Unsplinted Implants Research Articles

Stability and marginal bone level measurements of unsplinted implants used for mandibular overdentures: a 1‐year randomized prospective clinical study comparing early and conventional loading protocols

The aim of this study was to compare the performance of two non-splinted implants used as retention for a mandibular overdenture when applying conventional or early loading protocols. Twenty edentulous patients were treated with two unsplinted and non-submerged implants (15 mm long, TiUnite RP, Brånemark System) in the anterior mandible. The patients were randomly allotted into two groups: (i) test group (Group A), in which the overdenture was connected 1 week after surgery, and (ii) control group (Group B), in which the overdenture was connected after 12 weeks of healing. Resonance frequency analyses (RFA) for implant stability measurements were performed at implant surgery and after 1, 3, 6, 9 and 12 months. Marginal bone levels were evaluated at implant surgery and after 6 and 12 months. No implant from either group was lost and all implants showed less than 1 mm of marginal bone resorption during the first year. The mean implant stability quotient (ISQ) values at implant surgery were 76.2+/-2.8 for Group A and 75.6+/-4.5 for Group B. The 12-month measurements showed 76.4+/-2.5 ISQ and 76.4+/-2.8 ISQ for Groups A and B, respectively. There were no statistically significant changes between or within the groups with time. There were no differences in marginal bone loss, which was on average 0.3 mm for both groups after 1 year. Although a limited number of patients were followed for 1 year only, the results of the present study indicate that early loading of two unsplinted 15 mm long implants with an overdenture does not negatively affect implant stability or marginal bone conditions when compared with implants subjected to 12 weeks of healing before loading.

Clinical and radiological results of patients treated with two loading protocols for mandibular overdentures on Brånemark implants

The aim of this study was to evaluate clinical and radiological outcomes of the unsplinted implants supporting mandibular overdenture when applying conventional or early loading protocols. Twenty-six edentulous patients were treated with two unsplinted Brånemark System implants supporting mandibular overdenture. There was a test group, in which the overdenture was connected 1 week after surgery, and a control group, in which the overdenture was connected 3 months after surgery. Peri-implant parameters were recorded 1, 6, and 12 months after surgery. Clinical stability measurements were performed at surgery, and after 3, 6, and 12 months. Marginal bone levels were evaluated at implant surgery, after 6, and after 12 months. No implant from either group was lost. Clinical peri-implant parameters, clinical stability measurements, and marginal bone resorptions showed no statistically significant differences between two groups during 12 months. The results of this study suggest that one-week of early loading protocol of two Brånemark implants supporting mandibular overdenture does not compromise implant stability, marginal bone loss, and peri-implant soft-tissue health.

A 10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: Peri-implant outcome

Purpose This randomized controlled clinical trial aimed to evaluate the efficacy of splinted implants versus unsplinted implants in overdenture therapy over a 10-year period. Materials and Methods The study sample comprised 36 completely edentulous patients, 17 men and 19 women (mean age 63.7 years). In each patient, 2 implants (Branemark System, Nobel Biocare, Goteborg, Sweden) were placed in the interforaminal area. Three to 5 months after placement, they were connected to standard abutments. The patients were then rehabilitated with ball-retained overdentures, magnet-retained overdentures, or bar-retained overdentures (the control group). Patients were followed for 4, 12, 60, and 120 months post–abutment connection. Group means as well as linear regression models were fitted with attachment type and time as classification variables and corrected for simultaneous testing (Tukey). Results After 10 years, 9 patients had died and 1 was severely ill. Over 10 years, no implants failed. Mean Plaque Index, Bleeding Index, change in attachment level, Periotest values, and marginal bone level at the end of the follow-up period were not significantly different among the groups. Discussion The annual marginal bone loss, excluding the first months of remodeling, was comparable with that found around healthy natural teeth. Conclusion The fact that no implants failed and that overall marginal bone loss after the first year of bone remodeling was limited suggested that implants in a 2-implant mandibular overdenture concept have an excellent prognosis in this patient population, irrespective of the attachment system used.— Reprinted with permission of Quintessence Publishing.

