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ITI Literature Update March-April 2010

Clinical Implant Dentistry and Related Research

Vol. 12 No. 1 (March 2010)

Becker W, Gabitov I, Stepanov M, Kois J, Smidt A, Becker BE. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res 2010;12(1):1-8.

A total of 11 patients with at least one papillary deficiency in the esthetic zone were treated with a commercially available gel of hyaluronic acid, < 0.2 ml of which was injected 2-3 mm apical to the coronal tip of the affected papillae. Patients were followed up from 6 to 25 months after initial application. Three implant sites and one tooth site showed 100% improvement,  seven sites showed 94-97% improvement, three showed 76-88% improvement, and one showed 57% improvement. The results suggested that papillary deficiencies can be enhanced by hyaluronic acid injection.


Morton D, Bornstein MM, Wittneben J-G, Martin WC, Ruskin JD, Hart CN, Buser D. Early loading after 21 days of healing of nonsubmerged titanium implants with a chemically modified sandblasted and acid-etched surface: two-year results of a prospective two-center study. Clin Implant Dent Relat Res 2010;12(1):9-17.

A total of 89 implants were placed in single-tooth gaps or extended edentulous spaces in 56 patients and loaded after 21 days with provisional restorations in full occlusion. Definitive restorations were placed after 6 months. Two implants were removed due to lack of osseointegration and another two required prolonged healing; 85 implants were therefore loaded after 21 days. After 2 years, one further implant was lost to follow-up, but favorable clinical and radiographic outcomes were observed at the 86 loaded implants; the 2-year success rate was 97.7%. Implants with a chemically modified SLA surface can therefore result in predictable osseointegration with full occlusal loading after 21 days.

Östman P-O, Wennerberg A, Albrektsson T.  Immediate occlusal loading of NanoTite PREVAIL implants: a prospective 1-year clinical and radiographic study. Clin Implant Dent Relat Res 2010;12(1):39-47.

A total of 102 implants (66 maxillary, 36 mandibular) with a nanometer scale surface (NanoTite) were placed in 35 patients. Surgical requirements were an ISQ value of ≥ 55 and final torque of ≥ 25 Ncm. A total of 44 prostheses were immediately placed (14 single-tooth restorations, 26 FPDs and four full fixed restorations). Definitive restorations were placed after 4 months. There was one implant failure, giving a 1-year survival rate of 99.2%. Mean bone resorption was 0.37 ± 0.39 mm and the success rate, according to Albrektsson and Zarb criteria, was 93%. Immediate loading of nanometer scale-surface implants was therefore a suitable and predictable treatment option.


Aparicio C, Oazzani W, Aparicio A, Fortes V, Muela R, Pascual A, Codesal M, Barluenga N, Manresa C, Franch M. Extrasinus zygomatic implants:  three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla. Clin Implant Dent Relat Res 2010;12(1):55-61.

Zygomatic implants are normally placed far from the alveolar crest in the case of buccal concavity: This study assessed 36 zygomatic implants placed with an extrasinus approach (the implant body passed from the alveolar crest through the concavity to then zygomatic bone), together with 104 conventional implants, in 20 patients with pronounced buccal concavity. Mean follow-up after occlusal loading was 41 months (range 36-48 months), and there were no implant losses. Emergence of the zygomatic implant was a mean 3.8 ± 2.6 mm palatal to the top of the crest, compared to 11.2 ± 5.3 mm with the conventional technique. The extrasinus approach can therefore be useful and gives predictable results.


Clinical Oral Implants Research

Vol. 21 No. 3 (March 2010)

Vol. 21 No. 4 (April 2010)

Rodrigo D, Aracil L, Martin C, Sanz M. Diagnosis of implant stability and its impact on implant survival: a prospective case series study. Clin Oral Implants Res 2010;21(3):255-261.

A total of 4,114 implants were evaluated and implant stability was classified according to degree of rotation, i.e. A (stable, no rotation), B (unstable, light rotation), C (unstable, rotation without resistance) and D (unstable, rotation and lateral oscillation), RFA was also measured on the day of surgery and at restoration placement. Of the 4,114 implants, 3,899 and 213 were classified as stable and unstable, respectively, with survival rates of 99.1% and 97.2%, respectively. Survival rates were  significantly different between the implants classified as unstable, i.e. B (98.1%), C (94.1%) and D (100%). No association was found between primary implant stability measured by RFA and implant  survival, but there was a  significant association between stability at restoration placement and implant survival.


Schwarz S, Gabbert O, Hassel AJ, Schmitter M, Séché C, Rammelsberg P. Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5-year clinical results from a prospective study. Clin Oral Implants Res 2010;21(3):284-289.

Each of 37 patients received five implants to support FPDs in the edentulous mandible; the FPDs were connected after 2 weeks. The mean observation period was 4.5 years (range 1-8 years), during which 32 complications occurred. Implant survival was 89.7% (19 implants  lost) and implant success was 84.9%. Signs of peri-implantitis were noted at 2.2% of implants, and complications included one complete prosthesis failure, 10 framework fractures, three adaptations/modifications and repair of facings. Early loading was therefore associated with higher complication rates than in delayed loading studies.

Arısan V, Bölükbaşı N, Ersanlı S, Özdemir T. Evaluation of 316 narrow diameter implants followed for 5-10 years: a clinical and radiographic retrospective study. Clin Oral Implants Res 2010;21(3):296-307.

A total of 139 patients received 316 narrow diameter  implants restored with 120 prostheses andevaluated clinically and radiographically for 60-124 months (mean 9.1 years). Survival and success rates were 92.3% and 91.4%, respectively, and the risk of failure was  increased in smoking patients and with posterior implants. Mean marginal bone loss was 1.32 ± 0.13 mm in the maxilla and 1.28 ± 0.3 mm in the mandible, which predominantly occurred within 2 years of loading. The results suggested that narrow diameter implants can be used where regular diameter implants are not suitable.


Vercruyssen M, Marcelis K, Coucke W, Naert I, Quirynen M. Long-term, retrospective evaluation (implant and patient-centred outcome) of the two implants-supported overdenture in the mandible. Part 1: survival rate. Clin Oral Implants Res 2010;21(4):357-365.

