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Objectives: Working Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval. Materials and Methods: Two systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary. Results: Five consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research. Conclusions: Based on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to analyse the outcomes of early implant placement after 6 and 12 weeks of healing in ridge preserved sites in a canine model. Materials and methods: Implants were placed in second maxillary incisors sites in 9 dogs 6 weeks after grafting of the sockets with 90% deproteinized bovine bone mineral in 10% collagen matrix (DBBMC) and closure with resorbable type I/III porcine collagen matrix (PCM). The implants were randomly assigned to 6 (T6) and 12 (T12) weeks of healing. Results: The percentage of bone‐to‐implant contact (%BIC), old bone, new bone and residual DBBMC was similar between T6 and T12. In relation to the implant shoulder (IS), the original bone crest (IS‐ROB) was more apical on the buccal than the palatal side. The regenerated bone crest (IS‐C) and IS‐ROB were similar between groups. However, the distance from IS to first bone‐to implant contact (IS‐fBIC) was significantly less in T12 compared with T6 (p =.022; Wilcoxon signed‐rank test). The bucco‐palatal ridge dimensions between T6 and T12 were similar. Conclusions: This study confirms that implants can successfully be placed early in ridge preserved maxillary second incisor sites and are osseointegrated by 6 weeks. There were significantly lower IS‐fBIC values at 12 weeks than at 6 weeks on the buccal aspect. The original buccal bone crest underwent greater corono‐apical resorption than the palatal crest. The %BIC, relative proportions of mineralized tissues and dimensions of the alveolar ridge demonstrated stability between 6 and 12 weeks of healing. [ABSTRACT FROM AUTHOR]

Objective: The aim of this multicenter, randomized controlled trial was to compare the clinical and radiographic outcomes of 6‐mm or 11‐mm implants, placed in the posterior maxilla and mandible, during a 5‐year follow‐up period. Materials and methods: Ninety‐five patients with adequate bone height for 11‐mm implants, were randomly allocated to a 6‐mm group (test group with short implants) or an 11‐mm group (control group with standard‐length implants). Two or three implants of the same length were placed in each patient and after 6 weeks loaded with a splinted provisional restoration. This was followed by definitive splinted restoration 6 months after implant placement. Clinical and radiographic parameters, including the occurrence of complications were recorded. Results: A total of 49 patients were enrolled to receive 6‐mm implants (n = 108) and 46 patients to receive 11‐mm implants (n = 101). Three implants (two of 6 mm and one of 11 mm in length) were lost before loading and one 6‐mm implant after 15 months of function, and one 11‐mm implant was lost during the first year of function. The 5‐year survival rates were 96.0% and 98.9% in the 6‐mm and 11‐mm group, respectively. The mean marginal bone level changes 5 years post‐loading were 0.01 ± 0.45 mm (bone gain) in the 6‐mm group and −0.12 ± 0.93 mm (bone loss) in the 11‐mm group (p =.7670). Clinical parameters, including plaque, bleeding on probing and pocket probing depth were not significantly different between the groups, and also technical complications were low. Conclusion: The clinical and radiographic outcomes of 6‐mm short and 11‐mm standard‐length implants were not different during a 5‐year evaluation period. [ABSTRACT FROM AUTHOR]

