ITI Literature Update for Members

September-October 2011

ITI International Team for Implantology ITI Center Peter Merian-Weg 10 CH-4052 Basel Tel. +41 (0)61 270 83 83 Fax +41 (0)61 270 83 84 ITI International Team for iticenter@iticenter.ch Implantology www.iti.org ITI Center Peter Merian-Weg 10 CH-4052 Basel Tel. +41 (0)61 270 83 83 Peter Merian Weg 12 CH-4002 Basel SwitzerlandFax +41 (0)61 270 83 84 iticenter@iticenter.ch +41 (0)61 / 965 11 01 info@straumann.com www.straumann.com www.iti.org

Compiled by: Colin A McKinnon e-mail: literature@iticenter.ch

Institut Straumann AG Telephone +41 (0)61 / 965 11 11 Fax

Table of Contents
Literature Update ............................................................................................................... 3 Clinical Oral Implants Research ....................................................................................... 3 Vol. 22 No. 10 (October 2011) ..................................................................................... 3 Implant Dentistry .............................................................................................................. 4 Vol. 20 No. 4 (August 2011) ......................................................................................... 4 International Journal of Oral and Maxillofacial Implants ................................................... 4 Vol. 26 No. 4 (July/August 2011) .................................................................................. 4 International Journal of Periodontics and Restorative Dentistry ...................................... 6 Vol. 31 No. 4 (July/August 2011) .................................................................................. 6 Journal of Clinical Periodontology .................................................................................... 6 Vol. 38 No. 9 (September 2011) ................................................................................... 6 Vol. 38 No. 10 (October 2011) ..................................................................................... 6 Journal of Oral Implantology ............................................................................................ 7 Vol. 37 No. 4 (August 2011) ......................................................................................... 7 Journal of Periodontology ................................................................................................ 8 Vol. 82 No. 8 (August 2011) ......................................................................................... 8 Vol. 82 No. 9 (September 2011) ................................................................................... 8 Quintessence International .............................................................................................. 8 Vol. 42 No. 9 (October 2011) ....................................................................................... 8 Vol. 42 No. 10 (November/December 2011) ................................................................ 8

