SLActive Implants Research Articles

A systematic assessment of the stability of SLA® vs. SLActive® implant surfaces over 12 weeks.

This study aims to assess the impact of two implant surfaces, SLA and SLActive, on implant stability, measured by ISQ levels over a 12-week period. A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Dentistry and Oral Sciences databases for randomized controlled trials (RCTs) up to February 2023 was conducted. The inclusion criteria were studies involving adult patients treated with SLA and SLActive implants, with assessment of implant stability through ISQ levels up to 12 weeks post-placement. From the initial 180 potentially eligible publications identified, six RCTs were included in our analysis, comprising 326 implants (50.6% SLA and 49.4% SLActive). Three studies were classified as low risk, while three had an unclear risk of bias. Overall, SLActive implants demonstrated comparable stability levels, as measured by ISQ, to SLA implants within the 12-week interval for implants placed in the maxillary or mandibular region. However, findings from the RCTs suggest that the SLActive surface led to an earlier transition point, a faster return to stability levels, and higher ISQ values at the end of 12 weeks compared to the SLA surface for implants placed in the palatal region. SLActive surfaces exhibited stability levels similar to SLA surfaces for maxillary and mandibular implants. Notably, for palatal implants, SLActive resulted in a quicker transition point and higher stability levels at the 12-week mark. Due to the limited number of trials and potential study heterogeneity, further research is needed to validate these findings.

Comparison of Malondialdehyde Levels among Patients with Sandblasted Acid-Etched and Anodized Surface Dental Implants: A Prospective Clinical Study.

Inflammation that occur as a part of body's response to implant-tissue contact can result in oxidative stress. Therefore, exploring the oxidative stress around different surface treated dental implants is essential to improve the performance of implants. The purpose of this study was to detect and measure the level of malondialdehyde (MDA), oxidative stress marker among patients with sandblasted acid-etched and anodized surface dental implants. In this prospective clinical study, 78 patients who had undergone implant placement for missing single posterior tooth in mandible using sandblasted acid-etched and anodized surface dental implants during August 2019 - December 2019 were enrolled according to strict inclusion and exclusion criteria and were categorized into Group 1: SLA (n = 27), Group 2: SLActive (n = 26), Group 3: TiUnite (n = 25) based on the surface modification of the implants. Peri-implant crevicular fluid (PICF) was collected and MDA was quantified using ELISA kit at 3 months and 1 year. Statistical analysis was performed using one-way ANOVA, followed by Tukey's HSD post hoc. For intragroup comparison, paired t-test was used. MDA levels in group 3 implants was significantly higher than groups 1 and 2 (P ≤ 0.05). On pairwise comparison, there was a statistically significant difference between the groups at baseline (P ≤ 0.05) and 1-year follow-up (P ≤ 0.05). Intragroup comparison showed that there was a statistically significant difference from baseline in all the three groups (P ≤ 0.05). MDA level in peri-implant crevicular fluid was high around TiUnite dental implant as compared to SLA and SLActive implants.

Surface Modifications of Commercial Dental Implant Systems: An Overview.

The aim of this review was to perform a comprehensive overview of evidence pertaining to the influence of various surface modifications on the surface roughness, bone implant contact, and the success and complication rates of the implants. Modified sandblasted, large-grit, acid-etched (SLA) implants (SLActive implants) have a higher implant stability quotient compared with conventional SLA implants. Also, when compared between the implant surfaces from various manufacturers, Biomet 3i Nanotite implants were shown to have a relatively higher implant stability quotient compared to Straumann implants as well as the Biomet Osseotite implants. Only one study reports the insertion torque values as obtained by the various implant surfaces, with the findings being statistically similar for all the types, and a higher mean value for Biomet 3i Nanotite implants. Among SLA and SLActive surfaces, the latter was found to have a lower marginal bone loss, and among Astratech implants, the marginal bone loss levels were similar for Osseospeed and Tioblast surfaces. When Osseospeed, TiUnite and SLActive surfaces were compared, Osseospeed was found to have the minimum bone loss while TiUnite was found to have the highest. The bone implant contact percentages are similar and satisfactory for most of the implant surface modifications that are available currently. Upon assessing the recent literature on the survival rates for implants with various surface modifications, it was found that among Nobel Biocare implants, the survival rate was higher for TiUnite implants, compared with the turned surfaces. Surprisingly, among the Straumann implant surfaces, the survival rates were found to be higher for the SLA implants when compared to the modified SLA implants. Only one of the included studies evaluated the survival rate for Astratech implant surfaces and found a 100% survival rate for both the Osseospeed and Tioblast surface implants. Therefore, major advancements have been made in developing novel surfaces of dental implants. The numerous innovations set the stage for rehabilitating patients with high success and predictable survival rates even in challenging conditions.

