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OBJECTIVE To report the 1-year implant survival/success and peri-implant outcomes of mandibular overdentures retained by four titanium-zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes. MATERIALS AND METHODS A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri-implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1-year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within-patient clustered data. RESULTS Two hundred and ninety-six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1-year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6-month and 1-year follow-ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1-year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss. CONCLUSION The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri-implant outcomes, even when flapless surgery and immediate loading protocols are adopted.

Objective To describe early prosthesis implantations in a cohort of patients with juvenile idiopathic arthritis (JIA) followed in a tertiary referral hospital and to analyze possible factors influencing implant survival. Methods This was a retrospective cohort study. Charts of all patients with JIA who underwent total joint replacement at Gaetano Pini Hospital, Milan, Italy from January 1992 to June 2019 were retrieved, and relevant data were analyzed. Results Eighty-five patients met the inclusion criteria for this study, with a median follow-up period of 17.2 years. The median age at first prosthesis was 22.7 years. The total number of replaced joints was 198 over a period of 27 years. The hip was the most frequently replaced joint, accounting for almost two-thirds of the total number of implants; the other one-third refers mostly to knee implants. Polyarticular JIA and systemic JIA were the most represented JIA categories in the study cohort. A significant upward trend of the age at arthroplasty and of disease duration before arthroplasty over decades was found. The rates of implant survival at 5, 10, and 15 years were comparable (from 84% to 89%); 50% of implants lasted ≥20 years. Conclusion We reported retrospective data on early joint replacement in a cohort of patients with JIA. We observed a progressive and significant upward trend of both age at arthroplasty and disease duration before the first arthroplasty over time. The JIA category, year of implant, and presence of complications significantly affected implant survivorship.

Objective:Ectodermal dysplasia syndrome is a complex group of genetic disorders identified by the abnormal development of the ectodermal structures. The aim of this retrospective clinical case series report was to evaluate the outcomes of the ectodermal dysplasia syndrome patients that underwent zygomatic implant surgery. Materials and methods:A total of 9 ectodermal dysplasia syndrome patients aged between 21 and 56 years (mean age 36.8) with severely atrophic maxilla were included in this study. All the patients were treated with a total of 19 zygomatic implants. The mean follow-up of the patients was 55 months (with a range of 44-84 months). The implant survival rate was evaluated as a primary outcome. The intra- and postoperative complications were evaluated as additional criteria for success. Results:The overall implant survival rate was 100% without any complications. Final or provisional prosthesis was delivered on the same day of surgery, which resulted in an improvement of the quality of life of the patients. Conclusion:According to the results of this study, zygomatic surgery can be considered as a viable and safe alternative to conventional treatment modalities for oral rehabilitation of ectodermal dysplasia syndrome patients.

Objectives The aim of the present paper was to present medium- and long-term data on implant survival and on the prevalence of peri-implantitis in a cohort of patients treated with full-arch rehabilitations. Materials and methods Clinical records of all patients treated with immediately loaded full-arch rehabilitation in the Dental Clinic of the IRCCS Istituto Ortopedico Galeazzi in Milan, Italy, supported by moderately rough implants were retrospectively examined to calculate survival curves for implant loss and for the occurrence of peri-implantitis (both at implant- and at patient level). Regression methods were used to evaluate the correlation between the presence of periodontitis and smoking habits with the outcomes. Results A total of 384 implants placed in 77 patients (96 rehabilitations) were evaluated for a mean period of 8.0 years (range 1.0-13.7 years) from loading. After 10 years, the cumulative survival rate was 96.11% (95% CI: 99.17%-93.05%; 84 implants) while the cumulative rate of implants free from peri-implantitis was 86.92% (95% CI: 82.14%, 91.71%; 60.69% [95% CI: 44.19%, 77.19%] at patient level). The cumulative proportion of implants without peri-implantitis after 10 years was significantly higher in mandible (89.76%, 95% CI: 84.49%, 95.03%) than in maxilla (81.71%, 95% CI: 71.91%, 91.51%; p = 0.028). No correlation was found between periodontal and smoking status and outcomes. Conclusions The study reported high 10-year implant survival rate for full-arch rehabilitations since implant loss was relatively rare. Peri-implantitis was relatively frequent in the examined population although the number of subjects available for 10-year evaluation was limited.

