Prosthetic Survival Rate Research Articles

Long-Term Outcomes of Reverse Total Shoulder Arthroplasty: A Follow-up of a Previous Study.

Despite the increasing numbers of reverse total shoulder arthroplasty (RTSA) procedures, the long-term results have been rarely reported. We previously reported early outcomes of a cohort of patients treated with a Grammont-style RTSA. The purpose of this study was to evaluate the outcomes after a minimum of 10 years, and to document prosthetic survival and complications. Clinical outcome assessment was based on the absolute and relative Constant scores and the active range of motion. Radiographic evaluations of scapular notching, tuberosity osteolysis, and periprosthetic radiolucent lines were done as well. Complications and revisions were compiled, and a Kaplan-Meier survival analysis was performed. The original report included the outcomes for 186 patients (191 RTSAs) who had been followed for a mean of 40 months. In the present study, in which the mean duration of follow-up was 150 months, follow-up clinical evaluations were available for 84 patients (87 prostheses) and radiographic assessments were available for 64 patients (67 prostheses). Seventy-seven patients (79 prostheses) had died before the 10-year follow-up, and 17 patients (17 prostheses) had been lost to follow-up. The mean absolute and relative Constant scores (and standard deviations) were 55 ± 16 points and 86 ± 26 points, respectively, with both having decreased significantly compared with the scores at the medium-term follow-up evaluation (at a minimum of 2 years) (p < 0.001 and p = 0.025, respectively). Forty-nine shoulders (73%) exhibited scapular notching. Forty-seven complications (29%) were recorded, with 10 cases (10%) occurring after 2 years. Sixteen (12%) of the original patients underwent revision surgery. The 10-year overall prosthetic survival rate using revision as the end point was 93%. Despite a high arthroplasty survival rate and good long-term clinical results, RTSA outcomes showed deterioration when compared with medium-term results. The cause of this decrease is probably related to patient aging coupled with bone erosion and/or deltoid impairment over time. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Impact of prosthetic material on mid- and long-term outcome of dental implants supporting single crowns and fixed partial dentures: A systematic review and meta-analysis.

The impact of prosthetic material selection on implant survival is not clear. The current criteria for choosing a prosthetic material seem to be based on clinician preferences. This systematic review aims to evaluate the impact of restorative materials on the mid- and long-term survival of implants supporting single crowns and fixed partial dentures. Hand and MEDLINE searches were performed to identify relevant literature for single crowns (SC) and fixed partial dentures (FPD). Further inclusion criteria were a mean follow-up period of at least 3 years, the inclusion of at least 10 patients in a relevant study cohort, and a clear description of prosthesis type and prosthetic material. A total of 63 studies for the SC group and 11 studies for the FPD group were included. Full arch restorations were not included. The materials utilised in the SC group were metal-ceramic (precious and non-precious), lithium-disilicate, veneered zirconia, veneered alumina, and nanoceramics. The materials used in the FPD group were metal-ceramic (precious), veneered titanium, metal-resin (precious), and veneered zirconia. No significant impact on the prosthetic material relating to mid- or long-term implant survival was identified. Furthermore, there were no statistically significant differences between the survival rates of the dental prostheses made from different materials (SC and FPD group). Single crowns made of nanoceramics showed a higher risk for decementation relative to other materials (0.80, 95% CI [0.67; 0.89]; P < 0.0001), whereas metal-resin FPDs showed a higher risk for chipping (0.36, 95% CI [0.23; 0.52]; P = 0.0072). The current evidence suggests that prosthetic material selection has no influence on mid- and long-term survival of implants restored with single crowns and fixed partial dentures. Similarly, the prosthetic material seems to have no significant impact on prosthetic survival rates. Further research is required to provide more evidence regarding the impact of the prosthetic material on long-term outcome. Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Retrospective Analysis of Biological and Technical Complications Using Individual CAD/CAM Abutments