This retrospective evaluation analyzed 495 cases with ≥ 5 years loading time over the past 25 years. Follow-up visits were possible for 248 patients and data were collected by phone from another 121 patients; no contact was possible for the remaining 126 patients, so information from the last visit to the clinic was used. The majority of implants (95.5%) were machined  surface and the most used anchorage system was bar (86.3%) followed by ball attachments (11.7%). Mean survival rate after 20 years of loading was 95.5% and was adversely affected by smoking and one-stage implant placement but not influenced by bone quality or implant length.

Lindeboom JA, van Wijk AJ. A comparison of two implant techniques on patient-based outcome measures: a report of flapless vs. conventional flapped implant placement. Clin Oral Implants Res 2010;21(4):366-370.

Implant placement was performed by either flapless of conventional flapped surgery using a Nobel Guide CT surgical template in 16 patients with edentulous maxillae. A total of 96 implants were placed. The results showed no significant differences in dental anxiety, emotional impact, anxiety, procedure duration or technical difficulty, but scores were higher in the flapless group. The results suggested that flapless implant placement has more of an effect on quality of life than conventional flapped placement.


Degidi M, Nardi D, Piattelli A. Prospective study with a 2-year follow-up on immediate implant loading in the edentulous mandible with a definitive restoration using intra-oral welding.  Clin Oral Implants Res 2010;21(4):379-385.

Four inter-foraminal tapered-connection implants were placed in each of 20 patients and immediately loaded with an intra-orally welded titanium framework supporting a fixed restoration. Marginal bone loss was recorded immediately after surgery and after 6, 12 and 24 months. After 24 months, implant survival was 100%n and no framework fractures occurred. Mean marginal bone growth was 0.21 ± 0.25 mm and the mean probing depth was 1.38 ± 0.41 mm. The intra-oral welding technique therefore did not adversely affect implant survival and marginal bone loss.

Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M.  The impact of dietary advice on edentulous adults’ denture satisfaction and oral health-related quality of life 6 months after intervention. Clin Oral Implants Res 2010;21(4):386-391.

A denture satisfaction and oral health impact profile  questionnaires were completed by 26 patients with conventional dentures and 28 patients with implant overdentures before and 6 months after being given dietary advice (i.e. to consume more fruits, vegetables and fiber-rich food). Scores were significantly greater for denture comfort, stability and perceived chewing  ability for the overdenture group after 6 months, compared to no difference between the groups before the dietary advice. There were no differences in oral health-related quality of life between the groups. The  authors speculated that the diet may make the conventional denture patients more aware of the shortcomings of their prosthesis.


de Vicente JC, Hernández-Vallejo G, Braña-Abascal P, Peña I.  Maxillary sinus augmentation with autologous bone harvested from the lateral maxillary  wall combined with bovine-derived hydroxyapatite: clinical and histologic observations. Clin Oral Implants Res 2010;21(4):430-438.

Autogenous bone was harvested from the lateral maxillary wall in each of 34 patients and combined with bovine-derived HA in the sinus cavity; a total of 90 implants were then placed and the access window covered with a collagen membrane. After 9m months, 14 randomly selected biopsies were obtained and evaluated. New bone comprised lamellae with osteocytes in close contact with HA particles. The specimens consisted of 29% newly formed bone, 21% anorganic bovine bone and 50% marrow space. Implant survival was 98.9% (one implant was lost). Outcomes were therefore predictable with this technique.


Kim J-J, Lee D-W, Kim C-K, Park K-H, Moon I-S.  Effect of conical configuration on the maintenance of marginal bone level: preliminary results at 1 year of function. Clin Oral Implants Res 2010;21(4):430-438.

Implants with straight and conical neck designs were placed in edentulous areas in 12 patients and the bone loss analyzed after 1 year. There were no significant differences in bone loss between the two groups (0.05 ± 0.09 mm for straight and 0.07 ± 0.14 mm for conical neck implants).


Clinical Oral Investigations

Vol. 14 No. 2 (April 2010)

Habre-Hallage P, Bou Abboud-naman N, Reychler H, van Steenberghe D, Jacobs R.  Assessment of changes in the oral tactile function of the soft tissues by implant placement in the anterior maxilla: a prospective study. Clin Oral Investig 2010;14(2):161-168.

Psychophysical tests were performed to assess somatosensory function in peri-implant soft tissues at implants before and up to 18 months after placement of one or two implants in the anterior maxilla. High intra-individual correlations were observed for light-touch sensation (LTS) and two-point discrimination (2PD) tests. There was no significant change in LTS thresholds over time, but there was a significant increase in 2PD from surgery, and the level was maintained  for one year. However, no correlation between LTS and 2PD was found. Control sites remained stable over time for both parameters. The 2PD sensitivity may be the result of regenerated nerves, but this could not be confirmed by LTS.

Implant Dentistry

Vol. 19 No. 1 (February 2010)

Barboza EP, Stutz B, Ferreira VF, Carvalho W.  Guided bone regeneration using nonexpanded polytetrafluoroethylene membranes in preparation for  dental implant placements – a report of 420 cases. Implant Dent 2010;19(1):2-7.

In 420 cases of alveolar ridge maintenance for  implant placement, nonexpanded PTFE membranes were placed over extraction sites and bone allograft used to prevent membrane collapse in the case of buccal wall loss. Soft tissue compatibility and keratinized gingiva were apparent at the time of implant placement, with preservation of the mucogingival position. The use of nonexpanded PTFE membranes therefore resulted in tissue suitable for implant placement.


Anner R, Grossman Y, Anner Y, Levin L.  Smoking, diabetes mellitus,  periodontitis, and supportive periodontal treatment as factors associated with dental implant survival: a long-term retrospective evaluation of patients followed for up to 10 years. Implant Dent 2010;19(1):57-64.

Data were obtained regarding smoking, diabetes, periodontitis and implant survival from 475 patients who received 1,626 implants. Patients were either in a supportive periodontal program (246 patients) or only attended annual implant examination (229 patients). Mean follow-up time was 30.82 ± 28.26 months (range 1 to 114 months). The implant survival rate was 95.3% (77 implants lost). Implant survival was significantly associated with attendance in a supportive periodontal program and smoking status. Implant survival was lower in patients with moderate-to-advanced periodontal disease, but the difference was not significant, and diabetes appeared to have no influence on implant survival.


