Peri-implant Marginal Bone Loss Research Articles

The effect of using Different designs on distal implant for treatment of mandibular Kennedy class II cases

The Purpose of the current study was to evaluate radiographically the effect of using OT CAP, OT unilateral and magnet extra-coronal attachments placed on second premolars with different RPD designs on the distal implant placed in mandibular unmodified kennedy class II cases. Materials and methods: Twenty-one patients having unmodified mandibular kennedy class II with distal implant installed in the molar region. Group I patients were rehabilitated with an implant assisted removable bilateral partial denture retained by ball and socket extra-coronal attachment (OT CAP attachment Rhien 83, Italy). Group II were rehabilitated with an implant assisted removable bilateral partial denture retained by magnet attachment (Dyna system magnet). Group III Patients were rehabilitated with unilateral (side plate) removable partial denture retained by another design of extra-coronal attachment (OT unilateral Rhien 83, Italy). Peri-implant marginal bone loss was evaluated around the distal implant in each group using standardized periapical intra-oral radiographs using a long cone paralleling technique. The peri-implant marginal bone loss was measured at the time of loading of the distal implant (0 month), after 6 months and 12 months. Results: There was no statistically significant difference in the mean marginal bone loss (P> 0.05) between the OT unilateral, magnet and OT CAP attachment groups at 0-6 months follow up interval. There was a statistically significant difference in the mean marginal bone loss around the distal implant between the three groups in the (6-12 months) and (0-12 months) follow up intervals. The highest peri-implant marginal bone loss was recorded in group III with the unilateral partial denture design. Conclusion: Within the limitation of this study it could be concluded that although enrolling extracoronal attachments in the design of Kennedy class II is acceptable as a treatment modality, the unilateral design may cause the highest bone resorption around the distal implant.

Clinical and Radiographic Evaluation of Reconstruction and Prosthetic Rehabilitation of mandibular resection defects using iliac grafts combined with implant placement

The aim of the current study was to evaluate efficacy of using iliac grafts combined with implants and retaining a provisional fixed-detachable (hybrid) prosthesis in the reconstruction of mandibular defects regarding average bone loss in graft height, peri-implant marginal bone loss, maximum bite force, facial asymmetry ,patient satisfaction and oral health quality of life (OHRQoL).Patients and methods: 11 patients were subjected to mandibular marginal resection with immediate reconstruction by autogenous iliac crest graft with implant placement. After 6 months they were rehabilitated with provisional screw-retained prosthesis. Radiographic assessment of average bone loss in graft height and marginal bone loss around dental implants was performed. Facial asymmetry, Maximum bite force, Patient satisfaction and oral health quality of life (OHRQoL) were assessed after the first surgery, at loading, 6 and 12 months later.Results: Average bone loss of graft height (mean 2.14±1.03). Average peri-implant Marginal bone loss after 1 year 1.42±0.38. The increase in marginal bone loss along the study period was significant (P<0.001). Maximum bite force of the rehabilitated side increased significantly along the study period. There was a statistically high significant difference between the scores of all OHIP-5 items scores except in the scores of the difficulty doing usual jobs item.Conclusion: Within the limitations of this study, it was concluded that construction of mandibular defect using iliac crest graft combined with dental implants and retaining a provisional fixed- detachable prothesis can be an effective procedure to restore bony defect, facial asymmetry, maximum bite force, patient satisfaction and oral health quality of life.

Influence of Abutment Shape on Peri-implant Marginal Bone Loss

Influence of Abutment Shape on Peri-implant Marginal Bone Loss

Oral hygiene maintenance of locator attachments implant overdentures in edentulous population: A longitudinal study

