| 1. |
- Albrektsson, Tomas, et al.
(författare)
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Foreign body reactions, marginal bone loss and allergies in relation to titanium implants
- 2018
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Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 11, s. 37-46
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy. Materials and methods: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy. Results: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult. Conclusions: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present.
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| 2. |
- Cannizzaro, G., et al.
(författare)
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Early implant loading in the atrophic posterior maxilla: 1-stage lateral versus crestal sinus lift and 8mm hydroxyapatite-coated implants. A 5-year randomised controlled trial
- 2013
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Ingår i: European Journal of Oral Implantology. - 1756-2406 .- 1756-2414. ; 6:1, s. 13-25
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the efficacy of long implants (10-16 mm) inserted in maxillary sinuses augmented according to a lateral approach versus short (8 mm) implants placed in crestally augmented sinuses, early loaded after 45 days. Materials and methods: Forty partially or fully edentulous patients having 3 to 6mm of residual crestal height and at least 4mm in thickness below the maxillary sinuses were randomised according to a parallel group design to receive either one to three 10 to 16 mm-long hydroxyapatite-coated implants (20 patients) after lateral sinus lifting with 50% anorganic bovine (Bio-Oss) and 50% autogenous bone, or 8mm implants (20 patients) after crestal sinus lifting with autogenous bone. Implants were submerged and left healing for 45 days before loading the implants. Within 1 week after abutment connection, implants were loaded with screw-retained full acrylic provisional prostheses. Definitive metal-ceramic prostheses were provisionally cemented 45 days after abutment connection. Outcome measures were prosthesis and implant failures, any complications, and radiographic peri-implant marginal bone level changes. In addition, the stability of individual implants was assessed with Osstell and Periotest at abutment connection (baseline), and at 1 and 5 years after loading by blinded outcome assessors. All patients were followed up to 5 years after loading. Results: One patient dropped out (death) from the longer implant group. One implant failed in the short implant group versus 5 implants in 3 patients of the longer implant group. The difference was not statistically significant. Four complications occurred in 4 patients of the short implant group versus 8 complications in 7 patients of the long implant group, the difference being not statistically significantly different. However, the 2 major postoperative complications occurred in the longer implant group: 1 abscess, and 1 sinusitis that led to the complete failure of the treatment in 2 patients (4 implants lost). A total of 0.72 mm of peri-implant marginal bone was lost after 5 years at long implants and 0.41 mm at short implants, the difference between the two groups was statistically significant (P = 0.028). Osstell values increased and Periotest decreased over time and there were no differences between groups at any time points. Conclusions: In atrophic maxillary sinuses with a residual bone height of 3 to 6mm, 8 mm short implants placed in a simultaneously crestally lifted sinus might be a preferable choice than a 1-stage lateral sinus lift for placing longer implants since they appear to be associated with less morbidity. If these implants are placed with an insertion torque >35 Ncm and are joined together under the same prosthesis, they can be early loaded at 6 weeks.
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| 3. |
- Christiaens, Veronique, et al.
(författare)
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Intraoral radiography lacks accuracy for the assessment of peri-implant bone level : a controlled clinical study
- 2017
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Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 10:4, s. 435-441
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to compare clinical and radiographic bone level assessments to intra-surgical bone level registration around implants with peri-implantitis and to identify the clinical variables rendering peri-implant bone level assessment accuracy. Materials and methods: The study sample included 50 implants with peri-implantitis in 23 patients. Registration methods included probing of the vertical distance between the implant/abutment interface and the bottom of the pocket (= VPD), intraoral radiography, bone sounding without flap elevation and intra-surgically assessed interproximal bone level. The latter was considered the true bone level (gold standard). Twenty clinicians evaluated all radiographs. Results: VPD and intraoral radiography resulted in a significant underestimation of the true bone level by 1.0 mm (95% CI: 0.495-1.585; P < 0.001) and 2.3 mm (95% CI: 1.650-2.980; P < 0.013) respectively. Bone sounding without flap elevation did not differ significantly from the true bone level (mean difference 0.2 mm; 95% CI: -0.775 - 0.335; P = 0.429). Duplicate magnification registration of 50 implants resulted in excellent intra- and inter-rater reliability (ICC intra <= 0.99; ICC inter = 0.964; P < 0.001). Radiographic underestimation was significantly affected by defect depth (P < 0.001). Variation among clinicians was substantial (mean underestimation range 1.1 mm to 3.8 mm); however, clinical experience had no impact on radiographic underestimation (P = 0.796). Conclusions: Bone sounding without flap elevation was the best predictor of peri-implant bone level, whereas intraoral radiography was the most inferior. Consequently, peri-implantitis may be under-diagnosed if examination is only based on radiographs.
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| 4. |
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| 5. |
- Hjalmarsson, Lars, 1958, et al.