Akeredolu PA, Adeyemo WL, Omolulu OB, Karunwi O.  Implant restoration of partially edentulous ridges: a review of 121 Nigerian patients. Implant Dent 2010;19(1):57-64.

A data analysis was carried out on 121 patients who had received 227 implants supporting complete superstructures over a 6-year period. The majority were of high socioeconomic class; 91.7% received 2-stage implant procedures and only 8.3% received immediate implants. The greatest number of implants (39.2%) was placed in the molar region. There were nine implant failures, giving a success rate of 96%.


International Journal of Oral and Maxillofacial Implants

Vol. 24 No. 7 (Suppl 2009)

Vol. 25 No. 1 (February 2010)

Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl):12-27.

A literature search was performed to identify studies citing implant survival in patients diagnosed with at least one of 12 systemic diseases. No comparisons with  and without the condition in a controlled setting were found for most conditions – only case reports or case series were available for most conditions. There appeared to be no tendency towards a higher failure rate in diabetic patients, but a formal meta-analysis was not possible. Evidence for increased implant failure in osteoporosis was low, but the use of bisphosphonates was considered a risk factor for osteonecrosis of the jaw. A low level of evidence was therefore found for contraindications in implant therapy. Prospective controlled studies are therefore required.


Martin W, Lewis E, Nicol A.  Local risk factors for implant therapy.  Int J Oral Maxillofac Implants 2009;24(Suppl):28-38.

Literature on clinical studies evaluating potential local risk factors was reviewed, a total of 19 papers were selected from an initial screen of 2,681. Proximal bone may be at risk when an implant is placed within 3 mm of an adjacent tooth, but data are limited. Implant placement in infected sites may be possible, but data are insufficient. There appeared to be no evidence of soft tissue  thickness or keratinized tissue as a risk factor for success. No bone density studies were found, and examination of implant stability was difficult due to a lack of validated measurements.


Heitz-Mayfield LJA, Huynh-Ba G. History of treated peridontitis and smoking as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl):39-68.

Literature on periodontitis and smoking as risk factors for implant success was examined. Studies were very heterogeneous and most did not account for confounding variables. Survival rates > 90% were found in patients with treated periodontitis, and  a higher risk of peri-implantitis  was suggested in these patients, compared to patients with no history of periodontitis, by three studies. Smoking appeared to be a significant risk factor, with significantly lower implant survival rates found in smokers versus non-smokers. 


Salvi GE, Bragger U. Mechanical and technical risks in implant therapy.  Int J Oral Maxillofac Implants 2009;24(Suppl):69-85.

From a total of 3,568 articles, 111 on the impact of mechanical/technical risk factors were selected, of which 33 were included in the analysis. After grouping according to different types of risk factor, the results indicated that more mechanical/technical complications were noted with an absence of metal framework in overdentures, cantilever extensions > 15 mm, length of construction, history of repeated complications, and bruxism. Type of retention, angled abutments, crown-implant ratio  and number of implants were not associated with more complications. Implant survival/success rates did not appear to be affected.


Jung RE, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hammerle CHF, Tahmaseb A.  Computer technology applications in surgical implant dentistry: a systematic review.  Int J Oral Maxillofac Implants 2009;24(Suppl):92-109.

From a literature search on studies assesing the accuracy and performance of computer-assisted implant systems a total of 2,827 articles were identified, and 32 studies (13 clinical and 19 accuracy studies) on 29 guidance systems were selected. The total mean error calculated was 0.74 mm and 0.85 mm at the entry point of the bone and the apex, respectively. The mean implant failure rate for a follow-up of at least 12 months was 3.36% and the intraoperative complication rate was 4.6%. High implant survival and reasonable accuracy were therefore noted, but further studies are recommended.


Kapos T, Ashy LM, Gallucci GO, Weber H-P, Wismeijer D. Computer-aided design and computer-assisted manufacturing in prosthetic implant dentistry. Int J Oral Maxillofac Implants 2009;24(Suppl):110-117.

Long-term follow-up studies focusing on the restorative aspects of CAD/CAM were evaluated; five articles (189 prostheses supported by 888 implants) fulfilled the search criteria from an initial total of 885. The follow-up times were from 12 to 60 months for three CAD/CAM framework studies. Four implants failed before prosthesis placement, 46 failed after prosthesis placement, and there was one prosthesis failure. In CAD/CAM abutment studies, 53 abutments supported by 53 implants were followed for between 12 and 44 months with no failures or significant complications. However, the clinical studies evaluated were too preliminary and underpowered for any conclusions to be drawn.


Brodala N.  Flapless surgery and its effect on dental implant outcomes.  Int J Oral Maxillofac Implants 2009;24(Suppl):118-125.

A literature search was performed for clinical studies with flapless surgery form implant placement. The available prospective studies showed an implant survival rate of 98.6%, while retrospective studies showed a survival rate of 95.9%. Mean radiographic bone loss ranged from 0.7 to 2.6 mm. Intraoperative complications reported in four studies included perforation of the buccal or lingual bony plate, and the overall incidence was 3.8%. Flapless surgery therefore appeared to be suitable, but successful  outcomes are dependent on a number of factors.

Gallucci GO, Morton D, Weber H-P. Loading protocols for dental implants in edentulous patients. Int J Oral Maxillofac Implants 2009;24(Suppl):132-146.

From a total of 2,371 articles, 61 articles on loading protocols for rough-surfaced implants fulfilled the inclusion criteria; the data included 9,701 implants in  2,278 patients. Conventional loading with maxillary fixed prostheses and mandibular overdentures had the highest level of evidence; in contrast, evidence was insufficient for immediate loading of maxillary overdentures and immediately placed implants with foxed or removable prostheses.


Roccuzzo M, Aglietta M, Cordaro L.  Implant loading protocols for partially edentulous maxillary sites.  Int J Oral Maxillofac Implants 2009;24(Suppl):147-157.