A cost comparison of mandibular two-implant overdenture and conventional denture treatment

Purpose This article compares the cost of mandibular two-implant overdenture treatment to that of conventional denture treatment in an academic teaching hospital. Materials and Methods Sixty edentulous patients (aged 65 to 75 years) participated in a randomized clinical trial. All patients received a new maxillary complete denture and either a mandibular conventional denture (n=30) or an implant overdenture on two unsplinted implants (n=30). Resource-based microcosting of direct and indirect costs (eg, expenses and time cost to patients) of all scheduled and unscheduled visits was conducted through 1 year following delivery of the prostheses. Results Mean direct costs (1999 CD dollars) for scheduled visits in the implant and conventional groups were 2,332 dollars and 814 dollars, respectively, and mean indirect costs were 1,150 dollars and 810 dollars, respectively. Differences between the two groups were significant. Twenty-six patients in each group had unscheduled visits during the study at a median direct cost for the overdentures of 85 dollars and 64 dollars for the conventional dentures. Median indirect costs for unscheduled visits were 163 dollars and 202 dollars, respectively. These differences were not significant. Mean total costs of the overdentures were 4,245 dollars and 2,316 dollars for the conventional dentures, and the between-group difference was significant. Conclusion The direct cost of mandibular two-implant overdenture treatment was 2.4 times higher than that of conventional denture treatment. When indirect costs were added, the implant-to-conventional total cost ratio estimate was 1.8. These cost data can now be combined with estimates of the efficacy of the two types of prosthesis so practitioners and patients can make informed decisions about these prosthodontic treatment concepts.

Biologic and mechanical stability of single-tooth implants: 4- to 7-year follow-up.

Single-tooth implants have been reported to achieve a high level of surgical and prosthetic success. However, close inspection of the literature reveals a paucity of data on the follow-up of single-tooth implants in function for 5 years or more. Since unsplinted implants may be considered to be subject to greater functional stresses, there is a need to report on the long-term biologic and mechanical integrity of such implant-supported restorations. To report on the long-term follow-up of single-tooth implants, restored and in function for 4 to 7 years. Twenty-seven Astra Tech single-tooth implants were subject to a clinical audit to evaluate implant and prosthetic success as well as response of both hard and soft tissues over a 1- to 4-year follow-up. This current report presents data on the biologic and mechanical integrity of 23 of these single-tooth implants, which have been in function for up to 7 years (mean, 63 mo). Data are provided with respect to implant survival, maintenance of marginal bone levels, soft-tissue health, and the recording of any adverse events, including prosthetic complications. Only 14 implants in 13 patients were available for review, with no failures for this group of implants. One patient from the original group, who was lost to follow-up, was known to have suffered an implant failure. Furthermore, in accordance with established criteria, the remaining 13 implants that are not included in this report must at this time also be considered as potential failures. As such, the best-case scenario would be a 95.6% success rate for the 23 implants included in this review and the worst-case scenario would be a 60.8% success rate. Mean marginal bone loss measured 0.49 mm mesially and 0.76 mm distally, with a frequency of bone loss of 50%. Soft tissues were clinically healthy. There were few adverse events, with only one case of abutment screw loosening, detected at the 6-year review. In addition, crown decementation was recorded three times in two patients. It can be concluded that the Astra Tech single-tooth implant can achieve long-term biologic and mechanical stability when used to restore single missing teeth, over the long-term.

