152 909 low sla scientific evidence first edition 2011 by Straumann AUNZ

Straumann 速 SlA Scientific Evidence First Edition (2011)

Straumann速 Dental Implant System

The ITI (International Team for Implantology) is academic partner of Institut Straumann AG in the areas of research and education.

Contents

2 Introduction 3 Study overview 4 Preclinical studies 12 Clinical studies 26 Additional studies 30 References

Introduction Straumann® SLA – reliable and scientifically well documented Roughened surfaces for dental implants have consistently demonstrated advantages over the older machinedtype titanium surfaces. Significantly greater success rates, enhanced bone-to-implant contact (BIC) and greater biomechanical and functional stability have all been demonstrated by rough surface implants compared to those with smoother surfaces1. Straumann’s proprietary Sandblasted, Large-grit, Acid-etched (SLA®) surface has become one of the best documented rough surfaces in implantology, having shown advantages over other roughened implant surfaces1. In particular, preclinical analysis has shown the superiority of SLA® over the previously most common rough surface, titanium plasma-sprayed (TPS), with better maintenance of vertical bone height2 and significantly greater BIC3. Shear strength of the bone-to-implant interface has also been shown to be greater with SLA® compared to TPS and machined surfaces4, and compared to a machined and acid-etched surface5 in preclinical studies; a biomechanical comparison using implants of the same design showed that the better bone anchorage was a result of the surface topography rather than the implant design.6

Sandblasted, Large-grit, Acid-etched (SLA®) The extent of the bone-to-implant interface appears to increase with increasing surface roughness,7,8 but problems have been noted with surfaces that are very rough, suggesting that there may be an ‘optimum range’ of moderate surface roughness9. The SLA® surface is sandblasted with large-grit (250–500 μm), which results in a peak-to-peak macro-roughness of approximately 20–40 μm, followed by micro-roughness of approximately 2–4 μm upon acid etching. Micro-rough surfaces increase the rate of cell spreading and the number of cells attached to the surface, and increase the rate that cells produce factors regulating the differentiation of bone-forming cells (osteoblasts) and reduce the activity of bone-destroying cells (osteoclasts).10,11

The clinical benefit The advent of the SLA® surface, with its proven osseointegration properties, therefore revolutionized the conventional timing of provisionalization, allowing it to be cut by half, from 12 weeks for the previous TPS surface to just 6 weeks*12,13,14; subsequently, even earlier loading (e.g. early and immediate) have been shown to be successful and predictable.14,15,16,17,18,19 The longevity of Straumann® Soft Tissue Level implants with the SLA® surface has also been demonstrated by success in numerous long-term investigations (e.g. 5 years and over).20,21,22,23,24 The substantial level of evidence for SLA® also acts as a proven foundation for the SLActive® surface, which is based on the SLA® technology. The SLA® surface is available and has proven to be successful on various Straumann implant designs, Narrow Neck implants,25 Wide Neck implants,26 Tapered Effect implants27 and short implants28. The SLA® surface is also available on BL implant. The 20 years of investigation and 10 years of clinical evidence for SLA®24 have provided a wealth of information, and implant survival rates of > 98 % have consistently been observed.12,14,15,20,21,22,29,30 The following information shows data from selected† key preclinical and clinical studies with Straumann’s SLA® -surfaced implants, representing a range of indications, loading protocols and implant types. The excellent data demonstrate the advantages and versatility of the SLA® surface.

* With good bone quality and adequate bone quantity and implants of Ø 4.1 mm or Ø 4.8 mm, over 8.0 mm lengths. † Please note that this Straumann Scientific Evidence document contains a selection of studies and makes no claim to be a complete study list. Articles were selected on merit from the results of a literature search using combinations of the following key words: sand-blasted and grit-blasted, sand-blasted and particle blasted, tapered effect, standard implant, standard plus, narrow neck implant, sand-blasted and large-grit and acid-etched, wide neck implant, ITI implant, sand-blasted and acid-etched, Straumann, rough surfaces, blasted SLA®, surface topography, dental implant, surface chemistry, surface modification, surface roughness, acid-etching, titanium, synOcta®, Locator®, IPS e.max®, preshaped abutment

Study overview

Preclinical Studies #

Topic

Authors

Reference

Interface shear strength

Wilke HJ et al.

Clinical Implant Materials (Heimke G, Soltész U, Lee AJC, eds). Advances in Biomaterials; 9, 1990: 309–314.

Surface characteristics on bone reactions

Buser D et al.

J Biomed Mater Res 1991;25(7):889–902.

Implant surface under loaded / unloaded conditions

Cochran DL et al.

Clin Oral Implants Res 1996;7(3):240–252.

Histometric analysis SLA®

Cochran DL et al.

J Biomed Mater Res 1998;40(1):1–11.

Comparative Removal Torque Evaluation

Buser D et al.

Int J Oral Maxillofac Implants 1998;13(5):611–619.

Interface shear strength

Buser D et al.

J Biomed Mater Res 1999;45(2):75–83.

Immediate and early loading

Quinlan P et al.

Int J Oral Maxillofac Implants 2005;20(3):360–370.

Comparative study to investigate bone healing around 4 different implant systems

de Sanctis M et al.

J Clin Periodontol 2009;36(8):705–711.

Page

Clinical Studies #

Topic

Authors

Reference

Page

Early healing (6 weeks)

Cochran DL et al.

Clin Oral Implants Res 2002;13(2):144–153.

Early loading in partially edentulous patients (6 weeks)

Bornstein MM et al.

Int J Oral Maxillofac Implants 2003;18(5):659–666.

Early loading in posterior mandible (2 or 6 weeks)

Salvi GE et al.

Clin Oral Implants Res 2004;15(2):142–149.

Early loading in edentulous posterior maxilla and mandible – 12-month follow-up

Nordin T et al.

Int J Oral Maxillofac Implants 2004;19(6):880–886.

Immediate loading with 3-unit fixed partial dentures

Cornelini R et al.

Int J Oral Maxilliofac Implants 2006;21(6):914–918.

5-year life table analysis on WN SLA® implants

Bischof M et al.

Clin Oral Implants Res 2006;17(5):512–520.

Clinical field trial with Soft Tissue Level SLA® implants

Cochran D et al.

J Periodontol 2007;78(56):974–982.

Clinical performance of WN SLA® – 3-year follow-up

Bornstein MM et al.

Int J Oral Maxillofac Implants 2007;22(4):631–638.

5-year follow-up RCT in the edentulous maxilla

Fischer K et al.

Clin Oral Implants Res 2008;19(5):433–441

Staged sinus floor elevation in partially edentulous patients

Bornstein MM et al.

Clin Oral Implants Res 2008;19(10):1034–1043.

Kaplan-Meier curve for TPS and SLA® implants

De Boever AL et al.

Clin Oral Implants Res 2009 ;20(12) :1341–1350.

Mandibular overdentures supported by 2 implants: a 5-year RCT

Cehreli MC et al.

Clin Implant Dent Relat Res 2010;12(2):114–121.

10-year data on Soft Tissue Level SLA® implants in the edentulous maxilla

Fischer K

ITI World Symposium, Geneva, Switzerland, 15–17 Apr 2010.

The influence of various titanium surfaces on the interface shear strength between implants and bone Wilke HJ, Claes L, Steinemann S. Clinical Implant Materials (Heimke G, Soltész U, Lee AJC, eds). Advances in Biomaterials; 9, 1990: 309–314.

Abstract: Mechanical effects of bone healing were evaluated for implants with various surface treatments. Maximum removal torque was shown by the SLA® surface.

Introduction

Results

Bone healing around titanium implants can be influenced by the titanium surface. This investigation therefore examined the mechanical effect of the bone healing response to various surface morphologies of titanium implants in terms of implantation time.

SLA® implants showed the maximum removal torque, and the maximum removal torque increased over time for SLA® and TPS implants (Figure 1); in contrast, no significant changes in removal torque were observed for the remaining implants.

Methods

Preclinical studies

Titanium screws with six different surface treatments (electropolished; sandblasted with fine grit/acid-pickled (HF/HNO3)/anodized; titanium plasma-sprayed (TPS); sandblasted with medium grit/acid-pickled (HF/HNO3); sandblasted with large grit/acid-pickled (HF/ HNO3); sandblasted with large grit/acid-etched (HCl/H2SO4) (SLA®) were placed in the tibiae of 10 sheep. Removal torque was evaluated after 2, 9, 12, 24 and 52 weeks, and histological analysis was performed after 9, 24 and 52 weeks.

SLA® V IV

III

II 4

SLA® III

2 V IV II I 0

2 weeks

8 weeks

9 weeks

12 weeks

18 weeks

24 weeks

52 weeks

Figure 1: Removal torque (Nm) of titanium screws according to surface treatment and time in place.

I: electropolished II: sandblasted with fine grit, acid pickled using HF/HNO3 and anodized III: titanium plasma-sprayed IV: sandblasted with medium grit and acid pickled using HF/HNO3 V: sandblasted with large grit and acid pickled using HF/HNO3 SLA®: sandblasted with large grit and acid etched using HCl/H2SO4

Conclusions • The interface shear strength of implants can be increased by altering the surface structure morphology. • An optimal surface can potentially be developed for various biomechanical situations, e.g. strong anchorage for permanent implants, or weaker anchorage for temporary/removable implants.

Influence of surface characteristics on bone integration of titanium implants. A histomorphometric study in miniature pigs

Buser D, Schenk RK, Steinemann S, Fiorellini JP, Fox CH, Stich H. J Biomed Mater Res 1991;25(7):889–902.

Abstract: Bone healing with various implant surface characteristics was evaluated. Rough surface promoted greater bone apposition, with an additional effect shown by SLA®.

Introduction

Results

Several techniques have been employed to improve anchorage of titanium implants in bone by surface modification or coatings. The aim of this study was to investigate the influence of various surface characteristics on bone reactions in titanium implants.

Histological analysis showed direct bone-to-implant contact for all implants, but with significant differences in the percentages obtained. The lowest bone-to-implant contact was observed with the HF/ HNO3 implants (25.1 % ± 7.4 % and 21.6 % ± 9.3 %, respectively, at 6 weeks), while the highest bone-to-implant contact was found with the SLA® and HA implants (57.7 % ± 9.5 % and 69.5 % ± 6.5 %, respectively, at 6 weeks). The results showed increasing bone-to-implant contact with increasing surface roughness (Fig. 2).

Methods Hollow cylinder implants with six different surface treatments (electropolished (E); sandblasted with medium grit/acid-pickled (HF/ HNO3) (SMP); sandblasted with large grit (SL); sandblasted with large grit/acid-etched (HCl/H2SO4) (SLA®); titanium plasma-sprayed (TPS); hydroxylapatite plasma-sprayed (HA)) (Fig. 1) were placed in the metaphyses of the tibia and femur in six mini-pigs. Twelve implants of each type were placed. Histomorphometric analysis was performed after 3 and 6 weeks.

n.s.

