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Literature Update Nov - Dec 2010

Clinical Implant Dentistry and Related Research

Vol. 12 No. 4 (December 2010)

Dahlin C, Simion M, Hatano N.  Long-term follow-up on soft and hard tissue levels following guided bone regeneration treatment in combination with a xenogeneic filling material: a 5-year prospective clinical study.

Clin Implant Dent Relat Res 2010;12(4):263-270.

A total of 41 implants were placed conjunction with GBR in 20 patients and followed up for 5 years. The cumulative survival rate was 97.5% and the reduction in mean bone height was from -3.51 mm to -2.38 mm. Marginal  soft  tissue  level  was  stable  throughout  the  5-year  period.  GBR  in  conjunction  with  implant placement is therefore a viable treatment option to maintain hard and soft tissue levels.


Hjalmarsson L, Örtorp A, Smedberg J-I, Jemt T.  Precision of fit to implants: a comparison of Cresco and

Procera implant bridge frameworks. Clin Implant Dent Relat Res 2010;12(4):271-280.

Titanium or Co-Cr Cresco frameworks and titanium Procera frameworks for implant-supported fixed compete prostheses were fabricated and measurements of fit on implants calculated. The maximal 3D range of center point distortion was 279 μm. Framework width increased in the titanium frameworks but decreased for Cresco-CoCr, and fewer distortions were apparent in the vertical dimension for the Procera versus the Cresco frameworks. However, no complete passive fit was observed for any of the frameworks.


Shibli JA, Grassi S, Piattelli A, Pecora GE, Ferrari DS, Onuma T, D’Avila S, Coelho PG, Barros R, Iezzi G. Histomorphometric evaluation of bioceramic molecular impregnated and dual acid-etched implant surfaces in the human posterior maxilla. Clin Implant Dent Relat Res 2010;12(4):281-288.

Implants with a dual acid-etched surface (control) and with bioceramic molecular impregnation (test) were placed in 10 subjects (one of each surface in each subject) during conventional implant surgery in the maxilla. The implants were removed and evaluated after 2 months. Significantly higher BIC and osteocyte index values were found for the test implants but there was no significant difference in bone density in threaded area between the two groups. The bioceramic molecular impregnation therefore appeared to have a positive influence on early bone healing.


Gahlert  M,  Röhling  S,  Wieland  M,  Eichhorn  S,  Küchenhoff  H,  Kniha  H.  A  comparison  study  of  the osseointegration of zirconia and titanium dental implants. A biomechanical evaluation in the maxilla of pigs. Clin Implant Dent Relat Res 2010;12(4):297-305.

Acid-etched zirconia implants and sandblasted and acid-etched titanium implants were placed in the maxillae of 16 pigs 6 months after the extraction of second and third incisors. Removal torque was assessed after 4, 8 and 12 weeks. Removal torque values for the zirconia and titanium implants were 42.4 Ncm and 42.1 Ncm, respectively, after 4 weeks, 69.6 Ncm and 75.0 Ncm, respectively after 8 weeks, and 69.3 Ncm and

73.1 Ncm, respectively, after 12 weeks. The results indicated that bone apposition was similar between zirconia and titanium implants.


Balleri P, Ferrari M, Veltri M. One-year outcome of implants placed strategically in the retrocanine bone triangle. Clin Implant Dent Relat Res 2010;12(4):324-330.

A total of 40 implants were placed in the bone anterior to the sinus wall in 20 patients with atrophic posterior

maxillae. Three-unit screw-retained FPDs were placed after 6 months. After 1 year of loading, there were no implant failures or biological or mechanical complications, and there were no differences in bone level between axial and tilted implants. Three-unit FPDs supported by two implants therefore showed positive


Clinical Oral Implants Research

Vol. 21 No. 11 (November 2010) Vol. 21 No. 12 (December 2010)

Koong  B.   Cone  beam  imaging:  is  this  the  ultimate  imaging  modality?  Clin  Oral  Implants  Res


Cone beam imaging is an essential technique that all clinicians should be familiar with, and should be considered in daily clinical practice if low-dose systems and protocols are used. The technique complements

2D radiographic and other techniques, although multislice computed tomography may be more powerful and flexible, and is the technique of choice for many. However, all techniques should be evaluated in their entirety,  and  the  clinician  skill  levels  and  responsibilities,  and  medico-legal  implications  need  to  be considered.


Van Der Bilt A, Burgers M, Van Kampen FMC, Cune MS.  Mandibular implant-supported overdentures and oral function. Clin Oral Implants Res 2010;21(11):1209-1213.

Patients who had received two mandibular implants and an overdenture with magnet, ball-socket or bar-clip

attachments were evaluated for oral function 10 years after participation in a clinical trial. Of the original 18 patients, 14 were evaluated at the 10-year follow-up. Maximum bite force increased from 162 N to 341 N after implant treatment, and the number of chewing cycles decreased from 55 to 27; no significant changes were seen after 10 years. The improvement in oral function with implant-supported overdentures was therefore maintained for a long time.


