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The term "buccal implant position" is commonly used but lacks a precise definition and missing a reference point. Considering its major impact on peri-implantitis and esthetic failures the purpose of this study was to find a correlation between bucco-palatal implant positioning and the midfacial soft tissue level of implant crowns using newly defined Emergence-points.Patients with unilateral single-tooth implant crowns in the region of the central or lateral maxillary incisor were included in this study. Digital intraoral scans were superimposed over a scan of the master cast or the original digital data set and analyzed in a computer planning program. In relation to the corresponding natural tooth, an ideal Emergence-point (ESeventy-three patients met the inclusion criteria. AD ranged from 0 to 3.5 mm (AD = 0.87 ± 1.01), SIP from 0.2 to 5.1 mm (AD = 2.66 ± 1.64). Statistical analysis showed a significant inverse correlation between AD and SIP (ρ = -.55, p .001). VIP, the implant inclination, time span since implant insertion, and phenotype revealed no significant correlation to AD.The more palatal the implant was positioned, the less AD was observed. The position of the implant shoulder should preferably be planned more than 2 mm behind the ideal E-point. This E-point can be used for implant planning as it defines the ideal crown length for prospective planning.

Objectives The aim of the present systematic literature review was to determine whether long-term treatment results with single-tooth implants may differ depending on the timing of implant placement in relation to tooth extraction (immediate IP/early EP/delayed DP) and the timing of prosthetic loading (immediate IL/early EL/delayed DL). Material and methods Electronic and manual searches were performed to identify studies reporting on long-term results (survival rate and/or marginal bone resorption after ≥3 years) of maxillary single-tooth implants in the aesthetic zone using defined placement and loading protocols. Comparative trials were subjected to meta-analyses whilst data from single-arm studies were pooled to evaluate differences between timing protocols. Results A total of 7 controlled trials were considered for meta-analyses: immediate loading was compared to delayed loading in 3 studies on immediate placement (IPIL vs. IPDL, p = .306) and in 2 studies on delayed placement (DPIL vs. DPDL, p = 1.000) whilst 2 studies compared early versus delayed placement with delayed loading (EPDL vs. DPDL, p = .600), however, without significant differences. Pooled data analysis of 29 studies (965 implants) did not show differences between timing of placement or loading as well as marginal bone remodelling. No impact of the one abutment - one time concept, flap design and simultaneous bone or soft tissue augmentation could be established. Conclusions Insufficient data are available for meta-analytic comparison of all combinations of implant placement and loading protocols.

Purpose The aim of this systematic review is to provide an overview of finite element analyses comparing standard and short dental implants concerning biomechanical properties and to detect the most relevant parameters affecting periimplant stress concentrations. Material and methods After screening the literature and assessment of studies, 36 studies were included in this review. Results Eighty-three percent of the studies state that short dental implants have to bear higher stress concentrations compared with standard length implants. At the same time, 44% of articles note that implant diameter can be considered a more effective design parameter than implant length to reduce stress concentrations and to avoid an overload of periimplant bone. Regardless of implant dimension, in all studies, the highest stress concentrations are found in the cortical section around the upper part of the implant. Conclusions Unaffected of bone quality, implant diameter is found to play a key role to minimize periimplant stress concentrations. Concerning stress reduction implant length gains increasing relevance with decreasing bone density. Furthermore, splinting of short implants constitute an appropriate tool to avoid crestal overloading.

Background Due to chronic inflammation or trauma facial bone is frequently missing after tooth loss in the esthetic zone. As a consequence, procedures to augment or at least to preserve bone are frequently necessary prior to implant placement. Purpose The aim of this retrospective case series is to demonstrate the applicability of a staged all-flapless concept to establish satisfactory implant restorations following situations of partial missing facial bone in the esthetic zone. Materials and methods Radiological/clinical data of 25 patients were analyzed and an esthetic evaluation of 24 patients was performed. The staged concept included ridge preservation at time of tooth extraction and delayed guided implant placement. Marginal bone loss was measured radiologically and esthetic evaluation was performed based on standardized photographs using the Pink Esthetic Score as well as the Papilla Index. Results Implant success rate revealed 100%. The mean radiological peri-implant marginal bone loss measured 1.16 mm (SD: 0.16). Regarding the esthetic outcome 71% of patients were evaluated with a Pink Esthetic Score higher or equal to 10 constituting satisfactory esthetics (median pink esthetic score: 10). The mean follow-up time for clinical and radiographic analysis was 1.3 years (SD: 0.6 years) and 1.2 years (SD: 0.6) for esthetic evaluation. Conclusion Although marginal bone loss cannot be avoided, the staged concept of flapless ridge preservation and subsequent delayed flapless guided implant placement carries the potential to improve esthetics of single-tooth implants in the anterior maxilla.