3 weeks 6 weeks

Preclinical studies

% Bone Contact

Figure 1: Scanning electron micrographs of different implant surfaces (bar is 20 µm; original magnification x1700). (A) SMP, (B) SL, (C) SLA, (D) TPS, (E) HA

SMP

TPS

SLA®

Figure 2: Mean direct bone-to-implant contact (%) of different implant surfaces after 3 and 6 weeks; E = electro-polished; SMP = sandblasted with medium grit (0.12–0.25 µm) and acid pickling with HF/HNO3; SL = sandblasted with large grit (0.25–0.50 µm)

A narrow band of bone was often seen around SLA® and HA implants as an extension of perpendicularly oriented bone trabeculae; however, the HA coating consistently showed signs of resorption, predominantly in areas without bone covering.

Conclusions • Greater bone apposition was observed with rough surfaces compared to polished or fine structured surfaces. • The SLA® surface showed an additional effect on bone apposition compared to the sandblasted surface. • The highest bone-to-implant contact was found with SLA® and HA surfaces. • The HA coating consistently showed signs of resorption.

* Reproduced with permission of John Wiley & Sons, Inc.

Evaluation of an endosseous titanium implant with a sandblasted and acid-etched surface in the canine mandible: radiographic results

Cochran DL, Nummikoski PV, Higginbottom FL, Hermann JS, Makins SR, Buser D. Clin Oral Implants Res 1996;7(3):240–252.

Abstract: SLA® and TPS implants were compared under loaded and unloaded conditions in vivo. SLA® implants showed advantages in early healing and showed less crestal bone loss.

Introduction

Results

Surface characteristics of titanium implants have a direct impact on integration with hard and soft tissues, and radiography is the only non-invasive method to assess the bone reaction. The aim of this study was to compare titanium implants with TPS and SLA® surfaces in a dog mandible model under loaded and unloaded conditions over 15 months.

Excellent tissue integration with ankylotic stability and no signs of peri-implant infection were observed for all implants, and the radiography showed no signs of continuous peri-implant radiolucency around the implants. Stability was maintained after loading, and no complications were observed.

Methods

SLA® 1.4

TPS

1.2 % Bone Contact

Preclinical studies

Cylindrical implants with either a TPS or an SLA® surface (Fig. 1) were placed in the mandibles of six dogs after 3 months of healing following tooth extraction. A total of 69 implants were placed. In four dogs (groups B and C), impressions were taken 2 months after implant placement for the fabrication of screw-retained gold crowns, and the implants (48 implants) were loaded 3 months after implant placement. Radiographic analysis was performed for assessment of boneto-implant contact, by measuring the distance from the implant shoulder to the most coronal bone-to-implant contact, and bone density, measured using computer-assisted densitometric image analysis (CADIA). Measurements were taken 3 months after implant placement for the unloaded implants (group A, 2 dogs), 3 and 6 months after implant placement in group B (2 dogs), and 3, 6, 9, 12 and 15 months after implant placement (12 months of loading) in group C (2 dogs).

Mean crestal bone loss at the preload and 3-month evaluations were 0.52 mm and 0.73 mm, respectively, for SLA® implants and 0.69 mm and 1.06 mm, respectively, for TPS implants. All crestal bone loss occurred during the first 6 months after implant placement, 65 % before loading and 35 % in the first 3 months after loading, regardless of implant surface. Bone loss was significantly less with the SLA® implants at both preload and after 3 months of loading, and this was maintained during the 1-year follow-up period (Fig. 2).

1.0 0.8

0.6 0.4

*p<0.05

0.2 0

Preload

3 mo Load

6 mo Load

9 mo Load

12 mo Load

Figure 2: Interaction line plot for mean crestal bone loss for SLA® versus TPS implants, from preload to 12 months of loading

Bone density values were also significantly greater for SLA® implants than TPS implants, comparing both preload and 3 months to baseline, but no detectable changes in bone density were observed in the apical areas between SLA® and TPS implants.

Figure 1: Electron micrographs of SLA® (above) and TPS (below) surfaces; original magnification x 1700; bar = 10 μm (images courtesy of D Buser) * R eproduced with permission of Clinical Oral Implants Research.

Conclusions • SLA® implants showed a distinct advantage in early healing periods compared to TPS implants due to reduced crestal bone loss. • SLA® implants were shown to be superior to TPS implants as measured via radiographic bone loss under both loaded and unloaded conditions.

Bone response to unloaded and loaded titanium implants with a sandblasted and acid-etched surface: a histometric study in the canine mandible

Cochran DL, Schenk RK, Lussi A, Higginbottom FL, Buser D. J Biomed Mater Res 1998;40(1):1–11.

Abstract: SLA® and TPS implants were evaluated under loaded and unloaded conditions in vivo. Greater bone-to-implant contact was observed with SLA® implants.

Introduction

Results

Many investigations of titanium implants focus on the surface characteristics, and BIC has been shown to be greater with an SLA® surface compared to a TPS surface. This study was designed to evaluate the SLA® implant surface by histometric analysis in the canine mandible, compared to TPS surface implants.

All implants were stable after 3 months, with healthy peri-implant tissues and no significant peri-implant inflammation. Bone-to-implant contact was significantly greater for the unloaded SLA® implants versus the unloaded TPS implants after 3 months and after 12 months of loading, but there was no significant difference after 3 months of loading (Fig. 2). No qualitative differences in bone tissue were observed between the SLA® and TPS implants.

Surface Group A

Surface Group C

TPS

*p<0.01 n.s.

Unloaded

3 mo Loaded

12 mo Loaded

Figure 2: Bone-to-implant contact (%) for SLA® and TPS implants for unloaded implants and implants after 3 and 12 months of loading

Extr.

-3

100

Surface Group B

Implants

SLA®

Preclinical studies

Cylindrical implants with either a TPS or an SLA® surface were placed in the mandibles of six dogs after 3 months of healing following tooth extraction. A total of 69 implants were placed. Implants were left unloaded in two dogs (Group A), while the implants in the remaining four dogs were loaded with screw-retained gold crowns after 3 months (Groups B and C). Histometric analysis of the boneto-implant contact was performed 3 months after implant placement in the unloaded group and 6 and 15 months after implant placement (3 and 12 months of loading, respectively) in the loaded groups (Fig. 1).

Total bone contact (%)

Methods

15 (mo)

Figure 1: Study plan, showing implant placement and evaluation of the various groups

Conclusions • The SLA® surface promoted greater bone-to-implant contact at 3 months u nloaded and 12 months loaded compared to the TPS s urface. • SLA® showed the potential for superior osseointegration results compared to the existing TPS surface.

Removal torque values of titanium implants in the maxilla of miniature pigs

Buser D, Nydegger T, Hirt HP, Cochran DL, Nolte NP. Int J Oral Maxillofac Implants 1998;13(5):611–619.

Abstract: Removal torque was evaluated for SLA® and Osseotite® implants in vivo over 12 weeks, and was found to be significantly higher for SLA.

Introduction

Results

After the introduction of SLA®, another acid-etched implant surface, Osseotite®, was introduced onto the market, but there were no available data comparing this and other rough titanium surfaces. The aim of this investigation, therefore, was to compare an implant with this acid-etched surface (Osseotite®) with the sandblasted and acidetched surface (SLA®) by measurement of removal torque values.

Both surfaces showed similar features under scanning electron microscopy (i.e. small micropits of 1–2 μm in diameter), although the Osseotite® surface appeared to exhibit a flatter profile. Average roughness (Ra) was greater for the SLA® surface (Ra = 2.0 μm versus 1.3 μm). The mean removal torque was significantly higher for SLA® implants compared to Osseotite® implants at all time points (Fig. 3).

Methods

Preclinical studies

In the maxilla of each of nine adult miniature pigs, a total of 70 implants were placed (six to eight implants per animal) at least 6 months after tooth extraction. Biomechanical testing was performed on 54 of these implants by evaluation of removal torque after 4, 8 or 12 weeks. The implants had either a sandblasted and acid-etched (SLA®) surface or a machined and acid-etched (Osseotite®) surface (Fig. 1, Fig. 2). A commercially available standard hex device was used for removal of the Osseotite® implants, while a specially manufactured adapter was used for removal of the SLA® implants. Since the hex connection of the Osseotite® implants was rather short and unable to withstand the shear stresses during removal torque testing, the failure torque of these implants was also assessed. Torque rotation curves were recorded for each test and the removal torque was defined as the maximum torque on the curve.

Figure 2: The two implants evaluated: the 8 mm long SLA® implant without apical grooves (left) and the 10 mm long Osseotite® implant with four apical grooves (right) SLA®

240

Osseotite ®

210 *

Torque (Ncm)

180 150 120

90 60

* *p<0.01

30 0

4 weeks

8 weeks

12 weeks

Figure 3: Mean removal torque values for SLA® and Osseotite® implants after 4, 8 and 12 weeks

The removal torque curve of SLA® implants showed a high slope to the maximum level at 10°–12° and a subsequent clear reduction following fracture at the bone-to-implant interface; in contrast, Osseotite® implants showed a flatter removal torque curve, with no clear reduction following failure torque after 12°–18°. Figure 1: Electron micrographs of the Osseotite® (above) and SLA® (below) surfaces

Osseotite® is a registered trademark of Biomet 3i, USA. * Reproduced with permission of Quintessence Publishing Co Inc., Chicago.

Conclusions • Mean removal torque was 75–125 % higher for SLA® implants versus Osseotite® implants. • In vitro and in vivo evaluation of new implant surfaces is therefore essential prior to clinical application in patients.

Interface shear strength of titanium implants with a sandblasted and acid-etched surface: a biomechanical study in the maxilla of miniature pigs

Buser D, Nydegger T, Hirt HP, Cochran DL, Nolte NP. J Biomed Mater Res 1999;45(2):75–83.

Abstract: Interface shear strength was evaluated for SLA®, TPS and machined implants in vivo. Removal torque was significantly higher for SLA® and TPS, and was higher for SLA® versus TPS at 4 weeks.

Introduction

Methods A total of 54 implants with an SLA®, TPS or machined surface (Fig. 1) were placed in the maxillae (three implants on each side) of nine adult miniature pigs at least 6 months after tooth extraction. The anterior-posterior position of each implant type was varied so that no preference was given for any one implant type. Shear strength was evaluated by removal torque testing after 4, 8 and 12 weeks; torque rotation curves were recorded for each test and the removal torque was defined as the maximum torque on the curve. Histologic and histomorphometric analysis was also performed.

2.0

8 Healing periods (weeks)

Figure 2: Removal torque values for SLA®, TPS and machined surface implants after 4, 8 and 12 weeks

Removal torque (Nm)

middle

posterior

Preclinical studies

Mean removal torque for the machined surface implants varied from 0.13 to 0.26 Nm, while mean values for the rough surfaced implants were between 1.14 and 1.56 Nm. Mean removal torque was higher for the SLA® surface after 4 weeks compared to the TPS surface, while mean values were similar for both surfaces at 8 and 12 weeks (Fig. 2). Implant position had a significant influence on removal torque – lower removal torque values were found for more posterior locations (Fig. 3), which correlated significantly with decreasing bone density from anterior to posterior sites. Histological analysis showed a separation between the bone and implant surface for machined surface implants. Bone trabeculae fractures were often observed for TPS and SLA® implants, but the bone-to-implant interface was maintained.