Purpose: The aim of the present study was to assess the biological and technical complication and survival rates of implants and prosthetic superstructures using custom-milled CAD/CAM abutments made of titanium or zirconia. Material and Methods: A total of 109 patients were treated with 225 AstraTech OsseoSpeed implants (Dentsply IH) between July 2008 and November 2012 in the same private dental practice. Following submerged healing, the implants were uncovered and restored with Atlantis custom CAD/CAM abutments made of zirconia or titanium. Single crowns, fixed bridges, or telescope crowns as attachments for removable prostheses were connected to the abutments with zinc oxide phosphate cement. Patients were clinically and radiologically followed at the abutment level for a mean 20.85 months. The clinical assessment included biological and technical complications a well as the survival of the implants, abutments, and prosthetic superstructures. Mean crestal bone loss was assessed on standardized radiographs. Patient satisfaction was surveyed with a self-developed questionnaire. Results: The records of 69 patients (49 female, 20 male: mean age: 53.51 years) treated with 124 implants/custom abutments were included in the final analysis. Most abutments were made of titanium (n=90), followed by zirconia (n=34). The survival rates of implants and abutments were 100.00%. Eight restorations (6.50%) had to be replaced during follow-up, for an implant/abutment-related cumulative prosthetic success rate of 93.50%. The patient-related cumulative prosthetic survival rate was 92.75%. A mean bone gain of 0.06 mm (SD: 0.28 mm) on the mesial side and 0.11 mm (SD: 0.37 mm) at the distal side of the implants (n=122) was recorded. Only a few cases of soft-tissue complications such as mucositis, loss of papilla height, or bleeding on probing were observed. Therapy was rated as very good by 92.65% of patients. The esthetic result was assessed as very good as well by the majority of patients (88.41%). Due to the small sample size, no tests for statistical significance could be performed for any of the examination parameters, except for radiological crestal bone loss. No statistical significance was found for crestal bone loss as a function of the abutment material (p ≥ 0.05). Conclusions: Individual CAD/CAM -abutments are a good and predictable treatment option and deliver high patient satisfaction concerning the therapeutic and esthetic results.

Anatomic placement of the acetabulum improves the survival rate in patients with Crowe type-II dysplasia undergoing total hip arthroplasty.

Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult, technical procedure for surgeons to perform because of the potential risks for these patients to have severe abnormalities in their bones and soft tissues (1,2).. The procedure is more demanding and is associated with a higher rate of complication compared to total hip arthroplasty (THA) for the treatment of primary degenerative osteoarthrosis of the hip (3). In general, the accepted practice is that placement of the acetabulum in the anatomic location is more advantageous biomechanically and may lead to higher prosthetic survival rates in these patients (4-6). Some of the most experienced hip surgeons agree that the optimum location for the center of rotation of a THA is the anatomic position. Therefore, recent literatures suggest placing the acetabular component in the anatomic hip-center for different types of DDH. Several techniques have been used to reconstruct the acetabulum during THA in DDH patients, including augmentation with bone grafting with cemented or noncemented acetabular component (7-9) or using high hip centre (10,11) when there is no better choice. Yet, there still remain some controversies as to whether a high hip center, particularly without bone graft, is the best option for patients with severe hip dysplasia.

Modular cementless prosthetic reconstruction after resection of lower extremity malignant tumor