Van de Velde T, Sennerby L, De Bruyn H.  The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. Clin Oral Implants Res 2010;21(11):1223-1233.

Implants were placed in the bilateral maxillary edentulous areas of 14 patients in a split-mouth design: a stereolithographic guide was used in one side and implants were immediately loaded (test; 36 implants), and a conventional protocol and loading after 6 weeks (control; 34 implants) was performed on the other side. Clinical and radiographic analyses were performed after 1 and 6 weeks, and 3, 6, 12 and 18 months. Implant survival was 97.3% and 100% in the test and control groups, respectively. Mean bone level after 18 months was 1.95 ± 0.70 mm and 1.93 ± 0.42 mm for test and control groups, respectively. Differences between test and control sides were found in the first 6 weeks for speech, function, esthetics, self-confidence and overall appreciation, and there was a significant difference change in height of the attached mucosa at implants placed with a conventional flap after 1 and 6 weeks.


Beitlitum I, Artzi Z, Nemcovsky CE.  Clinical evaluation of particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for bone augmentation of atrophic alveolar ridges. Clin Oral Implants Res 2010;21(11):1242-1250.

Vertical and/or lateral ridge deficiencies of 3 mm in 50 patients were treated with either particulate

mineralized freeze-dried bone allograft (FDBA) alone or with bi-layered autogenous bone chips and covered with a cross-linked collagen barrier membrane. Mean vertical and horizontal bone gain were 3.47 ± 1.25 mm and 5 ± 1.28 mm, respectively, for FDBA alone and 3.5 ± 1.2 mm and 3.6 ± 1.72 mm, respectively, for FDBA

+ bone chips. The addition of autogenous bone chips therefore had no significant effect.


Junker R, Manders PJD, Wolke J, Borisov Y, Jansen JA.  Bone reaction adjacent to microplasma-sprayed CaP-coated oral implants subjected to occlusal load, an experimental study in the dog. Part I: short-term results. Clin Oral Implants Res 2010;21(11):1251-1263.

A total of 48 implants (acid-etched, plasma-sprayed CaP ceramic, microplasma-sprayed CaP ceramic or microplasma-sprayed at the apical part only) were placed into the mandibles of six dogs. Functional loading was performed on one side of the mandible after 6 weeks, while the contralateral side served as a control. Implants were assessed after a further 6 weeks. There were no significant differences between the groups for BIC or amount of bone; however, there was a tendency towards crestal bone loss for the functionally loaded non-coated implants. Microplasma-sprayed coatings therefore elicit a favorable bone response, but this does not differ from conventionally sprayed coatings.


Urban  T,  Wenzel  A.   Discomfort  experienced  after  immediate  implant  placement  associated  with three different regenerative techniques. Clin Oral Implants Res 2010;21(11):1271-1277.

In 92 patients requiring single implants in then molar region. Resulting peri-implant defects were treated with

autogenous  bone  chips,  Ossix  membrane,  or  a  combination  of  both.  The  post-operative  course  was recorded using visual analogue scales for pain, swelling and bleeding from the wound on the day of surgery and after 1, 2 and 3 days. Peak pain occurred 5-6 hours after surgery, while peak swelling and bleeding occurred after 1 day. Pain scores were higher for smokers than non-smokers, with a significant difference from 1 to 3 days. Pain was also significantly higher in younger (< 50 years) than older patients.


Al-Kalaly AA, Wong RWK, Cheung LK, Purkayastha SK, Schätzle M, Rabie ABM. Evaluation of bone thickness around the mental foramen for potential fixation of a bone-borne functional appliance: a computer tomography scan study. Clin Oral Implants Res 2010;21(11):1288-1293.

Bi-cortical bone thickness in the mental foramen area was measured in 60 patients by assessing the buccal and lingual cortical bone 10 mm and 5 mm anterior, 10 mm and 5 mm posterior and 5 mm below the mental foramen. Buccal cortical thickness ranged from 1.89 mm (10 mm anterior) to 2.16 mm (10 mm posterior), and there was a marginally significant difference between 10 mm and 5 mm anterior. Total bone thickness ranged from 10.19 to 12.06 mm. Although no large variation was observed, evaluation on a case by case basis is advised.


Wahlström M, Sagulin GB, Jansson LE.  Clinical follow-up of unilateral, fixed dental prosthesis on maxillary implants. Clin Oral Implants Res 2010;21(11):1294-1300.

Patients who had received FDPs on implants, in function for at least 3 years, were asked to participate in a

follow-up evaluation. Of 50 patients invited, 46 were examined. Prior to treatment, tooth extraction was due to periodontal disease in 80% of cases. There was one implant fracture after 3 years and another after 6.5 years. Veneer fractures and loose bridge crews were the most common mechanical complications. Bleeding was  more  frequent  in  patients  with  peri-implant  mucositis,  and  deep  periodontal  pockets  around  the remaining teeth were more frequent in patients with peri-implantitis. Fewer teeth, more periodontal pockets

≥ 4 mm, and greater marginal bone loss was found in smoking versus non-smoking patients.


