OBJECTIVES: The objective of this systematic review was to assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological and technical complications. METHODS: An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on SCs with a mean follow-up time of at least 5 years. Failure and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5-year proportions. RESULTS: Twenty-six studies from an initial yield of 3601 titles were finally selected and data were extracted. In a meta-analysis of these studies, survival of implants supporting SCs was 96.8% [95% confidence interval (CI): 95.9-97.6%] after 5 years. The survival rate of SCs supported by implants was 94.5% (95% CI: 92.5-95.9%) after 5 years of function. The survival rate of metal-ceramic crowns, 95.4% (95% CI: 93.6-96.7%), was significantly (P=0.005) higher than the survival rate, 91.2% (95% CI: 86.8-94.2%), of all-ceramic crowns. Peri-implantitis and soft tissue complications occurred adjacent to 9.7% of the SCs and 6.3% of the implants had bone loss exceeding 2 mm over the 5-year observation period. The cumulative incidence of implant fractures after 5 years was 0.14%. After 5 years, the cumulative incidence of screw or abutment loosening was 12.7% and 0.35% for screw or abutment fracture. For supra-structure-related complications, the cumulative incidence of ceramic or veneer fractures was 4.5%. CONCLUSION: It can be concluded that after an observation period of 5 years, high survival rates for implants and implant-supported SCs can be expected. However, biological and particularly technical complications are frequent.

/pdf/a-systematic-review-of-the-5-year-survival-and-complication-2taohaw9al.pdf

A systematic review of the 5-year survival and complication rates of implant-supported single crowns

Background: Peri-implant diseases include peri-implant mucositis, describing an inflammatory lesion of the peri-implant mucosa, and peri-implantitis, which also includes loss of supporting bone.

Methods: A literature search of the Medline database (Ovid), up to 21 January 2008 was carried out using a systematic approach, in order to review the evidence for diagnosis and the risk indicators for peri-implant diseases.

Results: Experimental and clinical studies have identified various diagnostic criteria including probing parameters, radiographic assessment and peri-implant crevicular fluid and saliva analyses. Cross-sectional analyses have investigated potential risk indicators for peri-implant disease including poor oral hygiene, smoking, history of periodontitis, diabetes, genetic traits, alcohol consumption and implant surface. There is evidence that probing using a light force (0.25 N) does not damage the peri-implant tissues and that bleeding on probing (BOP) indicates presence of inflammation in the peri-implant mucosa. The probing depth, the presence of BOP, and suppuration should be assessed regularly for the diagnosis of peri-implant diseases. Radiographs are required to evaluate supporting bone levels around implants. The review identified strong evidence that poor oral hygiene, a history of periodontitis and cigarette smoking, are risk indicators for peri-implant disease. Future prospective studies are required to confirm these factors as true risk factors.

Peri-implant diseases: diagnosis and risk indicators

Objectives: The objectives of this systematic review were to assess the survival rate of implants placed in sites with transalveolar sinus floor elevation. Material and Methods: An electronic search was conducted to identify prospective and retrospective cohort studies on transalveolar sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates/ year proportions. Results: The search provided 849 titles. Full-text analysis was performed for 176 articles, resulting in 19 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated annual failure rate of 2.48% (95% confidence interval (95% CI): 1.37‐4.49%) translating to an estimated survival rate of 92.8% (95% CI): 87.4‐96.0%) for implants placed in transalveolarly augmented sinuses, after 3 years in function. Furthermore, subject-based analysis revealed an estimated annual failure of 3.71% (95% CI: 1.21‐11.38%), translating to 10.5% (95% CI: 3.6‐28.9%) of the subjects experiencing implant loss over 3 years. Conclusion: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable to those in non-augmented sites. This technique is predictable with a low incidence of complications during and post-operatively.