Background In this study, we present medium- and long-term data on implant survival in a cohort of patients with severe maxillary atrophy rehabilitated using reconstructive implant site development with calvarial bone grafts. Materials and methods We obtained clinical records from patients treated with implant rehabilitation supported by calvaria bone grafts in the Oral Surgery Department of IRCSS San Raffaele (Milan, Italy). Implant and prosthetic survival and success rates were retrospectively evaluated. Graft survival and postoperative complications were also assessed. Results A total of 207 implants placed in 32 patients were evaluated for a mean period of 10.0 years from loading. After 10 years, the cumulative survival rate was 97.10%, the implant success rate was 92.75%, and the prosthetic complication rate was 9.76%. A graft survival percentage of 96.88% was observed, and postoperative complications occurred in 28.13% of cases. Conclusions The 10-year survival rate and prosthetic complications for patients treated with implant rehabilitation supported by calvarial bone grafts are excellent, as implant loss was relatively rare, although limited subjects were available for the 10-year follow-up.

Little is known regarding the success, failure, or complication rates of advanced implant procedures in patients after discontinuation therapy of long-term medications for the treatment of chronic myelogenous leukemia (CML). This case report presents initial results of a case involving implant placement in the mandible and maxilla as well as reduction of palatal oral pigmentation in a patient discontinuing long-term tyrosine kinase inhibitor (TKI) therapy for CML.A 57-year-old male was referred to the Department of Periodontics, University of Washington, Seattle, Washington, for an assessment of edentulous areas (tooth sites #3 and #14) and failing tooth #19. Previous medical treatment included oral administration (10 years) of TKI for the treatment of CML. Systemic complications arising from long-term TKI therapy were treated with discontinuation of this medication. Concurrently, after multispecialty dental and medical consultation, extraction of tooth #19 with immediate implant placement and bilateral sinus augmentation with simultaneous implant placement were successfully performed during three separate surgical appointments. Additionally, marked reduction of oral palatal pigmentation was observed during the surgical and restorative phases after TKI discontinuation.Patients with a history of long-term TKIs for CML are at risk for developing complications that result in discontinuation of therapy. Long-term benefits of therapy may allow these patients to enjoy remission with an extended and improved quality of life. Patients undergoing discontinuation therapy may seek dental care. Therefore, dental providers need to understand these systemic interactions and, with multispecialty consultation, may help effectively treat these individuals.

Background The treatment of severely atrophied and edentulous jaws by means of fixed implant supported solutions is a challenging procedure. Purpose The immediate loading of four to six axial and tilted implants offers the possibility to overcome elaborate hard tissue augmentation procedures but lacks implant and patient related data on implant survival rates. Materials and Methods This retrospective 7-years clinical trial investigated the implant survival rates of 2,081 implants (380 patients, 482 jaws) using an immediate loading protocol with either 4, 5, or 6 implants per restoration. Survival rates were calculated concerning implantation related factors (jaws/number of supporting implants/angulations/diameters/lengths) and patient related factors (medical status/smoking). Results Overall survival of 2,081 implants was 97.0% on implant level. Survival rates of implantation related factors did not yield significant differences. Significant differences were yield between healthy patients and patients with osteoporosis (p = .002) and the medical status group “other” (p = .032), respectively. Smokers yielded a significantly higher survival than nonsmokers (p = .002). Conclusions It is assumed that four implants per jaw serve as a sufficient implant number for full arch restorations in both, the mandible and the maxilla. Osteoporosis under the medication with bisphosphonates seems to be a risk factor for implant survival. The authors suggest that the effect of smoking on ISRs remains controversial within this treatment concept.

