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16 Osseointegration and Dental Implants Table 1.3. Search strategy for different types of reconstructions. when no data were available with respect to the reconstruction, or if no distinction was made between the type of reconstruction or between totally and partially edentulous patients. Also excluded were publications based on questionnaires or interviews without clinical examinations, multiple publications on the same patient cohorts, and case descriptions of failures without relevant information on the entire patient cohort. Data Extraction Implant-Supported FDPs Data were extracted independently by at least two reviewers using a data extraction form. Disagreement regarding data extraction was resolved by consensus. Information was retrieved on the survival and success rates of the reconstructions and on biological and technical complications. Survival was defi ned as the reconstruction remaining in situ at the follow-up examination visit irrespective of its condition. Success was defi ned as the reconstruction that remained unchanged and did not require any intervention during the entire observation period. Biological complications for implant and combined tooth-implant-supported reconstructions were characterized by a biological process affecting the supporting tissues. Included in this category were soft tissue com- Combined Tooth-Implant- Supported FDPs First electronic search—titles 3,844 3,844 3,601 Abstracts 560 560 543 Full text articles 151 151 54 Full text articles added by manual search 25 25 0 Total full text articles 176 176 54 Included articles 29 14 26 plications, peri-implantitis, bone loss exceeding 2 mm, intrusion of abutment teeth, and aesthetic complications. Technical complications for implant and combined tooth-implant-supported reconstructions were denoted by mechanical damage of implants, implant components, and/or the suprastructures. Included were fractures of the implants, fractures of screws or abutments, loss of retention, fractures or deformations of the framework or veneers, loss of the screw access hole restoration, and screw or abutment loosening. For all these categories the number of events was extracted and the corresponding total exposure time of the reconstructions was calculated. Statistical Analysis Implant-Supported Single Crowns Failure and complication rates were calculated by dividing the number of events (failures or complications) in the numerator by the total exposure time of the reconstruction in the denominator. The numerator could usually be extracted directly from the publication. The total exposure time was calculated by taking the sum of 1. Exposure time of reconstructions that could be followed for the entire observation time.
2. Exposure time up to a failure of the reconstructions that were lost due to failure during the observation time. 3. Exposure time up to the end of observation time for reconstructions that did not complete the observation period due to reasons such as death, change of address, refusal to participate in the follow-up, non-response, chronic illness, missed appointments, and work commitments. For each study, event rates for reconstructions were calculated by dividing the total number of events by the total reconstruction exposure time in years. For further analysis, the total number of events was considered to be Poisson distributed for a given sum of implant exposure years, and Poisson regression with a logarithmic link-function and total exposure time per study as an offset variable were used (Kirkwood and Sterne 2003). Robust standard errors were calculated to obtain 95% confi dence intervals of the summary estimates of the event rates. To assess heterogeneity of the study-specifi c event rates, the Spearman goodness-of-fi t statistics and associated p-value were calculated. If the goodness-of-fi t p-value was below 0.05, indicating heterogeneity, random-effects Poisson regression (with Gamma-distributed random effects) was used to obtain a summary estimate of the event rates. Five-year and 10-year survivals were calculated via the relationship between event rate and survival function S, S(T) = exp(−T × event rate), by assuming constant event rates (Kirkwood and Sterne 2003). The 95% confi dence intervals for the survivals were calculated by using the 95% confi - dence limits of the event rates. All analyses were performed using Stata®, version 8.2. Results Study Characteristics The studies were almost exclusively published within the past 10 years. The majority of studies on implant-supported reconstructions Chapter 1 Implant Dentistry 17 (42 out of 57) were prospective in nature. The highest proportion (81%) of prospective studies was found for the implant-supported SCs. To evaluate the potential infl uence of the study design on effect size, ten prospective studies and fi ve retrospective studies reporting on survival of implants supporting FDPs were analyzed separately. For the prospective studies, based on 1,576 implants, the summary estimate of the survival was 95.6% (95% CI: 93.3–97.2%) and for the retrospective studies, based on 1973 implants, the summary estimate of the survival was 95.0% (95% CI: 93.0–96.4%). Formally investigating the difference in event rates in a Poisson regression analysis confi rmed the absence of a study design effect (p = 0.64) for this material (Pjetursson et al. 2004a, 2004b). Survival Survival was defi ned as the reconstruction remaining in situ with or without modifi cation over the observation period. Conventional FDPs Fifteen studies provided data on the survival of conventional FDPs. The reports were divided into two groups: the fi rst group with a total of 2,088 FDPs and a mean follow-up time of 5.7 years, and the second group with a total of 1,218 FDPs and a mean follow-up time of 11.9 years. In the fi rst group, 273 out of 2,088 FDPs and in the second group 190 out of 1,218 FDPs were lost. In meta-analysis, the annual failure rate was estimated at 1.28 per 100 FDP years for the former and 1.14 for the latter group, translating into a 5-year survival of conventional FDPs of 93.8% and a 10-year survival of 89.2%. Cantilever FDPs Twelve studies provided data on the survival of cantilever FDPs. The reports were, as for
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Page 8 and 9: viii Contents What Have We Learned
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66 Osseointegration and Dental Impl
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Table 4.1. Distribution of tooth lo
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Figure 5.23. The implant bed prepar
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102 Osseointegration and Dental Imp
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e f Figures 5.32e and f. Following
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Figure 6.5a. Preoperative radiograp
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Figure 6.7a. Preoperative CT scan i
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a. b. 128 Osseointegration and Dent