0.5

2.0

Results

TPS

1.0

Figure 1: The three tested implants, which had the same design but different surfaces: SLA® (left), TPS (center) and machined (right)

SLA®

1.5 Removal torque (Nm)

The SLA® titanium surface has demonstrated enhanced bone apposition versus the TPS surface. This study was designed to evaluate the interface shear strength of the SLA® surface in the maxilla of miniature pigs versus TPS and machined surfaces.

1.5

1.0

0.5

SLA®

TPS

Figure 3: Removal torque values for SLA®, TPS and machined surface implants according to implant position

Conclusions • Interface shear strength of titanium implants is significantly influenced by the surface characteristics. • SLA® and TPS surfaces showed significantly higher removal torque values than machined surface implants. • Mean removal torque was higher for SLA® compared to TPS implants after 4 weeks.

* R eproduced with permission of John Wiley & Sons, Inc.

Immediate and early loading of SLA® ITI single-tooth implants: an in vivo study. Quinlan P, Nummikoski P, Schenk R, Cagna D, Mellonig J, Higginbottom F, Lang K, Buser D, Cochran D. Int J Oral Maxillofac Implants 2005;20(3):360–370.

Abstract: SLA® implants were loaded immediately or early in vivo; no significant differences were found between the loading protocols.

Introduction

Results

A healing time of 6 weeks has been suggested for SLA® surfaced implants, indicating the potential for the implants to be loaded immediately or early. The aim of this study was to determine whether immediate or early loading of SLA® implants has any adverse effects compared to conventional loading, as assessed by clinical, radiographic and histological examination.

All implants were well osseointegrated; implant survival was 100 %. Clinically normal peri-implant tissues were observed, with no signs of inflammation or suppuration. Changes in crestal bone height (combined mesial and distal aspects) for implants loaded after 2, 10 and 21 days and 3 months were 0.35 ± 0.18 mm, 0.15 ± 0.08 mm, 0.30 ± 0.08 mm and 0.02 ± 0.07 mm, respectively. The differences were not statistically significant, suggesting that loading time does not adversely affect the peri-implant crestal bone. There were also no significant differences in primary or secondary BIC, total BIC (Fig. 1) or total connective tissue-to-implant contact. For bone marrow-to-implant contact, the amount was marginally significantly greater for the implants placed 2 days before loading (19.16 ± 35 %) compared to those placed 3 months before loading (13.98 ± 2.02 %), but no other differences were observed.

Preclinical studies

Methods Mandibular premolars and first molars were removed from four dogs and a total of 48 SLA® surfaced implants (12 per dog) were placed 4 months later. The implants were loaded with single screw-retained gold crowns 2, 10 or 21 days or 3 months after implant placement and placed in functional occlusion. Block sections were obtained for histologic examination and the changes in crestal bone height mesially and distally at each implant, and the change in bone density of the coronal 3 mm of crestal bone, were recorded. Histological evaluation included primary, secondary and total BIC as well as bone marrow-to-implant contact and connective tissue-to-implant contact.

Primary bone 100

Secondary bone

Bone-to-implant contact (%)

80 70 60 50 40 30 20 10 0

Figure 1: Total BIC for implants placed 3 months (group A), 21 days (group B), 10 days (group C) and 2 days (group D) before loading

Conclusions • No significant differences were observed between the four loading protocols. • Immediate and early loading of SLA® implants is therefore possible with no adverse peri-implant tissue effects.

Immediate implants at fresh extraction sockets: bone healing in four different implant systems.

de Sanctis M, Vignoletti F, Discepoli N, Zucchelli G, Sanz M. J Clin Periodontol 2009;36(8):705–711.

Abstract: Bone healing in extraction sockets was evaluated for SLA®, OsseoSpeed™, Osseotite® and SPI® Element implants. Healing patterns were similar in all groups, but bone-to-implant contact was highest with SLA®.

Introduction

Results

Implant placement immediately after tooth extraction has become a common procedure, but the outcomes may depend on implant design and/or surface. The aim of this study, therefore, was to investigate the differences in bone healing around four different implant systems placed in fresh extraction sockets in the dog, and to observe the influence on modelling of the buccal plate.

BIC proved to be highly variable, ranging from 39.84 % to 78.63 % for 3i implants (3i Osseotite® Certain straight miniplant), 35.78 % to 76.58 % for Astra Tech implants (Astra Tech MicroThread OsseoSpeed™ Ø 3.5 mm), 50.13 % to 86.88 % for Thommen implants (Thommen SPI® ELEMENT Ø 3.5 mm) and 58.14 % to 83.40 % for Straumann implants (Straumann® Standard Plus Ø 3.3 mm); BIC was therefore most consistent around Straumann implants. Mean BIC was also highest for Straumann implants (Fig. 2), although the difference was not statistically significant. Marked bone remodelling of the buccal plate of approximately 2.5 mm was observed, regardless of the implant system. Similar bone area percentages and amounts of new bone formation were observed for all implant systems.

Methods

Preclinical studies

Third and fourth premolars were removed in each of eight dogs and four different implant types were randomly placed in the distal extraction sockets: Thommen SPI® ELEMENT Ø 3.5 mm; Straumann® Standard Plus Ø 3.3 mm; Astra Tech MicroThread OsseoSpeed™ Ø 3.5 mm; 3i Osseotite® Certain straight miniplant (Fig. 1). Histologic, histometric and histomorphometric analysis was performed after 6 weeks of healing to assess BIC, bone area, new bone formation and ridge alterations.

90.0

Bone to implant contact (%)

* 67.5

45.0

22.5

0 Figure 1: The four implant systems evaluated: (from left to right) Thommen SPI ® ELEMENT; Straumann® Standard Plus; Astra Tech MicroThread OsseoSpeed™; 3i Osseotite® Certain

Astra Tech

Straumann

Thommen

Figure 2: Mean BIC (± SD) for the four implant systems: 3i Osseotite® Certain; Astra Tech MicroThread OsseoSpeed™; Straumann® Standard Plus; Thommen SPI® ELEMENT

Conclusions • Healing patterns for implants placed in fresh extraction sockets after 6 weeks were similar for all four implant systems. • The highest BIC was observed with SLA® implants.

SPI® is a registered trademark of Thommen Medical AG, Switzerland. OsseoSpeed™ is a trademark of Astra Tech AB, Sweden. Osseotite® is a registered trademark of Biomet 3i, USA. * Reproduced with permission of John Wiley & Sons, Inc.

The use of reduced healing times on ITI implants with a sandblasted and acid-etched (SLA®) surface: early results from clinical trials with ITI SLA® implants Cochran DL, Buser D, ten Bruggenkate CM, Weingart D, Taylor TM, Bernard JP, Peters F, Simpson JP. Clin Oral Implants Res 2002;13(2):144–153.

Abstract: SLA® implants were placed in 133 patients and restored after 6 weeks (12 weeks in class IV bone). The cumulative survival rate after 2 years was 99.3 %.

Introduction

Results

Since the SLA® surface has demonstrated advantages in earlier healing following implant placement, the aim of this investigation was to determine whether SLA® implants could be predictably and safely restored after 6 weeks after placement in class I to III bone and after 12 weeks in class IV bone.

There were 80 patients (198 implants), 21 patients (46 implants and 32 patients (139 implants) in groups A, B and C, respectively. At the time of publications, 110 patients with 326 implants had completed the 1-year follow-up evaluation, and 47 patients with 138 implants had completed the 2-year recall. Three implants were lost before abutment connection, giving a success rate of 99.3 %, for a mean implant loading time of 49 days. No implant failures or implant-related adverse events were reported after abutment connection. The cumulative implant success rate, as determined by life table analysis, was 99.1 % for both the 1-year and 2-year evaluations (Table 1).

clinical studies

Methods This was a prospective multicenter trial to evaluate the success of abutment connection by descriptive analysis and implant success by life table analysis. A total of 133 patients were recruited into the trial, and 383 implants were placed. Abutments were placed and torqued to 35 Ncm 42–63 days after implant placement for implants in bone class I, II and III, and after 84–105 days in bone class IV. The patient groups were as follows: at least one tooth missing in the posterior mandible and a fixed implant-to-implant restoration on at least two implants (group A); at least one tooth missing in the posterior maxilla and a fixed implant-to-implant restoration on at least two implants (group B); at least 1 tooth missing in the posterior mandible and either a fixed restoration on at least four implants or a removable denture on at least four implants (group C). Implants were placed in a non-submerged technique and restorations were either cement- or screw-retained. Implant mobility, radiographic bone loss, gingival health and plaque accumulation were assessed.

Group A, B, C

Interval (mo)

No implants at start interval

No drop-outs during intervals

No implants lost during interval

CSR (%)

0–12

383

99.1

12–24

326

99.1

0–12

198

99.4

12–24

165

99.4

0–12

100

12–24

100

0–12

139

98.4

12–24

126

98.4

Table 1: Life table analyses

Conclusions • Implants with an SLA® surface can be restored after 6 weeks with high levels of predictability and success. • Very high implant success rates were observed after 1 and 2 years. • The results confirm the concept of enhanced bone formation around SLA® surfaced implants and confirm the possibility of reduced healing times prior to restoration. 12

Early loading on nonsubmerged titanium implants with a sandblasted and acid-etched (SLA®) surface: 3-year results of a prospective study in partially edentulous patients

Bornstein MM, Lussi A, Schmid B, Belser UC, Buser D. Int J Oral Maxillofac Implants 2003;18(5):659–666.

Abstract: Non-submerged SLA® implants were evaluated in 51 partially edentulous patients after 3 years; the success rate was 99 %.

Introduction

Results

To evaluate the success rate of SLA® implants loaded after 6 weeks of healing in posterior sites in partially edentulous patients, and to determine whether the success rate is comparable to previous studies for implants with the TPS surface.

One implant failed to osseointegrate and became unstable during healing, so was consequently removed; A second implant was placed 3 months later and osseointegrated with no complications. One patient was lost to follow-up and considered a drop-out from the study. The remaining 102 implants were successfully osseointegrated after 3 years, resulting in a success rate of 99.03 %.

Methods

A local peri-implant infection as a result of excess cement was noted at two implants at the 3-month follow-up; the cement was removed and the infection successfully treated (Fig. 1). All other implants were firmly osseointegrated with no signs of peri-implant infection or radiolucency. Mean values for the clinical and radiographic examinations are shown in Table 1. Mean PLI significantly decreased at 1, 2 and 3 years compared to 3 months, and the mean decreases in mSBI from 3 months were also significant. PD, DIM, CAL and DIB remained stable throughout the study period, while there was a tendency for decreasing PTV score.

clinical studies

In 51 partially edentulous patients, 104 implants (89 mandibular, 15 maxillary) were placed in posterior sites in bone densities of class I, II or III. Solid abutments were connected and torqued to 35 Ncm and the implants functionally loaded with cement-retained single crowns (39 implants), splinted single crowns (43 implants) or fixed partial dentures (21 implants) after 6 weeks. Clinical and radiographic examination was performed after 3, 12, 24 and 36 months – the parameters measured were modified plaque index (mPLI), modified sulcus bleeding index (mSBI), probing depth (PD), distance from implant shoulder to mucosal margin (DIM), clinical attachment level (CAL), mobility assessed by Periotest (PTV), and distance from implant shoulder to most coronal visible BIC (DIB).