IntroductionThe aim of the study is to report the preliminary clinical and functional outcomes of a modular cementless tumor resection prosthesis system (Megasystem-C®, Waldemar Link GmbH&Co. KG, Hamburg, Germany) in patients undergoing limb salvage surgery with wide resection in a lower extremity primary or metastatic malignant bone tumor. Material and methodsFifty-two consecutive patients (33 male and 19 female; mean age 37.1 years (range, 16 to 79) with primary or metastatic lower extremity malignant bone tumor who underwent wide resection and reconstruction with cementless Megasystem-C® system were included in the study. Patients were analyzed for age at diagnosis, gender, type and localization of the tumor, time of follow-up, patient and prosthesis survival, complications, oncological and functional outcomes. ResultsMean follow-up time was 43.2 months (range, 8 to 66). Cumulative patient survival rate was 92.3 percent and cumulative prosthetic survival rate was 65.4 percent. 18 complications were recorded and 9 of them required revision (17.3 percent). Mean overall Musculoskeletal Tumor Society score score was 72.7 percent (range, 52 to 86). Subgroup analyzes demonstrated no difference in complication rates, overall patient or prosthetic survivals. Functional scores according to age, diagnosis and location of the reconstruction also were not significantly different. ConclusionThe preliminary short-term follow-up results revealed that, the new generation modular cementless endoprosthetic system offers promising clinical and functional outcomes with reasonable complication rates. Level of evidenceLevel IV, Therapeutic study

Limb-salvage treatment of en-block resected distal femoral tumors with endoprosthesis of all-polyethylene tibial component: a 9-year follow-up study.

ObjectiveTo evaluate the medium-term outcome of limb-salvage surgery using all-polyethylene tibial endoprosthetic replacement following en-block resection for distal femoral tumors.MethodsForty-nine patients with distal femoral tumor were treated between June 2006 and June 2012. The follow-up period was 6–110 months (average 53.4 months). The prosthetic survival was analyzed using the Kaplan–Meier method. The classification of failure of limb salvage after reconstructive surgery for bone tumors was adapted. Limb function was evaluated with the scoring system of the Musculoskeletal Tumor Society (MSTS).ResultsComplications were observed in six cases (12.2%). Four suffered infection around the prosthesis, of which two cases were treated with debridement, drainage, and antibiotics without removal of the prosthesis, and the other two cases underwent amputation. Two cases were identified as radiographically loose at 7 year follow-up and did not require revision surgery. One patient underwent amputation due to local recurrence. Failure of limb salvage occurred in nine cases (18.4%), of which two cases were of type 1A, two cases of type 2B, three cases of type 4A, one case of type 4B, and one case of type 5A. The mean MSTS score was 84.3%. Twelve cases died due to distant metastases (24.5%), and the average survival time for these patients was 13.5 months. Thirty-seven patients survived (75.5%), for whom the average follow-up time was 66.3 months and the 5-year prosthetic survival rate was 88.2%.ConclusionThe outcome of medium-term and long-term clinical follow-up was satisfactory. All-polyethylene tibial endoprosthetic replacement following en-block resection can be an alternative method of limb salvage for distal femoral tumors.

Acetabuloplasty at the anatomic centre for treating Crowe class III and IV developmental hip dysplasia: a case series.

Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult technical procedure for surgeons to perform because of the potential for these patients to have severe anomalies in their bones and soft tissues. We performed acetabuloplasty in 54 hips from 44 patients by reaming the posterior wall of the native acetabulum and medialising the acetabular component to restore the anatomic centre of hip rotation using a small cup without bone grafting. Median time to post-surgery follow-up was 5 (range 2-14) years. Prosthetic survival rates in patients after 2 and 5 years post hip replacement were 93% (50/54) and 89% (48/54), respectively. 4 patients required early revision because of malposition and instability of the acetabular cup. 3 patients with Crowe type IV dislocations had transient sciatic nerve palsy and 3 had deep vein thrombosis. Placement of the acetabular shell using posterior bone stock to provide normal hip rotation is a successful alternative technique for acetabuloplasty in patients with DDH.

Four-implant overdenture fully supported by a CAD-CAM titanium bar: A single-cohort prospective 1-year preliminary study

Statement of problemIn patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure. PurposeThe purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar. Material and methodsThis single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index. ResultsEighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque. ConclusionsA 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.

