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12 Osseointegration and Dental Implants
No statistically signifi cant differences in
postoperative infections and adverse
events were observed. No major adverse
events were reported. Therefore it might
be sensible to suggest the routine use of
one dose of prophylactic amoxicillin just
before placing dental implants. It remains
unclear whether an adjunctive use of
postoperative antibiotics is benefi cial.
3. There is no evidence showing that any
particular type of dental implant has
superior long-term success. There is
limited evidence showing that implants
with relatively smooth (turned) surfaces
are less prone to lose bone due to chronic
infection (peri-implantitis) than implants
with rougher surfaces. There is a tendency
for implants with a turned surface to fail
early more often than implants with
roughened surfaces. No trial described
implants made or coated with materials
other than titanium. These conclusions
are based on RCTs with relatively short
follow-up periods, few patients, and at
high risk of bias. So we do not know if
there are implant characteristics or an
implant system superior to others due to
the scarcity of reliable scientifi c research.
4. There is evidence suggesting that fl apless
or mini-invasive procedures can cause
less postoperative pain, edema, and consumption
of analgesics than conventional
fl ap elevation. Flapless surgery performed
by skillful clinicians in properly selected
cases can be as successful and complication-free
as conventional fl ap elevation.
However, there is still insuffi cient evidence
regarding a potential increased risk
of complications or failures using a fl apless
approach. Clinicians should select
patients for fl apless implant placement
with a great deal of caution in relation
to their own clinical skills and experience.
Still needing to be assessed are the
safety and effi cacy of customized surgical
templates created with the help of planning
software on CT scans to facilitate
placement of dental implants.
There is still a lack of evidence about
the most effective incision or suturing
techniques or materials, or the most
effective techniques to manipulate or
augment soft tissues for aesthetic reasons
or to increase the width of keratinized or
attached mucosa, if the latter is of any
benefi t for the patients.
5. Post-extractive immediate and immediatedelayed
implants are viable treatment
options. Immediate-delayed implants
may provide a better aesthetic outcome
and are preferred by patients when compared
to delayed implants, even though
they might be associated with increased
failure and complication rates. More
RCTs are needed to confi rm these preliminary
fi ndings.
6. Two implants appear to be as effective as
four implants to support a mandibular
overdenture.
7. It is possible to successfully load implants
immediately or early after their placement
in selected patients, though not all
clinicians may be able to achieve optimal
results. A high degree of primary implant
stability (high value of insertion torque)
seems to be one of the prerequisites for
a successful procedure.
8. No relevant clinical differences appear
to exist between a one- or a two-stage
implant procedure; however, the number
of patients included in the trials (45 subjects)
was too small to draw defi nitive
conclusions. If these fi ndings are confi
rmed by larger trials, the major clinical
implication will be that the one-stage
approach might be preferable since it
avoids one surgical intervention and
shortens treatment times. However, there
might be situations, for instance when an
implant has not obtained an optimal
primary stability or when barriers are
used for guided tissue regeneration, in
which a two-stage submerged approach
might still be preferable.
9. Three trials investigated whether and
when augmentation procedures are necessary:
the augmentation of resorbed
mandibles of 6–12 mm height with an
interposed iliac crest graft resulted in
more surgical and prosthetic complica-