Literature Update Clinical Oral Implants Research

Vol. 22 No. 10 (October 2011)
Collaert B, Wijnen L, De Bruyn H. A 2-year prospective study on immediate loading with fluoride-modified implants in the edentulous mandible. Clin Oral Implants Res 2011;22(10):1111-1116. Each of 25 patients received five fluoride-modified implants that were immediately functionally loaded with provisional restorations. Marginal bone loss was evaluated at placement and after 3, 6, 12 and 24 months. Implant survival was 100%, and mean bone loss values were 0.14 mm, 0.13 mm, 0.11 mm and 0.11 mm after 3, 6, 12 and 24 months, respectively. Mean bone loss after 24 months at the patient level was 0.12 0.14 mm, while the mean probing depth and bleeding index were 2.45 0.43 mm and 0.55 0.34%, respectively. Immediate loading of fluoride-modified implants may therefore be a predictable treatment option. Mangano C, Mangano F, Shibli JA, Ricci M, Sammons RL, Figliuzzi M. Morse taper connection implants supporting planned maxillary and mandibular bar-retained overdentures: a 5-year prospective multicenter study. Clin Oral Implants Res 2011;22(10):1117-1124. A total of 60 patients received 288 implants with a Morse taper connection (152 in maxillae and 136 in mandibles), and bar-retained overdentures were planned to be supported by four implants. Implant survival after 5 years was 98% (97.4% and 98.6% in the maxilla and mandible, respectively); 98.6% of the surviving implants were classified as successful. The mean distance from the implant shoulder to the first crestal bone was 0.7 0.53 mm, and there were few prosthetic complications. Cordaro L, Torsello F, Morcavallo S, di Torresanto VM. Effect of bovine bone and collagen membranes on healing of mandibular bone blocks: a prospective randomized controlled study. Clin Oral Implants Res 2011;22(10):1145-1150. A total of 22 ridges with horizontal alveolar deficiency were treated with multiple mandibular blocks for horizontal augmentation only (control) or with additional deproteinized bovine bone at the periphery and over the graft (test); collagen membranes were then placed. A total of 55 implants were placed after 4 months: crest width was measured before and after augmentation, and before implant placement. No significant differences in width were noted between groups at baseline and after grafting, with mean augmentation values of 4.18 mm and 4.57 mm in the test and control groups, respectively. Augmentation values at implant placement were 3.93 mm and 3.67 mm in the test and control groups, respectively. Mean graft resorption was significantly greater in the control group, but slightly more complications were noted in the test group. All implants were successful after 24 months. Graft resorption was therefore minimised by the additional use of bovine bone mineral. Vasak C, Watzak G, Gahleitner A, Strbac G, Schemper M, Zechner W. Computed tomography-based evaluation of template (NobelGuide)-guided implant positions: a prospective radiological study. Clin Oral Implants Res 2011;22(10):1157-1163. Eighteen patients with partially or fully edentulous maxillae and mandibles received a total of 86 implants via the NobelGuide protocol. Pre- and post-operative CT scans were taken and merged into Procera planning software. Mean deviations at the implant shoulder were 0.43 mm (bucco-lingual), 0.46 mm (mesio-distal) and 0.53 mm (depth) and at the apex were 0.7 mm (bucco-lingual), 0.63 mm (mesio-distal) and 0.52 mm (depth). The maximum deviation (2.02 mm) was seen in the corono-apical direction. Deviations were significantly lower in the anterior versus posterior regions and in the mandible versus the maxilla, and there was a significant correlation between deviation and mucosal thickness. All maximum deviations were within the recommended safety margins. van Brakel R, Noordmans HJ, Frenken J, de Roode R, de Wit GC, Cune MS. The effect of zirconia and titanium implant abutments on light reflection of the supporting tissues. Clin Oral Implants Res 2011;22(10):1172-1178. In 11 patients, Ti or ZrO2 abutments were placed on 15 implants and hyper-spectral images were taken. High resolution images at 70 nm intervals were obtained within 30 s, and black-and-white references were used for special and spectral normalisation and correction for motion. Reflection spectra were then obtained from the images from 1 mm above the soft tissue to 3 mm apically. The median soft tissue height was 2.3 mm, and a rapid increase in buccal mucosa thickness was observed in an apical direction. At a mucosa thickness of 2.0 0.1 mm, no difference in mucosal light reflection could be detected between Ti and ZrO 2 abutments. The difference in light reflection is therefore no longer noticeable to the human eye for a mucosal thickness of at least 2 mm.
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Enkling N, Jhren P, Klimberg V, Bayer S, Mericske-Stern R, Jepsen S. Effect of platform switching on periimplant bone levels: a randomized clinical trial. Clin Oral Implants Res 2011;22(10):1185-1192. Each of 25 subjects received two implants (diameter 4 mm) in one side of the posterior mandible. After 3 months, the test implant received an abutment of 3.3 mm diameter, while the control implant received an abutment of 4 mm diameter, and provisional single-tooth crowns were placed. Subjects were monitored over 1 year, and radiography and microbiological samples were taken at baseline and 3, 4 and 12 months. Mean vertical bone loss after 12 months was 0.53 0.35 mm and 0.58 0.55 mm for the test and control implants, respectively, and the mean intra-individual difference was 0.05 0.56 mm. Changes in crestal bone level were significantly dependent on time but not on platform switching. The internal spaces of the implants in both groups were contaminated with bacteria, with no significant difference between test and control. The results did not confirm the hypothesis of reduced bone loss with platform switching. ______________________________________________________________________________________

