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One thousand eight hundred seventeen implants were placed in the completely edentulous maxillae of 189 patients (122 female; 67 male). The patients' mean age was 60 years (range 28 to 91 years). Three hundred fifty-six of the 1,817 implants were placed in the pterygomaxillary area, and all patients were restored with complete-arch fixed detachable prostheses. The mean number of implants per maxillary prosthesis was 9.0 (range 6 to 15). During stage II surgery and before loading, 41 pterygomaxillary implants (11.5%) were not osseointegrated and were removed. After a mean loading period of 4.68 years (range 0.06 to 9.20 years), 1 additional pterygomaxillary implant was lost. Altogether, 42 of 356 pterygomaxillary implants (11.8%) were removed. Survival rates according to implant size, bone quality, and tooth position were also recorded. This study illustrates a cumulative survival rate of 88.2% for pterygomaxillary site implant placement in edentulous maxillary arches.

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It has become increasingly common for controlled diabetic patients to be considered as candidates for dental implants. This study reports on the results of placing implants in 34 patients with diabetes who were treated with 227 Brånemark implants. At the time of second-stage surgery, 214 of the implants had osseointegrated, a survival rate of 94.3%. Only one failure was identified among the 177 implants followed through final restoration, a clinical survival rate of 99.9%. Screening for diabetes and trying to ensure that implant candidates are in metabolic control are recommended to increase the chances of successful osseointegration. Antibiotic protection and avoidance of smoking should also be considered.

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A method of using osseointegrated implants as an alternative treatment modality for transverse root fractures near the osseous crest is presented. A 15-mm Branemark implant was placed immediately after extraction of a maxillary central incisor with transverse root fracture. Five months after stage I surgery, the implant was uncovered. Custom fabrication of a substructure core cast directly to the titanium single tooth abutment was necessary due to the palatal inclination of the fixture. An overcasting porcelain fused to gold crown was fabricated to avoid an unesthetic labial access for the abutment screw. This treatment indicates that the use of osseointegrated implants seems to provide an effective solution to replacing teeth with transverse root fractures.

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A study involving the immediate loading of Brånemark implants in the edentulous mandibles of 10 patients is reported. The design involved the immediate loading of four widely distributed implants with a transitional fixed implant-supported prosthesis at first-stage surgery, avoiding the need for a removable prosthesis. A sufficient number of additional implants are allowed to heal in the conventional manner to provide sufficient support for a definitive fixed prosthesis even if all of the immediately loaded implants fail. Preliminary results have been favorable, with all patients functioning with a fixed implant prosthesis from the day of first-stage surgery.

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A technique is described for fabricating autopolymerizing acrylic resin copings for CeraOne provisional restorations. This method has the advantage of providing a chemical bond rather than only a bond between the mechanical coping and the relined provisional crown, as is the case when using the provisional components supplied by the manufacturer. The technique describes provisionalization at the time of stage II surgery. This type of coping can also be used after a period of soft tissue healing when a healing abutment is employed. The benefits of the procedure include increased patient satisfaction and reduced chair time for repairs.

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A 3-year multicenter study on 63 maxillary and 10 mandibular fixed prostheses in 71 patients is reported. Angulated abutments or a combination of angulated and standard abutments were used to support prostheses; all components were from the Brånemark System. Of 425 implants initially placed, 4 were lost before abutment connection. Of the remaining 421 implants, 209 angulated (test) abutments and 212 standard (control) abutments were placed to support fixed prostheses. The prosthesis success rates were 96.8% for maxillae and 100% for mandibles. A total of 5.3% of the loaded test implants and 7.5% of the loaded control implants failed. The survival rates after 3 years were 91.3% for maxillary control implants, 94.8% for maxillary test implants, 97.4% for mandibular control implants, and 94.1% for mandibular test implants. The findings in this study pointed out that angulated abutments will not necessarily promote peri-implant mucosal problems. The study indicated that angulated abutments on Brånemark System implants have exhibited good preliminary results and should be comparable to the standard abutment as a predictable modality in prosthetic rehabilitation.

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Posterior single-tooth implant restorations are subjected to an increased risk of bending overload. A high incidence of implant fracture has been reported when using a single standard 3.75-mm-diameter implant to support a molar restoration. The purpose of this article is to demonstrate the clinical feasibility of placing two implants to support a molar restoration and to compare this treatment option to the use of a single standard implant or a wide-diameter implant. Two osseointegrated dental implants used to support a molar restoration in interdental spaces as small as 10 mm is shown to be effective and predictable in 60 restorations over the past 7 years. The use of two implants provides more surface area for osseointegration and spreads the occlusal loading forces out over a wider area, reducing the potential bending forces that would otherwise exist in a single-implant molar restoration.

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An analysis of 4,045 implants placed in function during a 5-year period yielded eight fractured implants (0.2%). All fractures had associated marginal bone loss. The majority (six of eight) were supporting posterior prostheses. Parafunctional habits were diagnosed in all patients with fractured implants. Most patients presented with loosening or fracture of prosthetic gold screws or abutment screws prior to fracture. This study reports on the treatment of fractured implants accomplished by refacing the fractured titanium and adapting new abutments or replacing the entire implant with subsequent prosthesis refabrication.