Objectives The aim of the present study was to give a detailed analysis on eight proposed implant esthetic indices including a total of 48 parameters with respect to validity and reproducibility as well as its correlation to patients' perception of esthetics. Material and methods Standardized intraoral photographs of 189 patients with 189 implant-supported crowns and adjacent peri-implant soft tissue in the esthetic zone (central and lateral incisors, canine, first premolar) served as basis for this evaluation. Eight indices (Papilla Index [PI], Pink Esthetic Score [PES], Implant Crown Aesthetic Index [ICAI], Pink and White Esthetic Score [PES/WES], Complex Esthetic Index [CEI], Implant Aesthetic Score [IAS], Subjective Esthetic Score [SES], and Rompen Index) with a total of 48 parameters were selected. Esthetic evaluation was performed twice by five examiners with an interval of 4 weeks between the evaluations. Results A total of 1,890 evaluations including eight esthetic indices served as basis for the statistical analysis. Among the overall main scores tested for inter-rater reliability, the highest ρ ^ inter values were computed for CEI, PES, PI, and IAS scores. By contrast, SES and Rompen showed the worst inter-rater reliability, respectively. The highest level of intra-rater reproducibility was noted for PI, PES, and CEI. The lowest level of intra-rater reproducibility showed Rompen, SES, and ICA. The Papilla Index demonstrated the highest level of inter-rater reliability. The remainder of the single variables (n = 46) did not reach the ρ ^ inter level of 0.6. The single variables PI mesial, PI distal as well as CEI P4 showed the highest ρ ^ intra with statistical significance higher than 0.8. The lowest agreement was observed among the variables ICA3, WES5, and IASm2. In general, VAS did not show any good correlation to the esthetic indices proposed so far. The influence of esthetic parameters on subjective patient satisfaction was generally low. Conclusion In conclusion, significant differences regarding reliability and validity could be observed in the present comparison of eight esthetic indices. Objective evaluation of the esthetic outcome of implant therapy inherently fails to reflect subjective patient opinion, however, requires consistency of results to enable between-study comparison and meta-analysis.

Losing teeth – particularly in the aesthetic zone of the anterior maxilla – represents a great dilemma for a patient and a challenge for the attending dentist. Immediate placement of dental implants at the day of tooth extraction is an established treatment concept that offers the possibility to provide fixed provisional crowns within few hours. Troublesome removable prostheses can thus be avoided, and the psychological trauma of tooth loss is minimised. The Copy-abutment technique was developed at the Academy for Oral Implantology in Vienna (Austria) and guarantees the best possible preservation of soft-tissue aesthetics by immediate implant restoration using custom-made abutments composed of highly aesthetic zirconia ceramic. On the basis of a modern all-digital workflow and a close cooperation with the affiliated dental laboratory, it is possible to provide the patient with a new tooth in just 1 day.

Purpose: To compare long-term survival and marginal bone loss of immediate interantral implants in the nonaugmented maxilla subjected to immediate vs delayed loading. Materials and Methods: Graftless maxillary cross-arch rehabilitation was performed in a total of 362 patients in the years 2004 to 2013 (1,797 implants). Of the 240 patients with immediate implants replacing their failing maxillary dentition, 81% were subjected to immediate loading and 19% to delayed loading of their 4 to 6 interantral implants (980 and 235 implants, respectively). Kaplan-Meier survival estimates were computed and marginal bone loss was evaluated in a stratified random sample of 20 patients per group. Results: Thirty-one of 1,215 implants failed within the mean observation period of 3.9 years, and no difference in 8-year survival estimates could be seen between immediate (97.6% [95% CI: 96.7 to 98.6]) and delayed (96.6% [95% CI: 94.3 to 98.9]) loading protocols (P = .359). Mean marginal bone resorption following implant insertion did not differ significantly between the groups (1.5 ± 1.7 mm vs 0.7 ± 1.1 mm, P = .379); however, it was significantly associated with a reduced number of implants (P = .017) and patient history of periodontal disease (P < .001). Conclusion: Immediate loading of interantral implants yields satisfactory results in the transition of patients from a failing maxillary dentition to full-arch implant rehabilitation and thus may be favored over delayed loading concepts.