Mandibular Full‐Arch Fixed Prostheses Supported on 4 Implants with Either Axial Or Tilted Distal Implants: A 3‐Year Prospective Study

This prospective study evaluated the clinical and radiographic outcome of distally cantilevered 4-implant-supported fixed mandibular prostheses (4-ISFMP) with distal implants either in axial or distally tilted direction. Forty-one mandibulary edentulous patients received acrylic veneered 4-ISFMP with casted framework. Based on distal implant placement direction patients were assigned to 2 groups: 21 patients with four (2 anterior/2 posterior) axial implants (axial-group I) and 20 patients with 2 anterior axial/2 distal tilted implants (tilted-group II). Patients were prospectively followed for 3 years by annual examinations of implants and prosthetic survival rates including assessment for biological and mechanical complications. Additionally, peri-implant marginal bone resorption [MBR], pocket depth [PD], plaque index [PI], bleeding index [BI] and gingival index [GI], and calculus index [CI] were evaluated at each annual follow-up. 37/41 patients (19 axial-group I, 18 tilted-group II) and 148/164 implants were followed at the 1-, 2-, and 3-year evaluation (dropout rate: 11.8%) presenting no implant and denture loss (100% survival). The overall, MBR at year 1, 2, and 3 was 1.11 ± 0.4 mm, 1.26 ± 0.42 mm, and 1.40 ± 0.41 mm, respectively, representing a significant (p < .001) continuing time depending annual reduction. MBR and PD did not differ between anterior and posterior regions in both groups or for anterior and posterior regions between the groups. PI and CI were significantly (p < .001) higher for implants in anterior regions than for posterior regions in both groups. Moreover, posterior implant regions showed significantly (p < .001) higher PI and CI for axial-group I than for tilted-group II over time. Biological and mechanical complications as well as GI and BI did not differ between the groups over a 3-year follow-up period. For clinical implant and prosthesis outcome no statistical significant mean differences were noted for distally cantilevered 4-ISFMP supported by distal implants placed in tilted or axial direction.

Computer-aided flapless implant surgery and immediate loading. A technical note

The aim of the present technical note was to describe a prosthetic technique developed to increase the predictability of immediately loaded implants supporting a fixed prosthesis after computer-aided template-guided flapless implant placement. During a 2-year period, eight patients presenting partial edentulism underwent computer-aided template-guided implant placement. The presented technique was used during the prosthetic procedures to directly transfer the data obtained with the facebow to the surgical environment, allowing for accurate repositioning of the temporary prosthesis on the implants as previously planned with the digital software. A total of 78 dental implants were immediately loaded with an implant-supported fixed prosthesis after flapless template-guided implant placement. A survival and success rate of 100% was reported after a mean follow-up of 1year from the prosthetic loading. Neither major complications nor dropouts were observed during the healing time. From both clinical and radiological evaluations, implants appeared stable with no signs of soft tissue inflammation or infection and no evidence of pathological peri-implant bone resorption. The proposed technique associated with computer-aided implant placement and immediate loading protocol provided a high implant and prosthetic survival and success rate. No complications were reported during the recalls, suggesting predictability and reliability of the present technique over a short-term period.

Immediate Loading of Conical Connection Implants: Up-to-2-Year Retrospective Clinical and Radiologic Study.