Objectives: To compare the stability of apically tapered and straight (non‐tapered cylindrical) implants at the time of immediate placement and to histologically evaluate the healing outcomes after 6 weeks. Materials and Methods: The second maxillary incisors were extracted bilaterally in nine dogs. After randomization, apically tapered and straight implants with a 3.3 mm shoulder diameter were inserted into the extraction sockets. The implant stability quotient (ISQ) of the implants was recorded after placement. Peri‐implant defects on the buccal aspect were filled with deproteinized bovine bone mineral and covered with resorbable type I/III porcine collagen matrix. After 6 weeks of healing, sections were prepared for histological and morphometric analysis. Results: All implant sites healed uneventfully. The apically tapered implants had significantly higher ISQ values compared to straight implants at placement (p =.009). The histomorphometric outcomes 6 weeks following implant placement in both experimental groups were similar, except in the apico‐palatal region. Apically tapered implants demonstrated significantly less percentage bone‐to‐implant contact (p =.035) in the apico‐palatal region. At both implant types, substantial corono‐apical resorption of the buccal bone wall was noted in the coronal 2 mm of the implant. Conclusion: Apically tapered implants had significantly higher ISQ values at immediate placement compared to straight implants. The healing outcomes and remodelling of the buccal bone wall were similar for both implant designs. In the apico‐palatal region, there was less %BIC at the implant surface at apically tapered implants compared to straight implants. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present superiority study was to determine the effect of systemic antibiotics primarily on patient‐reported outcome measures (PROMs) and post‐surgical complications in patients undergoing oral implant therapy with simultaneous guided bone regeneration (GBR). Materials and Methods: A total of 236 medically and periodontally healthy patients received oral implants with simultaneous GBR at seven centres. Pre‐operative antibiotics of 2 g amoxicillin were prescribed to the test group 1 hr prior to surgery and 500 mg thrice daily on days 1–3 after surgery. The control group was given a placebo. Group allocation was performed randomly. Primary outcome variables were PROMs recorded as visual analogue scale scores assessed on days 1–7 and 14 on pain, swelling, haematoma and bleeding. Post‐operative complications as secondary outcome variables were examined at 1, 2, 4 and 12 weeks from surgery. Chi‐square tests and repeated measures of analysis of variance (ANOVA) were performed for statistical evaluation. Results: No statistically significant differences (p >.05) between the two groups were detected for the evaluated PROMs. The same was noted with respect to post‐surgical complications. Four implants were lost—three in the test group and one in the control group. Conclusion: In this trial, systemic antibiotics did not provide additional benefits to PROMs, nor the prevention of post‐surgical complications in medically and periodontally healthy patients undergoing oral implant therapy with simultaneous GBR. However, further studies with larger sample sizes are still required to support the clinical outcomes of this study. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the dimensional changes following the extraction of maxillary second incisors and to evaluate the influence of deproteinised bovine bone mineral on the healing outcomes. Materials and Methods: The second maxillary incisors in nine dogs were extracted bilaterally in a minimally traumatic manner. Deproteinised bovine bone mineral with collagen (DBBMC) and a collagen matrix (CM) was placed in one socket with the contralateral socket left to heal naturally. After 3 months of healing, the dogs were sacrificed and the pre‐maxilla resected. Cone beam computerised tomography scans (CBCTs) were obtained and the specimens prepared for histological preparation and analysis. Surface scans of study models taken pre‐ and post‐extraction were digitally subtracted to analyse volumetric changes. Results: All dogs healed uneventfully without any complications. No inflammation was seen, and DBBMC was well integrated into a network of mineralised tissues, bone marrow and connective tissue. The horizontal width of the buccal crest was found to be significantly greater in grafted sockets, but the vertical height to be similar. No significant difference was seen in regard to volumetric changes in sockets over 3 months post‐extraction. Conclusion: Maxillary second incisor sockets of dogs grafted with DBBMC post‐extraction had significantly greater horizontal width at the ridge crest compared with ungrafted sockets. Volumetric analysis revealed no significant difference between grafted and non‐grafted sockets, suggesting possible soft tissue thickening post‐extraction to counteract osseous resorption. [ABSTRACT FROM AUTHOR]

Objectives: Working Group 2 was convened to address topics relevant to prosthodontics and dental implants. Systematic reviews were developed according to focused questions addressing (a) the number of implants required to support fixed full‐arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs. Materials and methods: Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached. Results: A total of 27 consensus statements were developed from the systematic reviews. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements. Conclusions: The literature supports the use of various implant numbers to support full‐arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One‐piece zirconia dental implants can be recommended when appropriate clinical conditions exist although two‐piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications. Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported monolithic zirconia prostheses may be a future option with more supporting evidence. [ABSTRACT FROM AUTHOR]

Objectives: To systematically review the evidence for the clinical outcome of fixed implant prostheses treated with different combinations of implant placement and loading protocols in partially edentulous patients. Materials and methods: An electronic search was performed in Medline, Embase, and Central to identify studies investigating the outcome of implants subjected to immediate placement + immediate restoration/loading (Type 1A), immediate placement + early loading (Type 1B), immediate placement + conventional loading (Type 1C), early placement + immediate restoration/loading (Type 2‐3A), early placement + early loading (Type 2‐3B), early placement + conventional loading (Type 2‐3C), late placement + immediate restoration/loading (Type 4A), late placement + early loading (Type 4B), late placement + conventional loading (Type 4C) with implant‐supported fixed dental prostheses (IFDPs) in partially edentulous patients. Only human studies with at least 10 cases and a minimum follow‐up time of 12 months, reporting on solid‐screw‐type implants with rough surfaces and an intra‐osseous diameter between 3 and 6 mm, were included. A cumulative survival rate for each type of the implant placement and loading protocols was weighted by the duration of follow‐up and number of implants. Results: The search provided 5,248 titles from which 2,362 abstracts and 449 full‐text articles were screened. A total of 69 publications that comprised 23 comparative studies (15 randomized controlled trials, 7 controlled clinical trials) and 47 noncomparative studies (34 prospective cohort studies, 13 retrospective cohort studies) were included for analysis. Considerable heterogeneity in study design was found, and therefore, a meta‐analysis of controlled studies was not possible. The weighted cumulative survival rate of each type of placement and loading protocol was 98.4% (Type 1A), 98.2% (Type 1B), 96.0% (Type 1C), 100% (Type 2‐3B), 96.3% (Type 2‐3C), 97.9% (Type 4A), 98.3% (Type 4B), and 97.7% (Type 4C). Type 1C, Type 2‐3C, Type 4B, and Type 4C were scientifically and clinically validated (SCV). Type 1A, Type 1B, and Type 4A were clinically documented (CD), and Type 2‐3A and Type 2‐3B were clinically insufficiently documented (CID). Conclusions: Evaluating outcomes in oral implantology by combining the placement and loading protocols are paramount. The selected loading protocol appears to influence the outcome of immediate implant placement. [ABSTRACT FROM AUTHOR]