Articles on early and immediate loading of posterior maxillary implants were reviewed; 18 papers were identified for evaluation (12 on early loading and six on immediate loading). The results of the papers suggested that early or immediate loading is possible in selected patients, although success appears to be technique-sensitive. Implant surface characteristics and good primary stability seem to be important. No conclusions could be drawn on contraindications, bone quality, stability threshold values, impact of loading forces or surgical technique. Further clinical investigations are therefore necessary.


Cordaro L, Torsello F, Roccuzzo M. Implant loading protocols for the partially edentulous posterior mandible. Int J Oral Maxillofac Implants 2009;24(Suppl):158-168.

A total of 19 articles (15 prospective studies and five randomized clinical trials) on early and immediate loading of implants in the posterior edentulous mandible met the inclusion criteria for evaluation. Early loading is supported by the literature and can be a  routine and predictable procedure. Immediate loading was also shown to be a viable treatment alternative, however, the exclusion criteria were inconsistent in many immediate loading studies and confounding factors were noted. Further  clinical trials are therefore necessary.


Grutter L, Belser UC.  Implant loading protocols for the partially edentulous esthetic zone.  Int J Oral Maxillofac Implants 2009;24(Suppl):169-179.

Papers relating to different implant placement and loading protocols were reviewed. The results of 10 prospective cohort studies and one case series showed an  implant survival rate of 97.3% for immediately restored or conventionally loaded implants after 12 months, but the survival rate was as low as 10% from four studies with immediately placed and restored implants with full occlusal loading. It was not possible to evaluate success criteria. The authors suggested that objective esthetic success criteria should be used for implant protocols in the anterior maxilla.


Chen ST, Buser D.  Clinical and esthetic outcomes of implants placed in postextraction sites.  Int J Oral Maxillofac Implants 2009;24(Suppl):186-217.

A literature search for articles on implants in postextraction sites gathered a total of 1,107 articles, of which 91 studies were selected that met the inclusion criteria. Bone augmentation procedures appeared to be effective for defect resolution at post-extraction sites, more so with immediate and early implant placement than with late placement. Survival rates were over 95% in most studies, and survival rates were similar for immediately and early placed implants. Facial mucosal recession was often noted with immediate placement and was less common with early placement.


Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials.  Int J Oral Maxillofac Implants 2009;24(Suppl):218-236.

Articles on different grafting protocols were searched  for and a total of 2,006 identified, of which 424 were evaluated and 108 were included and categorized according to the defect type. Most were prospective or retrospective studies with a limited number of patients and only 11 were randomized controlled trials. It was not possible to identify the superiority of any one grafting protocol die  to the heterogeneity of studies, but there was a high level of evidence to suggest similar implant survival rates in augmented sites to those in native bone.

Chiapasco M, Casentini P, Zaniboni M.  Bone augmentation procedures in implant dentistry.  Int J Oral Maxillofac Implants 2009;24(Suppl):237-259.

A literature search focusing on different surgical techniques and implant survival/success rates in augmented sites was performed. A review of the relevant articles identified a wide range of surgical procedures, but it was not possible to demonstrate superiority of any  one treatment. Moreover, improvement of long-term implant survival was as yet unknown with some procedures, e.g. onlay autogenous bone grafts in edentulous mandibles and maxillary sinus grafting with limited/moderate pneumatisation. The authors suggested that priority should be given to simpler, less invasive procedures with less risk of complications.


Darby I, Chen ST, Buser D.  Ridge preservation techniques for implant therapy.  Int J Oral Maxillofac Implants 2009;24(Suppl):260-271.

A total of 135 abstracts were identified from a literature search on ridge preservation techniques, from which 53 articles were reviewed and 37 were evaluated. Comparisons were difficult due to the number of different techniques, methodologies and materials, but evidence for the effectiveness of ridge preservation for limiting horizontal and vertical ridge alterations in postextraction sites was observed. It was not possible to identify the superiority of any one technique.


Wennerberg A, Albrektsson T. On implant surfaces: a review of current knowledge and opinions. Int J Oral Maxillofac Implants 2009;25(1):63-74.

This review examined implant surface characteristics, particularly in terms of micro- and nanometer roughness, surface modifications (e.g. hydrophilicity, biochemical bonding) and suggested a hypothetical common mechanism behind enhanced bone response. Surface roughness (Sa) of implants from four major manufacturers varied from 0.3 to 1.78 μm, while developed surface area ratio varied from 24% to 143%. Implants from Biomet 3i had the lowest Sa and implants from Straumann had the highest. Novel implants from Biomet 3i, Astra Tech and Straumann all differed from their respective predecessors and all had nano-roughness structure characteristics that were not found in their respective predecessors. It was suggested that this may be a common mechanism leading  to the enhanced bone responses to these implants compared to controls.


Akça K, Cehreli MC, Uysal S.  Marginal bone loss and prosthetic maintenance of bar-retained implant-supported overdentures: a prospective study. Int J Oral Maxillofac Implants 2009;25(1):137-145.

A total of 35 patients received 124 implants (80  maxillary and 44 mandibular) to support bar-retained overdentures. There was one early implant failure in the mandible and one late implant failure in the maxilla, both of which were replaced after 12 weeks. Similar soft tissue parameters were noted for maxillary and mandibular implants, and 1- and 5-year survival rates were similar. Mandibular overdentures showed a higher probability of requiring retainer re-tightening and occlusal adjustments, but there appeared to be no difference in other maintenance requirements. The results indicated that maxillary and mandibular implant-supported overdentures have similar survival and soft tissue outcomes.

Cehreli MC, Karasoy D, Kokat AM, Akca K, Eckert SE.  Systematic review of  prosthetic maintenance requirements form implant-supported overdentures. Int J Oral Maxillofac Implants 2009;25(1):163-180.

A literature search for studies with implant overdentures gave 3,120 articles, of which 287 were selected for full-text analysis and 49 were included in the review. No change in the frequency of complications over time was noted, but more matrix replacements were required after 5 years in the maxilla and mandible, and more matrix and patrix fractures occurred after 1 year in the mandible. Dislodged, worn or loose matrices were more common with ball attachments after the first year, but prosthetic complications were comparable for all attachment types, with the exception of peri-implant or inter-abutment-mucosal enlargement after 1 year.