Koch FP, Becker J, Terheyden H, Capsius B, Wagner W.  A prospective, randomized pilot study on the safety and efficacy of recombinant human growth and differentiation factor-5 coated onto β-tricalcium phosphate for sinus lift augmentation. Clin Oral Implants Res 2010;21(11):1301-1308.

Patients requiring unilateral maxillary sinus floor augmentation were treated with a) augmentation with rhGDF-5/β-TCP and 3-month healing, b) augmentation with rhGDF-5/β-TCP and 4-month healing, or c) β- TCP/autologous bone and 4-month healing. Osseous regeneration was similar in all groups, with newly formed bone ranging from 28% to 31.8%. The largest augmentation height was achieved in the rhGDF-5/β- TCP groups. Of 47 implants in the rhGDF-5/β-TCP groups, four failed. Treatment with rhGDF-5/β-TCP was therefore found to be as safe and effective as the control treatment.


Çehreli MC, kat AM, Uysal S, Akca K. Spontaneous early exposure and marginal bone loss around conventionally  and  early-placed  submerged  implants:  a  double-blind  study.  Clin  Oral  Implants  Res


A total of 46 patients received 103 implants by either conventional or early placement protocols. Plaque index, cover screw exposure and marginal bone level change were recorded prior to second-stage surgery. Marginal bone level change was higher with early placement, and the use of an interim prosthesis led to higher marginal bone level changes with early placement but not conventional placement. There were significantly more exposed implants with early placement, and the mean plaque score was 11.5 times higher than with early placement. There appeared to be a correlation between screw exposure and early crestal bone loss; more perforations and bone loss was observed with early placement.



Kohal R-J, Wolkewitz M, Mueller C.  Alumina-reinforced zirconia implants: survival rate and fracture strength in a masticatory simulation trial. Clin Oral Implants Res 2010;21(12):1345-1352.

Three groups of 24 implants each (two groups of alumina-toughened zirconia (ATZ) and one of tetragonal

zirconium dioxide polycrystal (TZP-A)) were evaluated. Chamfer preparation at the implant heads was performed for the TZP-A implants and one group of the ATZ implants. Thermomechanical loading (1.2 or 5 million cycles) of 98 N was performed for eight implants in each group; the remaining eight implants in each group were not cyclically loaded. Fracture strength was then assessed. There were no implant fractures during loading in any group, and mean fracture strength was significantly higher for the ATZ implants in all situations, although modification of the implant head significantly reduced fracture strength. The results suggested that ATZ implants could withstand functional loading for up to 20 years.


Suarez-Feito J-M, Sicilia A, Angulo J, Banerji S, Cuesta I, Millar B. Clinical performance of provisional screw- retained metal-free acrylic restorations in an immediate loading protocol: a 242 consecutive patients’ report. Clin Oral Implants Res 2010;21(12):1360-1369.

A retrospective analysis was performed for 242 patients who received a total of 1011 implants to support 311 immediate provisional screw-retained restorations. After an healing period of 3 months, at least one fracture was observed in 23 restorations in 20 patients; in 12 cases, the fracture occurred within 4 weeks. The probability of cumulative survival was significantly greater in the mandible, in restorations without cantilever, and in restorations opposed by full restorations or natural teeth. The risk of fracture increased 4.7-fold with an opposing implant-supported prosthesis, while positions in the maxilla increased the risk of fracture 3.4-

4.5-fold. However, 92.6% of the restorations remained intact, so the technique was considered reliable.


Yoon H-I, Yeo I-S, Yang J-H.  Effect of a macroscopic groove on bone response and implant stability. Clin

Oral Implants Res 2010;21(12):1379-1385.

Twelve rabbits each received four anodized titanium implants, either with or without a macroscopic groove. No difference in BIC was found between the two implant types after 2 and 6 weeks, but implant stability was significantly higher for the grooved implants after 6 weeks and resistance to reverse torque was significantly higher after 2 and 6 weeks. The groove may therefore increase adhesion at the interface with the bone and resistance to shear load.


Nickenig H-J, Wichmann M, Schlegel KA, Nkenke E, Eitner S. Radiographic evaluation of marginal bone levels during healing period, adjacent to parallel-screw cylinder implants inserted in the posterior zone of the jaws, placed with flapless surgery. Clin Oral Implants Res 2010;21(12):1386-1393.

Implants placed using a flapless approach (785 implants in 417 patients) were compared with implants placed using a flap technique (459 implants in 227 patients). Marginal bone level was measured at implant placement and after healing. After a median follow-up time of 6 months, no significant differences in marginal bone level were noted between the groups, but differences in marginal bone level were significantly different between smokers and non-smokers in the flapless group.


Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M.  Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trial. Clin Oral Implants Res 2010;21(12):1394-1403.