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Figure 6.19. Augmentation of the in
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8 Pre-implant Surgical Intervention
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Figure 8.1. Sinus core 100% Bio-Oss
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Figure 8.8. Meisinger balloon contr
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ing bone formation in maxillary sin
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and concern for our patients, to ma
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growth factors have been studied ex
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clinical benefi t in the long-term
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composite bone graft: Preliminary r
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9 Biomaterials and Substances for S
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one graft in combination with a bar
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Figure 9.5. Photomicrograph of trep
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to harvest autogenous bone or use a
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the canine supraalveolar, peri-impl
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hBMP-2/ACS has also been shown to s
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References Adell R, Lekholm U, Rock
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10 Implant Surgery Interventions TH
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Figure 10.4. Interactive interpreta
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Figure 10.12. Graft marrow complex
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Figure 10.20. Complex 3-D aesthetic
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THE HEALING BONE-IMPLANT INTERFACE:
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was designed to resemble a more con
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A C BID (microns) 50 45 40 35 30 25
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sive strains exceeding 30% in the e
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INFLUENCES OF IMPLANT DESIGN AND SU
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numerous experimental studies (for
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Figure 13.2. Microphotograph of an
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a Clinical Experience with “Short
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as anchorage units during orthodont
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———. 1985. Introduction to os
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Rocci A, Martignoni M, Burgos P, Go
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Figure 14.17. A clinical situation
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INTEGRATION OF BIOLOGICAL PRINCIPLE
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Figure 15.1. Scanning electron micr
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process of bone bonding in vitro an
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e g Recent new knowledge may infl u
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Figure 15.5a. Prepared second left
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Baylink DJ, Wergedal JE, et al. 199
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mandible. Clin Oral Implants Res 8(
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STABILITY OF IMPLANT- ABUTMENT CONN
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fl at to fl at joints. With most in
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Figure 16.8. A solid one-piece impl
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Table 16.1. planning level & decisi
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When considering immediate restorat
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17 The Transmucosal Component and t
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Chapter 17 Transmucosal Component a
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Figure 17.14. CAD view (CAM StructS
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CONTEMPORARY DENTAL IMPLANTS AND CL
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the bone level at the time of impla
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94%. Forty-two percent (226) of the
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Based on the fi ndings of this stud
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Chapter 18 The Implant Design and C
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Figure 18.12b. The PrimaConnex TM i
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Hatley CL, Cameron SM, Cuenin MF, P
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emoval. Pract Periodont Aesthet Den
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322 Table 19.2. Systematic reviews
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Table 19.5. Clinical trials with fo
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23 Dental Implants in the Habilitat
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Figure 23.2. Severe loss of vertica
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Figure 23.8. The planned restoratio
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Figure 23.17. Occlusal view of maxi
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24 Minimum Competency for Providing
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tially restricted to perhaps only t
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386 Appendix Pre-implant Surgical I
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388 Appendix Michael A. Pikos Certi
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390 Appendix Patient Focus on Neuro
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392 Appendix periodontal plastic an
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394 Appendix the Norwegian Society
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396 Appendix prosthodontics. Dr. Kn
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398 Appendix Myron Nevins Dr. Myron
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400 Appendix Universidad de los And
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402 Appendix American College of Pr
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The University of Toronto, Faculty
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406 Index Animal studies, 8-9. See
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408 Index research design, 347 rese
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410 Index FDA. See Food and Drug Ad
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412 Index complications, 21t data e
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414 Index Neoss Bimodal, 229 Neukam
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416 Index RANKL, 219 Rare disorders
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418 Index Tatum, Hilt, 167 Taylor,
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