Background Implant esthetics may benefit from individualized zirconia abutments copying the emergence profile of the natural tooth and delivered within days after immediate implant insertion. Purpose To investigate the esthetic outcome of the Copy-Abutment technique using the Pink Esthetic Score (PES). Materials and Methods A total of 77 patients with single-tooth implants in the anterior maxilla restored at the day of immediate implant placement using Copy-Abutments and provisional crowns were followed-up after 1 week, 1 month, 4 months, 6 months, 1, 2, 3, 4, and 5 years to assess implant esthetics. Results PES ranged between 7 and 14 (median: 13) and improved significantly between the 6 month and 1 year follow-up (p

Purpose: Failing residual dentition gives rise to patient concerns about the surgical and prosthodontic management of immediate implant rehabilitation. The purpose of this study was to assess subjective patient experiences of full-arch immediate implant loading. Materials and Methods: Patients made a transition from poor dentition in the maxilla (25 patients) or mandible (25 patients) to full-arch rehabilitation on the day of extraction using four interantral or interforaminal implants. Provisional restoration was performed, and postoperative pain, swelling, and patient-perceived impairment in the first week was recorded. Results: Absence of pain was reported by 40%, 52%, and 66% of patients, on the day of surgery, on the first day after surgery, and on the second day after surgery, respectively; pain levels decreased significantly (from 1.8 to 0.9, P < .001) and patient-reported swelling decreased from 1.5 to 1.3 (P = .058) on a 10-point scale. Postoperative impairment of everyday life and work (mean score = 1.1) was significantly less pronounced than impairment of food intake (mean score = 2.2; P = .004) or speech (mean score = 1.9; P = .002). Of these patients, 88% would again undergo the procedure without doubt. Conclusion: Although patient-perceived morbidity after immediate full-arch implant rehabilitation is low in general, minor masticatory and phonetic impairment should be taken into account.

Background Discrimination between ongoing and solved research questions may help to distinguish established dogmas from evidence-based implant dentistry. Purpose The purpose of this study was to investigate topics of interest in the field of oral implant science and evolving thematic trends in clinical studies during the last decade. Materials and Methods Electronic and manual searches of English literature were performed to identify clinical studies on oral implants. Out of 15,695 publications screened, 2,875 clinical investigations were included. Results Among the most prevalent topics were immediate loading (14.3%), bone substitutes (11.6%), lateral sinus grafting (10.7%), implant overdentures (10.5%), single-tooth implant crowns (8.8%), cross-arch implant bridges (8.0%), immediate implant placement (7.5%), implant surfaces (7.0%), simultaneous implant placement and augmentation (6.4%) as well as guided bone regeneration (5.3%). Significant increase of scientific interest was seen in immediate loading (+6.3%, p

Bone grafting of the maxillary sinus is attempted to compensate for sinus pneumatization and permit reliable insertion of endosseous dental implants for prosthetic rehabilitation. The aim of the present clinical investigation was to study bone regeneration four months after transcrestal sinus floor elevation via the Gel-Pressure Technique (GPT) and application of pasteous nano-crystalline hydroxyapatite bone substitute. A total of 25 patients with deficient alveolar ridges in the posterior maxilla (mean residual bone height: 4.7 ± 1.8 mm) were subjected to 32 flapless transcrestal sinus floor augmentations and simultaneous insertion of 40 implants. Sinus membrane elevation height averaged 11.2 ± 2.7 mm and minimal vertical graft resorption of 0.1 mm was observed after four months. Radiographic bone density averaged 460 Hounsfield units in regions adjacent to the native jawbone (1 to 7 mm distance), while reduction of bone density by −7.2%, −11.3%, −14.8%, −19.6% and −22.7% was recorded in more apical regions of 8, 9, 10, 11, and ≥12 mm distance to the original sinus floor, respectively. The results suggest that graft remodeling is completed up to a distance of 7 mm within a healing period of four months after sinus augmentation using nano-crystalline hydroxyapatite bone substitute material.