Evaluation of Peri-Implant Crestal Bone Loss with Different Implant Systems, Primary Stability, Bone Density and Soft Tissue Thickness: A Retrospective Study.

The purpose of this retrospective study was to compare, among various implant systems, the influence of primary stability and the bone density and soft tissue biotype of the patient on the amount of peri-implant crestal bone loss after 1 year using radiography. Included in this retrospective study were patient records of 3583 implant placements utilized from an online dental information archiving software (DIAS). Clinical and radiographic assessments were conducted concurrently with implant placement (baseline) and 1 year post surgery. Statistical analysis was done to examine the mean marginal bone loss significance in the three different implant systems groups (group I: Straumann Roxolid SLAc-tive, group II: Nobel Biocare CC, group III: Straumann SLA), different primary stability values, different bone density. and soft tissue biotype at the time of implant placement. A significant difference was observed in the crestal bone loss with different implant systems used. Group I showed significantly lesser amounts of crestal bone loss when compared to groups II and III. However, the differences in the bone density, ISQ values, and the soft tissue biotype did not exhibit a statistically significant difference in the amount of crestal bone loss. Significant MBL preservation for implants with Straumann SLActive when compared to Nobel Biocare CC and Straumann SLA implants. No significant changes were observed with respect to primary stability, bone density, and soft tissue thickness and no correlation among early crestal bone loss and IT, ISQ at surgery, and ISQ at reopening was observed. Straumann Roxolid SLActive implants showed less crestal bone loss probably owing to its hydrophilic surface modification. However, more studies need to be done to evaluate the same.

Comparison of early osseointegration of non-thermal atmospheric plasma-functionalized/ SLActive titanium implant surfaces in beagle dogs.

Background: Hydrophilic dental implants are gaining increasing interest for their ability to accelerate bone formation. However, commercially available hydrophilic implants, such as SLActive™, have some major limitations due to their time-dependent biological aging and lower cost-effectiveness. The non-thermal atmospheric plasma (NTAP) treatment is a reliable way to gain a hydrophilic surface and enhance osseointegration. However, a few studies have been carried out to compare the osseointegration of NTAP-functionalized titanium implants and commercially available hydrophilic implants. Purpose: In this study, we compare the osseointegration abilities of the NTAP-functionalized titanium implant and Straumann SLActive. Material and methods: The NTAP effectiveness was examined using in vitro cell experiments. Then, six beagle dogs were included in the in vivo experiment. Straumann SLActive implants, SLA implants, and SLA implants treated with NTAP were implanted in the mandibular premolar area of dogs. After 2 w, 4 w, and 8 w, the animals were sacrificed and specimens were collected. Radiographic and histological analyses were used to measure osseointegration. Results: NTAP treatment accelerated the initial attachment and differentiation of MC3T3-E1 cells. In the in vivo experiment, bone parameters (e.g., BIC value and BV/TV) and volume of new bone of NTAP groups were close to those of the SLActive group. Additionally, although there was no statistical difference, the osseointegration of SLActive and NTAP groups was evidently superior to that of the SLA group. Conclusion: NTAP-functionalized implants enhanced cell interaction with material and subsequent bone formation. The osseointegration of the NTAP-functionalized implant was comparable to that of the SLActive implant at the early osseointegration stage.