Kronstrom M, Davis B, Loney R, Gerrow J, Hollender L. A prospective randomized study on the immediate loading of mandibular overdentures supported by one or two implants: a 12-month follow-up report.  Int J Oral Maxillofac Implants 2009;25(1):181-188.

A total of 36 patients received new maxillary and mandibular complete dentures. The patients then received one implant in the symphyseal area (17 patients) or two implants in the canine positions (19 patients) in the interforaminal area of the mandible and the dentures were relined, provided with O-rings and connected to the implants on the day of surgery. Within 12 months there were 10  implant failures in nine patients and three patients (each with two implants) withdrew from the study, giving a 12-month survival rate of 81.8%. Six of the failures were within the first month.  Caution should therefore be exercised when considering immediate loading on implant-supported overdentures on one or two implants with ball attachments. 


Boronat A, Carrillo C, Peñarrocha M, Peñarrocha M. Dental implants placed simultaneously with bone grafts in horizontal defects: a clinical retrospective study with 37 patients.  Int J Oral Maxillofac Implants 2009;25(1):189-196.

Of a total of 129 implants, 73 were placed simultaneously with 37 intraoral block grafts in 37 patients. After 1 year, partial graft exposure was noted at eight sites, spontaneous re-epithelialization was observed at six sites following chlorhexidine application, and infection was observed at two sites, necessitating graft removal. No donor site complications were noted and no other complications were noted 1 year after prosthesis placement. There were three implant failures, giving an implant success rate of 95.9%.The mean 1-year bone loss was 0.64 mm. Simultaneous bone grafting and implant placement can therefore be a viable option in certain patients.


International Journal of Periodontics and Restorative Dentistry

Vol. 30 No. 2 (March/April 2010)

Shapoff CA, Lahey B, Wasserlauf PA, Kim DM. Radiographic analysis of crestal bone levels around Laser-Lok Collar dental implants. Int J Periodontics Restorative Dent 2010;30(2):129-137.

A total of 49 Laser-Lok implants with microtexturing were retrospectively analysed radiographically. Mean crestal bone loss after 2 and 3 years was 0.44 mm and 0.46 mm, respectively, all of which was contained within the height of the implant collar. The results suggested that the concept of a biologic seal around an implant consisting of connective tissue fibers may be clinically relevant.

Cocchetto R, Traini T, Caddeo F, Celletti R.  Evaluation of hard tissue response around wider platform-switched implants. Int J Periodontics Restorative Dent 2010;30(2):163-171.

Ten patients received a total of 15 implants with body and collar diameters of 5.0 and 5.8 mm, respectively, with healing abutments of 4.1 mm in diameter. Radiographs were taken after 2, 12 and18 months of loading. Mean peri-implant one loss was 0.30 mm after 18 months, indicating that the platform switching concept may reduce the extent of peri-implant bone loss.


Wu S-Y, Chen Y-T, Chen C-W, Chi L-Y, Hsu N-Y, Hung S-L, Ling L-J. Comparison of clinical outcomes following guided tissue regeneration treatment with a polylactic acid barrier or a collagen membrane.  Int J Periodontics Restorative Dent 2010;30(2):173-179.

Guided tissue regeneration using a polylactic acid barrier or a collagen membrane was performed in 30 patients with chronic periodontitis and one or more intrabony defects of ≥ 4 mm. Clinical measurements were performed 1 week before and 6 months after surgery. Probing depth was significantly reduced and clinical attachment level was significantly increased in both groups, with no significant differences between the groups. However, bone fill was significantly greater with the collagen membrane compared to the polylactic acid barrier.


International Journal of Prosthodontics

Vol. 23 No. 2 (March/April 2010)

Rentsch-Kollar A, Huber S, Mericske-Stern R. Mandibular implant overdentures  followed for over 10 years: patient compliance and prosthetic maintenance. Int J Prosthodont 2010;23(2):91-98.

Follow-up periods of over 10 years were completed for 147 patients with 314 implants supporting mandibular ovedentures between 1984 and 2008, at which time 101 patients were available for re-evaluation. A high compliance rate (over 90%) was found and over 80% of dentures were still in service. Major prosthetic maintenance was uncommon, and retention device complications consisted mainly of the mounting of new female retainers, bar repair and changing of ball anchors; complications and the need for prosthetic service were significantly higher with ball anchors compared to bar attachments. Implant overdentures are therefore a useful treatment, provided there is regular maintenance and prosthetic service.

Ma S, Payne AGT. Marginal bone loss with mandibular two-implant overdentures using different loading protocols: a systematic literature review. Int J Prosthodont 2010;23(2):91-98.

From a literature search of studies with two-implant  overdentures, a total of 25 articles met the inclusion criteria. Long-term results were found for conventional  loading, but only short-term results were found for early and immediate loading; however, high success rates were found with all loading protocols. Long-term outcomes on marginal bone loss were not found, and there was a lack of standardization of radiographic methods for bone loss evaluation. Marginal bone loss values in the first year ranged from 0.2 to 0.7 mm for two-stage and from 0.0 mm to 2-0 mm for one-stage conventional loading protocols, while marginal bone loss ranged from 0.0 to 2.0 mm for early loading and was around 0.7 mm for immediate loading. Early and immediate loading of mandibular overdentures showed no detrimental effects, but no long-term data were available.

Journal of Biomedical Materials Research Part A

Vol. 93 No. 1 (April 2010)

Vol. 93 No. 2 (May 2010)

Vol. 93 No. 3 (June 2010)

Lai H-C, Zhuang L-F, Liu X, Wieland M, Zhang Z-Y, Zhang Z-Y. The influence of surface energy on early adherent events of osteoblast on titanium substrates. J Biomed Mater Res A 2010;93(1):289-296.

Cell morphology and cell attachment of human alveolar osteoblasts were measured on hydrophilic SLA and hydrophobic modified SLA (modSLA) surfaces, and the  expression of focal adhesion kinase measured. Attachment rates were significantly higher on the modSLA surface after 3 h, and after 6 h focal adhesion kinase expression was significantly higher and more defined actin stress fibers were apparent. Cell adhesion was therefore enhanced by modSLA in the early stages of cell response.