In 60 patients with edentulous posterior mandibles (residual bone height 7-8 mm), either short implants (7 mm)  were  placed  without  augmentation  or   10-mm-long  implants  were  placed  5  months  after augmentation with anorganic bovine bone blocks. Provisional prostheses were placed after 4 months, replaced by definitive prostheses after a further 4 months. There was insufficient bone to place longer implants in two mandibles due to breakage of the bone blocks, and prostheses could not be placed in one and  three  patients  in  the  short  and  augmented  groups,  respectively,  due  to  implant  failure.  Wound dehiscence occurred during graft healing in four cases in the augmented group, compared to none in the short implant group. Mean bone loss after 1 year was approximately 1 mm in both groups. Short implants may therefore be a preferable option to augmentation for residual mandibular bone height of 7-8 mm.



Clinical Oral Investigations

Vol. 14 No. 5 (October 2010) Vol. 14 No. 6 (December 2010)

Ettl T, Gerlach T, Schüsselbauer T, Gosau M, Reichert TE, Driemel E.  Bone resorption and complications in

alveolar distraction osteogenesis. Clin Oral Investig 2010;14(5):481-489.

A total of 36 alveolar distraction procedures were performed in 30 patients, 11 in the maxilla and 25 in the mandible. After a mean consolidation period of 4.5 months, a total of 82 implants were placed. Mean alveolar height achieved was 6.4 mm and the mean resorption was 1.8 mm at the time of implant placement. Implant survival was 95.1% after a mean follow-up of 45.8 months. Them main complications observed were displacement of the transport segment and inadequate soft tissue extension. Mean peri-implant bone resorption of 3.5 mm was recorded after a mean follow-up of 50.4 months. Alveolar distraction osteogenesis is therefore effective but can have complications, and there may be further bone resorption after implant placement.


Heinz B, Kasaj A, Teich M, Jepsen S. Clinical effects of nanocrystalline hydroxyapatite paste in the treatment of intrabony periodontal defects: a randomized controlled clinical study. Clin Oral Investig 2010;14(5):525-


Paired intrabony defects in 14 patients were treated with papilla preservation flap alone or in combination with a nanocrystalline HA paste. Probing depth and probing bone levels were measured at baseline and after

6 months.  Significant  improvements  from  baseline  were seen in both groups, with significantly greater reduction of probing depth and gain of probing bone level in the nano-HA group. Treatment with the nano-HA paste therefore led to improved clinical outcomes versus papilla preservation flap alone.


Implant Dentistry

Vol. 19 No. 5 (October 2010)

Grecchi F, Zingari F, Raffaella B, Zollino I, Casadio C, Carinci F.  Implant rehabilitation in grafted and native

bone in patients affected by ectodermal dysplasia: evaluation of 78 implants inserted in 8 patients. Implant

Dent 2010;19(5):400-408.

A retrospective analysis of 78 implants in eight patients with ectodermal dysplasia was performed, and patient-, implant-, surgical- and prosthetic-related variables were investigated. The implants replaced 19 incisors, 19 cuspids, 21 premolars and 19 molars. There was one implant loss, and implant length, grafted sites and type of loading appeared to have an influence on the analysis. Dental implant rehabilitation is therefore valuable in patients with ectodermal dysplasia.


Sohn D-S, Kim W-S, Lee W-H, Jung H-S, Shin I-H.  A retrospective study of sintered porous-surfaced dental implants  in  restoring  the  edentulous  posterior  mandible:  up  to  9  years  of  functioning.  Implant  Dent


A total of 43 patients with 122 sintered porous-surfaced implants (either 4.1 mm or 5.0 mm in diameter) were retrospectively analyzed; all implants were restored with fixed prostheses. Radiographic analysis was performed. The mean follow-up time was 55.8 months. The cumulative implant survival rate was 97.5%; survival rates were 100% and 91.2% for the 4.1 mm diameter and 5.0 mm diameter implants, respectively, indicating a significant difference. However, there was no significant difference in survival rates for implants of different lengths. No implant failures occurred when the crown-to-implant ratio was < 1.0 or between 1.5 and 2.0, but the failure rate was 6.7% where the crown-to-implant ratio was between 1.0 and 1.4; the difference was significant.


Pae A, Kim J-W, Kwon K-R.  Immediate loading of two implants supporting a magnet attachment-retained overdenture: one-year clinical study. Implant Dent 2010;19(5):428-436.

Each of six patients received two implants in the mandible to support immediate overdentures retained by

magnet attachments. Clinical and radiographic parameters and implant stability were measured after 1, 2, 6,

12 and 24 weeks and 1 year. Two implants failed in two patients, but all others remained stable. Crestal bone changes were minimal between 6 weeks and 1 year, and there were no significant differences in bleeding on probing. Immediate loading with overdentures retained by magnet attachments is therefore a viable treatment option in the fully edentulous arch.



Bilhan H, Kutay O, Arat S, Çekici A, Cehreli MC.  Astra Tech, Branemark and ITI implants in the rehabilitation of partial edentulism: two-year results. Implant Dent 2010;19(5):437-446.

In 26 patients, Astra Tech implants (42), Brånemark implants (36) and ITI implants (29) were placed;

abutment connection was performed for the Astra Tech and Brånemark implants after 3 months and all implants received fixed prostheses after 4 months. Clinical parameters were recorded after 6, 12 and 24 months and radiographic bone level was recorded after 2 years. Implant survival was 100% for all systems. Plaque index and peri-implant inflammation scores were significantly higher for the Brånemark implants in the first year. Marginal bone loss was similar for the Astra Tech and ITI implants after 2 years, but the marginal bone loss at Brånemark implants was significantly higher than at Astra Tech implants.