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The successful rehabilitation of a patient with severe vertical overlap resulting from the loss of posterior occlusal support and excessive wear of the mandibular incisors is described. The treatment plan necessitated extraction of the remaining periodontally compromised mandibular teeth and placement of eight implants. Lost occlusal vertical dimension and morphologic facial height were restored using a fixed detachable implant-supported mandibular prosthesis, and the maxillomandibular relationship was transformed from Class II to Class I.

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A comparative study between one and two Brånemark implants replacing a single molar was conducted. Forty-seven individuals comprised two groups of 22 patients treated with one implant and 25 with two implants. A total of 72 implants were placed, 66 (92%) in the mandible and six (8%) in the maxilla. After the first year of function, the success rate was 99%, with only one implant lost. Between the second- and third-year follow-ups, 100% of the implants continued to function in the remaining 46 patients, giving a 3-year cumulative success rate of 99%. The marginal bone loss between 1 and 3 years of function was 0.10 mm (SD 0.20) for the group with one implant and 0.24 mm (SD 0.20) for the group with two implants. No changes were observed in the Sulcus Bleeding Index during the 3-year follow-up. Prosthesis mobility or screw loosening was the most frequent complication and was predominant in the group using one implant (48%), but was substantially reduced in the group using two implants (8%). These mechanical problems, using one implant only, seem to be preventable using a stronger screw joint (CeraOne abutment). Precise centric occlusal contact was established and maintained over the study period, which was thought to contribute to the very high success rate for the single-implant-supported molars, despite their high degree of mechanical problems. This study suggests that implant-supported molars can be effective therapy, and the results confirm the biomechanical analysis that two implants provide more advantageous support than does one.

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A technique for fabricating a provisional fixed prosthesis for an edentulous arch immediately following abutment connection, termed conversion prosthesis, is described in detail. Advantages of the restoration include the following: it provides a fixed prosthesis immediately following stage 2 surgery with improved function, stability, and distribution of load; it protects the sutured mucosa; it serves as a prototype for the final prosthesis; it can be used as a verification jig; it preserves the original vertical dimension of occlusion; it aids in obtaining and transferring the interocclusal record; it assists long-term patient maintenance; and it reduces treatment visits. The advantages of its use clearly outweigh the disadvantages.

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The visor-sandwich osteotomy augmentation and onlay bone grafts are among the various methods for rehabilitating the lower third of the face and restoring oral function. However, these methods have provided unpredictable results. When sufficient bone is available for reconstruction of atrophic jaws with endosseous implants, this can be the treatment of choice. In patients with insufficient bone available for conventional implant treatment, the use of an adjunctive inferior border graft may be considered.

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Radical surgery was performed to remove the left side of the mandible in a patient diagnosed with mandibular carcinoma. For 36 years, the patient functioned with a hinged, removable partial denture anchored to the remaining natural dentition on the mandibular right side. Because of deterioration of the remaining natural dentition, the patient could no longer function with the partial denture. In lieu of reconstruction with a bone graft, the patient chose to undergo treatment with osseointegrated implants to permit insertion of a stable prosthesis with a cantilevered extension into the area of the surgical resection. The rigid attachment of the prosthesis to the remaining mandible provided function as well as soft tissue support in the area of the surgical defect.

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One hundred eighty-seven implants were placed in the maxillary posterior areas of 44 partially edentulous patients (29 female; 15 male). The mean age was 62 years (range 36 to 82 years). Fifty-one of the 187 implants were placed in the pterygomaxillary area and further restored with fixed prostheses. The mean number of implants per prosthesis was 3.7 (range 1 to 6) for the maxillary posterior area. These 51 implants are the subject of this report. During stage II surgery and before loading, six implants were not osseointegrated and were removed. After a mean loading period of 12.6 months (range 1 to 63 months), one additional implant was lost. Seven of 51 implants were removed (13.7%). Failure rates according to implant size and bone quality were also analyzed. The average loss of marginal bone height was 1.3 mm on the mesial and 1.1 mm on the distal surfaces between 1 and 3 years of loading. This study demonstrates the possible and successful use of the pterygomaxillary site for implant placement.

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Successful prosthodontic treatment begins with an accurate diagnosis and thorough and comprehensive treatment planning. Osseointegration is an integral part of prosthodontic treatment planning. When use of the single tooth implant is anticipated, there are several procedure objectives that should be considered: elimination of pathosis; attainment of ideal fixture alignment and stability; protection of teh adjacent teeth; preservation or augmentation of the alveolar ridge; attainment of primary closure; and avoidance of mucosal pressure. Esthetic and biologic complications are discussed.

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Among the goals of orthodontic therapy is the establishment of optimal facial form, occlusal function, and dental esthetics. Orthodontic treatment of patients with congenitally missing teeth, especially maxillary lateral incisors, can be accomplished best by positioning the remaining natural dentition in the anatomically correct location and closely coordinating therapy with the osseointegration team members. Special divergence of adjacent root tips is essential to provide space for the implant. The Brånemark system of implant therapy is the treatment of choice for the permanent replacement of congenitally missing teeth.

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