Development of a new preclinical model to study early implant loss: a validation study in the beagle dog

ObjectivesTo develop a new preclinical model to study early implant loss, where local infection conditions would impair the implant osseointegration.Materials and methodsForty-eight smooth, 2.9-mm diameter experimental implants were placed in the mandible of 8 beagle dogs (3 in each side). In half of the animals (test group, n = 24 implants), the implants received ligatures around the implant-abutment connection. In the other half, no ligatures were placed (control group, n = 24 implants). Four weeks later, implants were extracted in a flapless approach and standard 3.3-mm diameter SLActive implants were placed into the same osteotomy site without any further drilling. Eight weeks after the second implantation, animals were sacrificed and analyzed in terms of implant survival.ResultsAfter 8 weeks of healing, 4 implants were lost in the control group and 14 in the test group. This corresponded to a 17.4% of early implant loss in the control group and 58.3% in the test. Most of the early failures occurred within the first 5 weeks of healing.ConclusionsImplants placed in a pre-contaminated site present higher early loss than those placed in a non-contaminated site. This study represents a valid and robust preclinical model to study mechanisms and reduction of early implant loss as new technologies become available.Clinical relevanceScientific rationale for the study: There is lack of animal models to study early implant loss. Thus, a proposal of a new model is presented. With the validation of this model, new technologies can be implemented to prevent early implant loss.

Evaluation of marginal bone loss around SLActive implants by CBCT using different implant dimensions and surgical approaches: A clinical and radiological prospective study

Aim The reduction in the amount of marginal bone is the most important demand for the long term success of dental implants. This prospective clinical study was aimed to investigate the marginal bone loss of early loaded SLActive implants with different dimensions and surgical approaches. Materials and methods Fifteen patients aged from 18 to 60 years were divided into 2 groups (flapped and flapless approach) that underwent delayed implant placement protocol with SLActive implants. The marginal bone level was estimated by cone-beam computed tomography during three different periods: preoperatively, 8 weeks after surgery and 24 weeks after loading of the prosthesis. Results The mean value of marginal bone level was not significantly changed 8 weeks after surgery and 12 weeks after loading of the prosthesis when compared with baseline data in both flapped and flapless approach. Bone level was significantly decreased with dental implant dimension A˜ 4.1 mm RC, length 12 mm. Conclusion The results demonstrated that marginal bone loss is affected by many factors, such as age of the patient, and dental implant dimension.

Effect of lack of plaque control after the surgical treatment of peri-implantitis at surfaces with different characteristics: an experimental study in dogs.

The aim of the present study was to evaluate the effect of the induction of peri-implantitis and of plaque accumulation on implants with different surface characteristics after the surgical treatment. All mandibular premolars and first molars were extracted bilaterally in six dogs. After 3months, two non-submerged implants were installed, each with either a hydrophilic sandblasted and acid-etched surface stored in saline solution (SLActive) or an acid-etched and modified with calcium ions surface (UnicCa). After 3months, ligatures were placed in the sulcus around the implants to induce an experimental peri-implantitis and plaque accumulation was allowed. After 3months, ligatures were removed and, after one more month of plaque accumulation, a surgical treatment was performed using gauzes soaked in saline and irrigations. X-rays were taken at this stage. Plaque control maintenance was established at the control sites, while plaque accumulation was allowed at the test sites (plaque sites). After 5months, biopsies were obtained. Marginal bone levels were compared between x-rays and histological assessments. At the time of peri-implantitis treatment, two SLActive implants were lost. At the euthanasia, seven more implants were lost only in the plaque group, one control and six test implants. The calculated mean values of the marginal bone level of the two surfaces at the treatment were 3.65 ± 1.71mm in the control group, and 3.65 ± 1.76mm in the plaque group (p = 0.463). The additional marginal bone loss after 5months from surgical treatment was 0.67 ± 0.67mm (UnicCa, 0.48 ± 1.06mm and SLActive, 0.79 ± 2.10mm) and 3.11 ± 1.38mm (UnicCa, 2.67 ± 1.87mm and SLActive, 3.94 ± 2.11mm) for the control and plaque groups, respectively (p = 0.028). The lack of plaque control after the surgical treatment of the peri-implantitis strongly influenced the marginal bone loss.

Can implant surfaces affect implant stability during osseointegration? A randomized clinical trial.