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

OBJECTIVES: To assess the 5-year survival rates and incidences of complications of cemented and screw-retained implant reconstructions. METHODS: An electronic Medline search complemented by manual searching was conducted to identify randomized controlled clinical trials (RCTs), and prospective and retrospective studies giving information on cemented and screw-retained single-unit and multiple-unit implant reconstructions with a mean follow-up time of at least 1 year. Assessment of the identified studies and data abstraction were performed independently by three reviewers. Failure rates were analyzed using Poisson regression models to obtain summary estimates and 95% confidence intervals of failure rates and 5-year survival proportions. RESULTS: Fifty-nine clinical studies were selected from an initial yield of 4511 titles and the data were extracted. For cemented single crowns the estimated 5-year reconstruction survival was 96.5% (95% confidence interval (CI): 94.8-97.7%), for screw-retained single crowns it was 89.3% (95% CI: 64.9-97.1%) (P = 0.091 for difference). The 5-year survival for cemented partial fixed dental prostheses (FDPs) was 96.9% (95% CI: 90.8-99%), similar to the one for screw-retained partial FDPs with 98% (95% CI: 96.2-99%) (P = 0.47). For cemented full-arch FDPs the 5-year survival was 100% (95% CI: 88.9-100%), which was somewhat higher than that for screw-retained FDPs with 95.8% (95% CI: 91.9-97.9%) (P = 0.54). The estimated 5-year cumulative incidence of technical complications at cemented single crowns was 11.9% and 24.4% at screw-retained crowns. At the partial and full-arch FDPs, in contrast, a trend to less complication at the screw-retained was found than at the cemented ones (partial FDPs cemented 24.5%, screw-retained 22.1%; full-arch FDPs cemented 62.9%, screw-retained 54.1%). Biological complications like marginal bone loss >2 mm occurred more frequently at cemented crowns (5-year incidence: 2.8%) than at screw-retained ones (5-year incidence: 0%). CONCLUSION: Both types of reconstructions influenced the clinical outcomes in different ways, none of the fixation methods was clearly advantageous over the other. Cemented reconstructions exhibited more serious biological complications (implant loss, bone loss >2 mm), screw-retained reconstructions exhibited more technical problems. Screw-retained reconstructions are more easily retrievable than cemented reconstructions and, therefore, technical and eventually biological complications can be treated more easily. For this reason and for their apparently higher biological compatibility, these reconstructions seem to be preferable.

Cemented and screw‐retained implant reconstructions: a systematic review of the survival and complication rates

Objectives: The objectives of this systematic review were to assess the survival rate of implants placed in sites with transalveolar sinus floor elevation.

Material and Methods: An electronic search was conducted to identify prospective and retrospective cohort studies on transalveolar sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates/ year proportions.

Results: The search provided 849 titles. Full-text analysis was performed for 176 articles, resulting in 19 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated annual failure rate of 2.48% (95% confidence interval (95% CI): 1.37–4.49%) translating to an estimated survival rate of 92.8% (95% CI): 87.4–96.0%) for implants placed in transalveolarly augmented sinuses, after 3 years in function. Furthermore, subject-based analysis revealed an estimated annual failure of 3.71% (95% CI: 1.21–11.38%), translating to 10.5% (95% CI: 3.6–28.9%) of the subjects experiencing implant loss over 3 years.

Conclusion: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable to those in non-augmented sites. This technique is predictable with a low incidence of complications during and post-operatively.

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. Part II: transalveolar technique.

PURPOSE This study sought to identify the types, frequencies, and risk factors associated with complications following placement of dental implants. It was hypothesized that one or more factors could be identified that are associated with an increased risk for complications and may be modified by the clinician to enhance outcome. MATERIALS AND METHODS A retrospective cohort study design was used that included patients who received Bicon implants (Bicon, Boston, MA) between 1992 and 2000. Predictor variables were grouped into demographic, medical history, implant-specific, anatomic, prosthetic, and reconstructive categories. Complications were grouped into inflammatory, prosthetic, operative, and major or minor categories. Cox proportional hazards regression models were developed to identify risk factors for complications. RESULTS The sample was composed of 677 patients. The overall frequency of implant complications was 13.9% (10.2% inflammatory, 2.7% prosthetic, 1.0% operative), of which 53% were minor. The multivariate Cox model revealed that smoking, use of 1-stage implants, and reconstructive procedures were statistically associated with an increased risk for overall complications (P < or = .05). The median duration of follow-up was 13.1 months (range 0 to 85.6 months). DISCUSSION A lower frequency of complications was found compared to mean frequencies calculated from past reports. Investigations examining the influence of smoking and reconstructive procedures on implant complications are recommended. CONCLUSION Of the 3 factors associated with an increased risk for complications, tobacco use and implant staging may be modified by the clinician to enhance outcome.

Complications of dental implants: identification, frequency, and associated risk factors.