Implant Dentistry
Vol. 20 No. 4 (August 2011)
Caldern JH, Valencia RM, Casasa AA, Snchez MA, Espinosa R, Ceja I. Biomechanical anchorage evaluation of mini-implants treated with sandblasting and acid etching in orthodontics. Implant Dent 2011;20(4):273-279. Thirteen patients received a total of 24 orthodontic sandblasted and acid-etched implants for skeletal anchorage, and anchorage measurements were obtained radiographically every month for 6 months. All implants were effective for the trial, but 65% showed 1 of displacement, while 35% showed 2 of displacement. Less displacement was observed for mandibular compared to maxillary implants, and less displacement was observed in the anterior versus the posterior maxilla. Good bone anchorage was therefore observed with sandblasted and acid-etched orthodontic implants. Bae M-S, Sohn D-S, Ahn M-R, Lee H-W, Jung H-S, Shin I-H. Retrospective multicenter evaluation of tapered implant with a sandblasted and acid-etched surface at 1 to 4 years of function. Implant Dent 2011;20(4):280284. Patient records of 92 patients who received a total of 294 implants at three centres over a 3-year period were retrospectively evaluated. The mean observation period was 38 months (range 22 to 59 months) and the cumulative survival rate was 97.3%. The mean bone loss after 1 year of functional loading was 0.33 mm. Clinically reliable results were therefore obtained. Snchez-Prez A, Moya-Villaescusa MJ, Caffesse RG. Temperature of periimplant tissues in clinically successful implants: an observational clinical study in humans. Implant Dent 2011;20(4):292-298. One clinically and radiologically successful implant in each of 51 patients was examined. Peri-implant temperatures were measured and compared to sublingual temperatures. Significant differences in operaimplant temperature were found between the fourth and fifth sextants, but the differences were not significant in comparison to sublingual temperature. The mean difference between peri-implant and sublingual temperature was 0.81. ______________________________________________________________________________________

International Journal of Oral and Maxillofacial Implants

Vol. 26 No. 4 (July/August 2011)
Markovi A, oli S, Drai R, Gai B, Todorovi A, Staji Z. Resonance frequency analysis as a reliable criterion for early loading of sandblasted/acid-etched active surface implants placed by the osteotome sinus floor elevation technique. Int J Oral Maxillofac Implants 2011;26(4):718-724. SLActive implants were placed in the posterior maxilla of 27 patients using the osteotome sinus floor elevation technique. RFA was measured at surgery and every week for 6 weeks, after which only implants with an RFA value of 65 were loaded. Of 42 implants placed, 40 were loaded after 6 weeks (early loading), all of which survived for up to 2 years with no clinical or radiographic complications. Early loading is therefore suitable for SLActive implants placed via the osteotome sinus floor elevation technique if adequate stability is confirmed.

Sun HL, Huang C, Wu YR, Shi B. Failure rates of short ( 10 mm) dental implants and factors influencing their failure: a systematic review. Int J Oral Maxillofac Implants 2011;26(4):816-825. A literature search was conducted for data on failure and risk factors with short dental implants ( 10 mm). A total of 35 studies met the inclusion criteria, but a meta-analysis was not possible due to the heterogeneity and low quality of the studies. Of 14,722 implants placed in the studies, 659 failed, giving a total failure rate of 4.5%. Most failures (57.9%) occurred prior to prosthesis placement, and no difference in failure rate was found between short or standard implants, or between those placed in single or two stages. Failure rates were slightly higher in the maxilla versus the mandible, and