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Purpose: The aim of this study was to evaluate implants placed according to several methods of sinus floor augmentation. Materials and Methods: Forty-eight patients (median age of 62 years, range 23 to 89) had been treated at least 3 years prior to examination with screw-type implants in the posterior maxilla. Depending on the vertical dimension of the residual bone, 1 of 3 surgical procedures had been performed: sinus lift by lateral antrostomy (SL) in 13 patients; osteotome technique (OT) in 18 patients; standard implantation in 17 patients (control). In each patient 1 implant was randomly chosen for analysis (48 implants with a mean observation time of 4.6 ± 1.4 years). Examination included probing pocket depth (PPD) measurement and radiographic examination. Radiographs were digitized to assess the marginal bone level. Differences between the groups were tested using analysis of variance, the Student t test and the Kruskal-Wallis test. Results: Mean PPD was 3.0 mm for the SL, 3.1 mm for OT, and 3.1 mm for control. The mean radiographic bone level was 1.53 mm for SL, 2.40 mm for OT, and 1.96 mm for control. No statistically significant differences were found between the groups for either of these parameters. Discussion and Conclusion: Clinical examinations as well as radiographically stable bone levels indicated similar biomechanical conditions for prosthetic restorations when applying the 3 surgical procedures tested. [ABSTRACT FROM AUTHOR]

Purpose: This prospective clinical study evaluated an experimental implant abutment made of densely sintered zirconia with respect to peri-implant hard and soft tissue reaction as well as fracture resistance over time. Materials and Methods: Twenty-seven consecutively treated patients with 54 single-tooth implants were included. Zirconia abutment ingots were individually shaped and set on the implants with gold screws. All-ceramic (Empress I) crowns were cemented using a composite cement. At the 1- and 4-year examinations, reconstructions were evaluated for technical problems (fracture of abutment or crown, loosening of abutment screw). Modified Plaque and simplified Gingival Indices were recorded at implants and neighboring teeth, and peri-implant bone levels were radiographically determined. Results: All but 1 of the 27 patients with 53 restorations could be evaluated at 1 year, and 36 restorations in 18 patients were evaluated 4 years after abutment and crown insertion. The median observation period for the reconstructions was 49.2 months. No abutment fractures occurred. Abutment screw loosening was reported for 2 restorations at 8 months and 27 months, respectively. Mean Plaque Index was 0.4 (SD 0.6) at abutments and 0.5 (SD 0.6) at teeth; mean Gingival Index was 0.7 (SD 0.5) at abutments and 0.9 (SD 0.5) at teeth. Mean marginal bone loss measured 1.2 mm (SD 0.5) after 4 years of functional loading. Conclusion: Zirconia abutments offered sufficient stability to support implant-supported single-tooth reconstructions in anterior and premolar regions. The soft and hard tissue reaction toward zirconia was favorable. [ABSTRACT FROM AUTHOR]

Purpose: A prospective, randomized, controlled 5-year multicenter study evaluated the long-term clinical function of CerAdapt ceramic abutments compared to titanium abutments on Brånemark implants supporting short-span fixed partial dentures (FPD). Materials and Methods: Initially, 105 Brånemark implants were placed in a total of 32 patients at three different clinics; 103 implants remained after initial healing. Fifty-three ceramic and 50 titanium abutments were connected to support 36 FPDs, 19 on ceramic and 17 on titanium abutments. Results: Thirty patients with 29 FPDs were examined after 5 years. There was a cumulative success rate of 97.2% for FPDs (94.7% for ceramic and 100% for titanium abutment-supported FPDs). One of 53 ceramic and none of 50 titanium abutments failed, giving survival rates of 98.1% and 100%, respectively. There was a mean marginal bone loss of 0.3 mm and 0.4 mm, respectively, for ceramic and titanium abutments. Soft tissues around abutments and adjacent teeth appeared healthy, and no significant differences were recorded for mucosal bleeding and plaque between ceramic and titanium abutments. Crown margins at FPD insertion were positioned as follows: 21% submucosally, 33% at the mucosal margin, and 46% supramucosally. Changes in mucosal level were recorded at 12% of the abutments, with 73% of all changes recorded at ceramic abutments. There was a balance between more or less exposed crown margins during the first 2 years, in contrast to the 2- to 5-year period, when all changes meant less exposed margins. Conclusion: Safe long-term functional and esthetic results can be achieved with CerAdapt alumina ceramic abutments on Brånemark implants for short-span FPDs. [ABSTRACT FROM AUTHOR]

The article analyzes the ceramic and composite veneering methods for implant-supported fixed prostheses. The factors to consider when choosing between ceramic and resins systems are esthetics, abrasion resistance, polishability, repair options, and cost. Composite veneers have an increased incidence of fractures, citing cohesive fractures caused by insufficient transversal or shear resistance of the material. There are limitations in modifying completed metal-ceramic restorations and localized chipping on metal-ceramic restorations are said to be time-consuming and expensive. The authors recommend the use of composite-veneered superstructures only for long-term temporary restorations or on an experimental basis.