To investigate the oral hygiene status of edentulous patients with locator attachments implant overdentures (IOD) and to analyze the relationship among daily hygiene behavior, oral hygiene status and peri-implant diseases. Edentulous patients who received IOD treatment with locator attachments from January 2012 to May 2016 were recruited. Clinical and radiographic examinations were conducted to assess the peri-implant tissue status. Modified plaque index (mPLI), sulcus bleeding index (SBI), gingival index (GI), and probing depth (PD) were recorded and peri-implant marginal bone loss (MBL) was measured using paralleling projection technique. Patients' peri-implant oral hygiene maintainence habits were investigated. The correlation between peri-implant diseases and oral hygiene status and behaviors was analyzed. Fifty patients (125 implants) with an average follow-up time of 22 months (6-54 months) were enrolled. The mean values of mPLI, SBI, and GI were 1.4±1.2, 0.8±0.7, and 0.7± 0.6, respectively. Average PD was (2.2±0.7) mm. Mesial and distal maginal bone resorptions were (1.1±1.1) mm and (0.9±0.9) mm, respectively. The prevalance of mucositis and peri-implantitis of the implants were 49.6% and 0. The prevelance of mucositis in the patients with poor oral hygiene (mPLI≥2) was 11.9 times as much as that of those with adequate oral hygiene (mPLI<1). The patients who performed oral hygiene procedure on attachments at least twice a day achieved much lower mPLI scores than those who cleaned less than twice a day. Oral hygiene condition in the group of patients with implant overdentures was poor, and it contributed to increased risk of peri-implant mucositis. The prevelance of musositis of the paitients with poor oral hygiene was 11.9 times as much as that of those with proper oral hygiene. Patients wearing IOD should pay more attention to the hygiene of the attachments.

The effects of diabetes mellitus on peri-implant marginal bone loss in the posterior maxilla

Aim: The aim of this retrospective study was to evaluate the effects of Diabetes Mellitus on peri-implant marginal alveolar bone loss in sinus lifted well-controlled diabetic patients at long term.Materials and Methods: Thirty eight patients with 77 dental implants were included the study. The study consists of 2 groups; control group (C) and diabetes mellitus group (DM). The dental implants were placed after open window maxillary sinus lifting surgery at maxillary posterior region. After conventional loading process patients were followed periodically for bone loss and clinical parameters. The peri-implant marginal bone loss was assessed at minimum 3 years after functional loading. Standardized panoramic radiographs were obtained at the baseline and maintenance which were used for evaluating the marginal bone loss and clinical and anatomical crown to implant ratio. The Student-t test and Mann Whitney-U test were used to analyse any significant differences between two groups (p0.05). The Kruskal Wallis test was used for inter-group comparisons of parameters and Chi-square test, Fisher’s Exact Chi-square test and Continuity (Yates) correction were used to compare qualitative data. Spearman’s rho correlation analysis was used to examine the relationships between parameters with non-normal distribution.Results: A total of 77 dental implants were followed up for at least 36 months. The mean follow-up was 43.47±10.30 months. 2 implants were failed in DM group. The mean marginal bone loss in DM and C group were 1.35±1.22 mm and 0.91±1 mm respectively. There was no statistically significance in terms of marginal bone loss between the two groups (p>0.05).Conclusion: Within the limitations of this study, it was shown that long-term follow-up results of dental implants in well-controlled diabetic patients were similar to those of healthy individuals and DM did not increase the peri-implant marginal bone loss.

Relationship Between Primary/Mechanical and Secondary/Biological Implant Stability.

This systematic review was prepared as part of the Academy of Osseointegration (AO) 2018 Summit, held August 8-10 in Oak Brook Hills, Illinois, to assess the relationship between the primary (mechanical) and secondary (biological) implant stability. Electronic and manual searches were conducted by two independent examiners in order to address the following issues. Meta-regression analyses explored the relationship between primary stability, as measured by insertion torque (IT) and implant stability quotient (ISQ), and secondary stability, by means of survival and peri-implant marginal bone loss (MBL). Overall, 37 articles were included for quantitative assessment. Of these, 17 reported on implant stability using only resonance frequncy analysis (RFA), 11 used only IT data, 7 used a combination of RFA and IT, and 2 used only the Periotest. The following findings were reached: ·Relationship between primary and secondary implant stability: Strong positive statistically significant relationship (P < .001). ·Relationship between primary stability by means of ISQ and implant survival: No statistically significant relationship (P = .4). ·Relationship between IT and implant survival: No statistically significant relationship (P = .2). ·Relationship between primary stability by means of ISQ unit and MBL: No statistically significant relationship (P = .9). ·Relationship between IT and MBL: Positive statistically significant relationship (P = .02). ·Accuracy of methods and devices to assess implant stability: Insufficient data to address this issue. Data suggest that primary/mechanical stability leads to more efficient achievement of secondary/biological stability, but the achievement of high primary stability might be detrimental for bone level stability. While current methods/devices for tracking implant stability over time can be clinically useful, a robust connection between existing stability metrics with implant survival remains inconclusive.