Purpose: This study sought to identify the types, frequencies, and risk factors associated with complications following placement of dental implants. It was hypothesized that one or more factors could be identified that are associated with an increased risk for complications and may be modified by the clinician to enhance outcome. Materials and Methods: A retrospective cohort study design was used that included patients who received Bicon implants (Bicon, Boston, MA) between 1992 and 2000. Predictor variables were grouped into demographic, medical history, implant-specific, anatomic, prosthetic, and reconstructive categories. Complications were grouped into inflammatory, prosthetic, operative, and major or minor categories. Cox proportional hazards regression models were developed to identify risk factors for complications. Results: The sample was composed of 677 patients. The overall frequency of implant complications was 13.9% (10.2% inflammatory, 2.7% prosthetic, 1.0% operative), of which 53% were minor. The multivariate Cox model revealed that smoking, use of 1-stage implants, and reconstructive procedures were statistically associated with an increased risk for overall complications (P ≤ .05). The median duration of follow-up was 13.1 months (range 0 to 85.6 months). Discussion: A lower frequency of complications was found compared to mean frequencies calculated from past reports. Investigations examining the influence of smoking and reconstructive procedures on implant complications are recommended. Conclusion: Of the 3 factors associated with an increased risk for complications, tobacco use and implant staging may be modified by the clinician to enhance outcome. INT J ORAL MAXILLOFAC IMPLANTS 2003;18:848–855

/pdf/complications-of-dental-implants-identification-frequency-3w2hau2ji5.pdf

Complications of dental implants: identification, frequency, and associated risk factors

Purpose The investigators sought to determine whether maxillary sinus augmentation (MSA) was an independent risk factor for implant failure. Materials and methods Using a retrospective cohort study design, the investigators enrolled a sample composed of subjects having 1 or more implants placed in the posterior maxilla. The primary predictor variable was MSA status at the time of implant placement (MSA present or absent). MSA consisted of a lateral window (external) or an osteotome (internal) procedure. The outcome variable was implant failure defined as implant removal. Demographic, health status, anatomic, implant-specific, abutment-specific, prosthetic, and perioperative variables were also examined. Overall implant survival was estimated using Kaplan-Meier analysis. Risk factors for implant failure were identified using Cox proportional hazard regression models. Results The sample consisted of 318 patients and 762 posterior maxillary implants. The mean duration of follow-up was 22.50 ± 19.06 months. The 5-year survival rates for implants in the ungrafted and grafted posterior maxilla were 88.0% and 87.9%, respectively ( P =.08). After adjustment for covariates, MSA status was not an independent risk factor for implant failure ( P =.9). Tobacco use ( P P P Discussion MSA status was not associated with implant failure risk. This finding may be subject to selection bias, as successful MSA was requisite prior to implant placement. Conclusion MSA status was not associated with an increased risk for implant failure. Of the 3 factors associated with an increased risk for failure, tobacco use and implant staging may be modified by the clinician to enhance outcome.— Reprinted with permission of Quintessence Publishing.

Maxillary sinus augmentation as a risk factor for implant failure

PURPOSE The investigators sought to determine whether maxillary sinus augmentation (MSA) was an independent risk factor for implant failure. MATERIALS AND METHODS Using a retrospective cohort study design, the investigators enrolled a sample composed of subjects having 1 or more implants placed in the posterior maxilla. The primary predictor variable was MSA status at the time of implant placement (MSA present or absent). MSA consisted of a lateral window (external) or an osteotome (internal) procedure. The outcome variable was implant failure defined as implant removal. Demographic, health status, anatomic, implant-specific, abutment-specific, prosthetic, and perioperative variables were also examined. Overall implant survival was estimated using Kaplan-Meier analysis. Risk factors for implant failure were identified using Cox proportional hazard regression models. RESULTS The sample consisted of 318 patients and 762 posterior maxillary implants. The mean duration of follow-up was 22.50 +/- 19.06 months. The 5-year survival rates for implants in the ungrafted and grafted posterior maxilla were 88.0% and 87.9%, respectively (P = .08). After adjustment for covariates, MSA status was not an independent risk factor for implant failure (P = .9). Tobacco use (P < .001), implants replacing molars (P < .001), and 1-stage implants (P < .001) were statistically associated with an increased risk for implant failure. DISCUSSION MSA status was not associated with implant failure risk. This finding may be subject to selection bias, as successful MSA was requisite prior to implant placement. CONCLUSION MSA status was not associated with an increased risk for implant failure. Of the 3 factors associated with an increased risk for failure, tobacco use and implant staging may be modified by the clinician to enhance outcome.

Maxillary sinus augmentation as a risk factor for implant failure.

Extranodal natural killer T-cell lymphoma, nasal type, with minimal osseous involvement: report of a case and literature review.

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