for machined versus rough-surfaced implants. Schnitman PA, Hwang JW. To immediately load, expose or submerge in partial edentulism: a study of primary stability and treatment outcome. Int J Oral Maxillofac Implants 2011;26(4):850-859. Data from 18 patients who requested immediate loading of implants in areas other than the anterior mandible were retrospectively analysed. A total of 58 implants were placed, which were loaded immediately, left exposed or submerged after surgery based on bone density and primary stability. The implant survival rate was 88%; seven implants failed. Mean bone density for the surviving implants was 983 83 for immediately loaded implants, 803 29 for exposed implants and 480 23 for submerged implants, and was significantly different between failed and surviving implants. Primary stability measurements at insertion correlated with bone density and with bone density prior to surgery. Mean insertion torque was also higher for successful implants than failed implants. Stability and bone density measurements may therefore provide a suitable algorithm for decisions on implant loading. Morea C, Hayek JE, Oleskovicz C, Dominguez GC, Chilvarquer I. Precise insertion of orthodontic miniscrews with a stereolithographic surgical guide based on cone beam computed tomography data: a pilot study. Int J Oral Maxillofac Implants 2011;26(4):860-865. In the dental arches of four patients, acrylic splints were adapted and radiopaque reference points were filled with gutta percha for CBCT imaging (both with the splint alone and in place in the patient). The placement of miniscrews was then planned using software where the implant position could be visualised in three dimensions and all planes. Stereolithographic drilling guides were then fabricated, and CBCT was performed once more to assess the accuracy of miniscrew placement. Mean differences between the planned and actual positions at the coronal end, centre and apical tip were 0.86 mm, 0.71 mm and 0.87 mm, respectively, and the mean angular discrepancy was 1.76. Accurate placement could therefore be obtained using stereolithographic surgical guides. Al-Omiri MK, Hammad OA, Lynch E, Lamey P-J, Clifford TJ. Impacts of implant treatment on daily living. Int J Oral Maxillofac Implants 2011;26(4):877-886. A Dental Impact on Daily Living questionnaire was administered to 80 patients who received dental implants, and personality profiles were assessed using the NEO Five Factor Inventory (NEO-FFI). The questionnaires were completed prior to implant surgery and 3 months after prosthetic rehabilitation. Satisfaction with dentition was greater after implant treatment. Satisfaction and impact on daily living were significantly influenced by neuroticism and conscientiousness before and after treatment, were significantly influenced by openness and agreeableness only after treatment, and were significantly influenced by extraversion only before treatment. Daily living and satisfaction were positively influenced by implant-supported prostheses, and may be influenced by the patients personality traits. Lethaus B, Klber J, Petrin G, Brandsttter A, Weingart D. Early loading of sandblasted and acid-etched titanium implants in the edentulous mandible: a prospective 5-year study. Int J Oral Maxillofac Implants 2011;26(4):887-892. A total of 60 implants were placed in 14 patients and loaded after 6 weeks; peri-implant bone and mucosal conditions were assessed over 5 years. There were two implant failures and four implants lost to follow-up, so 13 patients with 54 implants were evaluated after 5 years. The 5-year cumulative success rate was 96.7% and the mean crestal bone loss was 0.77 mm. Early loading of implants after 6 weeks was therefore highly predictable. ______________________________________________________________________________________