To report the up-to-2-year outcomes of the immediately loaded novel variable-thread tapered implant with an internal conical connection and built-in platform shifting. Sixty-four partially and completely edentulous patients were referred to two private centers for implant treatments between December 2010 and June 2012. Clinical and radiographic parameters were assessed retrospectively; the outcomes were implant and prosthetic failure, marginal bone remodeling, and complications. One hundred forty-eight NobelReplace Conical Connection implants were placed in both postextraction sockets (n = 67) and healed sites (n = 81). One maxillary postextractive implant failed before the definitive prosthesis delivery, accounting for a cumulative success rate of 99.3%. No definitive prostheses failed. A mean marginal bone loss (MBL) of 0.42 ± 1.16 mm and 0.71 ± 1.53 mm was observed between implant placement and the 1-year (n = 147) and 2-year (n = 74) follow-up periods, respectively. In the postextraction sites, the mean MBL was 0.28 ± 0.39 mm and 0.69 ± 0.75 mm at the 1-year (n = 66) and 2-year (n = 50) follow-up periods; in the healed sites, the mean MBL was 0.51 ± 0.88 mm (n = 81) and 0.62 ± 0.80 mm (n = 24), respectively. At the 2-year follow-up session (n = 74), bleeding on probing was 8.3%, and the plaque score was 15.7%. No technical complications were observed. One biologic complication (0.8%) was reported. Within the limitations of this study and the relatively short follow-up, the immediately loaded NobelReplace Conical Connection implants demonstrated good treatment outcomes with regard to implant and prosthetic survival rate, MBL, and soft tissue conditions, in both postextraction and healed sites.

An up to 7-Year Retrospective Analysis of Biologic and Technical Complication With the All-on-4 Concept.

The aim of this study was to evaluate retrospectively biologic and technical complications as well as clinical and radiographic outcomes of patients treated with 4 implants according to the All-on-4 protocol and followed up to 7 years of function. Data from 56 consecutive patients presenting complete edentulous jaw, aged 18 years or older, treated between January 2008 and December 2013, were evaluated. The outcomes were implant and prosthetic survival and success rates, any complications, and marginal bone loss (MBL). Two-hundred twenty-four implants were placed in 56 patients. During the entire follow-up, 1 maxillary implant but no prosthesis failed during the healing process. Fourteen patients experienced 1 complication each (10 technical, 4 biologic). The overall implant and prosthetic success rate was 98.2% and 82.1%, respectively. All complications were considered as minor and successfully resolved chairside. A mean MBL of 1.30 ± 0.63 mm was observed at the last follow-up. Statistically significant difference was found for postextractive implants (0.79 ± 0.26) vs implants placed in healed sites (1.03 ± 0.46; P = 0.024). Within the limits of the present study, the All-on-4 concept may be a valuable surgical and prosthetic option for the treatment of complete edentulous jaws. However, minor technical and biologic complications can occur. Further long-term prospective data with primary outcomes focused on success rates are needed.

A Retrospective 2-Year Clinical Study of Immediate Prosthetic Rehabilitation of Edentulous Jaws with Four Implants and Prefabricated Bars.

The purpose of this retrospective investigation was to evaluate the use of a prefabricated bar system for immediately loaded implants placed and restored according to the All-on-Four concept with up to 24-month follow-up. A total of 51 patients (31 males and 20 females; mean age 63.4 years) presented with edentulous or partially edentulous jaws with severe atrophy of the posterior regions. All patients were treated with full-arch fixed prostheses (28 maxillary, 34 mandibular) each supported by four implants (two vertical, two distally tilted). The implants were immediately loaded with screw-retained full-arch restorations. Each prosthesis was supported by a prefabricated metal bar combined with high-density acrylic resin. Follow-up visits were scheduled at 6, 12, and 24 months after initial prosthetic loading. Intraoral radiographs were obtained immediately after surgery and at each follow-up visit by using a custom radiograph holder and parallel technique. Marginal bone levels were assessed using digital image analysis. Implant and prosthetic survival and success rates were evaluated. Patient satisfaction was further assessed using a 100-mm visual analog scale (VAS). Data were compared by means of the Mantel-Haenszel test. No drop-outs occurred. The overall implant survival rates were 100% and 98.38% for the vertical and tilted implants respectively. Two of the 62 definitive fixed prostheses were lost during the observation period due to implant failure. Since restoration replacement due to implant failure was not judged a prosthodontic failure according to the survival criteria provided in this study, the overall prosthetic survival rate was 100%. No statistically significant differences in marginal bone levels between vertical and tilted implants were detected at 24-month follow-up evaluation in either jaw. All participants were functionally and esthetically satisfied with their definitive restorations after 2 years functioning, as confirmed by the average VAS scores (masticatory function: 99.7; phonetic function: 99.5, esthetics: 99.2). The preliminary 24-month results indicate that immediate loading of vertical and tilted implants using the evaluated prefabricated bar system may be a viable solution for edentulous jaw rehabilitation; however, more long-term prospective clinical trials are needed to affirm the effectiveness of this surgical-prosthetic protocol.