Toffler M, Toscano N, Holtzclaw D.  Osteotome-mediated sinus floor elevation using only platelet-rich fibrin:

an early report on 110 patients. Implant Dent 2010;19(5):447-456.

Osteotome-mediated sinus floor elevation with platelet-rich fibrin was performed in 110 patients and 138 implants were placed. Mean subantral bone height of the alveolar ridge was 6.6 mm, and the mean increase was 3.4 mm. Of the 138 implants placed, 97 were restored an in function for a mean of 5.2 months, with a mean healing time of 4 months until abutment placement. The implant survival rate was 97.8% (three implants failed). The procedure therefore led to a high degree of success.


International Journal of Oral and Maxillofacial Implants

Vol. 25 No. 5 (September/October 2010)

Orlando B, Barone A, Giorno TM, Giacomelli L, Tonelli P, Covani U. Insertion torque in different bone models

with different screw pitch: an in vitro study. Int J Oral Maxillofac Implants 2010;25(5):883-887.

Wide-pitch or fine-pitch implants were placed in polyurethane foam blocks simulating hard (D1 or D2) or soft (D3 or D4) density bone following the preparation of insertion sites using 1.5 mm or 2.5 mm drills. The final insertion torque was recorded for each implant. Greater insertion torque was noted with wide-pitch implants in cancellous bone. The results suggested that implants with a wide pitch design and 2.5 mm osteotomy are more suitable for dense cortical bone, while wide-pitch implants and 1.5 mm osteotomy are more appropriate for softer bone.


Pessoa RS, Vaz LG, Marcantonio E Jr, Vander Sloten J, Duyck J, Jaecques SVN.  Biomechanical evaluation of platform switching in different implant protocols: computed tomography-based three-dimensional finite element analysis. Int J Oral Maxillofac Implants 2010;25(5):911-919.

A CT-based element model of a central incisor extraction socket was created with a conical external hex implant  with  a  4.3  mm  shoulder  diameter  and  abutment  models  of  4.3  mm  or  3.8  mm  in  diameter. Immediately placed, immediately loaded and conventionally loaded protocols were simulated. Differences in the biomechanical environment between platform-switched and non-platform-switched models were minor, but slightly higher EQV stress was noted for the platform-switched model in all cases, but the difference was not  significant.  Platform-switching  therefore  has  little  influence  on  the  biomechanical  environment  of implants.


Drago C, Saldarriaga RL, Domagala D, Almasri R.  Volumetric determination of the amount of misfit in

CAD/CAM and cast implant frameworks: a multicenter laboratory study. Int J Oral Maxillofac Implants


Acrylic resin models with five interforaminal implants were scanned and master casts constructed. A gold alloy framework and titanium milled bar by CAD/CAM were fabricated to clarify the construction processes, and subsequently five cast and five CAD/CAM frameworks were fabricated at each of three dental schools (15 cast bars and 15 milled bars). Restorative interfaces were scanned and the virtual frameworks fit onto digitized scans of the restorative platforms. Volumetric measurements were used to determine the amount of misfit. Significantly better fit was demonstrated by the frameworks made with CAD/CAM technology, and there were significant differences between the right and left one-screw tests, but no significant differences were observed between the three sites.


Winter W, Möhrle S, Holst S, Karl M.  Bone loading caused by different types of misfits of implant-supported fixed dental prostheses: a three-dimensional finite element analysis based on experimental results. Int J Oral Maxillofac Implants 2010;25(5):947-952.

Two finite element models were created to simulate strain values of three-unit FPDs on two implants using

horizontal, vertical and angular misfits. Horizontal misfit of 36 μm and vertical misfit of 79 μm were required to simulate the experimental strain value results, and comparable levels were obtained from an angular misfit of 0.083°. Bone loading ranged from 50-90 MPa in the cortical area and 2-5 MPa in trabecular bone around implants for horizontal and vertical misfit and up to 20 MPa in the cortical layer and 1 MPa in the cervical part of the trabecular bone for angular misfit. Comparable loading patterns were observed around both implants for horizontal and vertical misfit, and bone loading under angular misfit was mainly where the misfit had been introduced.


Faggion CM, Schmitter M.  Using the best available evidence to support clinical decisions in implant dentistry.

Int J Oral Maxillofac Implants 2010;25(5):960-969.

A  strategy  for  searching,  selecting  and  appraising  scientific  literature  was  developed  using  a  focused question in the PICO (patient, intervention, comparison and outcome) format. Systematic reviews on peri- implantitis were searched, two were found and the quality assessed by two referees using three checklists. The  reviews  suggested  that  subgingival  debridement  (with  or  without  antibiotics)  and  regenerative procedures may be effective for peri-implantitis. The checklists used showed that the trials in the reviews were rigorous. Reviewer assessment agreement was good, and the algorithm demonstrated the available options for peri-implantitis management.


