SLA) ont été placés, 351 (66,5%) d'entre eux pour reconstruire la région postérieure et 71,1 étaient ,11 mm. Dans les parties postérieures de la mandibule et du maxillaire la longueur implantaire moyenne était respectivement de 9,90 et 9,74 mm. La longueur de l'implant était déterminée à partir uniquement de radiographies standards. L'augmentation du nombre d'implants ou la réduction de la largeur ou la longueur des reconstructions n'étaient pas spécifiquement recherchées pour les implants les plus courts. Cent vingt-deux implants SLA ont été mis en charge avant 63 jours. Tous les implants SLA avec mise en charge précoce ont resistéà la force de 35 Ncm appliquée sans rotation ni douleur. Trois implants ont échoué: 1) de manière précoce et 2) plus tard, tous étaient des implants SLA placés dans la mandibule. Les implants les plus courts n'avaient pas davantage d'échec que les plus longs. Le taux de succès cumulatif était de 99,40%. L'utilisation prévisible des implants courts portant des couronnes uniques et des petites prothèses fixées de deux à quatre unités supportées par deux à trois implants permettait 1) de réduire la nécessité de processus préchirurgicaux sophistiqué et cher visant ,a d"terminer précisemnentla hauteur osseuse disponible par des méthodes radiographiques avec ordinateur, 2) le placement de restaurations axées sur la prothèse plutôt que sur la chirurgie, 3) de diminuer la portée des indications des processus invasifs complexes comme l'épaississement du plancher buccal et les processus de greffe osseuse, 4) de faciliter la chirurgie sans essayer de placer l'implant le plus long, 5) d'éviter l'apparition de troubles de sensation. L'utilisation s,re d'implants court dans une pratique privée pourrait rendre la thérapie plus simple et accessible à un polus grand nombre de patients et de praticiens. Zusammenfassung Diese Arbeit berichtet über eine 7 Jahre Life Time Analyse von ITI TPS und SLA Implantaten, welche in einer Privatpraxis gesetzt wurden und für mindestens 1 Jahr unter Belastung standen. Bei 236 Patienten wurden 528 Implantate (264 TPS und 264 SLA) eingesetzt, 351 Implantate (66.5%) dienten der Wiederherstellung der posterioren Region und 71.1% der Implantate waren 11 mm lang. In der posterioren Mandibula bzw. Maxilla betrug die mittlere Implantatlänge 9.9 bzw. 9.74 mm. Die Implantatlänge wurde nur auf Standardröntgenbildern bestimmt. Bei Rekonstruktionen mit kurzen Implantaten wurden nicht speziell mehr Implantate verwendet oder die Breite oder die Länge der Rekonstruktionen reduziert. 122 SLA Implantate wurden innerhalb von 63 Tagen belastet. Alle frühbelasteten SLA Implantate widerstanden den applizierten 35Ncm ohne Rotation oder Schmerzen. 3 Implantate zeigten Misserfolge, einen Früh- und 2 Spätmisserfolge. Es handelte sich dabei ausschliesslich um SLA Implantate, welche im Unterkiefer eingesetzt worden waren. Kurze Implantate zeigten nicht mehr Misserfolge als lange. Die kumulative Erfolgsrate betrug 99.4%. Die Verwendung von kurzen Implantaten, welche Einzelkronen und kleine festsitzende Brücken mit 2,4 Einheiten auf 2,3 Implantanten trugen, erlaubte, 1) die Notwendigkeit von komplizierten und teuren prächirurgischen Abklärungen zur genauen Bestimmung der zur Verfügung stehenden Knochenhöhe durch computerisierte radiologische Methoden zu beschränken, 2) die Platzierung von prothetisch diktierten Rekonstruktionen anstelle von chirurgisch diktierten Rekonstruktionen, 3) eine Reduktion der Indikationsbreite von komplexen invasiven Prozeduren wie Sinuslift und Knochentransplantationen, 4) eine Erleichterung der Chirurgie indem nicht ein möglichst langes Implantat gesetzt werden musste, 5) das Auftreten von Sensibilitätsstörungen zu vermeiden. Die sichere Verwendung von kurzen Implantaten in einer Privatpraxis sollte die Implantattherapie einfacher machen. Dadurch sollte die Behandlung mit Implantaten einer grösseren Anzahl Patienten und Praktikern zugänglich werden. Resumen Este estudio informa sobre un análisis de un cuadro de vida de implantes ITI TPS y SLA colocados en una consulta privada y cargados durante al menos un año. Se colocaron 528 implantes (264 TPS y 264 SLA) en 236 pacientes, 351 implantes (66.5%) rehabilitaron el maxilar posterior y el 71.1% de los implantes fueron ,11 mm. La longitud media de los implantes en la mandíbula posterior y el maxilar fue de 9,90 y 9.74 mm respectivamente. La longitud del implante se determinó solamente a través de radiografías. No se buscaron específicamente incrementos en el número de implantes o reducción en la anchura o longitud de las rehabilitaciones para los implantes cortos. Se cargaron 122 implantes dentro de los 63 días. Todos los implantes SLA cargados tempranamente resistieron la fuerza de 35 Ncm aplicada sin rotación ni dolor. 3 implantes fracasaron, uno tempranamente y 2 tardíos, todos fueron implantes SLA colocados en la mandíbula. Los implantes mas cortos no fracasaron más que los implantes largos. El índice acumulativo de éxito fue del 99.4%. El uso predecible de implantes cortos soportando coronas unitarias y pequeñas prótesis fijas parciales de 2,4 unidades soportadas por 2,3 implantes permitieron, 1) restringir la necesidad de procedimientos quirúrgicos sofisticados y costosos con la intención de determinar con precisión la altura de hueso disponible por medio de métodos de radiografías computarizadas, 2) la colocación de restauraciones orientadas prosteticamente en vez de quirúrgicamente, 3) reducir el abanico de indicaciones para procedimientos complejos invasivos tales como procedimientos de elevación del seno e injertos, 4) facilitar la cirugía, sin intentar colocar el implante mas largo, 5) evitar la aparición de sensación de molestia. El uso seguro de implantes cortos en una consulta privada debería hacer el tratamiento de implantes mas simple y accesible para un mayor número de pacientes y profesionales. [source]