(författare)
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A systematic review of survival of single implants as presented in longitudinal studies with a follow-up of at least 10 years
- 2016
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Ingår i: European Journal of Oral Implantology. - 1756-2406 .- 1756-2414. ; 9:2
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Forskningsöversikt (refereegranskat)abstract
- Background: Placement of single implants is one of the most common applications for implant treatment. Millions of patients have been treated worldwide with osseointegrated implants and many of these patients are treated at a young age with a long expected remaining lifetime. Therefore long-term evidence for such treatment is important. Aim: To report patient treatment, implant and implant-supported single crown survival over at least a 10-year period of follow-up. Material and methods: After reviewing long-term publications, included by Jung et al (2012), a complementary PubMed search was performed using the same search strategy for the period September 2011 to November 2014. Data on implant and single implant crown treatment survival were compiled from included studies. Results: Four new publications were identified from the 731 new titles. They were added to an earlier list of five manuscripts by Jung et al (2012), which were already included. Accordingly, nine publications formed the database of available long-term evaluations. The database consisted of 421 patients altogether, provided with 527 implants and 522 single crowns. From the 367 patients that were followed-up for at least 10 years (87%), altogether 502 implants were still in function at the completion of the studies (95.3%), supporting 432 original and 33 remade single implant crowns. Based on patient level and implant level data, implant survival reached 93.8% and 95.0%, respectively. The corresponding survival rate for original crown restorations was 89.5%. Conclusions: Single implant treatment is a predicable treatment over a 10-year period of time, with no indication of obvious changes in implant failure rate between 5 and 10 years. However, replacement of new single crowns must be considered during the follow-up as part of regular maintenance. Compared to the number of treated patients worldwide, the available numbers with a follow-up of 10 years was low.
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| 6. |
- Klinge, Björn
(författare)
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Peri-implant marginal bone loss : an academic controversy or a clinical challenge?
- 2012
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Ingår i: European Journal of Oral Implantology. - : Quintessense. - 1756-2406 .- 1756-2414. ; 5, s. S13-S19
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Forskningsöversikt (refereegranskat)abstract
- Purpose: The aim of this narrative review was to explore and discuss marginal bone loss around transmucosal oral implants and the related incidence of this biologic complication. Results: Treatment with osseointegrated implants is most often successful and improves the quality of life for the patient. At present only limited data are available to evaluate long-term technical and biological complications. When pen-implant tissue destruction occurs, little is known about the initiating process. Possible factors of relevance for the initiation and progression of peri-implantitis are discussed. Periodontitis, smoking and a variety of local factors are among the most plausible putative reported risk factors. Also, oral hygiene and the inability to clean the reconstruction were reported. The unit for reporting incidence of pen-implant bone loss varies in different studies between implants and patients. Since there seems to be a clustering effect, and implants in the same mouth cannot be considered independent from each other, it is recommended to use the patient as a unit. The different cut-off values for clinical parameters reported in different studies will exert a significant influence on the magnitude of the reported incidence of peri-implantitis. It is suggested that the composite variables including bone loss >= 2 mm, compared to initial radiographs at delivery of the prosthetic device, in combination with bleeding on probing should be interpreted as a 'red flag' for the clinician to critically evaluate if any intervention is indicated in the individual case. Conclusion: Until more solid scientific evidence has been made available, it is likely that the academic controversy in relation to pen-implant bone loss and peri-implantitis will continue.
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| 7. |
- Liljeholm, Robert, et al.
(författare)
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Cone-beam computed tomography with ultra-low dose protocols for pre-implant radiographic assessment : An in vitro study.
- 2017
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Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 10:3, s. 351-359
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate the ultra-low dose scanning protocols of a newly developed CBCT for pre-implant radiographic assessment. MATERIALS AND METHODS: A total number of 32 CBCT scans were exposed at 90 kV using ProMax 3D's standard (GS) and three ultra-low dose scanning protocols: high, mid and low definition (UL-HD, UL-MD and UL-LD) on eight human dry skulls with simulated soft tissue. The mAs values and the voxel size were 96mAs/200 µm, 28mAs/150 µm, 22.4mAs/200 µm and 7.5mAs/400 µm for scanning protocols GS, UL-HD, UL-MD and UL-LD, respectively. The overall image quality and the precision of anatomical landmarks were assessed on a 4-rank ordinal scale by seven observers. Logistic regression analysis and post-hoc Scheffé test were applied to analyse possible differences in image quality and recognition of the anatomical structures for the three ultra-low dose protocols, compared with the standard protocol. Additionally, observers performed bone quality assessment and bone quantity measurement at 96 predefined 2D cross-sectional images. A Pearson Chi-square test and a paired t-test were used to analyse assessed bone quality and quantity using the four scanning protocols respectively. RESULTS: For the CBCT unit, ProMax 3D, UL-LD was not diagnostically acceptable for pre-implant assessment, whereas the UL-HD and UL-MD were diagnostically acceptable regarding overall image quality, visibility of most anatomical structures and bone quality assessment. However, to recognise the border of mandibular canal and the border of maxillary sinus, standard protocol may be indicated for some cases. No statistically significant differences in bone height measurement were found when applying standard protocol and the three ultra-low dose protocols. CONCLUSIONS: Low-dose scanning protocols may be applied for pre-implant radiographic assessment, although image quality can be hampered if the radiation exposure is too low and the voxel size too large. PMID: 28944361
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| 8. |
- Papia, Evaggelia, et al.