Background The amount of marginal bone resorption around dental implants is considered to have a significant impact on implant stability as well as implant survival rates. Purpose The aim of this prospective study was to investigate the influence of prosthetic as well as patient specific factors on marginal bone loss around short dental implants. Materials and methods Seventy-six implants, which supported splinted crowns were included for investigation. All implants were from the same type and had an intraosseous length of 6.5 mm and a diameter of 4.0 mm. Twenty implants were additionally splinted onto longer ones. Measurements of marginal bone loss were performed at a mean of 12.38 months after prosthetic loading and the mean follow-up for clinical evaluation was 20.52 months. Results Overall two implant failures were recorded, revealing a survival rate of 97.3%. Marginal bone resorption around 72 short implants measured 0.71 mm (SD: 0.74 mm) and was found to have a strong correlation with calculated Crown-to-Implant ratio (r = .71; P

Background Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality. Purpose The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla. Materials and Methods Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography (CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score (PES). Results Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 (p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations ≥ 0.8 mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [IQR]: 8–11) compared with more accurate implant positions (median PES: 13, IQR: 12–13, p = .039). Conclusion Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla.

Purpose To compare five different implant treatment protocols in the anterior maxilla, including immediate, early, and delayed implant placement, as well as implant placement in conjunction with simultaneous guided bone regeneration and implant placement 3 months following horizontal autologous bone block grafting. Material and Methods Aesthetic indices used included the Pink Esthetic Score (PES), Papilla Index (PI), Subjective Esthetic Score (SES), and White Esthetic Score (WES). Subjective evaluation of implant aesthetics was performed using a visual analogue scale (VAS). The VAS consisted of a 10 cm–long line representing the degree of discontent (0%) or satisfaction (100%). Results A total of 153 implants in 153 patients (80 women, 73 men) were evaluated after a mean follow-up of 4.5 ± 2.9 years. Mean peri-implant bone loss was 1.6 ± 0.9 mm and not affected by treatment protocol, time after implant placement, or crown length. Papilla presence, by contrast, differed significantly between the protocols: Papilla formation was more pronounced following delayed and immediate implant placement. No statistical significance was found among treatment modalities with regard to PES, SES, or WES. Longer crowns were associated with lower PES and PI ratings and correlated with greater midfacial recession. SES was also influenced by time after implant placement and keratinized mucosa. Patient satisfaction differed significantly among treatment protocols, favoring immediate implant placement. Agreement between objective and subjective aesthetic ratings was low. Conclusion The present study suggests that comparable clinical, radiological, and aesthetic results can be achieved with all treatment protocols. Gingival recession, however, seems to occur in the long term irrespective of the technique used.

Dental implant fracture is a rare biomechanical complication, however, one of the most serious and frustating ones as it is generally associated with implant and prosthesis failure as well as the surgical hazards of explantation and reimplantation. To gain insights into implant fracture rates and the impact of patient-, surgery-, and prosthetic-related factors, systematic review and meta-analysis of the English literature were performed. Electronic and hand searches yielded 69 relevant publications reporting on 827 fractures out of 44521 implants investigated. The overall incidence of implant fractures was 1.6%. Mean patient age at the time of implant fracture was 54 ± 11 years, and 70% occurred in males. The vast majority (85%) occurred in posterior regions of the mouth (premolar or molar positions). No tendency of increased fracture rates could be noted for short implant lengths or narrow implant diameters. Implant fractures occurred after 4.1 ± 3.5 years of loading, on average, in most cases (88%) supporting fixed restorations; however, only 56% were preceded by screw loosening. Although further investigations are needed to fully explore the characteristics and causes of this rare complication, it can be concluded that no more than 2.8% of implants fracture is within a mean loading period of 8.3 years.

Research on oral surgery and dental implants has a long tradition at the Medical University of Vienna, Austria and is profoundly associated with the head of the Dental Clinic’s Department of Oral Surgery for over three decades, Professor Georg Watzek. He has (co)authored more than 200 scientific papers and edited 9 books in the field. The aim of this series of review articles is to provide an overview of research topics and results published in PubMed listed international scientific journals. The first part presents a summary of publications by Georg Watzek and coworkers in the time period of 1976–1991. Thematic issues involve oral malignancies, neurofibromatosis, macroglossia, amyloidosis, craniosynostosis, maxillary sinusitis, oral anatomy, endoscopic and temporomandibular joint surgery, fibrin adhesives, heavy metal deposits, dental cysts, root resections, interradicular periodontal defects, marginal bone resorption and mucosal condition around dental implants as well as interdisciplinary treatment planning.

