Int Poster J Dent Oral Med 2008, Vol 10 No 01, Poster 394
Early loading of unsplinted chemically modified dental implants in the edentulous jaw
Preliminary results of a prospective clinical trial
Dr. med. dent. Arne F. Boeckler
Centre for Dentistry and Oral Medicine, Department of Prosthodontics
Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
Roy Rosado, DMD, MS
William Martin, DMD, MS
James Ruskin, MD, DMD, MS
Dean Morton, BDS, MS
University of Florida, Center for Implant Dentistry, Gainesville, Fl, USA
26.-28. April 2007
ITI World Symposium
New York City, USA
The quality of life of elderly edentulous patients can be improved using
implants to support prostheses and resolve the edentulous milieu (Zarb
1983). Prospective and retrospective studies have shown that unsplinted
implants used to support overdentures in the edentulous jaw are both
clinically successful and economically advantageous (Mericske-Stern 1998,
Buser et al. 1999, Wismeijer et al. 1999). These clinical studies have
recommended a healing time of 12 weeks for implants with TPS-surfaces. Other
studies on implants with SLA-surfaces have shown successful loading after a
healing time of approximately 6 weeks (Cochran 2002). A chemically modified
SLA-surface (SLActive) has been introduced in the Straumann Implant System.
Research has shown improved bone anchorage during early stages of healing
for SLActive when compared to the SLA-surface (Ferguson et al. 2006).
Implant success and survival data indicates that altered loading protocols
may exert only limited effects on treatment outcomes and are rarely
associated with an increase in negative observations. Early functional
loading of unsplinted implants with attachment overdentures may become more
widespread as a simplified and efficient treatment option for edentulous
patients. Prospective trials on unsplinted, SLActive implants supporting and
retaining overdentures in the edentulous jaw are now required to evaluate
this simple and cost-effective approach.
This study was designed to evaluate early loading of unsplinted dental
implants characterized by a chemically modified SLA-surface (SLActive), when
used to support overdentures in the edentulous jaw.
|Fig.1-9 Early loading of four SLActive implants in the edentulous mandible with Locators
Material and Methods
Eight patients with edentulous mandibles and/or maxillas received between
2 and 4 solid screw titanium implants (n=26). The implant were placed using
a standardized non-submerged (one-stage) surgical protocol (Fig.1-3). The
implants were characterized by a chemically modified surface (SLActive,
Straumann Dental Implant-System, Straumann AG, Basel, Switzerland). The
patient's prostheses was not worn in the week immediately subsequent to
implant placement. After one week of healing a tissue conditioner (Coe Soft,
GC, Alsip, USA) was applied to the appropriately relieved intaglio of the
denture. Throughout the remainder of the healing period new complete
removable prostheses were fabricated for all patients. For six of the
patients the opposing prosthesis was a newly fabricated complete denture.
The remaining two patients received newly fabricated removable partial
prostheses. Mean healing time was 45 days subsequent to implant placement.
After healing Locator abutments (Straumann Dental Implant System) were
positioned (n=18 mandible and n=8 maxilla) and torqued to 35 Ncm (Fig.4-6).
The torquing of one implant resulted in pain (maxillary implant). For this
implant torque was limited to 15 Ncm. This abutment was definitively torqued
to 35 Ncm at the following appointment. Locator attachments were placed on
each abutment and picked up individually in the denture (Fig.7-9).
Radiographs were taken and assessments (implant mobility, implant success
criteria, peri-implant probing measurements, plaque index, sulcus bleeding
index, oral hygiene, patients' health status and satisfaction) were made at
loading and after 3 months in function.
Participants were aged 56-74 years (gender distribution of 1:1) and
received a total of 26 SLActive Standard Plus Implants (Straumann Implant
System) with a length of 10 mm and a diameter of 4.1 mm. One participant was
not available for 3 months follow-up because of emigration and was therefore
excluded. The remaining 7 participants with a total of 22 osseointegrated
implants were successfully wearing their prostheses at the 3-month recall.
No change in concomitant medication or health status could be observed.
Throughout the period of follow-up no implants were lost or considered
failures. The implant survival and success rates were therefore 100% for
this preliminary evaluation (Tab.1). No implant showed direct or indirect
mobility. This observation is in agreement with the results of previously
published studies on early loading of unsplinted SLA-implants in the
edentulous mandible (Payne 2002 & 2004, Raghoebar 2003). The overall oral
hygiene was slightly decreased. In 10 implants plaque (PLI 1) was detected,
and in one participant soft matter with an SBI of 2 was found (Tab.2). These
participants were taken into an advanced hygiene program. The patient's
satisfaction was consistent (Tab.3).To date one implant abutment could not
be torqued to the recommended 35Ncm in the reduced time frame. This implant
was, however, torqued without incident after approximately four weeks of
additional healing and remains successful. No other complications have been
recorded with regard to denture function and denture esthetics. To date no
evidence of bone loss associated with the healed or loaded SLActive implants
|Tab.1 Implant survival and success rates
|Tab.2 Periodontal parameters
|Tab.3 Patient's satisfaction
Within the limitations of this pilot study results suggest that the early
loading of unsplinted, chemically modified surface implants, results in
implant and prosthesis survival rates comparable with existing literature
when considering treatment of the edentulous jaw.
This Poster was submitted by Dr. med. dent. Arne F. Boeckler.
Dr. med. dent. Arne F. Boeckler
Department of Prosthodontics
06108 Halle (Saale)