An N, Schedle A, Wieland M, Andrukhov O, Matejka M, Rausch-Fan X. Proliferation, behavior, and cytokine gene expression of human umbilical vascular endothelial cells in response to different titanium surfaces. J Biomed Mater Res A 2010;93(1):364-372.

Cell behavior of human umbilical vascular endothelial cells on acid-etched (A), grit-blasted/acid-etched (SLA) and modified acid-etched (modA) and modified grit-blasted/acid-etched (modSLA) was evaluated. The greatest cell proliferation, mobility and cluster formation were observed with modA, and little cell aggregation was observed on SLA and modSLA surfaces. Gene expression of thrombomodulin, endothelial cell protein C receptor, von Willebrand factor and adhesion molecules was greatest with modSLA, suggesting that this surface is optimal for proliferation and angiogenic behavior of endothelial cells, and promoted the expression of genes that play an important role in controlling inflammation and revascularization.


O’Dowd LK, Durham J, McCracken GI, Preshaw PM.  Patients’ experiences of the impact of periodontal disease. J Clin Periodontol 2010;37(4):334-339.

Data were obtained from patients with periodontal disease using semi-structured interviews conducted with a topic guide; the data were then organized and themes identified. Effects on patients’ daily lives included impairment, functional limitation, discomfort and disability, many of the themes related to Locker’s conceptual model of oral health, with stigma and retrospective regret identified as two additional themes. Patients’ lives are therefore affected by periodontitis in a number of different ways.


Trombelli L, Rizzi A, Simonelli A, Scapoli C, Carrieri A, Farina R. Age-related treatment response following non-surgical periodontal therapy. J Clin Periodontol 2010;37(4):346-352.

Two groups of periodontitis patients (mean age 34.7 ± 4.4 years and 58.9 ± 5.3 years) who received non-surgical periodontal therapy were retrospectively selected and analyzed. Probing depth and bleeding on probing were significantly improved in both groups, and  there were no significant differences between the groups for any of the clinical parameters; however, the risk of residual pockets following treatment was significantly greater in the older group. Age therefore has a limited effect on treatment response to non-surgical periodontal treatment.

Journal of Oral and Maxillofacial Surgery

Vol. 68 No. 3 (March 2010)

Vol. 68 No. 4 (April 2010)

Martin DC, O’Ryan FS, Thomas Indresano A, Bogdano P, Wang B, Hui RL, Lo JC. Characteristics of implant failures in patients with a history of oral bisphosphonate therapy. J Oral Maxillofac Surg 2010;68(3):508-514.

From a dental survey, dental implants were reported in 589 patients out of 8,572 who received oral bisphosphonate drugs; 26 implant failures were reported in 16 of these patients and  the characteristics of loss were analyzed. There were 12 failures in the maxilla (8 patients) and 14 failures in the mandible (9 patients). The majority of failures occurred more than  1 year after placement, so were classified as late failures (18 implants in 10 patients compared to 8 implant  failures in 8 patients within 1 year). The role of chronic bisphosphonate therapy in implant survival and osseointegration requires further investigation.


Salinas TJ, Desa VP, Katsnelson A, Miloro M. Clinical evaluation of implants in radiated fibula flaps. J Oral Maxillofac Surg 2010;68(3):524-529.

Mandibular resection and reconstruction was performed in 44 patients, who were retrospectively evaluated. Half of the patients received adjuvant doses of radiation therapy (> 6,000 Gy) and 20 preoperative and 10 postoperative hyperbaric oxygen treatments. In 44 patients, 206 implants were placed (144 in a fibula flap and 92 in the native mandible). After a mean follow-up of 41.1 months (range 4-108 months), there were 31 implant failures, giving a success rate of 85% (82.4% in fibula flaps and 88% in native bone) and a cumulative survival rate of 91.1%. Most failures in fibula flaps occurred within 6 months, while more failures in native bone occurred later. Radiation therapy therefore did not adversely affect implant survival.

Créton M, Cune M, Verhoeven W, Muradin M, Wismeijer D, Meijer G.  Implant treatment in patients with severe hypodontia: a retrospective evaluation. J Oral Maxillofac Surg 2010;68(3):530-538.

A total of 294 patients diagnosed as having oligodontia or severe hypodontia were selected and evaluated, and implant outcomes assessed. Of  the 294 patients, 44 were treated in combination with 214 implants. Mean observation period was 2.9 years, and the cumulative implant survival after 5 years was 89.8%. The implant patients were missing fewer teeth and were more recently treated compared to those who received conventional or no treatment. The survival rate in these patients was therefore deemed to be acceptable.

Lazarovici TS, Yahalom R, Taicher S,  Schwartz-Arad D, Peleg O, Yarom N.  Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg 2010;68(4):790-796.

Records of patients with bisphosphonate-associated osteonecrosis of the jaws (BRONJ) treated with dental implants over a 6-year period; a total of 27 patients were enrolled. BRONJ was seen in 11 patients taking oral bisphosphonates and 16 patients on intravenous bisphosphonates, and BRONJ developed after a mean of 68 months for alendronate, 16.4 months for zoledronic acid and 50.2 months for pamidronate. The mean duration of onset of BRONJ if treatment began prior to implant placement was 16.2 months. No significant association was found between BRONJ and diabetes, steroid intake or smoking.


Johansson L-Å, Isaksson S, Lindh  C, Becktor JP, Sennerby L.  Maxillary sinus floor augmentation and simultaneous implant placement using locally harvested autogenous bone chips and bone debris: a prospective clinical study. J Oral Maxillofac Surg 2010;68(4):837-844.

A total of 81 patients requiring maxillary sinus floor augmentation received one of two treatments: in 17 patients (20 implants) a bone trap was used to collect bone debris during implant placement, with additional bone from drilling adjacent to the implant sites; in  44 patients (61 implants), cortical bone chips were harvested from the zygomatic buttress and lateral sinus wall using a bone scraper prior to opening of a bony window. The implant survival rate was 98.8% after  a 12-60 month follow-up; one implant was lost in the second group prior to loading. There were no differences in marginal mesial and distal bone loss from baseline, but there was significant decrease in graft height on the distal apical side of the implants.