The scientific output in the decade 1992–2002 mimics the development of the Department for Oral Surgery in Vienna. While in 1992 there was only one professor 10 years later the department had produced over a dozen prestigious researchers and more than half of them had earned a PhD degree. The topics of the publications dealt with the top issues of scientific interest during those years. Finite element analysis of dental implants had been introduced and animal models were used worldwide as a standard for sinus floor augmentation research. Histological evaluation was performed in the laboratory founded by Professor Watzek with the help of Professor Dr. mult. Karl Donath. This enabled the department staff to easily expand scientific investigations and was subsequently also used by other institutes. This second part tells the story of the rise of the department to one of the leading research centers on oral implantology in Europe.

This review summarizes the articles published by Georg Watzek and coworkers between 2008 and 2012. Georg Watzek has always been not only an inspiring mentor but also a visioner in his field. He has (co)authored more than 200 scientific papers in renowned international scientific journals and edited 9 books. Prof. Georg Watzek and his 150 coworkers have been cited over 2,500 times, clearly reflecting the high scientific impact of the publications. More than 80 % of the work constitutes original articles with thematic issues concentrating mainly on implant osseointegration and bone regeneration. This review provides a short summary of the projects that forms the basis of ongoing research.

Background The first year of prosthetic loading is crucial to peri-implant bone levels; however, contributing factors are yet barely understood. Purpose The purpose of the study is to investigate the influence of patient-, implant-, and prosthetic-related parameters on marginal bone resorption in partially edentulous patients within the first year of prosthetic loading. Materials and Methods This retrospective multifactorial analysis involved the following influencing factors: patient gender and age, implant diameter, implant location and neck design, insertion torque, insertion depth, splinted versus single-tooth restorations, crown height space, and crown-to-implant ratio. Results Mean peri-implant bone resorption around 200 dental implants was 0.98 ± 0.76 mm and significantly correlated to higher implant insertion depth (p

Objectives Single-tooth replacement of anterior mandibular teeth is frequently complicated by insufficient bucco-lingual bone width and limited mesio-distal space available for implant placement. The aim of the present study was to assess implant esthetics in the partially edentulous anterior mandible. Material and methods Esthetic evaluation of 43 anterior mandibular single-tooth implants in 15 women and 28 men was performed using esthetic indices (PES = Pink Esthetic Score, PI = Papilla Index, SES = Subjective Esthetic Score) as well as subjective patients' Visual Analogue Scale (VAS) ratings. Clinical and radiological parameters (implant and crown dimensions, pocket depth, bleeding on probing, plaque, keratinized mucosa, marginal bone level, and distance to adjacent teeth) were tested for influence. Results Implant esthetics were judged satisfactory (PES ≤10) in 42% of implants compared with a patient satisfaction rate of 87%. Correlation between objective indices (PES/PI: rs = 0.62, PES/SES: rs = −0.73, PI/SES: rs = −0.48) was highly significant (P ≤ 0.001); however, no association to subjective patients' ratings could be observed. Type of prosthetic restoration (single crown vs. tulip-shaped double crowns), mesio-distal crown width as well as anatomic crown length significantly affected esthetic scores. Patients' judgment, by contrast, could not be associated to any prognostic factor. Conclusion Subjective patient satisfaction with implant esthetics in the partially edentulous anterior mandible is high, however, remains hard to predict or objectively quantify.

Periimplantitis is the most frequent cause of late implant failure; however, little is known about the long-term success of periimplantitis treatment and the effectiveness of various therapeutic interventions.A total of 142 patients were referred to the Academy for Oral Implantology in Vienna for the treatment of recurrent periimplantitis around single-tooth implants. Of them, 72 patients (51%) were treated by laser decontamination, 47 patients (33%) by implantoplasty surgery, and 23 patients (16%) by a combination of both approaches.Overall success of periimplantitis therapy was 89% after 9 years of follow-up, and it did not differ significantly between female and male patients (P = 0.426). The number of implant failures that could not be prevented by periimplantitis treatment was 6 after laser decontamination (8%), 6 after implantoplasty surgery (13%), and 4 after a combination of both therapies (17%). Implant loss occurred after 4.9 ± 1.9 years of therapy, on average. No significant difference between the 3 treatment groups could be observed (P = 0.393).The present results suggest that success rates of periimplantitis therapy with either laser decontamination or surgical implantoplasty are high. These success rates do not appear to be associated with patient gender or treatment strategy.