Juodzbalys G, Wang H-L.  Socket morphology-based treatment for implant esthetics: a pilot study. Int J Oral

Maxillofac Implants 2010;25(5):970-978.

A total of 25 maxillary anterior teeth were extracted from 25 patients; soft and hard tissue assessments were made and therapeutic approaches proposed using a decision tree. The morphology of the sockets was adequate (five sockets), compromised (12 sockets) or deficient (eight sockets). Adequate esthetic results were achieved in Type I sockets regardless of treatment, while Type II sockets with immediate-delayed implant placement were adequate in 87.5% of cases at prosthesis placement and in 62.5% of cases after 1 year. For Type III sockets treated with delayed implant placement, 75% were adequate at both evaluation periods.


Nothdurft FP, Doppler KE, Erdelt KJ, Knauber AW, Pospiech PR.  Influence of artificial aging on the load- bearing capacity of straight or angulated zirconia abutments in implant/tooth-supported fixed partial dentures. Int J Oral Maxillofac Implants 2010;25(5):991-998.

Four test groups representing anterior implant/tooth-supported FPDs; groups 1 and 2 simulated an ideal situation allowing for a straight, prefabricated zirconia abutment, and groups 3 and 4 simulated a compromised situation requiring an angulated abutment. Implants and metal tooth analogs with simulated mobility were mounted in polymethyl methacrylate, and FPDs were cemented; groups 2 and 4 were thermomechanically loaded, with static loading until failure. All samples survived thermomechanical loading, and no significant increase in load-bearing capacity in the straight or angulated abutments was observed. Fracture loads were significantly higher for the restorations on angulated abutments than those on straight abutments. Compensating for angulated positions with angulated abutments is therefore possible with no reduction of the load-bearing capacity of the FPDs.


Hinze M, Thalmair T, Bolz W, Wachtel H. Immediate loading of fixed provisional prostheses using four implants for the rehabilitation of the edentulous arch: a prospective clinical study. Int J Oral Maxillofac Implants 2010;25(5):1011-1018.

Each of 37 patients received four implants to support immediately loaded mandibular or maxillary full-arch

fixed prostheses, with definitive reconstructions delivered after 6 months. Follow-up visits were performed 6 and 12 months after prosthetic loading and every year for 5 years. Implant survival after 1 year for axial and tilted implants was 96.0% and 94.6%, respectively, and for maxillary and mandibular implants was 96.6% and 98.7%, respectively. The mean bone loss around axial and tilted implants after 1 year was 0.82 ± 0.31 mm and 0.76 ± 0.49 mm, respectively. Four implants supporting a full-arch fixed prosthesis is therefore a viable treatment option.


Cho-Lee J-Y, Naval-Gías L, Castrejón-Castrejón S, Capote-Moreno A, González-García R, Sastre-Pérez J, Muñoz-Guerra MF. A 12-year retrospective analytic study of the implant survival rate in 177 consecutive maxillary sinus augmentation procedures. Int J Oral Maxillofac Implants 2010;25(5):1019-1027.

A retrospective analysis was performed of 272 implants placed in 127 augmented sinuses in 119 patients. The mean follow-up period was 60.7 months, and the cumulative implant survival rate was 93%. Factors in predicting implant failure included peri-implantitis and the presence of complications related to the augmentation procedure. Sinus augmentation is therefore versatile with high predictability independent of the graft material.


Deng F, Zhang H, Zhang H, Shao H, He Q, Zhang P.  A comparison of clinical outcomes for implants placed in fresh extraction sockets versus healed sites in periodontally compromised patients: a 1-year follow-up report. Int J Oral Maxillofac Implants 2010;25(5):1036-1040.

Hopeless teeth were extracted form periodontally compromised patients, the sites debrided and implants placed using a surgical guide. An immediate provisional restoration was placed and a definitive restoration delivered after 6 months. A total of 84 implants were placed, 32 of which were in fresh extraction sockets. The implant survival rate was 95.2% (92% and 100% in the maxilla and mandible, respectively); all of the failed implants had been placed in fresh extraction sockets. All prostheses survived and the mean change in bone level at 12 months was -1.12 ± 0.18 μm. A relatively high risk for implant failure in the periodontally compromised maxilla was therefore noted.


International Journal of Periodontics and Restorative Dentistry

Vol. 30 No. 5 (September/October 2010)

Alves CC, Correia AR, Neves M.  Immediate implants and immediate loading in periodontally compromised

patients – a 3-year prospective clinical study. Int J Periodontics Restorative Dent 2010;30(5):447-455.

In each of 23 periodontally compromised patients, 168 implants were placed (mostly six Straumann implants distributed along the arch according to surgical guide or bone availability); 83 were placed in the maxilla and

85 in the mandible. Most were immediately loaded except nine maxillary implants that underwent delayed loading. The prosthesis was adapted in the first 48 hours and a definitive restoration placed after 2 months. The 3-year cumulative survival rate was 98.74% (98.65% and 98.82% in the maxilla and mandible, respectively); two implants failed. The 3-year cumulative prosthesis survival rate was 100%, indicating that immediate loading is a predictable technique for periodontally compromised patients.