This randomized clinical trial evaluated the insertion torque (IT), primary, and secondary stability of dental implants with different surface treatments during the osseointegration period. Nineteen patients with bilateral partial edentulism in the posterior mandibular region were randomly allocated to two implant brand groups and received implants with different surface treatments in the opposite site of the arch: Osseotite and Nanotite or SLA and SLActive. During implant placement, the maximum IT was recorded using a surgical motor equipped with a graphical user interface. The implant stability quotient (ISQ) was assessed immediately after the IT, and was measured weekly via resonance frequency analysis during 3 months. The data were analyzed by a one-way ANOVA, the Bonferroni test, paired t tests and Pearson's correlation coefficient. The IT values were similar (p > 0.05) for all implant types ranging from 43.82 ± 6.50 to 46.84 ± 5.06. All implant types behaved similarly until the 28th day (p > 0.05). Between 35 and 56 days, Osseotite and SLActive showed lower ISQ values (p < 0.001) compared to Nanotite and SLA implants. After 56 days, only Osseotite maintained significantly lower ISQ values than the other implants (p < 0.05). After 91 days the ISQ values were significantly higher than the baseline for all four implant types (p < 0.001). The ISQ and IT values were significantly correlated at the baseline and at the final evaluation for Osseotite, Nanotite, and SLActive implants (p < 0.001). After 91 days, ISQ and IT values were only significantly correlated for the Osseotite implants (p < 0.05). All implants types exhibited acceptable primary and secondary stability.

Endo-sinus bone formation after transalveolar sinus floor elevation without grafting with simultaneous implant placement: Histological and histomorphometric assessment in a dog model.

To evaluate endo-sinus new bone formation and implant osseointegration after transalveolar sinus floor elevation (TSFE) and simultaneous implant placement without any grafting materials and to investigate the influence of implant surface modification on bone healing process under this circumstance. Transalveolar sinus floor elevation and simultaneous implant placement were conducted bilaterally on 12 Labrador dogs. No grafting materials were used during surgery. Implants with two different surfaces (SLA and SLActive) were placed in a split-mouth design. The animals were sacrificed 4, 8 and 24weeks after surgery for histological and histomorphometric assessments. Bone-to-implant contact (BIC%), alveolar bone height (ABH) and the percentages of mineralized bone (MB%) in the area of interest were analysed. The probing depth (PD) and bleeding on probing (BOP) were also assessed to describe peri-implant health conditions. Sprouts of new bone in direct contact with implant surface were seen in the elevated area at every time point. Newly formed woven bone under sinus membrane was visible. SLActive implants exhibited favourable results compared with SLA implants regarding ABH at 4weeks and BIC% at 4 and 8weeks. Sites with BOP positive could be observed in both groups at any time point. No newly formed bone can be found on the implant apex with either SLA or SLActive surfaces at any time point. Spontaneous new bone formation from the parent bone walls could be observed after TFE without any grafting materials. No clear evidence of bone formation from the Schneiderian membrane could be found. Even though there were trends for quicker bone response of SLActive implants, this study failed to show the absolute advantage of SLActive in achieving endo-sinus bone formation.

Marginal Bone Loss Around Early-Loaded SLA and SLActive Implants: Radiological Follow-Up Evaluation Up to 6.5 Years.

The aim of this study was to compare marginal bone loss around early-loaded SLA and SLActive tissue-level implants (Straumann Dental Implants; Institut Straumann AG, Basel, Switzerland) after a mean of 81-month follow-up period. One hundred seven SLA and 68 SLActive implants were placed in 55 patients and loaded with final restoration after 8 and 3 weeks of healing time, respectively. Marginal bone loss around implants was determined radiographically at initial and after a mean observation time ranging between 20 and 81 months. The effect of location (mandible vs maxilla), smoking habit, sex, implant length and diameter, and the type of prosthesis on the marginal bone loss was evaluated. The overall cumulative survival rate was 98.2% being 99% for SLA implants and 97% for SLActive implants. After 20-month follow-up period, mean marginal bone loss values for the SLA and SLActive implants were 0.24 and 0.17 mm, respectively. After 81 months, mean marginal bone loss for the SLA and SLActive implants reached 0.71 and 0.53 mm, respectively. Marginal bone loss was affected by the length and type of implant and patients' smoking habit after a mean observation time of 20 months. However, none of the parameters had any significant effect on the marginal bone loss after a follow-up period of 81 months. With both SLA and SLActive implants, successful clinical results could be achieved up to 6.5 years of follow-up period.