Purpose: To compare long-term survival and marginal bone loss of late interantral implants in the nonaugmented edentulous maxilla subjected to immediate vs delayed loading. Materials and Methods: One hundred twenty-two edentulous patients with implants in native, healed jawbone were subjected to either immediate loading (179 implants) or delayed loading (403 implants) of their four to six interantral implants (part I of 362 graftless maxillary cross-arch rehabilitations performed in the years 2004 to 2013). Kaplan-Meier survival estimates were computed, and marginal bone loss was evaluated in a stratified random sample of 20 patients per group. Results: Fifteen of 582 implants failed within the mean observation period of 4.7 years, and no difference in 8-year survival estimates could be seen between immediate (98.3% [95% CI: 96.4-100.0]) and delayed (96.7% [95% CI: 94.7-98.6]) loading protocols (P = .370). Mean marginal bone resorption following implant insertion did not differ significantly between the groups (1.1 ± 1.3 mm vs 1.4 ± 1.3 mm, P = .490). Conclusion: Immediate loading of interantral implants in the nonaugmented edentulous maxilla yields favorable results comparable to delayed loading and may be considered to shorten periods of removable provisional prostheses in maxillary edentulism.

This systematic review looks at thematic trends in clinical research publications on dental implants. For this purpose, MEDLINE electronic searches as well as additional hand searches of six main journals in the field were conducted. A total of 2875 clinical studies published between 2001 and 2012 met the inclusion criteria and were subjected to statistical analysis. Hot topics in dental implant literature included immediate loading (14.3%), bone substitutes (11.6%), cross-arch full bridges (8.0%), and immediate implant placement (7.5%). A significant increase in scientific interest for immediate loading (+6.3%, p = 0.001), platform switching (+2.9%, p = 0.001), guided implant surgery (+1.9%, p = 0.011), growth factors (p = 0.014, +1.4%), piezoelectric surgery (+1.3%, p = 0.015), and restorative materials (+0.7%, p = 0.011) was found. A declining scientific interest in onlay grafting (-0.3%, p = 0.042) was recorded. The findings regarding current clinical oral implants research tie in with better-informed consumers and increased patient demands. Our results demonstrate an increasing interest in techniques that avoid complicated procedures such as bone grafting and that reduce treatment duration.

OBJECTIVES Simultaneous implant placement in conjunction with lateral or transcrestal maxillary sinus floor augmentation gives the benefit of reduction in healing times and surgical interventions. Primary implant stability, however, may be significantly reduced in resorbed residual ridges. Aim of the present study was to investigate the impact of residual bone height, bone density, and implant diameter on primary stability of implants in the atrophic sinus floor. MATERIAL AND METHODS A total of 66 NobelActive implants were inserted in the sinus floor of fresh human cadaver maxillae: 22 narrow (3.5 mm), 22 regular (4.3 mm), and 22 wide (5.0 mm) diameter implants in residual ridges of 2-6 mm height. Presurgical computed tomographic scans were acquired to assess bone height and density. Primary implant stability was evaluated by insertion torque values (ITV), Periotest values (PTV), and Osstell implant stability quotients (ISQ). RESULTS Correlations within outcomes (ITV, PTV, ISQ) were highly significant (P < 0.001). Radiographic bone density was found to significantly impact all three outcome measures (P < 0.001), while no influence of residual bone height and implant diameter could be revealed by multifactorial analysis. Consistent results were seen in all subgroups (including residual ridges of 5-6 mm height). CONCLUSIONS Bone density seems to represent the major determinant of primary stability in maxillary sinus augmentation with simultaneous implant placement (as well as 5-6 mm short implants in the maxillary sinus floor). Preoperative bone density assessment may help to avoid stability-related complications in one-stage implant treatment of the atrophic posterior maxilla.

Explantation of failed dental implants using a piezoelectric device may provide a viable treatment modality, especially for implants in precarious locations. The traditional mechanical procedures compared to piezosurgical technique for maxillary implant removal are described. Furthermore, the remaining bone on dental implants was analyzed by scanning electron microscopy (SEM) in order to semi-quantitatively evaluate the amount and structure. The piezoelectric device appears to be a valuable minimally invasive alternative if removal of dental implants is required.