Splinting of Mini Implants Used to Assist Complete Mandibular Overdentures with Two Different Bar Designs: A 3-Year Clinical and Radiographic Study

Purpose : Clinical and radiographic evaluation of early loaded four splinted mini dental implants (MDIs) with two different bar designs for assisting mandibular complete overdenture. Materials and Methods: Twenty completely edentulous patients (10 males and 10 females) with mean age of 52.5 years old were selected for this study.All patients received four mini implants in the mandibular interforaminal area. Patients were assigned into two equal groups according to splinting bar design, where it was milled bar for Group I and round bar joint for Group II. Maxillary complete denture was constructed for each patient against implant assisted mandibular overdenture. Periimplant soft tissue health parameters were monitored and cervical bone height changes were evaluated through standardized periapical radiographs just after loading of mini implants and 6, 12, 24 and 36 months later as represented by (T 0), (T6), (T12), (T24), and (T 36) respectively. Results: Insignificant difference of all peri-implant soft tissue health arameters was observed over time within each group and between the two groups at all observational times. Peri-implant marginal bone resorption was significantly higher in group I in comparison to group II at T 6, T12 and T36. Significant difference was found between T0 and T6 in both groups and also between T24 and T36 in group I. Conclusions: Both milled and round bar splints can provide a satisfactory clinical outcome for early loaded mini implants assisting mandibular complete overdenture. However, splinting with milled bars seems to be associated with a higher rate of peri-implant marginal bone loss.

Does Apico-Coronal Implant Position Influence Peri-Implant Marginal Bone Loss? A 36-Month Follow-Up Randomized Clinical Trial

Preserving peri-implant bone and reducing exposure of the rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiologic parameters after crestal and subcrestal dental implant placement at 36months' follow-up. We carried out a randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown. Patients were randomized according to the implant insertion depth: implants placed approximately 2mm below the bone crest (test group) or implants placed at bone crest level (control group). They were evaluated 6, 12, 24, and 36months after prosthetic loading. Peri-implant marginal bone loss was the primary outcome, and the following secondary outcomes were registered: coronal bone changes, plaque index, probing depth, modified bleeding index, retraction and width of the peri-implant mucosa, and peri-implant health condition. Implant survival and success rates after 36months' follow-up were calculated. The study comprised 128 patients (83 men and 45 women; mean age, 54.4±12.2years) and a total of 265 implants (133 in control group and 132 in test group). No statistically significant differences in the peri-implant clinical parameters were found. After 3years' follow-up, 53.4% of the crestal implants and 25.8% of the subcrestal implants presented marginal bone loss, with a mean exposed rough surface of -0.2±0.3mm and -0.09±0.1mm, respectively (P=.001). The overall success rate was 99.6%. Crestal and subcrestal implants showed similar clinical outcomes 3years after prosthetic loading. Significant differences were observed in the radiologic parameters, showing less peri-implant marginal bone loss with subcrestal implants.

Peri-Implant Bone Resorption during Healing Abutment Placement: The Effect of a 0.20% Chlorhexidine Gel vs. Placebo-A Randomized Double Blind Controlled Human Study.