Splinting does not affect the oral tissues surrounding the implants

Objectives To investigate treatment outcome of splinted and unsplinted implants retaining mandibular hinging overdenture.Design 5-year prospective randomised-controlled-trial (RCT)Setting Prosthetic Department of Dental School in Belgium.Patients 36 edentulous patients (17 male, 19 female) with a Mean age of 63 yrs (range 36-85 years). Exclusion criteria were, insufficient bone volume to harbour at least 2 10mm implants, Angle class II jaw relationship, physiological problems for accepting dentures, gagging reflexes, less than 1 year of edentulism in mandible, absence of a maxillary complete denture and administrative or physical considerations that would seriously affect the surgical procedure or follow-up.Intervention Each patient was provided with 2 screw shaped c.p. titanium implants (Branemark system). 3–5 months later transmucosal abutments were placed. The patients were randomised to 3 groups with different retention systems, (a bar group, a magnet group and a ball group) for attachment of the overdenture. Patients received regular follow-up for 60mths.Results 5 patients failed to complete all the follow-up visits (3 in Bar group, 1 Magnet, 1 Ball). None of the loaded implants failed. 1 implant was replaced at abutment surgery and survived. Of the peri-implant outcomes considered (plaque levels, mucosal bleeding, pocket depth, attachment level and marginal bone level) the only significant finding was a higher level of plaque in the magnet group compared to the ball group. No differences in plaque levels were noted between the bar and ball or between the bar and magnet groups.Conclusions The peri-implant outcome is hardly any difference between splinted and unsplinted implants, Plaques levels a slightly higher on abutments fitted with magnets. There was no correlation between bleeding on probing and marginal bone loss. Marginal bone loss and attachment loss were not statistically different at year 5. The bone-implant interface rigidity was equal between the groups and increased over time.

Channel nomenclature: IUPHAR recommendations

Several studies reported better outcomes when restoring edentulous mandible with unsplinted IODs compared to CCDs; however, it is not clear if these outcomes remain when the full literature is considered. The aim of this systematic review is to compare conventional complete dentures (CCDs) to unsplinted implant-retained overdentures (IODs) with regard to efficacy, satisfaction and quality of life.The main question addressed was: How do CCDs compare to unsplinted IODs with regard to efficacy, satisfaction and quality of life? Three databases were electronically searched to identify articles comparing CCD to unsplinted IOD. Twenty-six articles were selected and reviewed in full. Of these selected articles, twenty-five compared CCDs restoring function in both arches to a maxillary CCD opposing a mandibular IOD retained by two unsplinted implants. Only one articles compared a maxillary CCDs to a maxillary IOD.Outcome measures varied among the studies, including the Oral Health Impact Profile (OHIP), visual analogue scales (VAS), and masticatory performance tests. Overall, IODs were associated with significantly better patient’s masticatory performance and quality of life as indicated by Oral Health as Related to Quality of Life (OHRQoL). Mandibular unsplinted IODs were more likely than CCDs to be associated with improved OHRQoL for edentulous patients and were associated with significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew.Results of this systematic review indicate the superiority of IODs retained by two unsplinted mandibular implants when compared to CCDs with regards to efficacy, satisfaction and quality of life.

Selection and Arrangement of Artificial Teeth for Complete Prosthetic Dentures

Several studies reported better outcomes when restoring edentulous mandible with unsplinted IODs compared to CCDs; however, it is not clear if these outcomes remain when the full literature is considered. The aim of this systematic review is to compare conventional complete dentures (CCDs) to unsplinted implant-retained overdentures (IODs) with regard to efficacy, satisfaction and quality of life.The main question addressed was: How do CCDs compare to unsplinted IODs with regard to efficacy, satisfaction and quality of life? Three databases were electronically searched to identify articles comparing CCD to unsplinted IOD. Twenty-six articles were selected and reviewed in full. Of these selected articles, twenty-five compared CCDs restoring function in both arches to a maxillary CCD opposing a mandibular IOD retained by two unsplinted implants. Only one articles compared a maxillary CCDs to a maxillary IOD.Outcome measures varied among the studies, including the Oral Health Impact Profile (OHIP), visual analogue scales (VAS), and masticatory performance tests. Overall, IODs were associated with significantly better patient’s masticatory performance and quality of life as indicated by Oral Health as Related to Quality of Life (OHRQoL). Mandibular unsplinted IODs were more likely than CCDs to be associated with improved OHRQoL for edentulous patients and were associated with significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew.Results of this systematic review indicate the superiority of IODs retained by two unsplinted mandibular implants when compared to CCDs with regards to efficacy, satisfaction and quality of life.