Aim To gain further insights and resolve conflicting results in the literature regarding prevalence, predominant location and morphologic variability of maxillary sinus septa. Material and Methods Electronic and hand searching of English literature identified 33 investigations published from 1995 to 2011. Septa were defined as at least 2–4 mm in height. Results Septa were present in 28.4% of 8923 sinuses investigated (95% confidence interval: 24.3–32.5%). Prevalence was significantly higher in atrophic sinuses compared with dentate maxillae (p

Non-invasive precursor lesions precede the development of oral squamous cell carcinoma. The prevalence of such conditions varies among literature. The awareness of treating dentists enables a timely diagnosis and treatment. A total of 230 patients with oral soft tissue lesions were examined during a 1-year period at the Department of Oral Surgery, Medical University of Vienna. The following data were collected: the type of lesion, benign, potentially malignant and malignant lesions according to gender and different age groups. The most common lesions were fibrous hyperplasia (n = 57; 25%), lichen ruber (n = 46; 20%) and leukoplakia (n = 36; 16%). Precursor lesions were present in 38% (n = 87) and malignoma in 3% (n = 7) of the patients. Most lesions were found in patients between the age of 30 and 60 years (n = 132; 57%). Precursor lesions have a high prevalence in the younger population (30–60 years of age). The referring practitioners act well in collaboration with a specialized center. Teamwork in healthcare promotion is important in the management and prevention of precursor lesions.

Objectives Autologous bone augmentation to rebuild compromised alveolar ridge contour prior to implant placement allows for favorable three-dimensional implant positioning to achieve optimum implant esthetics. The aim of the present study was to evaluate peri-implant soft tissue conditions around single-tooth implants following bone grafts in the esthetic zone of the maxilla. Materials and methods Sixty patients underwent autologous bone augmentation of deficient maxillary sites prior to placement of 85 implants in the esthetic zone. In case of multiple implants per patient, one implant was randomly selected. Objective evaluation of 60 single-tooth implants was performed using the Pink-Esthetic-Score (PES) and Papilla Index (PI) and supplemented by subjective patient evaluation, as well as clinical and radiologic examination. Results Objective ratings of implant esthetics were satisfactory (median PES: 11, median PI: 2) and significantly correlated with high patient satisfaction (mean VAS score: 80%). Both esthetic indices demonstrated respectable levels of inter- as well as intra-observer agreement. Poor implant esthetics (low PES and PI ratings) were significantly associated with increased anatomic crown height, while no influence of horizontal implant-tooth distance could be found. Conclusions The present investigation indicates that favorable esthetic results may be achieved in the augmented anterior maxilla. However, bony reconstruction of compromised alveolar ridges does not guarantee optimum implant esthetics.

Pommer B, Frantal S, Willer J, Posch M, Watzek G, Tepper G. Impact of dental implant length on early failure rates: a meta-analysis of observational studies. J Clin Periodontol 2011; 38: 856–863. doi: 10.1111/j.1600-051X.2011.01750.x. Abstract Aim: To test the null hypothesis of no difference in failure rates of short (minimum length: 7 mm) and longer dental implants (10 mm), a meta-analysis was performed on prospective observational trials. Materials and Methods: A systematic electronic and hand search was performed to identify eligible studies. Having additional data supplied by the authors, 54 publications were included (19,083 implants). Results: In case of mandibular implants, the null hypothesis of no impact of reduced implant length on failure within the first year of prosthetic loading could not be rejected. A significant impact of implant length could be substantiated for short machined implants in the anterior [odds ratio (OR) 5.4] and posterior maxilla (OR 3.4), while short rough-surfaced implants demonstrated increased failure rates in the anterior maxillary sites. No influence of implant diameter and denture type on the failure rate of short implants could be revealed. Conclusion: In areas of reduced alveolar bone height the use of short dental implants may reduce the need for invasive bone augmentation procedures.

Objectives: Little is known about the level of information on implant dentistry in the public. A representative opinion poll on dental implants in the Austrian population was published in 2003 (Clinical Oral Implants Research 14:621–642). Seven years later, the poll was rerun to assess the up-to-date information level and evaluate recent progress and trends in patients' mindset on dental implants. Material and methods: One thousand adults – representative for the Austrian population – were presented with a total of 19 questionnaire items regarding the level and the sources of information about dental implants as well as the subjective and objective need for patient information. Results: Compared with the survey of 2003, the subjective level of patient information about implant dentistry has significantly increased in the Austrian population. The patients' implant awareness rate was 79%. The objective level of general knowledge about dental implants was still all but satisfactory revealing unrealistic patient expectations. Three-quarters trusted their dentists for information about dental implants, while one-quarter turned to the media. The patients' wish for high-quality implant restorations was significantly higher than in 2003, yet the majority felt that only specialists should perform implant dentistry. Conclusions: This representative survey reveals that dentists are still the main source of patient information, but throws doubt on the quality of their public relations work. Dentists must improve communication strategies to provide their patients with comprehensible, legally tenable information on dental implants and bridge information gaps in the future. To cite this article: Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper G. Progress and trends in patients' mindset on dental implants. I: level of information, sources of information and need for patient information. Clin. Oral Impl. Res. 22, 2011; 223–229 doi: 10.1111/j.1600-0501.2010.02035.x