Introduction Peri-implant marginal bone loss (MBL) seems to be more pronounced in the first year of loading despite all the studies and changes implemented to reduce it. Among the different causes, the presence of a microgap makes the interface between fixture and abutment colonizable by bacteria, causing an inflammatory response and consequent bone resorption. To reduce this several local antiseptics like chlorhexidine digluconate (CHX) were used after surgical procedures. Aim The objective was to radiologically compare the MBL when a 0.20% CHX gel or a placebo gel was applied to the implant-abutment interface during all surgical and prosthetic phases and for a follow-up period up to 12 months. Method 32 patients (16 for each Group A and B) were enrolled and rehabilitated with a single implant (Cortex classic, Cortex, Shalomi, Israel). During each of the clinical stages a gel containing 0.20% CHX (Plak ®Gel; Polifarma Wellness Srl, Rome, Italy) or a placebo gel (Placebo, Polifarma Wellness Srl, Rome, Italy) was used as indicated by the randomization chart. In order to compare radiographic modification intraoral radiographs was taken. Also, clinical data regarding implant or prosthetic failure and gingival index were recorded. Data were presented as means and standard deviations (SD) and used for the statistical analysis. Results All implants showed no bleeding on probing and a very small plaque score at the 1 year of follow-up. MBL was statistically significantly different between the groups in every stage. Conclusion Results obtained showed that the use of CHX gel inside the connection significantly reduces MBL during the first year. A rigid disinfection protocol with 0.20% CHX from the time of implant insertion to crown delivery is recommended to reduce host inflammatory response and consequently MBL. This trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT03431766).

Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study

The purpose of the present cohort study was to investigate the 3-year efficacy and clinical performance of implant-supported rehabilitations in posterior mandibles augmented with the sandwich osteotomy technique. Twenty-three partially edentulous patients who developed atrophy of the posterior mandible (residual ridge height, 3 to 7mm) were treated (32 surgical sites) with vertical bone augmentation using interpositional equine cancellous bone blocks and porcine corticocancellous bone particulate. All implants were placed 4months after augmentation and were loaded with fixed dental prostheses. One side per patient was selected and followed for 3years, and the patient was the unit of analysis. Linear radiographic vertical bone gain and peri-implant marginal bone loss were assessed; secondary outcomes-complication rates after surgery, prosthesis and implant failure rates, width of keratinized mucosa, and patient satisfaction-were evaluated. All patients reported postoperative paresthesia that resolved over a period of 2months after the augmentation procedure. The mean vertical bone gain was 5.6mm after 4months. Ninety-one dental implants were positioned into the augmented areas. The global 3-year survival rate was 95.5%. The mean peri-implant marginal bone loss around implants was 1.06±0.37mm 3years after loading, whereas the width of keratinized mucosa had an overall increase of 0.39±0.36mm. The results of the present 3-year study suggested high success rates for implants placed in areas augmented with the osteotomy sandwich technique. This surgical approach could be helpful in the presence of a low residual vertical height in the posterior mandible before implant placement.

The effect of smoking on peri-implant marginal bone loss in periodontally compromised patients

The effect of smoking on peri-implant marginal bone loss in periodontally compromised patients

Performance and outcome of zirconia dental implants in clinical studies: A meta-analysis.

To evaluate implant survival, peri-implant marginal bone loss, technical, and biological complications as well as aesthetic outcomes of zirconia implants in clinical studies. Electronic (Medline, Embase) and hand searches were performed to identify clinical studies published between January 2004 and March 2017 investigating zirconia dental implants with a mean follow-up of at least 12months. Primary outcomes were implant survival and peri-implant marginal bone loss. Secondary outcomes included technical and biological complications as well as aesthetic outcomes. Meta-analyses were performed to estimate implant survival and marginal bone loss. From 943 titles, 264 abstracts were selected. Subsequently, 80 full-text articles were screened, and 18 studies were included for data extraction. One- (14 studies) and 2-piece zirconia implants (4 studies) were investigated. Commercially available (CA) (510 implants, 398 patients) and not commercially available (NCA) zirconia implants (618 implants, 343 patients) were identified. For CA implants (follow-up: 12-61.20months), technical complications (1.6%), implant fractures (0.2%) and biological complications (4.2%) were reported. Meta-analyses estimated 1- and 2-year survival rates of 98.3% (95% CI: 97.0%-99.6%) and 97.2% (95% CI: 94.7%-99.7%), respectively, and a mean 1-year marginal bone loss of 0.7mm (95% CI: 0.4-1.0mm). Since 2004, the survival rates of CA implants significantly improved compared with NCA implants. CA 1-piece zirconia implants showed similar 1- and 2-year mean survival rates and marginal bone loss after 1year compared with published data for titanium implants. However, more clinical long-term data are needed to confirm the presently evaluated promising short-term outcomes.