Comparison of removal torques of SLActive® implant and blasted, laser-treated titanium implant in rabbit tibia bone healed with concentrated growth factor application.

PURPOSEThe purpose of this study was to compare the removal torques of a chemically modified SLActive implant and a blasted, laser-treated (BLT) implant, which were soaked in saline for 2 weeks after their surface modifications. The removal torques of the two implants were measured 4 weeks after their implantation into the bone defect area in rabbit tibias with concentrated growth factor (CGF) application.MATERIALS AND METHODSTo make artificial bone defects in the cortical layers of both tibias, an 8-mm diameter trephine bur was used. Then, prepared CGF was applied to the bony defect of the left tibia, and the bony defect of the right tibia was left unfilled. Four weeks later, the surgical sites of 16 rabbits were re-exposed. For 8 rabbits, the SLActive implants (Straumann, Switzerland) were inserted in the left tibia, and the BLT implants (CSM implant, Daegu, Korea) were inserted in the right tibia. For other rabbits, the BLT implants were inserted in the left tibia, and the SLActive implants were inserted in the right. Four weeks afger the insertion, torque removal was measured from 4 rabbits exterminated via CO2 inhalation.RESULTSNo significant difference was observed between removal torques of the BLT implant and the SLActive implant (P>.05).CONCLUSIONIt was found that BLT surface modification exhibited excellent osseointegration. In addition, CGF application did not affect the insertion and removal torque of the implants.

Sinus Floor Augmentation Using Straumann® BoneCeramic™ and Bio-Oss® in a Split Mouth Design and Later Placement of Implants: A 5-Year Report from a Longitudinal Study.

Straumann® BoneCeramic™ is a synthetic biphasic calcium phosphate (BCP) aimed for sinus floor augmentation. Long-term follow-up of implants placed in BCP after sinus augmentation is still missing. The primary aim of the study was to compare survival rates and marginal bone loss of Straumann SLActive implants placed in either BCP (test) or Bio-Oss® (DBB) (control) after sinus floor augmentation. The secondary aim was to calculate graft sinus height at different time points. Bilateral sinus floor augmentation was performed in a split mouth model. Eleven patients (mean age 67 years) received 100% BCP on one side and 100% DBB on the contralateral side. After 8 months of graft healing, 62 Straumann SLActive implants were placed. After 5 years of functional loading (6 years after augmentation) of implants, marginal bone levels and grafted sinus height were measured, and implant survival and success rates were calculated. After 5 years of loading, all prosthetic constructions were in function although two implants were lost in each grafting material. The overall implant survival rate was 93.5% (91.7% for BCP, 91.3% for DBB, and 100% for residual bone). The success rates were 83.3% and 91.3% for BCP and DBB, respectively. There was no statistically significant difference in mean marginal bone level after 5 years between BCP (1.4 ± 1.2 mm) and DBB (1.0 ± 0.7 mm). Graft height reduction (GHR) after 6 years was limited to 6.6% for BCP and 5.8% for DBB. In this limited RCT study, the choice of biomaterial used for sinus floor augmentation did not seem to have any impact on survival rates and marginal bone level of the placed implants after 5 years of functional loading and GHR was minimal.

Survival and patient satisfaction of short implants during the first 2 years of function: a retrospective cohort study with 694 implants in 416 patients.

The present study aimed to evaluate the influence of implant length on implant survival and patient satisfaction during the first 24 months in function. A retrospective cohort of 312 "short" Straumann(®) SLActive(®) implants (length ≤ 8 mm) in 224 patients, which were inserted between 2008 and 2010 in private practice, were evaluated. The mean observation period was 26.7 ± 9.7 months. Three hundred and eighty-two Straumann SLActive(®) implants in 192 patients with a length ≥ 12 mm served as control group. The mean observation period in the control group was 28.3 ± 10.1 months. Implant survival rate, crown-to-implant ratio, resonance frequency analysis, and patient satisfaction were evaluated. Implant survival rate was 99% in the test vs. 98.7% in the control group. The crown-to-implant ratio was significantly higher in the control group (P < 0.0001). Resonance frequency analysis showed slightly higher values for the short implants. There was a tendency to higher satisfaction (Oral Health Impact Profile [OHIP]) in the test group without statistical significant differences but a high overall satisfaction in both groups. Within the limits of the present investigation, implant length had no significant influence on implant survival during the first 24 months of function of the specific implant system with hydrophilic surface (SLActive(®) ). Further follow-up studies are required to evaluate long-term results of the reduced implant length.