Short implants compared to implants in vertically augmented bone: a systematic review.

To assess relevant data comparing short implants or implants associated with vertical ridge augmentation derived from RCT's and CCT's. A PubMed and hand search was performed to identify all RCT's and CCT's published in English language comparing short implants to implants associated with vertical ridge augmentation. The initial search resulted in 3387 articles. A total of 17 articles were eligible for full-text analysis and four were finally included. This review tends to demonstrate similar implant survival rates between implants placed in vertically augmented bone and short implants (95.09% vs. 96.24%, respectively) with a follow-up ranging from 1 to 5 years. In terms of prosthetic survival rates, there were no differences between the treatments. More surgical complications were reported when using implants placed in vertically augmented bone compared to short implants (56 patients with surgical complications compared to 18 patients, respectively). This evidence should, however, be interpreted with caution as it is derived from four RCT's with limited sample size (ranging from 15 to 30 per group), limited follow-up and performed by the same research group.

Simplified procedure for the immediate loading of a complete fixed prosthesis supported by four implants in the maxillary jaw: a 2-year prospective study.

The aim of this study was to verify the reliability of a system for the fixed retention of complete maxillary prostheses supported by four implants with a follow-up of 2years. Patients were treated between September 2009 and December 2010 with four Straumann Bone Level SLActive implants supporting a complete prosthesis (CPs). The two distal implants were positioned mesially to the maxillary sinus and with a mesio-distal inclination ≤ 30° in order to reduce the distal prosthesis cantilever. An immediate loading surgical protocol was used. The CPs were planned to be fixed to multibase abutments to test their retention for a fixed rehabilitation. Clinical and radiographic parameters as probing pocket depth (PPD), bleeding score (mBI), plaque index (PI), and marginal bone loss (MBL) were assessed at a 1- and 2-year follow-up visits. Moreover, any biological and prosthodontic maintenance events were recorded. Clinical and radiographic parameters changes were analyzed. Twenty-one patients treated with a total of 84 implants completed the 2-year examination period. Four patients were lost to follow up. No technical complication was recorded. Also, no implant, reconstruction, or abutment failures were observed. Therefore, an implant and prosthetic survival rate of 100% were achieved after 2years. The mean periodontal parameter scores after 2years of function were 2.6mm for PPD (SD 0.8mm), 0.3 for mBI (SD 0.5mm), and 1.2 for PI (SD 0.4mm) indexes, respectively. In addition, the mean MBL score measured at the 2-year follow-up visit was -0.34mm (SD of -0.45mm). Furthermore, no peri-implant soft tissue inflammation or peri-implant infection was observed. It has been shown that immediate loading of four implants positioned anteriorly to the maxillary sinus could be a reliable treatment procedure to support fixed complete restorations.

All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level.