International Journal of Periodontics and Restorative Dentistry

Vol. 31 No. 4 (July/August 2011)
Ludovichetti M, Di Stefano DA, Pagnutti S, Vaccari E, Ludovichetti FS, Celletti R. Vertical ridge augmentation using a flexible heterologous cortical bone sheet: three-year follow-up. Int J Periodontics Restorative Dent 2011;31(4):401-407. A total of 18 patients received 49 implants in atrophic maxillary or mandibular ridges and simultaneous augmentation with flexible cortical bone sheets. The ridge volume was restored in all patients after 4 months, and all implants were osseointegrated. After 3 years of follow-up, the situation remained unchanged. El-Chaar ES. Immediate placement and provisionalization of implant-supported, single-tooth restorations: a retrospective study. Int J Periodontics Restorative Dent 2011;31(4):409-419. A total of 206 implants placed in fresh extraction sockets (with immediate provisionalization and definitive restoration after 2 weeks) were retrospectively evaluated. After a mean follow-up time of 23.1 months, the cumulative survival rate was 98.77%. The outcomes did not appear to be adversely affected by periodontitis and were similar to those achieved for delayed implants. ______________________________________________________________________________________

Journal of Clinical Periodontology

Vol. 38 No. 9 (September 2011) Vol. 38 No. 10 (October 2011)
Pommer B, Frantal S, Willer J, Posch M, Watzek G, Tepper G. Impact of dental implant length on early failure rates: a meta-analysis of observational studies. J Clin Periodontol 2011;38(9):856-863. From an electronic and hand search for observational trials on the impact of implant length, 54 studies with a total of 19,083 implants were selected. For mandibular implants, implant length appeared to have no effect on implant failure; however, length had a significant effect for short machined implants in the anterior and posterior maxilla, and a significant effect for short rough-surfaced implants in the anterior maxilla. No influence was observed for diameter or denture type. Charalampakis G, Rabe P, Leonhardt , Dahln G. A follow-up study of peri-implantitis cases after treatment. J Clin Periodontol 2011;38(9):864-871. From a total of 281 cases of peri-implantitis, 245 were followed up after treatment from between 9 months to 13 years. Peri-implantitis progression was not stopped in 54.7% of the patients, and failure of peri-implantitis treatment was significantly correlated with smoking and early development of the disease. Bone plasty and antibiotics were significantly associated with arrested peri-implantitis lesions. A regression analysis showed development of the disease to be the only independent significant predictor of treatment success. Sahm N, Becker J, Santel T, Schwarz F. Non-surgical treatment of peri-implantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine: a prospective, randomized, controlled clinical study. J Clin Periodontol 2011;38(9):872-878. Oral hygiene and either amino acid glycine powder (AAD) or mechanical debridement and chlorhexidine (MDA) were administered to 30 patients with at least one implant with initial to moderate peri-implantitis. Clinical parameters were assessed at baseline and after 3 and 6 months. The change in mean bleeding on probing was significantly higher in the AAD group, while probing depth reduction and clinical attachment level gain were comparable in both groups. Cortellini P, Stalpers G, Mollo A, Tonetti MS. Periodontal regeneration versus extraction and prosthetic replacement of teeth severely compromised by attachment loss to the apex: 5-year results of an ongoing randomized clinical trial. J Clin Periodontol 2011;38(10):915-924. In 50 patients with at least one hopeless tooth scheduled for extraction, 25 teeth were extracted and replaced with fixed partial dentures (conventional or implant-supported) as the control group, and 25 were treated via a regenerative strategy. All but one tooth was replaced in the control group; all FPDs survived up to 5 years and 83% were free from biological complications. Clinical improvements were noted in 23 of 25 teeth in the test group; the remaining two were extracted after 1 year. The successfully regenerated teeth remained healthy and functional up to 5 years and 84% remained free from biological complications. Comfort and function were reported by patients in both groups and most regenerated teeth showed a reduction in tooth mobility. Regenerative therapy can therefore change the prognosis of hopeless teeth.

Dvorak G, Arnhart C, Heuberer S, Huber CD, Watzek G, Gruber R. Peri-implantitis and late implant failures in postmenopausal women: a cross-sectional study. J Clin Periodontol 2011;38(10):950-955. Data were collected from 302 women with a total of 967 implants to assess the relationship between selfreported osteoporosis and implant success rate. Occurrence of peri-implantitis and late implant failures were the primary outcome parameters. The subjects were classified into three groups: osteoporosis (47 subjects), osteopenia (16 subjects) and healthy controls (140 subjects). No association was found between periimplantitis or implant failure and systemic bone loss. Stavropoulos A, Becker J, Capsius B, Ail Y, Wagner W, Terheyden H. Histological evaluation of maxillary sinus floor augmentation with recombinant human growth and differentiation factor-5-coated -tricalcium phosphate: results of a multicentre randomized clinical trial. J Clin Periodontol 2011;38(10):966-974. Maxillary sinus floor augmentation was performed in 31 patients using rhGDF-5/-TCP with a 3- or 4-month healing period, or with -TCP/corticocancellous autologous bone and a 4-month healing period. A total of 66 implants were placed in 30 patients; one patient withdrew from the study prior to implant placement. Similar proportions of newly formed bone were found between the groups (31.4 17%, 28 15.5% and 31.8 17.9% for rhGDF-5/-TCP/3 months, rhGDF-5/-TCP/4 months and -TCP/autologous bone, respectively), but more -TCP was found in the -TCP/autologous bone group (16.5 12.3% compared to 12.6 14.4% and 6.6 6.3% in the rhGDF-5/-TCP/3 month and rhGDF-5/-TCP/4 month groups, respectively). The amount and quality of new bone with rhGDF-5/-TCP was similar to that with -TCP/autologous bone. ______________________________________________________________________________________