 Journal of Oral Implantology

Vol. 36 No. 1 (January 2010)

Nahas AA, Dechichi P, de Magalhães D, Vieira AE.  Histologic analysis of the oral mucosa lining osseointegrated implant cover screws: a study in humans. J Oral Implantol 2010;36(1):3-10.

In 12 patients who received implants, 17 mucosal specimens were taken during the second surgical session and histologic analysis performed. Keratinized, stratified squamous epithelium was observed in all specimens, with unorganized dense connective tissue in the reticular layer. Four samples also showed a chronic inflammatory infiltrate in this region. Tall  connective papillae were found in the papillary layer that comprised loose connective tissue. The mucosa  over cover screws therefore shares morphologic characteristics with the alveolar mucosa.


Journal of Oral Rehabilitation

Vol. 37 No. 3 (March 2010)

Vol. 37 No. 4 (April 2010)

Ohkubo C, Baek KW. Does the presence of antagonist remaining teeth affect implant overdenture success? A systematic review. J Oral Rehabil 2010;37(3):306-312.

A literature review was performed to assess the potential influence of antagonist natural teeth on the success of implant overdentures. Opposing natural dentition was not well described in the literature, but 10 articles each on the maxilla and mandible were selected. High success/survival rates for mandibular overdentures were noted, while rates were lower for maxillary overdentures. Antagonist teeth were not judged to be a risk factor for mandibular overdentures but may have an adverse effect on maxillary overdentures; however, the presence of antagonist teeth is not a contraindication in these circumstances. No apparent correlation between the presence of antagonist teeth and overdenture success was found.

Journal of Periodontal Research

Vol. 45 No. 2 (April 2010)

Zeldich E, Koren R, Dard M, Weinberg E, Weinreb M, Nemcovsky CE. Enamel matrix derivative induces the expression of tissue inhibitor of matrix metalloproteinase-3 in human gingival fibroblasts via extracellular signal-regulated kinase. J Periodontal Res 2010;45(2):200-206.

In an  in vitro study, human gingival fibroblasts were treated with EMD or TNF or a combination of both to investigate MMP and TIMP expression. Expression of MMP-1, -2, -3, -7 and -13 and TIMP-1 and -3 was detected in untreated cells, but neither TNF nor EMD regulated the expression of MMP-2, -7 and-13 and TIMP-1. MMP-1 expression was increased by TNF and decreased by EMD; TIMP-3 expression was also induced by EMD. Gingival health may therefore be affected by EMD in terms of TIMP-3 production, which may improve the tissue MMP-TIMP balance.


Journal of Periodontology

Vol. 81 No. 2 (February 2010)

Vol. 81 No. 3 (March 2010)

Pradeep AR, Thorat MS. Clinical effect of subgingivally delivered simvastatin in the treatment of patients with chronic periodontitis: a randomized clinical trial. J Periodontol 2010;81(2):214-222.

A total of 60 patients with chronic periodontitis were treated with scaling and root planing together with either 1.2 mg simvastatin or placebo. Clinical evaluations were performed at baseline and after 1, 2, 4 and 6 months. Significant improvements were observed in both groups, but there was a greater decrease in modified sulcus bleeding index and probing depth, a greater increase in clinical attachment level, and a greater increase in intrabony defect fill in the simvastatin group. Locally delivered simvastatin therefore improved clinical parameters more than scaling and root planing alone.


Koldsland OC, Scheie AA, Aass AM. Prevalence of peri-implantitis related  to severity of the disease with different degrees of bone loss. J Periodontol 2010;81(2):231-238.

The prevalence of peri-implant disease was assessed in 109 subjects who received dental implants between 1990 and 2005. The mean loading time was 8.4 years. Assessment of clinical and radiographic parameters indicated a substantial variance in the prevalence of peri-implantitis (from 11.3% to 41.1%) at different levels of severity. Peri-implant disease was therefore a frequent finding, both with and without bone loss.

Martin JA, Page RC, Loeb CF, Levi PA Jr. Tooth loss in 776 treated periodontal patients. J Periodontol 2010;81(2):244-250.

Nine periodontists each evaluated 100 periodontal maintenance patients for disease severity, risk level and number of teeth lost. The rate of tooth loss was predicted by the disease severity and risk level, but only disease score was significantly associated with the probability of the loss of a specific number of teeth as measured by logistic regression analysis. Categorization by severity may therefore be beneficial and can be used to establish a criterion and target for care.


Crespi R, Capparè P, Gherlone E. Osteotome sinus floor elevation and simultaneous implant placement in grafted biomaterial sockets: 3 years of follow-up. J Periodontol 2010;81(3):344-349.

In 20 patients, a total of 30 teeth were extracted (one or two upper molars and/or a second premolar) and the sockets immediately filled with mg-enriched HA. Osteotome sinus floor elevation was performed after 3 months and 30 implants were placed;  restorations were placed after a further 3 months and radiographic evaluations were performed after 6, 12, 24 and 36 months. Implant survival was 100% after 36 months. Bone gain after 6, 12, 24 and 36 months were 2.41 ± 1.23 mm, 3.85 ± 1.37 mm, 3.86 ± 1.50 and 3.82 ± 1.57 mm, respectively. The difference was significant between 6 and 12 months. Osteotome sinus floor elevation for vertical expansion of grafted tissue was therefore a predictable procedure.


Chen L, Wei B, Li J, Liu F, Xuan D, Xie B, Zhang J. Association of periodontal parameters with metabolic level and systemic inflammatory markers in patients with type 2 diabetes. J Periodontol 2010;81(3):364-371.

Periodontal parameters were examined and blood analyses were performed in 140 patients with type 2 diabetes, who were then stratified according to probing depth level. The results indicated that patients with higher probing depth levels had significantly higher HbA1c and high-sensitivity C-reactive protein (hsCRP) levels, but there were no significant differences in TNF-α, fasting glucose or lipid profiles. Taking other patient parameters into account, there was a  positive correlation between probing depth and HbA1c and between probing depth and hsCRP.