Conclusions • Early loading of SLA® implants after 6 weeks leads to highly successful and predictable tissue integration in partially edentulous patients. • Successful tissue integration is maintained for up to 3 years of follow-up. • An excellent 3-year success rate of 99.03 % was observed. Figure 1: The two implants with previous peri-implantitis following successful treatment – at the 3-year examination both implants fulfilled the success criteria (Picture courtesy of M Bornstein).

Time

mPLI

mSBI

PD (mm)

DIM (mm)

CAL (mm)

PTV

DIB (mm)

3 mo

10.49

0.65

4.29

0.28

0.49

4.47

-1.12

3.18

-2.08

2.64

-1.24

3.22

-3.57

2.76

0.24

0.33

0.28

0.26

4.32

-1.12

3.19

-4.08

2.82

4.23

-1.09

3.15

-3.17

2.72

Table 1: Mean values for clinical and radiographic parameters at 3, 12, 24 and 36 months

* Reproduced with permission of Quintessence Publishing Co Inc., Chicago.

Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA®) ITI implants in the posterior mandible. A 1-year randomized controlled clinical trial Salvi GE, Gallini G, Lang NP. Clin Oral Implants Res 2004;15(2):142–149.

Abstract: SLA® implants were placed in 27 patients and loaded after 2 or 6 weeks. No implants were lost after 1 year, showing that 2-week loading does not jeopardize osseointegration.

Introduction

Results

Implants placed in a two-stage surgical protocol are traditionally restored after a non-loaded healing period of 3–6 months, but evidence suggests that the SLA® surface can promote faster osseointegration. The aim of this investigation, therefore, was to assess clinical and radiographic outcomes of SLA® surfaced implants in the posterior mandible loaded after 2 or 6 weeks.

The implant survival rate after 1 year was 100 %. For three implants (two in the test group and one in the control group), abutment rotation occurred at abutment connection, so the final impression was not taken and the abutments were successfully re-tightened to 35 Ncm 12 weeks later. There were no significant differences between the test and control groups for any of the clinical or radiographic parameters measured (Table 1).

clinical studies

Methods The study enrolled 27 patients with bilateral posterior mandibular edentulous areas requiring prosthetic reconstruction. A total of 67 implants were placed, 31 in one side of the mandible (test) and 36 in the contralateral side (control). In the control group, abutment placement was carried out after 35 days and single-tooth crowns were placed after 42 ± 2 days. Abutments were placed after 7 days in the test group and single-tooth crowns were placed after 14 ± 1 days. All abutments were torqued to 35 Ncm and all crowns were porcelain-fused-to-metal and were cemented. Clinical data (CAL, PD, bleeding on probing (BOP), implant stability by Periotest (PTV) were assessed 2, 6, 12, 24 and 52 weeks after implant placement; width of keratinized mucosa (KM) was evaluated at implant placement and after 1 year. Distance from implant shoulder to most coronal BIC was evaluated radiographically at baseline and after 6 weeks and 1 year to assess bone loss (BL).

Test sites (N=31)

Control sites (N=36)

Statistic

PPD (mm±SD)

2.6±0.5

2.7±0.5

CAL (mm±SD)

3.1±0.4

3.2±0.5

9.7

8.3

BOP (%) Width of KM (mm±SD)

1.8±0.4

1.9±0.5

PTV (±SD)

-1.4±0.9

-1.6±0.8

0.57±0.49

0.72±0.5

BL (mm±SD)

Table 1: Clinical and radiographic parameters at test and control sites at the 12-month follow-up evaluation

Conclusions • Loading of SLA® surfaced implants as early as 2 weeks does not jeopardize the process of osseointegration. • Proper handling of implant abutment rotation does not adversely affect tissue integration or implant stability. • Clinical and radiographic outcomes are similar for implants in the posterior mandible loaded after 2 weeks as for those loaded after 6 weeks.

A 3-arm study of early loading of rough-surface implants in the completely edentulous maxilla and in the edentulous posterior maxilla and mandible: results after 1 year of loading

Nordin T, Nilsson R, Frykholm A, Hallman M. Int J Oral Maxillofac Implants 2004;19(6):880–886.

Abstract: A total of 234 SLA® implants were placed in patients with an edentulous maxilla or mandible. Cumulative survival after 1 year was 99.1 %, with favourable results for both immediate and early loading.

Introduction

Results

Previous studies have indicated that early loading of SLA® implants may be feasible. The aim of this study was to investigate early loading of SLA® implants in the edentulous maxilla and posterior edentulous maxilla and mandible using a larger patient population than previously studied.

Two of the 234 implants were lost, giving an overall cumulative survival rate of 99.1 %; survival rates for groups A, B and C were 99.2 %, 98.3 % and 100 %, respectively. Implant placement torque varied from 29 to 35 Ncm among the groups, and no significant differences were observed between placement torque for implants (Fig. 1). The mean reduction in marginal bone level from baseline to implant placement was -0.75 ± 0.13 mm (range 0 to 3.5 mm); the mean changes in marginal bone level were -0.63 mm, -1.03 mm and -0.96 mm for groups A, B and C, respectively. No significant differences were found between the groups or between implants placed in extractions sockets and those placed in healed bone.

Methods

Immediate

Conclusions • Favorable results were obtained for immediate and early loading of SLA® implants in this patient population. • Early loading with SLA® implants can have predictable outcomes for the rehabilitation of the edentulous maxilla and edentulous posterior maxilla and mandible.

clinical studies

The study enrolled 54 patients in three groups: patients with a completely edentulous maxilla (20 patients, group A); patients with an edentulous posterior left and/or right maxilla (19 patients, group B); and, patients with an edentulous posterior left and/or right mandible (15 patients, group C). Patients each received from 2 to 7 implants – 234 implants were placed (122 implants in group A, 59 in group B and 53 in group C); 58 of the implants were placed immediately after tooth extraction. Straumann® synOcta abutments were mounted prior to flap suture and impressions were taken immediately after surgery. Placement torque was measured at all implant sites at the time the abutments were mounted. Sixty screw-retained prosthetic restorations were used to restore 2–12 teeth and were loaded after a mean period of 9 days (range 4 to 22 days). Intraoral radiographs were obtained at baseline and after 1 year of functional loading to evaluate change in marginal bone level, measured as the change in distance from the implant shoulder to the first bone apposition.

Healed

Torque (Ncm)

B Group

Figure 1: Implant placement torque for implants placed in extraction sockets and in healed bone for the three groups (A – edentulous maxilla; B – edentulous posterior left and/or right maxilla; C – edentulous posterior left and/or right mandible)

Immediate loading of implants with 3-unit fixed partial dentures: a 12-month clinical study Cornelini R, Cangini F, Covani U, Barone A, Buser D. Int J Oral Maxillofac Implants 2006;21(6):914–918.

Abstract: SLA® implants were immediately loaded with 3-unit fixed partial dentures in 20 patients. The survival rate after 1 year was 97.5 %.

Introduction

Results

Studies have shown that shortened treatment times (e.g. loading after 6 weeks) with SLA® implants can be predictable and have advantages for both patients and clinician. The aim of this investigation was to evaluate implant success after 12 months for immediately loaded SLA® implants in the posterior mandible supporting 3-unit fixed partial dentures (FPDs).

One implant was removed 2 months after placement due to acute infection at the implant site – a new implant was placed, which was subsequently successful. The remaining 39 implants were successful, giving a 1-year success rate of 97.5 %. No significant differences were observed between implant placement and 12 months for DIB, KM or ISQ (Table 1). No technical complications (e.g. screw loosening, resin fracture, pain during chewing) were observed.

clinical studies

Methods Twenty patients with missing mandibular molars or premolars were enrolled, and a total of 40 implants were placed. Copings were connected to the implants, wound closure was achieved and impressions were taken. Healing caps were then placed and temporary screw-retained acrylic resin 3-unit FPDs in functional occlusion were connected to the implants within 24 hours, i.e. immediate loading. Definitive abutments and metal-ceramic restorations were placed after 6 months. Implant stability (ISQ), width of keratinized mucosa (KM) and distance from implant should to point of first BIC (DIB) were measured at implant placement and after 12 months. Implants were included in the study only when the primary stability exceeded an ISQ measurement of 62.

Baseline

DIB Mesial

12 months

Mean

P-value

2.4

0.4

2.5

0.4

2.6

0.6

3.1

0.6

2.0

0.5

2.0

0.5

Distal Width of keratinized mucosa Midbuccal Middlingual ISQ

2.4

0.5

2.2

0.6

72.0

5.7

74.5

7.3

Table 1: Changes in clinical and radiographic parameters between baseline (implant placement) and 12-month follow-up

Conclusions • Immediate functional loading of SLA® implants resulted in an excellent survival rate. • The placement of SLA® implants in the mandible and immediate loading with 3-unit FPDs has been shown to be a successful procedure in this study.

A five-year life table analysis on wide neck ITI implants with prosthetic evaluation and radiographic analysis: results from a private practice

Bischof M, Nedir R, Abi Najm S, Szmukler-Moncler S, Samson J. Clin Oral Implants Res 2006;17(5):512–520.

Abstract: A 5-year life table analysis was performed for 263 wide neck SLA® implants in 212 patients. The cumulative survival rate after 5 years was 97.9 % and the mean bone loss after 2 years was comparable to standard SLA® implants.

Introduction

Results

Implants with diameters in the range of 3.75 to 4.1 mm have been extensively used and investigated, but conflicting clinical data have been reported for implants with wider diameters (e.g. 5–6 mm). The aim of this investigation was to report on the follow-up of SLA® Wide Neck implants (4.8 mm) in a 5-year life table analysis, including prosthetic outcomes.

The 1- and 2-year implant survival rates, based on 259 implants and 174 implants, respectively, were 98.8 % and 97.7 %; the 5-year cumulative survival rate was 97.89 %.Two early failures occurred before loading, and three late failures occurred after loading. A total of 157 single crowns and 80 FPDs were placed; the majority of prosthetic restorations were cement-retained. Over 5 years, 93 % of the single crowns and 95 % of FPDs were free from complications. Porcelain fracture was noted for 11 prostheses supported by 11 implants in 11 patients; all of these were cement-retained. Of these, five were major fractures, all of which occurred on single crowns, and six were minor fractures, four with single crowns and two with FPDs. After 2 years, mean crestal bone loss mesially and distally was 0.71 ± 0.62 mm and 0.60 ± 0.64 mm, respectively. Crestal bone loss > 1 mm was observed at 21.3 % of mesial and distal sides, and only 2.5 % showed crestal bone loss > 2 mm (Table 1).