Objectives To investigate objective and patient-centred aesthetic outcomes for single-tooth implants in the anterior maxilla. Materials and methods Ninety-eight patients (21 men and 77 women) with a mean age of 51.2 ± 13.8 years were included in this retrospective study. A total of 98 maxillary anterior single-tooth implant crowns with a mean functional time of 68.1 months (range 12-245) were evaluated. Aesthetic outcomes were measured by PES and WES. Statistical analysis was performed using the Mood's median and stepwise logistic regression with backward elimination to assess the effect of patient demographics, clinical parameters and surgical methods on aesthetic outcome ( P < 0.05). Results The median PES was 11 and 94% of implants were deemed aesthetically acceptable. The median WES was 9 and 98% of implants were deemed aesthetically acceptable. The PES was positively influenced by the use of a connective tissue graft ( CTG), adding 1 to the score ( P = 0.002) and negatively influenced by membrane use ( P = 0.026). Flapless techniques employed as part of an immediate implant placement protocol yielded better outcomes compared to flapped sites ( P = 0.017). Immediate implant placement demonstrated greater variability in outcomes compared to early implant placement. Conclusions Satisfactory objective and patient-reported aesthetic outcomes were achieved with dental implants replacing missing single teeth in the anterior maxilla. The use of CTG improved the aesthetic outcome mainly by increasing the alveolar process contour. Less variation in outcomes was observed with early (type 2) placement compared to immediate (type 1 placement). [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of submerged vs. non-submerged ( NS) protocols in healing outcomes of grafted marginal defects of immediate implants. Materials and methods The second maxillary incisors were extracted bilaterally in six greyhound dogs. Bone level reduced diameter implants were installed into the extraction sockets leaving orofacial gaps of 2 mm wide. Defects were filled with Bio-Oss® and covered with Bio-Gide®. On the one side, the flap was advanced to fully submerge the implant, and on the other, the flap was sutured to allow NS healing. After 3 months of healing, the dogs were sacrificed and block biopsies were obtained to perform histological and morphometric analysis. Results All implants were clinically healthy and well integrated into bone. In the majority of the specimens, the original bone in the coronal 2-3 mm of the buccal crest had completely resorbed and was replaced by a regenerated bone wall consisting of Bio-Oss® particles surrounded by newly formed bone. Horizontal and vertical resorption of the buccal bone resulted in ≥1 mm exposure of the implant surface in one-third of implants. Minor differences existed in some aspects of hard tissue healing between submerged and NS. Conclusion There was very little difference in healing outcomes as well as modelling of the facial bone wall between the submerged and NS protocols in relation to immediate implant placement in this dog model. [ABSTRACT FROM AUTHOR]