Background. Nasal defects resulting from tumor resection are preferably rehabilitated with implant-retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients' satisfaction with implant-retained nasal prostheses were assessed. Methods. Twenty-eight consecutive patients needing total rhinectomy because of tumor resection between 1998 and 2013 were treated according to a standardized protocol with 2 implants in the nasal floor. Surgical and prosthetic aftercare was scored using patient records. Finally in 2014, skin reaction, peri-implant bone loss, and patients' satisfaction were assessed in all 13 still living patients. Results. In total, 56 implants were inserted (median follow-up, 35.1 months; interquartile range [IQR], 8.9-63.3). Implant survival was 96.4%. Implant survival was independent of radiotherapy. Peri-implant skin was healthy and patients' satisfaction high. Longevity of the prostheses was limited. Conclusion. Rehabilitation of nasal defects resulting from total rhinectomy with implant-retained nasal prostheses, according to our protocol, resulted in high patient satisfaction and favorable treatment outcome. (C) 2015 Wiley Periodicals, Inc.

Purpose To evaluate aged partially and fully edentulous patients who received dental implants and were maintained over time. Further, to determine how the partially and edentulous ageing populations (65 and above) with dental implants maintain bone levels, proper oral hygiene, and perceive benefits of dental implants. Materials and Methods Since 1995, patients receiving dental implants have been prospectively entered into an Access-based computerized program (Triton Tacking System). Patient demographics (age, sex), bone quality, quantity, implant location, and type of surgery have been continuously entered into the database. The database was queried for patients receiving implants (first stage) between 66 and 93 years of age. Thirty-one patients were within this age group. Twenty-five patients returned to the clinic for periodontal and dental implant evaluation. The Periodontal Index was used to evaluate selected teeth in terms of probing depth, bleeding on probing, plaque accumulation, and mobility. Using NIH Image J, radiographs taken at second stage and last examination were measured for changes in interproximal bone levels. Once identified, each patient anomalously filled out an abbreviated quality of health life form. Due to small sample size, descriptive statistics were used to compare clinical findings. Results Fifteen males ranging from 78 to 84 (mean age 84 years) years and 16 females from 66 to 93 (mean age 83 years) (age range 66–93) were contacted by phone or mail and asked to return to our office for a re-examination. For this group, the first dental implants were placed in 1996 (n = initial two implants) and continuously recorded through 2013 (n = last seven implants). Thirty-one patients received a total of 84 implants. Two patients were edentulous, and the remaining were partially edentulous. Four implants were lost. Between implant placement and 6- to 7-year interval, 13 patients with 40 implants had a cumulative survival rate of 94.6%. Of the original group (n = 33), three were deceased, two were in nursing homes, and three could not be located. Conclusions Aged patients receiving dental implants had excellent implant survival rates, low periodontal disease index scores with minimal changes in interproximal bone levels. Results from this study indicate that patients with advanced age, in reasonably good health, have excellent implant survival rates, excellent quality of life scores, and can be maintained in good oral health.

Background Emerging evidence suggests that implant therapy may be a viable option for diabetic individuals with elevated glycemic levels. Purpose The purpose of this 2 year observational study was to evaluate survival and clinical complications of dental implants following placement in type 2 diabetes individuals having poor glycemic control. Materials and Methods Adult participants (n = 24) with poorly controlled type 2 diabetes (8.0% ≤ HbA1c ≤ 12.0%) received two or more transgingival dental implants. Survival was evaluated after 1 (23 participants, 72 implants) and 2 (20 participants, 59 implants) years. Clinical complications were evaluated in 18 participants (52 implants) after 21-34 months. Relationships between complications and stratified HbA1c levels were assessed using Pearson's correlation test. Results Survival rates were 98.6% (71/72 implants) after 1 year and 96.6% (57/59 implants) after 2 years. Complications were identified in 29% of participants with peri-implant mucositis, the most common event. Complications correlated directly with number of implants across HbA1c strata (0.42, R2 = 0.66). There was no correlation between HbA1c and the occurrences of complications or mucositis. Conclusions This 2-year evaluation supports the broader application of implant therapy in type 2 diabetes individuals with poor glycemic control in demonstrating high survival rates with limited complications.