(författare)
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Material-related complications in implant-supported fixed dental restorations : A systematic review
- 2018
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Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 11:Suppl 1, s. S147-S165
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Forskningsöversikt (refereegranskat)abstract
- Aim: A large variety of dental materials are available for the production of implant-supported fixed restorations. Materials with different properties are likely to behave differently during clinical function, which may result in different prevalence and types of complications. The aim of the present review was to summarise, analyse and discuss the prevalence and types of complications or failures related to dental materials in implant-supported restorations. Materials and methods: A strategy was set up using the PICO format and the search was performed using the PubMed database, including a hand search of reference lists. Two independent reviewers selected papers based on a set of criteria. The number of events of complications was summarised. Results: The initial search produced 2764 titles. After application of criteria, 47 publications were selected for analysis. Seventeen studies reported on 1447 single crowns and 30 studies reported on 2190 fixed dental prostheses. The most common complications were fracture or chipping of the veneer material, loss of retention and lost access hole fillings. Due to the heterogeneity of studies, and large variation in number of restorations per material group, no conclusive correlation between type of material and type of technical complication and/or failure could be established. Conclusions: The review did not succeed in providing convincing evidence to answer the question concerning a possible relationship between restoration materials and prevalence of technical complications in implant-supported restorations
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| 9. |
- Vandeweghe, Stefan, et al.
(författare)
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A within-implant comparison to evaluate the concept of platform switching : a randomised controlled trial
- 2012
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Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 5:3, s. 253-262
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate whether platform switching could preserve marginal bone around implants up to 6 months after loading. MATERIALS AND METHODS: 15 patients were selected for a randomised controlled trial. Each patient received one customised wide body implant, with the external hex connection located eccentrically, allowing an extra 1 mm switch on one side. The hex was positioned at random at the mesial or distal side and the implant was loaded after 6 months of non-submerged healing. Patients were examined at 3, 6 and 12 months after surgery, during which a radiograph was taken to evaluate bone levels. At 12 months, the mucosal thickness was measured using a perio-probe. RESULTS: All implants survived and the mean overall bone loss, calculated from both the switched and non-switched side, was 0.39 mm (SD 0.33, range 0.00-1.45), 0.85 mm (SD 0.59, range 0.10-2.50) and 0.80 mm (SD 0.46, 0.26-1.89) after 3, 6 and 12 months, respectively. The bone loss continued up to 6 months but stabilised thereafter (P = 0.615). Significantly more bone loss was observed at the non-switched side compared to the switched side at 3 months (0.51 mm versus 0.28 mm, P = 0.019), 6 months (1.05 mm versus 0.64 mm, P = 0.002) and 12 months (0.94 mm versus 0.66 mm, P = 0.002). The mean mucosal thickness was 4.22 mm (SD 1.45; range 1.50-7.00), and was not significantly different between the switched and non-switched sides (P = 0.882). However, using a post-hoc analysis with the mean thickness as a threshold, the mean bone loss was only significantly different between switched and non-switched sides when the mucosa was thicker than 4.22 mm (P = 0.036). CONCLUSIONS: The outcome of this randomised trial is in accordance with earlier studies suggesting that that platform switching decreases bone loss by 30%. Although the sample size was limited, it seems that the creation of a biologic width affects peri-implant bone loss to a significant extent and that platform switching is only effective when the mucosal thickness allows the establishment of a biologic width.
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| 10. |
- Wennerberg, Ann, et al.
(författare)
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Long-term clinical outcome of implants with different surface modifications
- 2018
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Ingår i: European Journal of Oral Implantology. - : Quintessence. - 1756-2406 .- 1756-2414. ; 11
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Forskningsöversikt (refereegranskat)abstract
- The aim of the present systematic review was to evaluate reported survival rate and marginal bone (MBL) loss of implants with different surface roughness and followed up for 10 years or longer. For the majority of the 62 included clinical studies, no direct comparison between different surfaces was made, thus our report is mainly based on reported survival rates and marginal bone loss for individual implant brands with known surface roughness. The survival rate was 82.9 to 100% for all implants after 10 or more years in function and the marginal bone loss was, on average, less than 2.0 mm for all implant surfaces included, i.e. turned, titanium plasma sprayed (TPS), blasted, anodised, blasted and acid-etched but the turned surface in general demonstrated the smallest MBL. However, the survival rates were in general higher for moderately rough surfaces. The roughest TPS surface demonstrated the highest probability for failure, while the anodised showed the lowest probability. In conclusion, the present systematic review demonstrates that it is possible to achieve very good long-term results with all types of included surfaces.
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