Objectives: Compared with widespread investigations on dental implant survival and biologic parameters, patient-based outcomes of implant dentistry have been neglected for years and are now becoming more popular. The aim of this representative opinion poll was to assess the up-to-date patients' mindset on dental implants and draw comparisons with the results published in 2003. Material and methods: One thousand adults – representative for the Austrian population – were presented with a total of 16 questionnaire items regarding acceptance and subjectively perceived costs of dental implant treatment as well as patient satisfaction with implant-supported rehabilitation. Results: The implant acceptance rate was 56%, while 23% of the interviewees decidedly rejected implant treatment (same rate as in 2003), especially those over 50 years of age. Only 5% had themselves undergone implant treatment and 22% reported to know someone fitted with implants. The estimated costs of implant treatment were significantly higher than those in 2003, and three-quarters felt that the prize was too high and that the sick fund or social security agencies should bear them. Satisfaction scores were significantly higher among interviewees wearing implant-supported rehabilitations compared with those with conventional fixed or removable dentures. Conclusions: Little has changed in patients' attitude toward dental implants compared with the representative opinion poll in 2003. Neither implant acceptance nor implant prevalence in the Austrian population demonstrated upward trends. Professional public relations efforts are indicated to drop resentments and increase patient acceptance of dental implants as a treatment modality. To cite this article: Pommer B, Zechner W, Watzak G, Ulm C, Watzek G, Tepper G. Progress and trends in patients' mindset on dental implants. II: implant acceptance, patient-perceived costs and patient satisfaction. Clin. Oral Impl. Res. 22, 2011; 106–112. doi: 10.1111/j.1600-0501.2010.01969.x

Objectives: Altered pulp sensitivity of anterior lower teeth is a frequent finding following chin bone harvesting. Persistent loss of tooth sensitivity has been reported in up to 20% of the patients. The aim of this study was to evaluate current recommendations for the location of the harvest zone with respect to the course of the mandibular incisive canal (MIC), the intrabony continuation of the mandibular canal mesial to the mental foramen. Material and methods: On computed tomographic (CT) scans of 50 dentate mandibles, the MIC was located and its distance to the root apices, to the labial bony surface, and to the inferior margin of the mandible was assessed. The risk of nerve injury and the percentage of patients suitable for chin bone grafting were calculated. Results: Respecting current recommendations for chin bone grafting, the content of the MIC was endangered in 57% of the CTs. Therefore, new safety margins are suggested: the chin bone should be harvested at least 8mm below the tooth apices with a maximum harvest depth of 4mm. Conclusions: Applying the new safety recommendations and proper patient selection in chin bone harvesting could reduce the risk of altered postoperative tooth sensitivity due to injury of the mandibular incisive nerve.

Implant esthetics may benefit from individualized zirconia abutments copying the emergence profile of the natural tooth and delivered within days after immediate implant insertion.To investigate the esthetic outcome of the Copy-Abutment technique using the Pink Esthetic Score (PES).A total of 77 patients with single-tooth implants in the anterior maxilla restored at the day of immediate implant placement using Copy-Abutments and provisional crowns were followed-up after 1 week, 1 month, 4 months, 6 months, 1, 2, 3, 4, and 5 years to assess implant esthetics.PES ranged between 7 and 14 (median: 13) and improved significantly between the 6 month and 1 year follow-up (p .001), then remained stable up to the fifth year. Significant improvement was seen for the variables PES-6 soft tissue color (p = .002) and PES-7 soft tissue texture (p .001) up to the 1 year follow-up, while PES-5 alveolar process deficiency deteriorated (p = .016). Mean mucosal recession was 0.26 ± 0.86 mm (range: 0-1.6) after 5 years and not related to gingival biotype.Copy-Abutments for immediate restoration of implants in the esthetic zone show satisfactory long-term esthetic outcomes.