Background and aim In cases with limited bone height, short implants could be a good alternative to augmentation procedures. The aim of this randomized controlled trial was to compare the clinical performance of implants of 6 mm or 11 mm in length in the posterior region. Materials and methods In this multicenter trial (six study sites), 95 subjects were included. Subjects were randomly allocated to receiving implants with lengths of either 6 or 11 mm both with a diameter of 4 mm ( Osseo Speed™ 4.0 S; Astra Tech AB; Mölndal, Sweden). In all cases, there had to be sufficient bone height to allow placement of an implant of at least 11 mm in length. Two or three implants were placed per subject using one-stage surgery with a 42-48 days' healing period before loading. They were restored with a screw-retained splinted fixed prosthesis. Clinical and radiographic examinations were performed preoperatively, postsurgery, at loading, and 6 and 12 months after prosthesis placement. Results A total of 208 implants were inserted in 49 subjects receiving 6-mm implants (test) and in 46 subjects receiving 11 mm implants (control). Two 6-mm implants failed before loading and one 6 and 11 mm implants failed before 1-year evaluation. From loading to the 12 months' follow-up, a mean marginal bone gain of 0.06 mm in the 6 mm group and 0.02 mm in the 11 mm group was found ( P = 0.478). Soft tissue behavior was equal in both groups (Bleeding and plaque [ P = 1.0] probing depth [ P = 0.91]). Conclusion One-year data indicate that treatment with the 6 mm implants is as reliable as treatment with the 11 mm implants. This provides a good treatment option in situations with limited bone height in the premolar and molar regions. Whether or not short implants provide a predictable treatment alternative to bone augmentation procedures remains to be investigated in the future randomized controlled clinical trials. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to compare the clinical outcomes after 2 years with bone level implants placed to restore a single missing teeth that needed simultaneous augmentation and were treated with a transmucosal or submerged approach. Methods This study analyzed a subset of patients included in an ongoing prospective multicenter randomized clinical trial ( RCT) involving12 centers where patients were to be followed-up to 5 years after loading. Of the 120 implants that were placed in the original study, and randomly assigned to submerged or non-submerged healing, 52 needed simultaneous augmentation (28 women patients and 24 men patients, between 23 and 78 years of age). Twenty-seven of them received implants with submerged healing ( AuS), while in 25 patients the implants were inserted with a non-submerged protocol ( AuNS). At the 2-year follow-up visit, radiographic crestal bone level changes were recorded as well as soft tissue parameters included Pocket probing depth ( PPD), bleeding on probing ( BoP) and clinical attachment level ( CAL) at teeth adjacent to the implant site. Results After 2 years a small amount of bone resorption was found in both groups (0.37 ± 0.49 mm in the AuS group and 0.54 ± 0.76 in the AuNS group; P < 0.001). There was no statistically significant difference between AuS Group and AuNS group for PPD (2.5 vs. 2.4 mm), BOP ( BOP + sites: 8.8% vs. 11.5%) and CAL (2.8 vs. 2.4 mm) at the 2-year follow-up visit. Conclusions When a single implant is placed in the aesthetic zone in conjunction with bone augmentation for a moderate peri-implant defect, submerged and transmucosal healing determine similar outcome, hence there is no need to submerge an implant in this given clinical situation. [ABSTRACT FROM AUTHOR]

Objectives: To test whether or not transmucosal healing at two-piece implants is as successful as submerged placement regarding crestal bone levels and patient satisfaction. Material and methods: Adults requiring implants in the anterior maxilla or mandible in regions 21-25, 11-15, 31-35 or 41-45 (WHO) were recruited for this randomized, controlled multi-center clinical trial of a 5-year duration. Randomization was performed at implantation allowing for either submerged or transmucosal healing. Final reconstructions were seated 6 months after implantation. Radiographic interproximal crestal bone levels and peri-implant soft tissue parameters were measured at implant placement (IP) (baseline), 6 and 12 months. Patient satisfaction was assessed by a questionnaire. A two-sided t-test (80% power, significance level α=0.05) was performed on bone-level changes at 6 and 12 months. Results: One hundred and twenty-seven subjects were included in the 12-month analysis (submerged [S]: 52.5%, transmucosal [TM]: 47.2%). From IP to 6 months, the change in the crestal bone level was −0.32 mm ( P<0.001) for the S group and −0.29 mm ( P<0.001) for the TM group. From IP to 12 months, bone-level changes were statistically significant in both groups (S −0.47 mm, P<0.001; TM −0.48 mm, P<0.001). The mean differences of change in the bone levels between the two groups were not statistically significant at either time point, indicating the equivalence of both procedures. For both groups, very good results were obtained for soft tissue parameters and for patient satisfaction. Conclusions: Transmucosal healing of two-piece implants is as successful as the submerged healing mode with respect to tissue integration and patient satisfaction within the first 12 months after IP. To cite this article: Hämmerle CHF, Jung RE, Sanz M, Chen S, Martin WC, Jackowski J, Ivanoff CJ, Cordaro L, Ganeles J, Weingart D, Wiltfang J, Gahlert M. Submerged and transmucosal healing yield the same clinical outcomes with two-piece implants in the anterior maxilla and mandible: interim 1-year results of a randomized, controlled clinical trial. Clin. Oral Impl. Res 23, 2012; 211-219. doi: 10.1111/j.1600-0501.2011.02210.x [ABSTRACT FROM AUTHOR]