Immediate Nonocclusal Versus Early Loading of Dental Implants in Partially Edentulous Patients – —15-year Follow-up of a Multicentre Randomised Controlled Trial

PURPOSE. To compare peri-implant bone and soft-tissue levels at immediately non-oc-clusally loaded versus non-submerged early-loaded implants in partially edentulous patients 15 years after loading. MATERIALS AND METHODS. Fifty-two patients from five Italian private practices were randomised, 25 to immediate loading and 27 to early loading. To be immediately loaded, single full Osseotite implants had to be inserted with a torque of at least 30 Ncm, and splinted implants with a torque of at least 20 Ncm. Immediately loaded implants were provided with non-occluding temporary restorations within 48 hours, which were brought into full occlusion after 2 months. In the early loading group, implants were loaded after 2 months. Definitive restorations were provided 8 months after implant placement in both groups. Outcome measures were prosthesis failures, implant failures and complica-tions, recorded by non-blinded assessors, and peri-implant bone and soft-tissue levels, as evaluated by blinded assessors. RESULTS. Fifty implants were loaded immediately and 54 early. Twelve patients with 24 implants dropped out from the immediate group versus 11 patients with 22 implants from the early loaded group, but all remaining patients were followed up for at least 15 years after loading. One single implant with its provisional crowns and one definitive prothesis failed in the immediate loading group. Seven patients with immediately loaded and two with early loaded implants reported complications. There were no statistically significant differences between groups in terms of implant failures (Fisher’s exact test P = 0.481; diff. =-0.04, 95% CI:-0.16 to 0.08), prosthesis failures (Fisher’s exact test P = 0.226; diff. =-0.08, 95% CI:-0.21 to 0.06), or complications (Fisher’s exact test P = 0.066; diff. =-0.22, 95% CI:-0.41 to 0.01). There were also no statistically significant differences in peri-implant bone (diff. = 0.28 mm, 95%CI:-0.35 to 0.91; P = 0.368) or soft-tissue level changes (diff. = 0.34 mm, 95%CI:-0.32 to 1.00; P = 0.292) between the two groups. Specifically, after 15 years immediately loaded patients had lost an average of 1.75 mm, and early loaded patients an average of 1.44 mm of peri-implant marginal bone. CONCLUSIONS. The long-term prognosis of prostheses supported by both immediately and early-loaded implants seems favourable

Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla : 1-year interim results of a multicenter prospective study

The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of fully edentulous maxillae and to compare the outcome of axial vs. tilted implants. MATERIAL AND METHODS: Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year. RESULTS: One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3-42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9+/-0.4 (standard deviation) mm and 0.8+/-0.5 mm. CONCLUSIONS: The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants

From cylindrical to non‐cylindrical foreland basin: Pliocene–Pleistocene evolution of the Po Plain–Northern Adriatic basin (Italy)

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Esthetic risk assessment of immediate implant: position paper and proposal of a novel diagnostic parameter

Objectives The aim of this paper is to assess the risk factors that could influence the esthetic and long term results of implant placement in fresh extraction sockets. Materials and methods The immediate implant risk factors that could influence the final outcome are analyzed and could be summarized in: the peri-implant soft tissue biotype, the vestibular bone thickness, the alveolar host infected site, the residual peri-implant gap and the final implant position. Furthermore a diagnostic parameter that could influence the therapeutic approach is proposed. Discussion Several factors have been proposed as being important in determining the stability of the peri-implant mucosa, including implant shoulder position in the bucco-lingual and apico-coronal direction and tissue biotype. The initial thickness of the buccal crestal bone may be a factor in determining the extent of the vestibular bone resorption. Thick soft and hard peri-implant tissues could contribute to marginal stability. Infected alveolar site is not a contradiction to implant placement and the peri-implant gap should be grafted in order to minimize the horizontal resorption. The implant position and diameter should be carefully analyzed in order to preserve peri-implant soft tissue stability. Conclusions Marginal tissue recession, occurred at both thin and thick biotype sites. When implants are placed immediately after tooth extraction, the implant-vestibular plate distance is a critical parameter to evaluate, and can be a useful diagnostic parameter that guides the clinician in the choice of the most appropriate grafting procedure. Grafting the marginal defects may limit the horizontal resorption, however \u201coverbuilding\u201d the buccal aspect may be a suitable technique to compensate for the physiological alveolar bone changes

Post-extraction implant placement into infected versus non-infected sites : a multicenter retrospective clinical study

Purpose: The aim of this study was to assess whether immediate implant placement into post-extraction sites presenting a chronic infection poses a greater risk of implant failure than immediate placement in non-infected sites. Materials and Methods: Records of patients who underwent extraction and immediate implant placement into both infected and non-infected sites from January 1998 to September 2014 at 5 different dental centers were considered for inclusion. Included records were subjected to statistical analysis of survival rates, along with a number of other patient-, implant-, surgery-, and prosthesis-related variables. Results: The inclusion criteria were met by 369 patients who received a total of 527 implants. The follow-up averaged 53.2 months (range 0.9-158.3) for implants placed into non-infected sockets (N = 334) and 50.1 months (range 1.6-146.1) for those placed into infected sites (N = 193). Seven implants failed in non-infected sites and 3 in infected ones. All failures occurred within 1 year of placement. Cumulative implant survival rate for non-infected and infected sites was, respectively, 97.9% \ub1 0.8% and 98.4% \ub1 0.9%, being not significantly different (P =.66). None of the investigated variables affected the outcome. Conclusions: Placement of implants into periodontally or endodontically infected sites immediately after tooth extraction is a safe option, even when the implants are loaded immediately or early

Immediate rehabilitation of the completely edentulous jaws with fixed prostheses supported by upright and tilted implants : a multicenter clinical study

Purpose: The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retained prostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulous jaws and to compare the outcomes of upright versus tilted implants. Materials and Methods: At 4 study centers, 342 Osseotite NT implants were consecutively placed in 65 patients (96 implants were placed in 24 mandibles and 246 implants in 41 maxillae). The 2 distal implants were tilted by 25 to 35 degrees. Provisional full-arch restorations made of a titanium framework and acrylic resin teeth were delivered within 48 hours of surgery and immediately loaded. The final prosthesis was delivered after 3 months of healing. Results: Three implants failed during the first year and another 2 within 18 months of loading in the maxilla. The cumulative implant survival rate for the maxilla was 97.59% for up to 40 months of follow-up. No implant failure was recorded for the mandible. The prosthetic success rate was 100%. Marginal bone loss around upright and tilted implants was similar. Patients were satisfied of their esthetics, phonetics, and function. Conclusion: The preliminary results of this study suggest that immediate rehabilitation of the edentulous maxilla and mandible by a hybrid prosthesis supported by 6 or 4 implants, respectively, may represent a viable treatment alternative with respect to more demanding surgical procedures. The clinical results indicate that immediately loaded tilted implants may achieve the same outcome as upright implants in both jaws