Stappert FJ, Tarnow DP, Tan JH-P, Chu SJ.  Proximal contact areas of the maxillary anterior dentition. Int J Periodontics Restorative Dent 2010;30(5):471-477.

Proximal contact area (PCA) between the eight maxillary anterior teeth was calculated by measuring 140

PCA sites and 160 crown lengths in 20 patients. The mean PCA dimensions were 4.2 mm between central incisors, 2.9 mm between central and lateral incisors, 2.0 mm between lateral incisors and canines, and

1.5 mm between canines and first premolars; the corresponding mesial mean proximal area contact portions were 41%, 32%, 20% and 18%, respectively. Significant differences were noted between all PCAs, except for canine/first premolar sites. Natural proximal area contact portions were well defined and should be considered in clinical anterior restorations.


Journal of Clinical Periodontology Vol. 37 No. 11 (November 2010) Vol. 37 No. 12 (December 2010)

Mattila  PT,  Niskanen  MC,  Vehkalahti  MM,  Nordblad  A, Knuuttila    MLE.  Prevalence and simultaneous

occurrence of periodontitis and dental caries. J Clin Periodontol 2010;37(11):962-967.

In a study population of 5,255 subjects as part of a national Health 2000 survey, pocket depths and dental caries were recorded. Periodontal disease (pocket depth ≥ 4 mm) was noted in 64%, severe periodontal disease ( 6 mm) in 21% and dental caries in 29%. Dental caries was significantly more prevalent in subjects with periodontal disease, and more so in subjects with severe periodontal disease. Subjects with dental caries were also significantly more likely to have severe periodontal disease. Periodontal disease and dental caries therefore tend to accumulate in the same subjects.


Bernabé E, Marcenes W.  Periodontal disease and quality of life in British adults. J Clin Periodontol


The short-form oral health impact profile (OHIP)-14 was used to assess 3,122 subjects in a cross-sectional study. Periodontal disease (at least two sites with loss of attachment 4 mm and one proximal site with pocket depth ≥ 4 mm) was found to be associated with OHIP-14 score, even after adjustment for demographic, socioeconomic and clinical factors, therefore indicating that periodontal disease is associated with quality of life.


Nedir R, Nurdin N, Vazquez L, Szmukler-Moncler S, Bischof M, Bernard J-P. Osteotome sinus floor elevation technique without grafting: a 5-year prospective study. J Clin Periodontol 2010;37(11):1023-1028. Osteotome sinus floor elevation was performed without grafting in 17 patients (mean residual bone height

5.4 ± 2.3 mm) and a total of 25 implants (10 mm in length) were placed. Implant survival after 5 years was

100% and the mean increase in peri-implant bone was 3.2 ± 1.3 mm, while implant protrusion into the sinus decreased from 4.9 ± 1.9 mm at baseline to 1.5 ± 0.9 mm. Mean crestal bone loss was 0.8 ± 0.8 mm, which stabilized over 5 years; bone gain after 1 year was noted at 20 implants. Grafting is therefore not required for bone gain of at least 3 mm.


Artzi Z, Nemcovsky CE, Tal H, Weinberg E, Weinreb M, Prasad H, Rohrer MD, Kozlovsky A.  Simultaneous versus two-stage implant placement and guided bone regeneration in the canine: histomorphometry at 8 and

16 months. J Clin Periodontol 2010;37(11):1029-1038.

Four sites were established in each of seven dogs: 1) implant placed in bovine bone grafted site after 6 months of healing; 2) implant placed with simultaneous bovine bone grafting and membrane coverage; 3) implant placed in non-grafted defect with membrane coverage; and, 4) implant placed in naturally healed site. Histomorphometric measurements were performed after 8 and 16 months. BIC ranged from 62-79% at all sites, and particle area fraction ranged from 17-27%. Bone area fraction was significantly smaller at the group 2 sites, and osteoconductivity was significantly less at the group 1 sites; crestal bone resorption and vertical intrabony defect were also smaller at group 2 sites versus group 1 sites. Enhanced newly formed bone was observed with the staged approach, with more osteoconduction and less bone loss.


Casarin RCV, Del Peloso Ribeiro E, Nociti FH Jr, Sallum AW, Ambrosano GMB, Sallum EA, Casati MZ. Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective

24-month randomized clinical trial. J Clin Periodontol 2010;37(12):1100-1109.

A total of 12 patients with bilateral proximal furcation defects 5 mm and bleeding on probing were treated with open flap debridement and EDTA alone (control) or in combination with EMD (test). Clinical parameters were evaluated prior to treatment and after 6, 12 and 24 months. No significant differences were observed after 24 months. Probing depth reduction was 1.9 ± 1.6 mm and 1.0 ± 1.3 mm in the test and control groups, respectively, and the gain in relative horizontal clinical attachment level was 1.4 ± 0.9 mm and 0.7 ± 1.3 mm in the test and control groups, respectively. After 24 months, only five class II furcations remained in the test group, compared to 10 in the control group.