Methods

CBL

Mesial side

Distal side

Sum

6 (6 %)

11 (10.8 %)

17 (8.4 %)

0–0.5

33 (33 %)

41 (40.2 %)

74 (36.6 %)

0.5–1

30 (30 %)

21 (40.6 %)

51 (25.2 %)

1–1.5

22 (22 %)

21 (40.6 %)

43 (21.3 %)

1.5–2

6 (6 %)

6 (5.9 %)

12 (5.9 %)

Gain (mm) 0–1

clinical studies

Over a 5-year period, 263 SLA® Wide Neck implants were placed in 212 patients; 61.2 % were placed in the maxilla and 38.8 % in the mandible. The majority (97 %) were placed in the molar region, with only 3 % in the premolar region. The mean implant lengths used were 8.9 mm and 9.7 mm in the maxilla and mandible, respectively. Single crowns were used to replace single missing molars, and bridges (two splinted crowns, FPDs with pontics and/or unit extensions) were used in larger edentulous spaces. The width of the vestibular and buccal lamellae was ≥ 1 mm in 89 % of cases (234 implant sites), while 9.1 % (24 implant sites) had one lamellae < 1 mm and 1.9 % (five implant sites) had both lamellae < 1 mm. Sinus perforation of 1–2 mm was tolerated and occurred with 52 % of the maxillary implants placed. Simultaneous bone augmentation was performed at 37 sites, 28 of which were vertical and 9 of which were lateral. Slightly detectable mobility was observed for 20 implants (7.6 %); the remaining 92.4 % were stable.

Conclusions • Wide Neck SLA® implants supporting single crowns and FPDs in molar regions are highly predictable. • Mean bone loss after 2 years was comparable to standard SLA® implants. • The safe and predictable use of Wide Neck implants simplified implant treatment. • Very few prosthetic complications were noted.

Loss (mm)

3 (3 %)

2 (2.0 %)

5 (2.5 %)

Sum

100 (100 %)

102 (100 %)

202 (100 %)

Table 1: Crestal bone loss distribution after 2 years

Clinical field trial examining an implant with a sand-blasted, acid-etched surface Cochran D, Oates T, Morton D, Jones A, Buser D, Peters F. J Periodontol 2007;78(6):974–982.

Abstract: A clinical field trial was performed with 990 implants in 509 patients. Survival and success after 5 years were 99.3 % and 97.4 %, respectively, comparable to those achieved in formal clinical trials.

Introduction

Results

Traditionally, dental implants required 3 to 6 months of undisturbed healing before the prosthetic restoration could take place. Formal clinical trials have demonstrated that implants with the SLA® surface can be successfully restored after 6 weeks. The aim of this study, therefore, was to evaluate the use of SLA® surfaced implants and a reduced healing time (6–8 weeks) in a large number of patients treated in predominantly private practice settings.

A total of 509 patients with 990 implants (270 in the maxilla and 720 in the mandible) were treated according to the protocol. There were four early implant failures (i.e. prior to or at abutment connection), and another implant failed 3 months after abutment placement; of these five, one was still in function after 3 years and was rated as successful by the investigator. One late implant failure occurred after 49 months of function. The cumulative survival rates after 3 and 5 years were 99.56 % and 99.26 %, respectively, while the corresponding success rates were 99.12 % and 97.38 % (Table 1). Complications noted included gingivitis in two patients (four and two implants),l recurrent peri-implant infection in two patients (one implant each) and pain/discomfort in one patient (one implant). Successfully treated complications included implant rotation on abutment placement (12 patients/15 implants), pain/discomfort on abutment placement (22 patients/34 implants), gingival recession (one patient), paresthesia of the lower lip (two patients) and gingival hyperplasia (one patient).

clinical studies

Methods The study was designed to include over 500 patients and over 800 implants. The patients were to be treated no differently to any other implant patients in the private practice setting. Requirements for treatment included good general health and sufficient bone at the implant site (crest width > 6 mm and height > 10 mm). The implants were placed in a non-submerged technique and had abutments placed and restored in full occlusion by 63 days following placement. Follow-up examinations were performed after 3 months and annually thereafter. A total of 86 investigators worldwide placed 1,406 implants in 706 patients; 27 patients (79 implants) were excluded because six investigators did not return documentation, and 170 patients (337 implants) were excluded due to implant restoration after > 63 days (Fig. 1).

Implant survival Interval (months)

Failures

Cumulative success rate (%)

0–12

990

99.56

12–24

809

99.56

99.42

24–36

686

99.56

99.12

603

99.56

98.56

48–60

462

99.26

97.38

Compliance with study protocol?

60–72

202

99.26

97.38

> 72

99.26

97.38

No 79 implants 27 patients 6 investigators

Implants restored within 63 days?

Cumulative survival rate (%)

36–48

1'327 implants 679 patients 86 investigators

990 implants 509 patients

337 implants 170 patients

Per protocol set

Off protocol

Figure 1: Study plan

Failures

1'406 implants 706 patients 92 investigators

Yes

Imlants at baseline

Implant success

Table 1: Cumulative implant survival and success rates – life table analysis

Conclusions • SLA® implants can be successfully restored after 6–8 weeks in a private practice setting. • Very high survival and success rates were documented (99.26 % and 97.38 % after 5 years). • Cumulative survival rates were comparable to those from formal clinical trials with stricter inclusion criteria. • The high numbers of investigators and patients suggested that the characteristics of the SLA® surface are such that critical aspects of the healing process are accounted for.

Clinical performance of wide-body implants with a sandblasted and acid-etched (SLA®) surface: results of a 3-year follow-up study in a referral clinic

Bornstein MM, Harnisch H, Lussi A, Buser D. Int J Oral Maxillofac Implants 2007;22(4):631–638.

Abstract: A total of 116 patients received SLA® wide body implants in a specialist clinic. Survival and success rates of 99.3 % were achieved after 3 years.

Results

The aim of this investigation was to evaluate the clinical performance of SLA® wide-body implants with a regular or wide neck in a referral clinic to assess whether the success rates were similar to those achieved under strict, well-defined conditions.

One implant in the left maxilla became unstable during the healing period due to a peri-implant infection and was removed; no signs of peri-implant infection or mobility were observed for the remaining 150 implants. Six patients with 11 implants did not attend the 36-month examination and were therefore lost to follow-up. Clinical and radiographic analysis therefore included 109 patients with 139 implants, all of which were successfully integrated. The 3-year survival and success rate was 99.3 %. All 139 implants showed favorable clinical and radiographic findings – mean mPI and mSBI were 0.26 and 0.6, respectively. Mean PD and CAL were 3.87 mm and 2.79 mm, respectively. Mean DIM at 3 years was -1.13 mm, and the mean DIB increased from 2.52 mm at implant insertion to 2.85 mm after 3 years; the difference was significant, but progressive bone loss was not detected at any implant over the 3-year evaluation period (Fig. 1). Frequency analysis showed that most implants had a DIB between -0.5 and +0.5 mm (Fig. 2), corresponding to < 0.2 mm bone gain or loss per year.

Methods This was a prospective investigation of patients referred by their private dentist to a specialist clinic for implant therapy. The study enrolled 116 partially edentulous patients, including smokers and those with defects requiring bone augmentation. A total of 151 wide-body implants with either a regular neck or wide neck configuration were placed (75 in distal extension situations, 56 in single-tooth gaps and 20 in extended edentulous spaces). Prosthetic rehabilitation took place after 6–8 weeks for implants placed without bone augmentation and after 10–14 weeks for implants with local bone augmentation. Single crowns were used for 95 implants, 29 were restored with splinted single crowns and 20 were used as abutments for implantsupported FPDs. After 36 months, clinical and radiographic followup was performed, and the following parameters were evaluated: modified plaque index (mPI); modified sulcus bleeding index (mSBI); probing depth (PD); distance from implant shoulder to mucosal margin (DIM); clinical attachment level (CAL); mobility, as measured by Periotest (PTV); and, distance from implant shoulder to first visible BIC.

clinical studies

Introduction

< 1.0 mm +0.5 mm to 1.0 mm 0 mm to +0.5 mm 0 mm to -0.5 mm -0.5 mm to -1.0 mm

-1.0 mm 0

40 50 Implants

Figure 2: Frequency analysis of bone gain or loss around 134 implants using ΔDIB values

Figure 1: 36-month peri-apical radiograph showing normal bone structures around implants, with no signs of peri-implant radiolucencies

Conclusions • Wide body SLA® implants with regular or wide neck configurations achieved successful integration and high predictability in patients referred for implant therapy. • Favorable clinical and radiographic results were observed. • The 3-year survival and success rates was 99.3 %. • The implant survival compares well with that from clinical studies with standard diameter SLA® implants in selected patient populations.

* Reproduced with permission of Quintessence Publishing Co Inc., Chicago.

Five-year results from a randomized, controlled trial on early and delayed loading of implant supporting full-arch prosthesis in the edentulous maxilla Fischer K, Stenberg T, Hedin M, Sennerby L. Clin Oral Implants Res 2008;19(5):433–441.

Abstract: SLA® implants were placed in the edentulous maxillae of 24 patients and loaded with full-arch prostheses either early or conventionally. The 5-year cumulative survival rate was 95.1 %, indicating that early loading in the maxilla is a viable treatment option.

Introduction

Results

Studies with SLA® implants have shown stable radiographic bone levels, but few studies have presented long-term radiographic data. The aim of this investigation, therefore, was to compare the clinical outcome and stability of early and delayed loaded one-stage implants with the SLA® surface in the edentulous maxilla.

During the 5-year study period, seven implants were lost (five in the test group and two in the control group); three were early failures (before loading) and four were late failures. In addition, one patient with six implants did not attend the 5-year follow-up evaluation. The 5-year cumulative survival rate was 95.1 % (94.7 % and 95.7 % in the test and control groups, respectively). There were no significant differences between the groups for RFA values. Plaque and bleeding on probing were greater in the control patients, and more control implants showed probing depths > 3 mm. Mean marginal bone level after 5 years was 2.9 ± 1.1 mm in the test group and 3.7 ± 1.2 mm in the control group (Fig. 1); mean bone loss was 0.8 ± 1.2 mm and 0.3 ± 1.0 mm for test and control implants, respectively – the difference was significant. It was noted, however, that the early loaded implants were generally placed deeper into the bone. The numbers of patients with > 2 mm bone loss was similar in both groups, but more patients in the test group showed > 3 mm bone loss. Resin-related technical complications were also more prevalent in the test group (18 versus 12 in the control group), but implant, abutment, abutment screw or assembly screw fractures did not occur in either group.

clinical studies

Methods The study included 24 patients with totally edentulous maxillae requiring implant treatment. Each patient received five or six implants (diameter 4.1 mm, length 8–12 mm). The patients were assigned to either early implant loading (16 patients with 95 implants loaded after 9–18 days) or delayed loading (eight patients with 47 implants loaded after 2.5–5.1 months). Prostheses were fabricated from cast titanium alloy with acrylic resin crowns. Clinical and radiographic evaluations (sulcus bleeding index, plaque index, probing depth, distance from implant shoulder to crestal bone level) were performed after 1, 3 and 5 years of loading; the prostheses were removed on each occasion. Implant stability was also recorded in mesial-distal and buccal-palatal directions for each implant using resonance frequency analysis (RFA).