Clinical and radiographic outcomes of a surgical reconstructive approach in the treatment of peri-implantitis lesions: A 5-year prospective case series.

The aim of this study was to evaluate the 5-year clinical and radiographic outcomes following reconstructive therapy of peri-implantitis lesions using mineralized dehydrated bone allograft and resorbable membrane in the nonsubmerged mode of wound healing. Thirty-four patients with at least one implant diagnosed with peri-implantitis were treated by mechanical debridement; chemical decontamination using hydrogen peroxide (3%), chlorhexidine (0.2%), and a tetracycline hydrochloride solution; and bone defect filling with mineralized dehydrated bone allograft and resorbable membrane. Clinical and radiographic assessments were obtained during 5-year follow-up. The primary outcome was the absence of additional marginal peri-implant bone loss ≥1.0mm after surgery, and the composite outcome included the additional marginal peri-implant bone loss, absence of probing depth (PD) ≥5mm, and absence of bleeding on probing (BoP)/suppuration. According to the primary and composite outcomes, the success rate of 34 implants included in the study was 100% and 91% (N=31), at 1year after surgery, and decreased progressively to 77% (N=26) and to 59% (N=20) at 5-year follow-up, respectively. Five years following treatment, only the BoP reduction was statistically significant compared to baseline (p<0.001), and no difference was found in PD (p=0.318) and in marginal peri-implant bone level (p=0.064). At 1-year follow-up, the surgical reconstructive therapy showed clinical improvement and radiographic defect filling. However, the results appeared to be unpredictable over time, due to a progressive decrease in the bone filling of the peri-implant defects and an increase in the mean PD.

Single tooth implants in the esthetic zone following a two-stage all flapless approach: A retrospective analysis.

Due to chronic inflammation or trauma facial bone is frequently missing after tooth loss in the esthetic zone. As a consequence, procedures to augment or at least to preserve bone are frequently necessary prior to implant placement. The aim of this retrospective case series is to demonstrate the applicability of a staged all-flapless concept to establish satisfactory implant restorations following situations of partial missing facial bone in the esthetic zone. Radiological/clinical data of 25 patients were analyzed and an esthetic evaluation of 24 patients was performed. The staged concept included ridge preservation at time of tooth extraction and delayed guided implant placement. Marginal bone loss was measured radiologically and esthetic evaluation was performed based on standardized photographs using the Pink Esthetic Score as well as the Papilla Index. Implant success rate revealed 100%. The mean radiological peri-implant marginal bone loss measured 1.16 mm (SD: 0.16). Regarding the esthetic outcome 71% of patients were evaluated with a Pink Esthetic Score higher or equal to 10 constituting satisfactory esthetics (median pink esthetic score: 10). The mean follow-up time for clinical and radiographic analysis was 1.3 years (SD: 0.6 years) and 1.2 years (SD: 0.6) for esthetic evaluation. Although marginal bone loss cannot be avoided, the staged concept of flapless ridge preservation and subsequent delayed flapless guided implant placement carries the potential to improve esthetics of single-tooth implants in the anterior maxilla.

Retrospective radiographic observational study of 1692 Straumann tissue-level dental implants over 10 years. II. Marginal bone stability.

Despite accumulating evidence for the longitudinal stability of the marginal bone level around an implant, there is limited evidence of predisposing risk factors for marginal bone loss based on some implants in a relatively large patient population. The aim of this study was to retrospectively determine the marginal bone loss around Straumann tissue-level dental implants during follow-up periods among which the maximum lasts up to 10 years, as well as the predisposing risk factors for peri-implant marginal bone loss. This study analyzed 1692 Straumann tissue-level dental implants in 881 patients, and relevant data were collected. The peri-implant marginal bone level was measured on periodic radiographs, and the changes in bone level were analyzed cumulatively from surgery until up to 10 years later. The log-rank test was used to select candidate critical risk factors for marginal bone loss, and multivariate analysis using Cox regression with the shared frailty model was performed. The overall peri-implant bone loss was 0.07 ± 0.21mm, 0.09 ± 0.26mm, 0.14 ± 0.41mm, and 0.17 ± 0.45mm at 3, 5, 7, and 9 years, respectively. Only 14 implants showed pathologic marginal bone loss exceeding 2mm during the follow-up period. While 2 implants were removed with continuous progressive marginal bone loss, 5 of the 14 implants showed early bone loss exceeding 1mm within the first year but then subsequently tended to show a stable marginal bone level. In the other seven implants, bone loss started after the first year and progressed continuously. Multivariate analysis revealed that diameter of the implant affected the peri-implant marginal bone loss. Straumann tissue-level dental implants showed only slight peri-implant marginal bone loss, with a very low incidence of pathologic marginal bone loss exceeding 2mm.