Various augmentation procedures involving the maxillary sinus, using bone substitutes or bone, have been used to enhance bone support for dental implants. The aim of this study was to retrospectively evaluate the status of implants in patients who had undergone a maxillary sinus lift and immediate implant placement without the addition of graft material.Nineteen patients who had required bone augmentation of their maxillary sinus floor were evaluated in this study. After a bone window in the lateral wall of the sinus has been prepared and the Schneiderian membrane had been carefully elevated, dental implants were inserted in the residual bone, creating a membrane elevation. Resorbable collagenous membrane was used to seal the lateral access window of the maxillary sinus after implant placement. Clinical and radiological follow-up was carried out up to 40 months after implant installation.A total of 28 implants in lengths of 10 and 12 mm were placed in a one-stage healing protocol, with an average residual bone height of 5.25 mm (SD = 1.48). All implants remained stable, with a survival rate of 100%. An increase in mean bone height of 4.75 mm (SD = 1.13) was gained. The marginal bone levels relative to the coronal aspect of the implant shoulder exhibited a mean change of 1.01 mm (SD = 0.49) from the baseline. Of the 19 patients, none showed a plaque index or gingival index greater than 2, and 14 patients showed no presence of plaque.The findings of the study regarding the immediate placement of implants without the use of bone grafts or other bone substitute materials demonstrate a successful approach for new bone formation around implants in the posterior part of the maxilla, when the preoperative height of the subantral bone is moderate and enough to achieve primary stability.

Purpose The objective of this work was to evaluate the effect of prosthetic restoration on the survival of implants and on the incidence of implant-related complications. Material and methods From a prospectively documented clinical study, 1569 implants placed in 630 patients (mean age 59.56 years) were evaluated. Selection criteria were a conventional loading protocol, prosthetic restoration with at least one follow-up, and a minimum observation period of 9 months. Implants that failed before prosthetic restoration were excluded. The sample included 1345 tissue-level implants and 104 bone-level implants (Straumann), and 120 Replace implants (Nobel Biocare). The observation period ranged between 9 months and 11 years after prosthetic restoration (mean 4.0 years; SD 2.5). The implants were restored with single crowns (n = 557), fixed dental prostheses (n = 594), or removable dental prostheses (RDP) (n = 418). In the RDP group, 356 implants were restored with telescoping crowns, 22 with bar units 24 with bar joints, and 16 with locator attachments. The incidence of implant-related complications and failures was analyzed by use of Kaplan–Meier survival curves. Cox regression analysis was used to identify possible risk factors. Results Twenty-seven failures (1.8%; loosened or removed implants) were observed after prosthetic restoration; the incidence of failure was 3% for implants placed in males and 1% for implants placed in females. Other factors had no effect on the incidence of failure. Peri-implantitis (n = 29) and marginal bone loss >2 mm without acute inflammation (n = 6) also resulted in a 4% incidence of severe implant-related complications (62 of 1569; success 96%). Cox regression analysis revealed combined tooth–implant-supported restorations as a significant risk-reducing factor for severe implant-related complications (hazard ratio, HR = 0.34; P = 0.04). There was, furthermore, a tendency toward a greater incidence of complications for implants restored with RDPs than for single crowns (P = 0.08). Other factors, for example location (anterior/posterior, maxilla/mandible), age, sex, or implant placement combined with bone augmentation, had no significant effect on the incidence of implant-related complications (P values ranging between 0.16 and 0.94). Conclusions The type of support has a small but significant effect on implant prognosis. For detailed analysis of the effects of loading by different types of prosthetic restoration, larger sample sizes are required.

Objective The objective of this study was to determine whether professional maintenance appointments were related to a decrease on dental implant loss. Methods We performed a retrospective review (1995–2012) of 1020 patient dental charts to collect data including a cadre of different variables such as age, gender, race, diabetes, osteoporosis, jaw location, implant dimensions and professional maintenance therapy. As a patient may have multiple implants which are correlated, we selected one random implant per patient to assure independence of observations assumption of the Cox proportional hazards regression model. Data analysis was performed using Kaplan–Meier survival curves and multivariate analysis using Cox proportional hazards regression analysis. Results Our results demonstrate that subjects with no maintenance had the lowest cumulative survival rate as compared to subjects with regular maintenance. In a multivariate Cox regression model, regular maintenance patients had the dental implant failure rate reduced by 90% as compared to no maintenance (P = 0.001). If patients had less than one maintenance visit per year, the failure rate was reduced by 60% as compared to no maintenance, but the difference was not statistically significant (P = 0.08). Conclusion From this research, we conclude that a professional administered periodontal maintenance at least on an annual basis is a critical factor for implant survival.