Journal of Oral Implantology

Vol. 37 No. 4 (August 2011)
enimen M, Glses A, zen J, Dergin C, Oku KM, Ayyldz S, Altu HA. Early detection of alterations in the resonance frequency assessment of oral implant stability on various bone types: a clinical study. J Oral Implantol 2011;37(4):411-419. In 19 patients, the recipient site for dental implants was evaluated for bone density and subdivided from D1 to D5. Implant stability (ISQ) was measured by resonance frequency analysis for 106 implants at placement and after 21 and 60 days. Mean ISQ decreased from baseline to 21 days and increased back to baseline levels at 60 days. No significant relationship between stability changes and bone type were observed, suggesting that bone quality does not influence implant stability in the early stages of osseointegration. Babbush CA, Kutsko GT, Brokloff J. The All-on-Four immediate function treatment concept with NobelActive implants: a retrospective study. J Oral Implantol 2011;37(4):431-445. A total of 708 implants with an immediately loaded fixed prosthesis (each supported by four implants) in 165 patients were retrospectively reviewed. For a follow-up time of up to 29 months, the cumulative survival rate was 99.6% (99.3% and 100% in the maxilla and mandible, respectively). The survival rate for definitive prostheses was 100%. Danza M, Grecchi F, Zollino I, Casadio C, Carinci F. Spiral implants bearing full-arch rehabilitation: analysis of clinical outcome. J Oral Implantol 2011;37(4):447-455. A total of 206 spiral implants placed in 23 patients for full arch rehabilitation were retrospectively evaluated. The mean follow-up time was 23 months and the survival and success rates were 97.1% and 82.5%, respectively. Of all the implant parameters measured, only implant length and implant/crown ratio significantly determined a better clinical outcome. Spiral implants may therefore be reliable for most difficult cases of oral rehabilitation. ______________________________________________________________________________________

Journal of Periodontology
Vol. 82 No. 8 (August 2011) Vol. 82 No. 9 (September 2011)
Del Fabbro M, Bortolin M, Taschieri S, Weinstein R. Is platelet concentrate advantageous for the surgical treatment of periodontal diseases? A systematic review and meta-analysis. J Periodontol 2011;82(8):11001111. Koh RU, Oh T-J, Rudek I, Neiva GF, Misch CE, Rothman ED, Wang H-L. Hard and soft tissue changes after crestal and subcrestal immediate implant placement. J Periodontol 2011;82(8):1112-1120. Implants were placed in 24 patients either at the palatal crest of 1 mm subcrestally. Clinical parameters were recorded at baseline and 4 months after surgery, and soft tissue parameters were recorded after crown placement and 6 and 12 months after surgery. Twenty of the 24 patients completed the study and the 4month implant success rate was 95.8%. Significantly greater gain in mucosal thickness was observed in the subcrestal group compared to the crestal group, but no significant differences between the groups were found for the other clinical parameters. Facial marginal bone loss was strongly correlated with facial plate thickness 1.5 mm and horizontal defect depth 2 mm, while horizontal dimensional changes were strongly correlated with facial plate thickness 2 mm and horizontal defect depth 3 mm. Persson GR, Roos-Jansker A-M, Lindahl C, Renvert S. Microbiologic results after non-surgical erbiumdoped:yttrium, aluminum, and garnet laser or air-abrasive treatment of peri-implantitis: a randomized clinical trial. J Periodontol 2011;82(9):1267-1278. Peri-implantitis in 42 patients was treated by Er:YAG laser or an air-abrasive device. Intraoral radiography were taken at baseline and after 6 months and bacterial species from the sites were assessed. Reductions in probing depth were no significantly different between the groups, and there were no differences in baseline bacterial counts. After 1 months, bacterial counts for P aeruginosa, S aureus and S anaerobius were significantly reduced in the air-abrasive groups and counts for F nucleatum naviforme and F nucleatum nucleatum were significantly reduced in the Er:YAG laser group. No significant reduction in bacterial counts were observed in either group at 6 months. P gingivalis counts were significantly higher in progressive periimplantitis. ______________________________________________________________________________________

Quintessence International
Vol. 42 No. 9 (October 2011) Vol. 42 No. 10 (November/December 2011)
Geckili O, Bilhan H, Mumcu E. Clinical and radiographic evaluation of three-implant-retained mandibular overdentures. A 3-year retrospective study. Quintessence Int 2011;42(9):721-728. Mandibular overdentures retained on three implants with ball or bar attachments in 29 patients were assessed after 3 years of loading. A visual analog scale and OHIP-14 profile were used to assess the dentures, patient satisfaction and quality of life. Marginal bone loss around implants and maximum occlusal force were also measured. The implant success rate was 100%, and marginal bone loss was significantly greater at implants on the left and right sides compared to the centre implant. Maximum occlusal force was significantly greater with implant support than without. No association was found between attachment type and marginal bone level, maximum occlusal force, patient satisfaction or quality of life, indicating that threeimplant-retained mandibular overdentures opposing complete dentures may be a suitable treatment option. ______________________________________________________________________________________