Implant rehabilitation of the edentulous jaws: Does tilting of posterior implants at an angle greater than 45° affect bone resorption and implant success?: A retrospective study.

This study aimed to (1) investigate the success of posterior implants tilted >45° when 4 immediately loaded implants were used to support full-arch prostheses, eliminating any distal cantilever and (2) examine the effect on marginal bone loss (MBL) of different combinations of anterior multi-unit abutment (MUA) angles and posterior implant tilting angles. Records of patients rehabilitated according to the Columbus Bridge Protocol were analyzed. Peri-implant bone levels (PBLs) and MBL were measured for each implant. The influence of posterior implant tilting angle on PBL, MBL, and implant and prosthetic success rate was investigated. The impact on the same endpoints of different anterior MUA angles, and different combinations of anterior MUA and tilted posterior implant angles was also examined. Records of 41 patients were analyzed, for a total of 46 complete rehabilitations, and 142 implants (52 anterior, 63 posterior tilted ≤45° [group 1], and 27 posterior tilted >45° [group 2]). No implants were lost during the follow-up (25.9 months), and no prosthetic complications were reported. Success rate for posterior implants was 100% in group 1 and 96.3% in group 2. Mean MBL differed significantly between the 2 groups (0.45 mm in group 1, 0.66 in group 2 [P = .04]), but not when the analysis was limited to implants in the same jaw. Implant tilting angle did not correlate with MBL and the MUA angle had no effect on bone resorption around posterior implants, neither in the sample as a whole nor in individual patients. Posterior implants tilted >45° to eliminate distal cantilever may be as safe as those tilted less in severely atrophic jaws rehabilitated with immediately loaded, full-arch prostheses supported on 4 implants. Further prospective studies on larger samples of patients and implants and with longer follow-up are needed to confirm these findings.

"Simpli5y" a noval concept for fixed rehabilitation of completely edentulous maxillary and mandibular edentulous arches: A 3-year randomized clinical trial, supported by a numerical analysis.

To evaluate the clinical outcome of "simpli5y" concept where in 3 and 2 implant placed cross arch in maxilla and in mandible respectively, restored with screw retained prosthesis. Total of 30 patients were randomized, with 15 in group1 with an average of 45 Ncm insertion torque with delayed loading and 15 in group 2 with above 65 Ncm inertion torque with immediate loading with equal number of male and female in each group following parallel design with 3 implants in maxillary and 2 implants in mandibular arch placed which was supported by a 3Dimensional finite analysis comparing the stress dissipation around implants of this concept-"Simplif5y" with All-on-4 concept. Von Mises strain recorded in the bone in the maxillary and mandibular arch models were higher in All-on-four than that in the "simpli5y", which was vice-versa in the framework. Three-year post loading marginal peri implant bone loss for the group 1 was less than group 2. These results, suggest that in both delayed loading and immediate loading protocol that cross arch prostheses can be successfully supported by 3 and 2 implants in maxillary and mandibular arch respectively-"Simpli5y" concept of full mouth restoration.

Digital versus Analog Procedures for the Prosthetic Restoration of Single Implants: A Randomized Controlled Trial with 1 Year of Follow-Up.