Jacobs R, Pittayapat P, Van Steenberghe D, De Mars G, Gijbels F, Van Der Donck A, Li L, Liang X, Van Assche N, Quirynen M, Naert I. A split-mouth comparative study up to 16 years of two screw-shaped titanium implant systems. J Clin Periodontol 2010;37(12):1119-1127.

Clinical and radiographic records from 18 patients who received Astra Tech and Brånemark implants in a split-mouth study were evaluated for up to 16 years. No significant differences were observed between the systems over time. Peri-implant bone density significantly increased after 10 years, while Periotest values significantly decreased. Mean bone loss after 15 years was 0.02 mm and 0.31 mm for the Astra Tech and Brånemark systems, respectively.


Journal of Oral and Maxillofacial Surgery

Vol. 68 No. 11 (November 2010)

Kacer CM, Dyer JD, Kraut RA.  Immediate loading of dental implants in the anterior and posterior mandible:

retrospective study of 120 cases. J Oral Maxillofac Surg 2010;68(11):2861-2867.

Of 2,904 implants placed in the mandibles of 979 patients in a 2-year period, 256 were immediately loaded;

161 were anterior to the mental foramen and 95 were posterior to the mental foramen. There were four implant failures, three in the anterior and one in the posterior mandible; the survival rate was 99.4% and 97% in the anterior and posterior mandible, respectively.



Journal of Oral Implantology

Vol. 36 No. 5 (October 2010)

Chrcanovic  BR,  Oliveira  DR,  Custódio  AL.   Accuracy  evaluation  of  computed  tomography-derived

stereolithographic surgical guides in zygomatic implant placement in human cadavers. J Oral Implantol


In four cadavers, 16 zygomatic implants were placed (four per cadaver) using CT-generated stereolithographic  surgical  guides.  CT  scans  were  taken again after implant placement and the angle between  the  actual  and  planned  implants  calculated.  Mean  angular  deviation  of  the  long  axis  was

8.06° ± 6.40  and  11.20°  ±  9.75  for  the  anterior-posterior  and  caudal-cranial  views,  respectively;  large deviations were therefore noted. The sinus slot technique in combination with a CT-based drilling guide may help to improve results.


Park Y-S, Lee S-P, Han C-Y, Kwon JH, Jung Y-C. The microtomographic evaluation of marginal bone resorption of immediately loaded scalloped design implant with various microthread configurations in canine mandible: pilot study. J Oral Implantol 2010;36(5):357-362.

Scalloped implants of four different designs (machined scalloped collar, sandblasted and acid-etched scalloped collar, horizontal microthreads, or parabolic microthreads) were placed in dog mandibles; prostheses were immediately placed and the implants evaluated after 12 weeks. The pattern of marginal bone loss was analogous to the scalloped margin for the implants with parabolic microthreads. Marginal bone resorption was therefore influenced by microthread geometry, but further studies under controlled conditions are necessary to confirm the results.


Bilhan H, Mumcu E, Arat S.  The role of timing of loading on later marginal bone loss around dental implants:

a retrospective clinical study. J Oral Implantol 2010;36(5):363-376.

A total of 252 implants placed in 57 patients were retrospectively evaluated and the time between implant placement and loading assessed. The results suggested that delayed loading increased the risk of marginal bone loss around implants, and that bone loss was less for implants placed next to a tooth on one or both sides. There were no differences in rate of bone loss between single or splinted implants, or between implants with a smooth collar or with microgeometry at the neck. Early loading of implants therefore appears more favorable.


Journal of Oral Rehabilitation

Vol. 37 No. 11 (November 2010) Vol. 37 No. 12 (December 2010)

Abduo J, Lyons K, Swain M.  Fit of zirconia fixed partial denture: a systematic review. J Oral Rehabil


A literature search was performed for studies evaluating the accuracy of fit of zirconia FPDs. Of 115 articles,

15 met the inclusion criteria, of which 12 were in vitro and three were in vivo. Superior results were observed with CAD/CAM, post-sintered milling, straight framework configuration and shorter span frameworks, compared to CAM, pre-sintered milling, curved framework configuration and longer span frameworks. A deterioration in fit was seen with veneered zirconia frameworks, but aging had no effect.


Bilhan H, Geckili O, Mumcu E, Bozdag E, Sünbüloğlu E, Kutay O.  Influence of surgical technique, implant shape and diameter on the primary stability in cancellous bone. J Oral Rehabil 2010;37(12):900-907.

Implant beds were prepared in the proximal region of cow ribs and 90 implants with three different shapes

and two different diameters were placed using two different surgical techniques. Primary stability was compared using insertion torque and resonance frequency analysis (RFA). Significantly higher RFA and insertion torque by both methods was obtained when under-dimensioned drilling was used, and significantly higher insertion torque was observed with wider implants. There were significant correlations between insertion torque and RFA. The use of wide diameter, partially conical implants placed with a modified surgical technique appeared to enhance primary stability in cancellous bone.