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.

Three-year outcomes of Straumann Bone Level SLActive dental implants in daily dental practice: a prospective non-interventional study.

The aim of this investigation was to evaluate the performance of Straumann Bone Level SLActive implants in various clinical situations in daily dental practice for up to 3 years. This was a prospective, multicenter, non-interventional study in which implants were placed within approved indications in any situation deemed suitable by the treating clinician. No implant placement or loading protocol was specified, and implants were placed according to the routine treatment protocols at each participating center. In this analysis, data were available from 342 implants in 233 patients in three countries (USA, Canada, and Switzerland). One or two implants were placed in the majority of patients (70.8% and 19.3%, respectively), mostly in the maxilla (71.3%); almost half (47.7%) were placed in the esthetic zone. Implant placement after 4 to > 16 weeks of healing was preferred in Switzerland (92.0%), while 42.0% of implants were placed immediately in the USA and Canada. A flapless procedure was performed in 25.2% of cases in the USA and Canada, compared to 0.5% in Switzerland. Cumulative implant survival and success rates after 3 years were 97.5% and 93.5%, respectively. Straumann Bone Level Implants can achieve favorable outcomes and high survival rates after 3 years in daily dental practice. The survival and success rates were comparable with those achieved in formal controlled clinical trials.

Survival of Chemically Modified Titanium Surfaced Implants in Irradiated Jaws of Oral Cancer Patients

Objective: To investigate the clinical performance of implants with chemically modified surfaces in irradiated bone in a period of five-years. Patients & Methods: 15 (6 females, 9 males, 50.2 years with a range of 38 - 60 years) patients who had been operated for oral tumors and had undergone radiotherapy were enrolled and 40 SLActive surface implants were placed (24 in the maxilla, 16 in the mandible). Implants were allowed to integrate for a period of 90 days and the stability of the implants was measured with Resonance Frequency Analyzer/Osstell? Mentor (Integration Diagnostics, Savedalen, Sweden) at implant placement, 30 days later and at the end of the 90th day. Patients follow up periods after the implant placement varied from 20 months to 60 months (mean: 45 months). Results: Two implants were lost in maxilla in healing period as a result of osseointegration failure. The survival rate was 95%. During the observation period, totally 4 implants were lost. The overall success rate was 90%. 3 of the lost implants were in maxilla and one was in mandible. The initial ISQ values of the implants differed from 20 - 71; the second values were between 24 - 71 and the last values were between 30 - 89. The implants which were lost could not show a value greater than 35. Conclusion: There was no any complication on the SLActive surface implant placed bones due to irradiation. Within the limitations of this study, it may be concluded that osseointegrated implants can be placed in irradiated bones, unless a careful patient selection and treatment planning is performed.

Rehabilitation of irradiated patients with chemically modified and conventional SLA implants: five-year follow-up.

The aim of this study is to evaluate the clinical and radiological parameters of standard SLA surface implants compared to chemically modified hydrophilic SLActive implants in irradiated patients after the initial 12-month loading period up to 5 years. Twenty patients with a mean age of 61·1 years were treated with dental implants after ablative surgery and radio-chemotherapy of oral cancer. All patients were non-smokers. The placement of 102 implants (50 SLA, 52 SLActive) was performed bilaterally according to a split-mouth design. Mean crestal bone changes were evaluated using standardised orthopantomographies and clinical parameters. Data were analysed using a Kaplan-Meier curve, Mann-Whitney U-test and two-factorial non-parametric analysis. The average observation period was 60 months. The amount of bone loss at the implant shoulder of SLA implants was mesial and distal 0·7 mm. The SLActive implants displayed a bone loss of mesial 0·6 mm as well as distal 0·7 mm after 5 years. Two SLA implants were lost before loading. One patient lost five implants due to recurrence of a tumour. The overall cumulative 12-month, 3-year and 5-year survival rate of SLA implants was 92%, 80% and 75·8% and of SLActive implants 94·2%, 78·8% and 74·4%, respectively. Eighteen implants were considered lost because the patients had died. Sandblasted acid-etched implants with or without a chemically modified surface can be used in irradiated patients with a high predictability of success. Lower implant survival rates in patients with irradiated oral cancer may be associated with systemic effects rather than peri-implantitis.