Crespi R, Capparè P, Gherlone E.  Fresh-socket implants in periapical infected sites in humans.  J Periodontol 2010;81(3):378-383.

Single tooth extraction was performed in 30 patients; 15 patients had periapical lesions/radiolucencies and 15 patients had no periapical lesions but had root caries/fractures. Implants were placed immediately in the extraction sockets and loaded after 3 months. Clinical evaluations were performed at baseline and after 12 and 24 months. Implant survival was 100% after 24 months and the mean bone loss was 0.86 ± 0.54 mm and 0.82 ± 0.52 mm in the groups with and without periapical lesions. Similarly, there were no significant differences in plaque accumulation, modified bleeding index or probing depth between the groups. Predictable outcomes were therefore observed in immediate implant placement in patients with periapical lesions.

Canullo L, Quaranta A, Teles RP. The microbiota associated with implants restored with platform switching: a preliminary report. J Periodontol 2010;81(3):403-411.

In 18 patients a total of 48 implants were placed,  33 with platform switching and 15 with conventional restoration. Plaque samples were taken from adjacent teeth after 36 months and the subgingival species evaluated. Similar microbial profiles were observed between teeth and implants. No significant differences between any of the species were found, but there was a lower trend towards early colonizing members of the Actinomyces, purple and yellow complexes. Campylobacter spp, T forsythia and P gingivalis. Differences in crestal bone resorption between platform-switched and  non-platform-switched implants are therefore not related to peri-implant microbiota.


Donovan R, Fetner A,  Koutouzis F, Lundgren T.  Crestal bone changes around implants with reduced abutment diameter placed non-submerged and at subcrestal positions: a 1-year radiographic evaluation. J Periodontol 2010;81(3):428-434.

Radiographs from the 1-year follow-up visit from 50 patients who received non-submerged subcrestal implants were compared to the radiographs obtained from the surgical appointment. The mean subcrestal implant positioning was 1.37 mm and 1.28 mm mesially and distally, respectively. Implant survival was 100% and the mean hard tissue loss was 0.11 ± 0.30 mm, with no differences between mesial and distal or between the maxilla and mandible. No correlation was found between the degree of subcrestal placement and the amount of hard tissue loss. Hard tissue was observed to extend to the implant shoulder in the majority (69%) of cases. 


Harrel SK, Wilson TG Jr, Nunn ME.  Prospective assessment of the use enamel matrix derivative with minimally invasive surgery: 6-year results. J Periodontol 2010;81(3):435-441.

Patients with advanced periodontitis  with sites with probing depths  ≥ 6 mm received minimally invasive surgery with EMD placed after surgical debridement; 11-month results from this  study were previously published. After 6 years, 142 sites in 13 patients were available for evaluation. The mean probing depth and attachment level were 3.18 ± 0.59 mm and 3.93 ± 0.19 mm, respectively, showing no significant difference from the 11-month results. The significant improvements in probing depth and gain in attachment level were therefore maintained for up to 6 years.


Journal of Prosthetic Dentistry

Vol. 103 No. 2 (February 2010)

Vol. 103 No. 3 (February 2010)

Gonda T, Maeda Y, Walton JN, MacEntee MI. Fracture incidence in mandibular overdentures retained by one or two implants. J Prosthet Dent 2010;103(3):178-181.

Retrospective data were obtained from 85 patients (42 with single implants and 43 with two implants) with implant overdentures followed for at least 17 months; the number and location of fracture sites was recorded. Eleven fractures were noted in nine single-implant subjects and sic fractures were noted in four two-implant subjects; the difference between groups was not significant. The most common fracture location was adjacent to the implants.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Vol. 109 No. 3 (March 2010)

Vol. 109 No. 4 (April 2010)

Gökçen-Röhlig B, Meriç U, Keskin H. Clinical and radiographic outcomes of implants immediately placed in fresh extraction sockets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(4):e1-e7.

Remaining mandibular teeth were extracted in 10 patients, each of whom received four implants, two in fresh extraction sockets and two in mature bone. Scores of 0 and 1 for modified plaque index were comparable in both groups at 1 year and remained stable at 2 years. There were also no significant differences in modified bleeding index, probing depth or keratinized mucosal width between the two groups, indicating that placement of implants in fresh extraction sockets can be a suitable and predictable treatment.


Quintessence International

Vol. 41 No. 3 (March 2010)

Vol. 41 No. 4 (April 2010)

Agliardi E, Clericò M, Ciancio P, Massironi D.  Immediate loading of full-arch  fixed prostheses supported by axial and tilted implants for the treatment of edentulous atrophic mandibles.  Quintessence Int 2010;41(4):285-293.

A total of 24 patients with edentulous atrophic mandibles received axial and tilted implants to support a complete prosthesis, delivered within 2 days if implant surgery, and were assessed for up to 42 months. The mean follow-up was 30.1 months and the mean bone loss after 12 months was 0.8 mm for tilted implants and 0.9 mm for axial implants (total mean bone loss 0.85 mm). Immediate rehabilitation of the edentulous atrophic mandible with careful implant positioning can therefore be successful.


Philipp A, Fischer J, Hämmerle CHF, Sailer I.  Novel ceria-stabilized tetragonal zirconia/alumina nanocomposite as framework material for posterior fixed dental prostheses: preliminary results of a prospective case series at 1 year of function. Quintessence Int 2010;41(4):313-319.

Ce-TZP/A-nanocomposite FDP frameworks were fabricated for eight patients to replace molars or premolars. The FDPs were cemented and technical and biological evaluations were performed at baseline and after 2 weeks and 3, 6 and 12 months, with radiographs taken at 6 and 12 months. The FDP survival rate after a mean follow-up time of 12.8 ± 1.1 months was 100%, and no biological or technical complications were observed. Plaque control, bleeding on probing and  probing depth were not significantly different between test and control teeth. The Ce-TZP/A nanocomposite framework was therefore suitable, but further investigation is recommended.

Nhan Tam Dental Clinic – Dental Implant And Cosmetic Restoration
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