Aim To compare the outcome of digital versus analog procedures for the restoration of single implants. Methods Over a two-year period (2014-2016), all patients who had been treated in a dental center with a single implant were randomly assigned to receive either a monolithic zirconia crown, fabricated with digital workflow (test group), or a metal-ceramic crown, fabricated with analog workflow (control group). All patients were followed for 1 year after the delivery of the final crown. The outcomes were success, complications, peri-implant marginal bone loss (PIMBL), patient satisfaction, and time and cost of the treatment. Results 50 patients (22 males, 28 females; mean age 52.6±13.4 years) were randomly assigned to one of the groups (25 per group). Both workflows showed high success (92%) and low complication rate (8%). No significant differences were found in the mean PIMBL between test (0.39±0.29mm) and control (0.54±0.32mm) groups. Patients preferred digital impressions. Taking the impression took half the time in the test group (20±5min) than in the control (50±7min) group. When calculating active working time, workflow in the test group was more time-efficient than in the control group, for provisional (70±15min versus 340±37min) and final crowns (29±9min versus 260±26min). The digital procedure presented lower costs than the analog (€277.3 versus €392.2). Conclusions No significant clinical or radiographic differences were found between digital and analog procedures; however, the digital workflow was preferred by patients; it reduced active treatment time and costs. The present study is registered in the ISRCTN (http://www.isrctn.com/ISRCTN36259164) with number 36259164.

Prosthetic Rehabilitation of the Partially Edentulous Atrophic Posterior Mandible with Short Implants (≤ 8 mm) Compared with the Sandwich Osteotomy and Delayed Placement of Standard Length Implants (> 8 mm): a Systematic Review.

ABSTRACTObjectivesTest the hypothesis of no difference in prosthetic rehabilitation of the partially edentulous atrophic posterior mandible with short implants (≤ 8 mm) compared with the sandwich osteotomy and delayed placement of standard lengths implants (> 8 mm).Material and MethodsA MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search was conducted by including studies published in English. No year of publication restriction was applied.ResultsSix randomized controlled trials characterized by low or moderate risk of bias fulfilled the inclusion criteria. There were no statistically significant differences (P > 0.05) in the survival rate of suprastructures and implants between the two treatment modalities after one year. Sandwich osteotomy and delayed implant placement demonstrated statistically significant higher long-term peri-implant marginal bone loss as well as biological and technical complications compared with short implants (P < 0.0001). Moreover, patients significantly favoured prosthetic rehabilitation with short implants (P < 0.0001).ConclusionsShort implants and the sandwich osteotomy with delayed placement of standard length implants appear to result in predictable outcomes in terms of high survival rate of suprastructures and implants after prosthetic rehabilitation of the partially edentulous atrophic posterior mandible. However, further long-term randomized controlled trials assessing donor site morbidity, an economic perspective, professional and patient-related outcome measures with the two treatment modalities are needed before definite conclusions can be provided about the beneficial use of short implants for prosthetic rehabilitation of the partially edentulous atrophic posterior mandible compared with the sandwich osteotomy and delayed placement of standard length implants.

Current Evidence on Dental Implants Outcomes in Smokers and Nonsmokers: A Systematic Review and Meta-Analysis.

This systematic review aims to answer the following PICO (Participants, Intervention, Comparison, and Outcome) question: "Does smoking increase the rates of implant failure and peri-implant marginal bone loss in patients with dental implants?" An extensive electronic search of the Cochrane Central Register of Controlled Trials, PubMed, Medline, Embase, and Web of Science databases and a subsequent hand search were performed. Only randomized controlled trial, controlled clinical trials, and prospective studies published up to January 2017 were included. For dichotomous outcomes, the effect estimates for smoking are expressed as odds ratios and 95% CIs. For continuous outcomes, weighted mean differences (WMDs) and 95% CIs are presented. Three randomized controlled trials and 7 prospective studies were included. The odds ratio for implant failure among smokers was 2.92 (95% CI, 1.76-4.83) ( P < .001). First-year marginal bone loss in smokers ranged from 0.02 to 0.45 mm. In the nonsmokers, bone loss ranged from -0.08 to 0.42 mm. Nonsmokers lost significantly less bone during the first year (WMD = 0.11 mm, 95% CI. 0.03-0.19) and subsequent years (WMD = 0.11 mm, 95% CI, 0.03-0.19, P = .009). The available scientific evidence suggests that smoking is associated with significantly increased rates of implant failure and marginal bone loss.