Review found little difference between sandblasted and acid-etched (SLA) dental implants and modified surface (SLActive) implants.

Medline, Embase, the Cochrane Oral Health Group's Trials Register and OpenGREY databases were searched together with the reference lists of identified articles. Randomised controlled trials (RCTs) and prospective cohort studies of at least six month duration were included. Studies/case series in which there was only one implant surface (SLA or SLActive) and one loading protocol (immediate or early) were also considered. Two reviewers screened, selected and abstracted data, independently. RCTs were assessed for quality using the Cochrane risk of bias approach and observational studies using the Newcastle-Ottawa scale (NOS). The primary outcomes were changes from baseline to follow-up of clinical attachment level (CAL), probing depth (PD) and radiographic changes in the peri-implant bone level and number of implants lost. Cumulative survival rates (%) of each included study were calculated. Twenty-three articles reporting 19 studies (seven RCTs; 12 prospective observational studies) were included. The seven RCTs included 407 patients with 853 implants (8% titanium plasma-sprayed, 41.5% SLA and 50.5% SLActive). Only one RCT was considered to be at low risk of bias, the others were considered to be at unclear risk. The 12 observational studies included 1394 SLA and 145 SLActive implants and were considered to be of medium methodological quality based on the NOS. A narrative summary of the studies was undertaken owing to marked heterogeneity of the loading periods, types of implants described and lack of occurrence of the outcome of interest. There were no significant differences reported in the studies in relation to implant loss or clinical parameters between the immediate/early loading and delayed loading protocols. Overall, 95% of SLA and 97% of SLActive implants still survive at the end of follow-up. Despite the positive findings achieved by the included studies, few RCTs were available for analysis for SLActive implants. Study heterogeneity, scarcity of data and the lack of pooled estimates represent a limitation between studies' comparisons and should be considered when interpreting the present findings.

Efficacy of standard (SLA) and modified sandblasted and acid-etched (SLActive) dental implants in promoting immediate and/or early occlusal loading protocols: a systematic review of prospective studies.

To assess the survival percentage, clinical and radiographic outcomes of sandblasted and acid-etched (SLA) dental implants and its modified surface (SLActive) in protocols involving immediate and early occlusal loading. MEDLINE, EMBASE and the Cochrane Oral Health Group's Trials Register CENTRAL were searched in duplicate up to, and including, June 2013 to include randomised controlled trials (RCTs) and prospective observational studies of at least 6-month duration published in all languages. Studies limited to patients treated with SLA and/or SLActive implants involving a treatment protocol describing immediate and early loading of these implants were eligible for inclusion. Data on clinical and/or radiographic outcomes following implant placement were considered for inclusion. Of the 447 potentially eligible publications identified by the search strategy, seven RCTs comprising a total of 853 implants (8% titanium plasma-sprayed, 41.5% SLA and 50.5% SLActive) and 12 prospective observational studies including 1394 SLA and 145 SLActive implants were included in this review. According to the Cochrane Collaboration's tool for assessing risk of bias, one of the studies was considered to be at a low risk of bias, whereas the remaining studies were considered to be at an unclear risk. Regarding the observational studies, all of them presented a medium methodological quality based on the Modified Newcastle-Ottawa scale. There were no significant differences reported in the studies in relation to implant loss or clinical parameters between the immediate/early loading and delayed loading protocols. Overall, 95% of SLA and 97% of SLActive implants still survive at the end of follow-up. Despite of the positive findings achieved by the included studies, few RCTs were available for analysis for SLActive implants. Study heterogeneity, scarcity of data and the lack of pooled estimates represent a limitation between studies' comparisons and should be considered when interpreting the present findings.