Dental implants with moderately rough surfaces show enhanced osseointegration and faster bone healing compared with machined surfaces. The sandblasting and acid-etching (SA) process is one technique to create moderately rough dental implant surfaces. The purpose of this study was to analyse different commercially available implant systems with a SA-modified surface and to explore the widespread notion that they have similar surface properties regarding morphology and cleanliness. SA-modified surfaces of nine implant systems manufactured by Alpha-Bio Tec Ltd, Camlog Biotechnologies AG, Dentsply Sirona Dental GmbH, Neoss Ltd, Osstem Implant Co. Ltd, Institute Straumann AG, and Thommen Medical AG were analyzed using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) and examined for surface cleanliness. Six implants from three different lots were selected per each implant system. Mean particle counts for each implant and the mean size of the particles were calculated from three different regions of interest and compared using ANOVA and Tukey's test. SEM analysis showed presence of particles on the majority of analyzed implant surfaces, and EDX evaluations determined that the particles were made of Al2O3 and thus remnants of the blasting process. SPI®ELEMENT INICELL® and Bone Level (BL) Roxolid® SLActive® implant surfaces showed the highest mean particle counts, 46.6 and 50.3 per area, respectively. The surface of BL Roxolid® SLActive® implant also showed the highest variations in the particle counts, even in samples from the same lot. The mean size of particles was 1120±1011 μm2, measured for USIII CA Fixture implants, while the biggest particle was 5900 μm2 found on a BL Roxolid® SLActive® implant. These results suggest that not all manufacturers are able to produce implant surfaces without particle contamination and highlight that the surface modification process with the SA technique should be appropriately designed and controlled to achieve a clean and consistent final medical device. [ABSTRACT FROM AUTHOR]

Background: Based on three-dimensional implant planning software for computed tomographic (CT) scan data, customized surgical templates and final dental prostheses could be designed to ensure high precision transfer of the implant treatment planning to the operative field and an immediate rigid splinting of the installed implants, respectively. Purpose: The aim of the present study was to (1) evaluate a concept including a treatment planning procedure based on CT scan images and a prefabricated fixed prosthetic reconstruction for immediate function in upper jaws using a flapless surgical technique and (2) validate the universality of this concept in a prospective multicenter clinical study. Materials and Methods: Twenty-seven consecutive patients with edentulous maxillae were included. Treatments were per-formed according to the Teeth-in-an-Hour concept (Nobel Biocare AB, Göteborg, Sweden), which includes a CT scan-derived customized surgical template for flapless surgery and a prefabricated prosthetic suprastructure. Results: All patients received their final prosthetic restoration immediately after implant placement, that is, both the surgery and the prosthesis insertion were completed within approximately 1 hour. In the 24 patients followed for 1 year, all prostheses and individual implants were recorded as stable. Conclusion: The present prospective multicenter study indicates that the prefabrication, on the basis of models derived from three-dimensional oral implant planning software, of both surgical templates for flapless surgery and dental prostheses for immediate loading is a very reliable treatment option. It is evident that the same approach could be used for staged surgery and in partial edentulism. [ABSTRACT FROM AUTHOR]

Background: Immediate occlusal implant loading has been documented as a viable treatment option for various indications. However, most of the available studies reported on the short-term outcome of this treatment modality. Purpose: The purpose of this prospective clinical study was to document, on a long-term basis, the outcome of immediate occlusally loaded Brånemark System* Mk IV TiUnite (Nobel Biocare AB, Göteborg, Sweden) implants placed to support fixed reconstructions in various regions of the jaws. Materials and Methods: Thirty-eight patients received a total of 51 fixed prosthetic reconstructions, all of which were connected on the day of implant insertion. Twenty restorations replaced single teeth, 30 were fixed partial dentures, and I was a fiill-arch fixed lower restoration. These prostheses were supported by 102 Brånemark System Mk IV TiUnite implants (38 maxillary and 64 mandibular), the majority of which were placed in posterior regions (88%) and mainly in soft bone (76%). Resonance frequency measurements and marginal periimplant soft tissue evaluations were conducted during the course of the study. Furthermore, radiographic examinations were performed at the time of prosthesis delivery and at the 1- and 6-month and 1-, 2-, 3-, and 4-year follow-up visits. This report summarizes the results after 4 years of loading. Results: Three maxillary implants were removed, although stable, in one patient at the 8-week follow-up owing to post-operative infection in the adjacent guided bone regeneration area. No implants were lost further on. This resulted in a cumulative implant success rate of 97.1% after 4 years of prosthetic loading. The mean marginal bone remodeling after 4 years of function was 1.3 ± SD 0.9 mm. At 4 years, absence of marginal plaque and bleeding on probing was reported for 87% and 69% of the sites, respectively, thereby remaining unchanged since the 1-year follow-up. On average, the interproximal soft tissue fill increased for both mesial and distal papillae from scores of 1.4 ± 1.1 and 1.0 ± 1.1, respectively, at the preoperative assessment to 2.0 ± 0.8 and 1.7 ± 0.8, respectively, at the 4-year assessment. Conclusion: The applied immediate loading protocol, in combination with a slightly tapered implant design and a modified implant surface texture, was shown to be a successful treatment alternative in regions exhibiting soft bone. [ABSTRACT FROM AUTHOR]