Studies are needed to evaluate long-term outcomes of the All-on-4® treatment concept (Nobel Biocare AB) for rehabilitation of edentulous mandibles by assessing marginal bone levels and risk indicators for implant failure. To evaluate 7-year clinical outcomes and 5-year radiographic outcomes of the All-on-4 treatment concept. This retrospective case series included patients admitted for implant rehabilitations in the mandible, who were followed for 7 years clinically and 5 years radiographically. Primary outcome measures were cumulative prosthetic and implant survival using patient as the unit of analysis (Kaplan-Meier product limit estimator). Secondary outcome measure was marginal bone level (MBL) at 5 years. Variables associated with implant failure were analyzed using the Cox proportional hazards regression model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Binary logistic regression was used to compute odds ratio (OR) with 95% CIs for variables associated with MBL ≥2.8 mm at 5 years. A total of 324 patients (194 women, 130 men, average age = 58.9 years) were rehabilitated with 1,296 implants supporting 324 full-arch fixed immediately loaded mandibular prostheses. Sixty-four patients (19.8%) were lost to follow-up. Prosthetic survival was 323/324 (99.7%), and 14 patients lost 18 implants, with an estimated cumulative survival rate of 95.4% at 7 years. Variables associated with implant failure were smoking (HR = 5.28; 95% CI: 1.33, 20.91]) and the learning curve effect (0.69 < HR < 0.33 for more experienced levels). Mean MBL at 5 years was 1.81 mm (95% CI: 1.70, 1.92), and smoking was associated with MBL ≥2.8 mm (OR = 2.4; 95% CI: 1.02, 5.62). The high implant and prosthetic survival rates and excellent MBL outcome confirm the predictability and safety of the All-on-4 treatment concept over a longer term than previously reported.

Prosthetic Survival and Complication Rate of Single Implant Treatment in the Periodontally Healthy Patient after 16 to 22 Years of Follow-Up.

Single implants were introduced in the 1980s, but long-term follow-up is scarce. The study aims to retrospectively investigate the prosthetic survival and complication rates of single implants in periodontally healthy patients after 16-22 years, and to evaluate the influence of different prosthetic procedures. Patients with a single implant were recalled for clinical examination. Prosthetic procedures included single-tooth (ST) and CeraOne (CO) abutments supporting a porcelain-fused-to-metal (PFM), all-ceramic (CER), or gold-acrylic (ACR) crown. Prosthetic survival, success, and occurrence of biological, technical, and aesthetic complications were obtained. Procedures were compared by log-rank tests. Fifty patients attended the examination. All implants were functional; however, 15% of abutments and 27% of crowns had been renewed. Replacements (1/4) were related to technical issues whereas the main cause was aesthetics. The abutment cumulative survival rate (CSR) differed significantly between ST-PFM (74%), ST-ACR (0%), and CO reconstructions (97%). The crown CSR was significantly lower for ST-ACR crowns (0%) compared with ST-PFM (68%) and CO (81%). Thirty-nine percent of implants remained complication free throughout the mean 18.5 years. Complications (1/3) required component replacement, and 53% occurred within 5 years after surgery. Prosthetic survival rates of single implants are encouraging after 16 to 22 years. However, 66% of the patients encountered at least one complication during follow-up.

Technical and biological complications of single‐molar implant restorations

Retrospective evaluation of the biological and technical complications in implant-supported single-tooth molar restorations performed in a private practice after functional periods of ≥4years. Sixty-five patients (34 females, age 51.7±10.6years) with 112 implants received annual follow-up examinations and participated in a maintenance program. The survival (in situ) and success (complication-free) rates of implants and superstructures were evaluated. Time-dependent peri-implantitis rates were calculated, and the influencing factors were identified using a multiple Cox regression. The implant survival rate was 100%. Three of 112 crowns required replacement (prosthetic survival rate=98.1%). Thirty technical complications were observed: loss of retention (16), ceramic fracture (10), and screw loosening (4). The success rate of the superstructures was 79.0% after 7years. Overall, 9.2% of the patients developed peri-implantitis (probing depth ≥5mm, BOP, suppuration, bone loss ≥3.5mm); (smokers: 41.6%, non-smokers: 1.8%). After 7years, the time-dependent implant success rate (free of peri-implantitis) was 100% for non-smokers and 58.6% for smokers. Multiple analysis showed a significant effect of smoking (hazard ratio, 19.5; P=0.008) on peri-implantitis. Implants with cemented single-tooth restorations in the molar region constitute a reliable treatment in private practice. Smokers have a significantly increased peri-implantitis rate.