Conclusions • Survival rates for early and delayed loaded SLA® implants in the edentulous maxilla were not significantly different after 5 years. • Minimal bone resorption indicated favorable long-term marginal bone response to the SLA® surface. • Early loading of SLA® implants to support full-arch prostheses in the edentulous maxilla is therefore a viable treatment option. • Technical complications were mainly resin-related, which may be improved by the use of a lingual gold onlay.

4.5 Control

Test

Bone level (mm)

4.0 3.5 3.0 2.5 2.0 1.5

Baseline

1-year

2-year

3-year

5-year

Figure 1: Marginal bone levels in relation to the upper part of the implant shoulder for test and control implants from baseline to 5 years

Performance of dental implants after staged sinus floor elevation procedures: 5-year results of a prospective study in partially edentulous patients

Bornstein MM, Chappuis V, von Arx T, Buser D. Clin Oral Implants Res 2008;19(10):1034–1043.

Abstract: SLA® and TPS implants were placed in 56 patients following sinus floor elevation. After 5 years, survival was 100 % for SLA® and 89 % for TPS implants.

Introduction

Results

Sinus floor elevation using graft material is the most common solution for insufficient bone volume in the posterior maxilla. The aim of this study was to evaluate the clinical and radiographic 5-year results for implants with either a TPS or an SLA® surface placed in a two-stage sinus floor elevation procedure in the posterior maxilla.

At the 5-year evaluation, 100 implants could be analyzed; six patients with 11 implants dropped out of the study at the 12- and 60-month examinations. There were two implant failures, both of which were TPS implants, resulting in a 5-year survival and success rate of 98 % (100 % for SLA® implants and 88.98 % for TPS implants). A local peri-implant infection occurred at two of the implants after 12 months – both cases were successfully treated. No peri-implant radiolucency or mobility was detected for any of the implants at any time point. There were no significant differences in gingival parameters between 12 and 60 months except for PD, which showed a significant decrease (Table 1).

Methods

clinical studies

A total of 59 sinus floor elevation procedures were performed in 56 partially edentulous patients. A composite graft was used, consisting of autogenous bone chips combined with deproteinized bovine bone mineral or synthetic ß -tricalcium calcium phosphate. After a healing period of 4–12 months, a total of 111 implants (90 SLA® and 21 TPS) were placed (93 in distal extension situations, four in singletooth gaps and 14 in extended edentulous spaces). Abutments were placed after a healing period of 8–14 weeks and prostheses were placed (41 single crowns and 71 splinted single crowns). Patients were recalled 12 and 60 months after abutment connection for clinical and radiographic examination, consisting of modified plaque index (mPI), modified sulcus bleeding index (mSBI), probing depth (PD), clinical attachment level (CAL), mobility (assessed by Periotest; PTV), distance between implant shoulder and mucosal margin (DIM) and distance from implant shoulder to first visible BIC (DIB).

Exam

mPI

mSBI

PD (mm)

DIM (mm)

CAL (mm)

PTV

1 year (n=103)

0.34 (± 0.03)

0.35 (± 0.04)

4.43 (± 0.11)

-1.35 (± 0.11)

3.04 (± 0.06)

-2.71 (± 0.31)

5 year (n=98)

0.27 (± 0.03)

0.29 (± 0.03)

4.14 (± 0.11)

-1.22 (± 0.11)

2.89 (± 0.08)

-3.00 (± 0.28)

Table 1: Gingival parameters and mobility at 1 and 5 years (mean ± SE)

Conclusions • Implants with an SLA® surface placed after sinus floor elevation with a composite graft achieve successful tissue integration with high predictability over 5 years of followup. • The survival and success rate for SLA® implants was 100 %. • Implant placement after sinus floor elevation for single crowns or FPDs can be considered the standard of care, provided that the patient has no active periodontal disease, is not a smoker and is not medically compromised.

Clinical and radiographic study of implant treatment outcome in periodontally susceptible and non-susceptible patients: a prospective long-term study De Boever AL, Quirynen M, Coucke W, Theuniers G, De Boever JA. Clin Oral Implants Res 2009;20(12):1341–1350.

Abstract: SLA® and TPS implants were placed in periodontally susceptible or non-susceptible patients. Implant surface and periodontal status significantly influenced implant survival, which was significantly greater for SLA® implants.

Introduction

Results

Placement of dental implants has become a routine procedure for tooth replacement, but clinical outcome in periodontally compromised or susceptible patients is still controversial. The aim of this investigation was to compare implant survival and periodontal and radiographic parameters of non-submerged implants with either a TPS or SLA® surface in periodontitis-susceptible and healthy nonperiodontally susceptible patients.

There were 24 implant failures in 22 patients, 20 of which occurred before loading and four of which occurred after loading. There were eight, seven and three failures in the NSP, CAP and GAP groups, respectively, giving implant failure rates of 3.06 %, 3.62 % and 15.25 %, respectively. Cumulative implant survival rates were 97 % in the NSP group (over 140 months) and 96 % in the CAP group (over 140 months), but was significantly lower at 80 % in the GAP group (over 100 months). General impaired health did not adversely affect survival for all patients combined, but led to a further decrease in survival rate (to 71 %) in the GAP group. The survival rate for TPS implants was lower than that for SLA® implants (93 % versus 97 %, respectively; Fig. 1). There was no difference in implant survival between current and former smokers for all patients combined, but smoking significantly decreased implant survival in the GAP group (to 63 %). Mean marginal bone loss compared to baseline was 0.28 ± 0.7 mm and 0.24 ± 0.6 mm at the mesial and distal sides, respectively. Mean mesial and distal bone loss/year was 0.08 mm and 0.07 mm in the NSP group, 0.12 mm and 0.09 mm in the CAP group and 0.17 mm and 0.17 mm in the GAP group, where bone loss was significantly related to bleeding on probing, age, inflammation, plaque and probing depth.

clinical studies

Methods A total of 221 patients requiring non-submerged implants and FPDs were enrolled – of these, 194 were available and were divided into three groups: non-periodontally susceptible patients (NSP; 110 patients, 261 implants), in whom teeth required replacement due to caries or trauma; periodontally susceptible patients (CAP; 68 patients, 193 implants), in whom teeth were lost due to generalized chronic adult periodontitis; or, patients with generalized aggressive periodontitis (GAP; 16 patients, 59 implants). TPS implants (259) were used in the first phase of the study and SLA® implants (254) were used after this surface was introduced. At the follow-up times (at least every 6 months), probing depth (PD), bleeding on probing (BOP), plaque score, bone score, bone loss and implant failures were evaluated.

1.00

Conclusions • Periodontally susceptible and non-susceptible patients demonstrated similar peri-implant variables and implant survival, but those with generalized aggressive periodontitis showed lower implant survival, higher marginal bone loss and more peri-implant pathology. • Implant surface and periodontal classification had a significant influence on implant survival. • Implant survival was significantly greater for SLA® versus TPS implants.

SLA® 0.95 TPS

0.9

0.85 p = 0.06 0.80 0

60 80 100 Follow-up in months

Figure 1: Kaplan-Meier survival curve for TPS and SLA® implants

120

140

Marginal bone level changes and prosthetic maintenance of mandibular overdentures supported by 2 implants: a 5-year randomized clinical trial

Cehreli MC, Uysal S, Akca K. Clin Implant Dent Relat Res 2010;12(2):114–121.

Abstract: SLA® or TiUnite® implants were placed in 28 patients to support mandibular overdentures. Implant survival was 100 % in both groups, but marginal bone loss was significantly less for Straumann® Soft Tissue Level SLA® implants.

Introduction

Results

Success with early loading of implant-supported restorations has been demonstrated, but documentation on early loading of mandibular overdentures is scarce. The aim of this investigation, therefore, was to compare biologic and prosthetic outcomes of mandibular overdentures supported by early loaded one- and two-stage implants after 5 years.

Six patients (two with Straumann® implants and four with Brånemark implants) were excluded from the study after 5 years; data were therefore available from 22 patients (12 patients with 24 Straumann® implants and 10 patients with 22 Brånemark implants). There were no implant failures in either group. Peri-implant parameters were comparable for both implant systems, but mean marginal bone loss was significantly higher for Brånemark implants (Fig. 1), and the maximal bone level change was also higher (1.8 mm compared to 1.3 mm for Straumann® implants; Fig. 1). Survival probabilities for overdentures were similar, but wear of the ball abutment was observed more for the Brånemark implants, while occlusal adjustment, broken/ loose/lost retainers and retainer retightening were more prevalent in the Straumann group.

Methods

1.75

clinical studies

This was a randomized, controlled, single-blind trial in 28 patients, randomized into two groups to receive either two unsplinted Straumann® Soft Tissue Level SLA® implants (14 patients) to support mandibular overdentures (retained by retentive anchor abutment with PVC ring covered gold matrix) or two unsplinted Brånemark (Mk III TiUnite®) implants (14 patients) to support mandibular overdentures (retained by ball attachments with gold caps). Straumann® implants were placed so that the SLA®/machined border was at the level of the cortical bone, and Brånemark implants were placed so that the upper outer edge of the implant neck was at the level of the cortical bone. During a healing period of 4–6 weeks after implant placement, the patients’ existing dentures were re-lined, and the prostheses were placed in both groups after 6–8 weeks. Plaque index, calculus index, peri-implant inflammation and bleeding were recorded, and radiographic marginal bone levels were examined 1 week and 5 years post-surgery.

Conclusions • Similar peri-implant soft tissue and prosthetic outcomes were found for mandibular overdentures supported by Straumann® Soft Tissue Level SLA® or Brånemark TiUnite® implants. • All implants survived after 5 years. • Marginal bone loss was significantly less for Straumann® SLA implants versus Brånemark TiUnite® implants after 5 years.

bone loss

1.5

1.25

1.0

0.75

0.5 Straumann

implant

Brånemark

Figure 1: Marginal bone loss (mm) around Straumann® and Brånemark implants after 5 years

TiUnite® is a registered trademark of Nobel Biocare AB, Sweden.

10-year outcome of SLA® implants in the edentulous maxilla Fischer K. ITI World Symposium; Geneva, Switzerland, 15–17 Apr 2010.

Abstract: SLA® implants were placed in the edentulous maxillae of 24 patients and loaded with full-arch prostheses either early or conventionally. The implant survival rate after 10 years was 95.1 %, with no significant bone loss between 5 and 10 years.

Introduction

Results

Studies with SLA® implants have shown stable radiographic bone levels and, although some trials show data over long periods (e.g. 5 years), no 10-year follow-up data have been published. The aim of this study, therefore, was to evaluate and compare the long-term outcomes of two different loading protocols for SLA® implants in the edentulous maxilla.