Total knee arthroplasty for severe valgus knee deformity

Background Primary total knee arthroplasty (TKA) in severe valgus knees may prove challenging, and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release. The purpose of this study was to review 8 to 11 years (mean, 10 years) follow-up results of primary TKA for varient-III valgus knee deformity with use of different type implants. Methods Between January 2002 and January 2005, 20 women and 12 men, aged 47 to 63 (mean, 57.19±6.08) years old, with varient-III valgus knees underwent primary TKA. Of the 32 patients, 37 knees had varient-III deformities. Pie crusting was carefully performed with small, multiple inside-out incisions, bone resection balanced the knee in lieu of soft tissue releases that were not used in the series. Cruciate-retaining knees (Gemini MKII, Link Company, Germany) were used in 13 knees, Genesis II (Simth &amp; Nephew Company, USA) in 14 knees, and hinged knee (Endo-Model Company, Germany) in 10 knees. In five patients with bilateral variant-III TKAs, three patients underwent 1-stage bilateral procedures, and two underwent 2-stage procedures. All implants were cemented and the patella was not resurfaced. The Hospital for Special Surgery (HSS) knee score was assessed. Patients were followed up from 8 to 11 years. Results The mean HSS knee score were improved from 50.33±11.60 to 90.06±3.07 (P &lt;0.001). The mean tibiofemoral alignment were improved from valgus 32.72°±9.68° pre-operation to 4.89°±0.90° post-operation (P &lt;0.001). The mean range of motion were improved from 93.72°±23.69° pre-operation to 116.61±16.29° post-operation (P &lt;0.001). No patients underwent revision. One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years. Three patients developed transient peroneal nerve palsies, which resolved within nine months. Two patients developed symptomatic deep vein thrombosis that was managed with rivaroxaban and thrombo-embolic deterrent stockings. There was no incidence of pulmonary embolism. Postoperative patient satisfaction was 80.7±10.4 points in the groups. Prosthetic survival rate was 100% at mean 10 years postoperative. Conclusions Not only hinged implants can be successfully used in variant-III valgus knees. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components. Our results also present alternative implant choices for severe knee deformities.

Clinical and Radiologic Experience with Moderately Rough Oxidized Titanium Implants: Up to 10 Years of Retrospective Follow-up

The long-term success of machined-surface implants is well documented, whereas the reliability of the moderately rough oxidized implant surface has not been definitively assessed in the long term. The aim of this retrospective study was to assess the long-term clinical and radiologic outcomes of moderately rough oxidized implants supporting fixed prostheses. Seventy-three consecutive patients needing an implant-supported restoration received 1 to 11 implants each (n=167). All implants (82 cylindric and 85 tapered-body implants) had a self-tapping design and a moderately rough oxidized surface and were immediately loaded (n=48) or loaded after a delay (n=113). Patients were followed for up to 10 years. Outcomes were implant and prosthetic survival rates, peri-implant bone level changes, bleeding on probing, and plaque and gingival indices. One patient (one implant) dropped out. Seventy-two patients (166 implants) were followed for at least 8 years (mean, 8.82 years; range, 8.0 to 10.4 years. No implants or prostheses were lost, resulting in a cumulative implant and prosthetic survival rate of 100% after up to 10 years in function. At the final follow-up, the accumulated mean marginal bone loss values were -1.72±1.53 mm (n=27) and -1.27±1.67 mm (n=44) for cylindric and tapered implants, respectively, with no statistically significant difference. Bleeding on probing was 12.1%. The cumulative plaque score was 19.7%; 83.8% of patients showed normal gingiva, 10.1% displayed mild inflammation, and 6.1% showed moderate inflammation. This retrospective study of 73 patients treated with either cylindric or tapered-body moderately rough oxidized implants and followed for up to 10 years demonstrated good treatment outcomes with regard to implant survival, marginal bone changes, and soft tissue conditions.