One-year31, 3-year32 and five-year17 results of the study were previously published. Seven implants were lost between baseline and 5 years, and no further implants were lost between 5 and 10 years. One patient with severe/aggressive periodontitis only had three implants still in place at the 5-year evaluation and dropped out of the study before the 10-year evaluation. No other patients showed signs of peri-implantitis. In terms of implant losses, the implant survival rate was 95.1 %, but if implants of unknown status were also considered (i.e. the drop-out patient with three implants), then the implant survival rate was 93 %. The prosthesis survival rate was 96 %, and high patient satisfaction was reported. The change in mean marginal bone level between 5 and 10 years was not significant; mean marginal bone loss after 5 and 10 years in the test group was -0.8 ± 1.2 mm and -1.1 ± 0.9 mm, respectively, and in the control group was -0.3 ± 1.0 and -0.7 ± 1.3 mm, respectively (Fig. 1). The majority of implants (67.9 %) had a sulcus bleeding index of 1 and most had a plaque index of 1 (28.6 %) or 2 (39.3 ). A total of 70 prosthesis-related complications occurred, 68 of which were resin-related and two of which were metal-related. There were no abutment fractures.

clinical studies

Methods This was a randomized, controlled study in 24 patients with completely edentulous maxillae. A total of 142 SLA® surfaced implants* were placed and loaded with full-arch prostheses either after 9–18 days (early loading – test group; 16 patients with 95 implants) or after 2.5–5.1 months (delayed loading – control group; eight patients with 47 implants). Radiographic examination was performed at prosthesis placement and after 6 months and 1, 2, 3, 5 and 10 years; prosthesis placement was the baseline measurement. Plaque index (PI), sulcus bleeding index (SBI) and probing depth (PD) were also measured.

Change in mean marginal bone from 5 to 10 years (mm)

test

control

Conclusions • There were no implant losses between 5 and 10 years. • There was no significant bone loss between 5 and 10 years. • Prosthesis survival was high (96 %) and complications were predominantly resin-related. • No signs of peri-implantitis were noted (except in one patient with severe aggressive periodontitis). • Patient satisfaction was high.

-0.1

-0.2

-0.3

-0.4 ns Figure 1: Marginal bone loss in the test and control group after 5 and 10 years

* SLA® surface implants refers to Straumann® Soft Tissue Level SLA® implants.

Additional studies The following publications indicate the scientific evidence about Straumann’s SLA® surface, including over 110 clinical studies (see list below), over 140 in vitro (e.g. laboratory, cell culture) investigations and over 80 preclinical in vivo investigations:

Clinical studies:

Aouate G. Osseointegration of mobile posterior single-tooth implants with SLA surface: report of 2 cases. Int J Oral Maxillofac Implants 2004;19(3):443-7. Arlin ML. Short dental implants as a treatment option: results from an observational study in a single private practice. Int J Oral Maxillofac Implants 2006;21(5):769-76. Arlin ML. Survival and success of sandblasted, large-grit, acid-etched and titanium plasma-sprayed implants: a retrospective study. J Can Dent Assoc 2007;73(9):821. Arvidson K, Esselin O, Felle-Persson E, Jonsson G, Smedberg JI, Soderstrom U. Early loading of mandibular full-arch bridges screw retained after 1 week to four to five Monotype implants: 3-year results from a prospective multicentre study. Clin Oral Implants Res 2008;19(7):693-703. Aydin M, Yilmaz A, Kâtibo lu B, Tunç EP. ITI implants and Dolder bars in the treatment of large traumatic defect of mandible: a clinical report. Dent Traumatol 2004;20(6):348-52. Barewal RM, Oates TW, Meredith N, Cochran DL. Resonance frequency measurement of implant stability in vivo on implants with a sandblasted and acid-etched surface. Int J Oral Maxillofac Implants 2003;18(5):641-51. Bergkvist G, Sahlholm S, Karlsson U, Nilner K, Lindh C. Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report. Int J Oral Maxillofac Implants 2005;20(3):399-405. Bergkvist G, Nilner K, Sahlholm S, Karlsson U, Lindh C. Immediate loading of implants in the edentulous maxilla: use of an interim fixed prosthesis followed by a permanent fixed prosthesis: a 32-month prospective radiological and clinical study. Clin Implant Dent Relat Res 2009;11(1):1-10. Bernard JP, Schatz JP, Christou P, Belser U, Kiliaridis S. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. A retrospective study. J Clin Periodontol 2004;31(11):1024-8. Bischof M, Nedir R, Szmukler-Moncler S, Bernard JP, Samson J. Implant stability measurement of delayed and immediately loaded implants during healing. Clin Oral Implants Res 2004;15(5):529-39. Bischof M, Nedir R, Abi Najm S, Szmukler-Moncler S, Samson J. A five-year life-table analysis on wide neck ITI implants with prosthetic evaluation and radiographic analysis: results from a private practice. Clin Oral Implants Res 2006;17(5):512-20. Bornstein MM, Lussi A, Schmid B, Belser UC, Buser D. Early loading of nonsubmerged titanium implants with a sandblasted and acidetched (SLA) surface: 3-year results of a prospective study in partially edentulous patients. Int J Oral Maxillofac Implants 2003;18(5):659666.

Bornstein MM, Schmid B, Belser UC, Lussi A, Buser D. Early loading of non-submerged titanium implants with a sandblasted and acid-etched surface. 5-year results of a prospective study in partially edentulous patients. Clin Oral Implants Res 2005;16(6):631-638. Bornstein MM, Harnisch H, Lussi A, Buser D. Clinical performance of wide-body implants with a sandblasted and acid-etched (SLA) surface: results of a 3-year follow-up study in a referral clinic. Int J Oral Maxillofac Implants 2007;22(4):631-8. Bornstein MM, Chappuis V, von Arx T, Buser D. Performance of dental implants after staged sinus floor elevation procedures: 5-year results of a prospective study in partially edentulous patients. Clin Oral Implants Res 2008;19(10):1034-43. Carinci F, Guidi R, Franco M, Viscioni A, Rigo L, De Santis B, Tropina E. Implants inserted in fresh-frozen bone: a retrospective analysis of 88 implants loaded 4 months after insertion. Quintessence Int 2009;40(5):413-9. Carlino P, Pepe V, Pollice G, Grassi FR. Immediate transmucosal implant placement in fresh maxillary and mandibular molar extraction sockets: description of technique and preliminary results. Minerva Stomatol 2008;57(10):471-83. Caruso G, Cattaneo A. Removable prosthesis supported by implants according to the Cagliari modified conometry technique: case report. Int J Periodontics Restorative Dent 2007;27(3):259-65. Cehreli MC, Uysal S, Akca K. Marginal bone level changes and prosthetic maintenance of mandibular overdentures supported by 2 implants: a 5-year randomized clinical trial. Clin Implant Dent Relat Res 2009;12(1):114-121. Chaddad K, Ferreira AF, Geurs N, Reddy MS. Influence of surface characteristics on survival rates of mini-implants. Angle Orthod 2008;78(1):107-13. Chiapasco M, Lang NP, Bosshardt DD. Quality and quantity of bone following alveolar distraction osteogenesis in the human mandible. Clin Oral Implants Res 2006;17(4):394-402. Cochran DL, Buser D, ten Bruggenkate CM, Weingart D, Taylor TM, Bernard JP, Peters F, Simpson JP. The use of reduced healing times on ITI implants with a sandblasted and acid-etched (SLA) surface: early results from clinical trials on ITI SLA implants. Clin Oral Implants Res 2002;13(2):144-53. Cochran D, Oates T, Morton D, Jones A, Buser D, Peters F. Clinical field trial examining an implant with a sand-blasted, acid-etched surface. J Periodontol 2007;78(6):974-82. Cordaro L, Torsello F, Mirisola Di Torresanto V, Rossini C. Retrospective evaluation of mandibular incisor replacement with narrow neck implants. Clin Oral Implants Res 2006;17(6):730-5. Cornelini R, Cangini F, Covani U, Barone A, Buser D. Immediate restoration of single-tooth implants in mandibular molar sites: a 12-month preliminary report. Int J Oral Maxillofac Implants 2004;19(6):855-60.

Cornelini R, Cangini F, Covani U, Barone A, Buser D. Immediate loading of implants with 3-unit fixed partial dentures: a 12-month clinical study. Int J Oral Maxillofac Implants 2006;21(6):914-8.

Fugazzotto PA, Vlassis J, Butler B. ITI implant use in private practice: clinical results with 5,526 implants followed up to 72+ months in function. 'Int J Oral Maxillofac Implants 2004;19(3):408-12.

Crismani AG, Bernhart T, Schwarz K, Celar AG, Bantleon HP, Watzek G. Ninety percent success in palatal implants loaded 1 week after placement: a clinical evaluation by resonance frequency analysis. Clin Oral Implants Res 2006;17(4):445-50.

Fugazzotto PA. Guided bone regeneration at immediate implant insertion and loading: a case report. Implant Dent 2004;13(3):223-7.

De Boever AL, De Boever JA. Guided bone regeneration around nonsubmerged implants in narrow alveolar ridges: a prospective long-term clinical study. Clin Oral Implants Res 2005;16(5):549-56. De Boever AL, Quirynen M, Coucke W, Theuniers G, De Boever JA. Clinical and radiographic study of implant treatment outcome in periodontally susceptible and non-susceptible patients: a prospective long-term study. Clin Oral Implants Res 2009;20(12):1341-50. Eliasson A, Blomqvist F, Wennerberg A, Johansson A. A retrospective analysis of early and delayed loading of full-arch mandibular prostheses using three different implant systems: clinical results with up to 5 years of loading. Clin Implant Dent Relat Res 2009;11(2):13448. Feldmann I, Bondemark L. Anchorage capacity of osseointegrated and conventional anchorage systems: a randomized controlled trial. Am J Orthod Dentofacial Orthop 2008;133(3):339.e19-28. Feloutzis A, Lang NP, Tonetti MS, B체rgin W, Br채gger U, Buser D, Duff GW, Kornman KS. IL-1 gene polymorphism and smoking as risk factors for peri-implant bone loss in a well-maintained population. Clin Oral Implants Res 2003;14(1):10-7. Ferrigno N, Laureti M, Fanali S. Inferior alveolar nerve transposition in conjunction with implant placement. Int J Oral Maxillofac Implants 2005;20(4):610-20. Ferrigno N, Laureti M, Fanali S. Dental implants placement in conjunction with osteotome sinus floor elevation: a 12-year life-table analysis from a prospective study on 588 ITI implants. Clin Oral Implants Res 2006;17(2):194-205. Erratum in: Clin Oral Implants Res 2006;17(4):479. Fischer K, Stenberg T. Early loading of ITI implants supporting a maxillary full-arch prosthesis: 1-year data of a prospective, randomized study. Int J Oral Maxillofac Implants 2004;19(3):374-81. Fischer K, Stenberg T. Three-year data from a randomized, controlled study of early loading of single-stage dental implants supporting maxillary full-arch prostheses. Int J Oral Maxillofac Implants 2006;21(2):245-52. Fischer K, Stenberg T, Hedin M, Sennerby L. Five-year results from a randomized, controlled trial on early and delayed loading of implants supporting full-arch prosthesis in the edentulous maxilla. Clin Oral Implants Res 2008;19(5):433-41. Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EA, ten Bruggenkate CM. The use of Straumann Bone Ceramic in a maxillary sinus floor elevation procedure: a clinical, radiological, histological and histomorphometric evaluation with a 6-month healing period. Clin Oral Implants Res 2010;21(2):201-8. Friedmann A, Kaner D, Leonhardt J, Bernimoulin JP. Immediate substitution of central incisors with an unusual enamel paraplasia by a newly developed titanium implant: a case report. Int J Periodontics Restorative Dent 2005;25(4):393-9.

Fugazzotto PA. Implant placement at the time of maxillary molar extraction: technique and report of preliminary results of 83 sites. J Periodontol 2006;77(2):302-9. Gallucci GO, Mavropoulos A, Bernard JP, Belser UC. Influence of immediate implant loading on peri-implant soft tissue morphology in the edentulous maxilla. Int J Oral Maxillofac Implants 2007;22(4):595602. Ganeles J. Early loading with the ITI SLA surface as a predictable, routine procedure. J Indiana Dent Assoc 2002;81(3):15-6. Ganeles J, Rosenberg MM, Holt RL, Reichman LH. Immediate loading of implants with fixed restorations in the completely edentulous mandible: report of 27 patients from a private practice. Int J oral Maxillofac Implants 2001;16(3):418-26. Giancotti A, Greco M, Docimo R, Arcuri C. Extraction treatment using a palatal implant for anchorage. Aust Orthod J 2003;19(2):87-90. Giancotti A, Greco M, Mampieri G, Arcuri C. Clinical management in extraction cases using palatal implant for anchorage. J Orthod 2004;31(4):288-94. Gokcen-Rohlig B, Yaltirik M, Ozer S, Tuncer ED, Evlioglu G. Survival and success of ITI implants and prostheses: retrospective study of cases with 5-year follow-up. Eur J Dent 2009;3(1):42-9. H채nggi MP, H채nggi DC, Schoolfield JD, Meyer J, Cochran DL, Hermann JS. Crestal bone changes around titanium implants. Part I: A retrospective radiographic evaluation in humans comparing two nonsubmerged implant designs with different machined collar lengths. J Periodontol 2005;76(5):791-802. Hayakawa T, Kiba H, Yasuda S, Yamamoto H, Nemoto K. A histologic and histomorphometric evaluation of two types of retrieved human titanium implants. Int J Periodontics Restorative Dent 2002;22(2):16471. Hoffmann O, Beaumont C, Tatakis DN, Zafiropoulos GG. Telescopic crowns as attachments for implant supported restorations: a case series. J Oral Implantol 2006;32(6):291-9. Hoshino K, Miura H, Morikawa O, Kato H, Okada D, Shinki T. Influence of occlusal height for an implant prosthesis on the periodontal tissues of the antagonist. J Med Dent Sci 2004;51(4):187-96. Huwiler MA, Pjetursson BE, Bosshardt DD, Salvi GE, Lang NP. Resonance frequency analysis in relation to jawbone characteristics and during early healing of implant installation. Clin Oral Implants Res 2007;18(3):275-80. Isono H, Kaida K, Hamada Y, Kokubo Y, Ishihara M, Hirashita A, Kuwahara Y. The reconstruction of bilateral clefts using endosseous implants after bone grafting. Am J Orthod Dentofacial Orthop 2002;121(4):403-10. Jackson A, Lemke R, Hatch J, Salome N, Gakunga P, Cochran D. A comparison of stability between delayed versus immediately loaded orthodontic palatal implants. J Esthet Restor Dent 2008;20(3):174-84.

Jaquiéry C, Rohner D, Kunz C, Bucher P, Peters F, Schenk RK, Hammer B. Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants -- a prospective study. Clin Oral Implants Res 2004;15(5):598-606. Jebreen SE, Khraisat A. Multicenter retrospective study of ITI implantsupported posterior partial prosthesis in Jordan. Clin Implant Dent Relat Res 2007;9(2):89-93. Jung BA, Wehrbein H, Hopfenmüller W, Harzer W, Gedrange T, Diedrich P, Kunkel M. Early loading of plalatal implants (ortho-type II) a prospective multicenter randomized controlled clinical trial. Trials 2007;8:24. Jung BA, Kunkel M, Göllner P, Liechti T, Wehrbein H. Success rate of second-generation palatal implants. Angle Orthod 2009;79(1):85-90. Jung UW, Choi JY, Kim CS, Cho KS, Chai JK, Kim CK, Choi SH. Evaluation of mandibular posterior single implants with two different surfaces: a 5-year comparative study. J Periodontol 2008;79(10):1857-63.

Mannai C. Early implant loading in severely resorbed maxilla using xenograft, autograft, and platelet-rich plasma in 97 patients. J Oral Maxillofac Surg 2006;64(9):1420-6. Männchen R, Schätzle M. Success rate of palatal orthodontic implants: a prospective longitudinal study. Clin Oral Implants Res 2008;19(7):665-9. Nedir R, Bischof M, Szmukler-Moncler S, Bernard JP, Samson J. Predicting osseointegration by means of implant primary stability. Clin Oral Implants Res 2004;15(5):520-528. Nedir R, Bischof M, Briaux JM, Beyer S, Szmukler-Moncler S, Bernard JP. A 7-year life table analysis from a prospective study on ITI implants with special emphasis on the use of short implants. Results from a private practice. Clin Oral Implants Res 2004;15(2):150-7.

Kato S, Kato M. 'Moderately roughened- and roughened-surface implants used as rigid orthodontic anchorage: a case series. Clin Implant Dent Relat Res 2006;8(2):87-94.

Nedir R, Bischof M, Vazquez L, Szmukler-Moncler S, Bernard JP. Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implants. Clin Oral Implants Res 2006;17(6):679-86.

Kermalli JY, Deporter DA, Lai JY, Lam E, Atenafu E. Performance of threaded versus sintered porous-surfaced dental implants using open window or indirect osteotome-mediated sinus elevation: a retrospective report. J Periodontol 2008;79(4):728-36.

Nedir R, Bischof M, Szmukler-Moncler S, Belser UC, Samson J. Prosthetic complications with dental implants: from an up-to-8year experience in private practice. Int J Oral Maxillofac Implants 2006;21(6):919-28.

Kessler-Liechti G, Zix J, Mericske-Stern R. Stability measurements of 1-stage implants in the edentulous mandible by means of resonance frequency analysis. Int J Oral Maxillofac Implants 2008;23(2):353-8.

Nedir R, Bischof M, Vazquez L, Nurdin N, Szmukler-Moncler S, Bernard JP. Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study. Clin Oral Implants Res 2009;20(7):701-7.

Kinsel RP, Liss M. Retrospective analysis of 56 edentulous dental arches restored with 344 single-stage implants using an immediate loading fixed provisional protocol: statistical predictors of implant failure. Int J Oral Maxillofac Implants 2007;22(5):823-30.

Nixon KC, Chen ST, Ivanovski S. A retrospective analysis of 1,000 consecutively placed implants in private practice. Aust Dent J 2009;54(2):123-9.

Lai HC, Zhang ZY, Wang F, Zhuang LF, Liu X, Pu YP. Evaluation of soft-tissue alteration around implant-supported single-tooth restoration in the anterior maxilla: the pink esthetic score. Clin Oral Implants Res 2008;19(6):560-4.

Nordin T, Nilsson R, Frykholm A, Hallman M. A 3-arm study of early loading of rough-surfaced implants in the completely edentulous maxilla and in the edentulous posterior maxilla and mandible: results after 1 year of loading. 'Int J Oral Maxillofac Implants 2004;19(6):880-6.

Lai HC, Zhang ZY, Zhuang LF, Wang F, Liu X, Pu YP. Early loading of ITI implants supporting maxillary fixed full-arch prostheses. Clin Oral Implants Res 2008;19(11):1129-34.

Nordin T, Graf J, Frykholm A, Helldén L. Early functional loading of sand-blasted and acid-etched (SLA) Straumann implants following immediate placement in maxillary extraction sockets. Clinical and radiographic result. Clin Oral Implants Res 2007;18(4):441-51.

Landes CA, Kovács AF. Comparison of early telescope loading of nonsubmerged ITI implants in irradiated and non-irradiated oral cancer patients. Clin Oral Implants Res 2006;17(4):367-74. Lang NP, Tonetti MS, Suvan JE, Pierre Bernard J, Botticelli D, Fourmousis I, Hallund M, Jung R, Laurell L, Salvi GE, Shafer D, Weber HP; European Research Group on Periodontology. Immediate implant placement with transmucosal healing in areas of aesthetic priority. A multicentre randomized-controlled clinical trial I. Surgical outcomes. Clin Oral Implants Res 2007;18(2):188-96.

Luongo G, Di Raimondo R, Filippini P, Gualini F, Paoleschi C. Early loading of sandblasted, acid-etched implants in the posterior maxilla and mandible: a 1-year follow-up report from a multicenter 3-year prospective study. 'Int J Oral Maxillofac Implants 2005;20(1):84-91.

Oates TW, Valderrama P, Bischof M, Nedir R, Jones A, Simpson J, Toutenburg H, Cochran DL. Enhanced implant stability with a chemically modified SLA surface: a randomized pilot study. Int J Oral Maxillofac Implants 2007;22(5):755-60. Palattella P, Torsello F, Cordaro L. Two-year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zone. Clin Oral Implants Res 2008;19(11):1148-53.

Levine RA, Ganeles J, Jaffin RA, Clem DS 3rd, Beagle JR, Keller GW. Multicenter retrospective analysis of wide-neck dental implants for single molar replacement. Int J Oral Maxillofac Implants 2007;22(5):736-42.

Pan YH, Ramp LC, Liu PR. Patient responses to dental implant-retained mandibular overdenture therapy: a 6-year clinical study. Chang Gung Med J 2007;30(4):363-9.

Longoni S, Sartori M, Apruzzese D, Baldoni M. Preliminary clinical and histologic evaluation of a bilateral 3-dimensional reconstruction in an atrophic mandible: a case report. Int J Oral Maxillofac Implants 2007;22(3):478-83.

Park JC, Ha SR, Kim SM, Kim MJ, Lee JB, Lee JH. A randomized clinical 1-year trial comparing two types of non-submerged dental implants. Clin Oral Implants Res 2010;21(2):228-36.

Payne AG, Tawse-Smith A, Duncan WD, Kumara R. Conventional and early loading of unsplinted ITI implants supporting mandibular overdentures. Clin Oral Implants Res 2002;13(6):603-9.

Tortamano Neto P, Camargo LO. Prospective clinical evaluation of dental implants with sand-blasted, large-grit, acid-etched surfaces loaded 6 weeks after surgery. Quintessence Int 2004;35(9):717-22.

Payne AG, Tawse-Smith A, Thompson WM, Kumara R. Early functional loading of unsplinted roughened surface implants with mandibular overdentures 2 weeks after surgery. Clin Implant Dent Relat Res 2003;5(3):143-53.

Tortamano P, Orii TC, Yamanochi J, Nakamae AE, Guarnieri Tde C. Outcomes of fixed prostheses supported by immediately loaded endosseous implants. Int J Oral Maxillofac Implants 2006;21(1):6370.

Peñarrocha M, Palomar M, Sanchis JM, Guarinos J, Balaguer J. Radiologic study of marginal bone loss around 108 dental implants and its relationship to smoking, implant location, and morphology. Int J Oral Maxillofac Implants 2004;19(6):861-7.

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. [Epub ahead of print].

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Notes

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