RESUMEN
OBJECTIVE: The objective of this study was to evaluate crestal bone changes around bone- and tissue-level implants related to initial mucosal thickness. MATERIALS AND METHODS: Patients received at least 2 implants: one with the prosthetic abutment connection at the crestal bone level (MC) and one with the prosthetic abutment connection at 2.5 mm supra crestal (LC). Flap thickness measurements were taken using a periodontal probe after raising the buccal flap. Patients were divided into 2 groups according to the mucosal thickness-Group A (thickness, ≤2 mm) and Group B (thickness, >2 mm). RESULTS: Our study included 33 patients and 78 implants. Each patient received at least 1 implant of each type: Group A (MC), 17 implants, with a mean bone change of -0.6 ± 0.5 mm; Group B (MC), 20 with a mean bone change of -0.2 ± 0.4 mm; Group A (LC), 15 with a mean bone change of -0.1 ± 0.5 mm; and Group B (LC), 22 with a mean bone change of -0.2 ± 0.4 mm. A paired-samples t-test for groups A (MC) and B (MC) yielded a statistically significant difference (P = 0.003); there was no statistically significant difference for groups A (LC) and B (LC) (P = 0.518). CONCLUSION: If the initial mucosal thickness surrounding bone-level implants is more than 2 mm, there is significantly less crestal bone change compared with bone-level implants placed in initial mucosal thicknesses of 2 mm or less. This difference is not statistically significant when tissue-level implants are used and the implant-abutment connection is 2.5 mm above the crestal bone level.
Asunto(s)
Proceso Alveolar/patología , Implantación Dental Endoósea/métodos , Implantes Dentales , Encía/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Pilares Dentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Colgajos QuirúrgicosRESUMEN
PURPOSE: The aim of this systematic review and meta-analysis was to evaluate crestal bone changes around implants when placing the implant-abutment connection at the crestal bone level or above. MATERIALS AND METHODS: Medline (Pubmed), EMBASE, and Cochrane Library up to January 2014 were electronically and hand searched for any publications that evaluated radiographic crestal bone changes around nonsubmerged, rough-surfaced implants placed in healed sites in humans and loaded for a minimum of 1 year. RESULTS: The search yielded 1,122 publications; 1,106 could not be included. After 16 full-text articles were read and subjected to inclusion and exclusion criteria, four were included. The mean difference was -0.29 mm (95% CI, -0.58 mm to -0.01 mm). Heterogeneity between studies was observed (I2 = 95%). Significantly more crestal bone change was seen in the epicrestal implant-abutment (bone level) connection group when compared to implants with the prosthetic connection above the crestal bone level (tissue level) (P < .00001). CONCLUSION: Dental implants at bone level show significantly less crestal bone change after 1 year of loading than tissue-level implants.
Asunto(s)
Proceso Alveolar/diagnóstico por imagen , Diseño de Implante Dental-Pilar , Implantes Dentales , Remodelación Ósea/fisiología , Implantación Dental Endoósea/métodos , Diseño de Prótesis Dental , Humanos , Radiografía , Propiedades de SuperficieRESUMEN
OBJECTIVE: Crestal bone loss around dental implants is a criterion for success as this could prevent loss of implant and superstructure. The macrogeometry of the implant could influence bone remodelling when the implant-abutment connection is placed at crestal bone level or above. The aim of this study was to evaluate crestal bone remodelling in a randomized clinical prospective trial in macrogeometrically similar implants with the prosthetic connection at the crestal bone level and 2.5 mm above. The null hypothesis was that there was no difference in crestal bone loss after 1 year of early loading. MATERIAL AND METHODS: Patients were referred to Academic Centre of Dentistry Amsterdam for implant placement. Patients were subjected to inclusion and exclusion criteria and received a minimum of two implants: an implant with the prosthetic abutment connection at the crestal bone level (minimized collar [MC], bone level) and one with the prosthetic abutment connection 2.5 mm supracrestal (long collar [LC], tissue level). The mesial or distal location of each implant type was blinded for the patient and randomized. The implants were loaded splinted after 3 weeks of healing. The primary outcome was bone-level change assessed after 1 year of loading. RESULTS: Thirty-three patients fulfilled the inclusion criteria. Thirty-nine Thommen SPI ELEMENT LC implants and 39 MC were placed, and each fixed dental prosthesis was supported by one LC and one MC implant. The intraclass correlation of measures performed by the first and second X-ray examiner was as follows: on the mesial side of the MC implant 0.990 (0.980-0.995; 95% confidence interval [CI]), 0.980 (0.962-0.990; 95% CI) on the distal side of the MC implant, 0.979 (0.959-0.989; 95% CI) and 0.988 (0.978-0.994; 95% CI) on the mesial and distal side of the LC implant, respectively. The mean bone loss of the MC implant was 0.4 ± 0.4 mm. The mean bone loss of the LC implant was 0.2 ± 0.5 mm. The paired samples t-test showed a statistically significant difference (P < 0.05) between the MC and LC implants. CONCLUSION: Dental implants at bone level show statistically significantly (P < 0.05) more crestal bone change after 1 year of loading than a tissue-level implant.
Asunto(s)
Pérdida de Hueso Alveolar/patología , Diseño de Implante Dental-Pilar , Prótesis Dental de Soporte Implantado , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/fisiopatología , Remodelación Ósea , Femenino , Humanos , Masculino , Mandíbula/patología , Mandíbula/cirugía , Maxilar/patología , Maxilar/cirugía , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: Safe loading of dental implants requires an optimal osseointegration. This osseointegration process during healing could be analyzed by resonance frequency analysis (RFA). The purpose of the study was to evaluate RFA changes during healing in splinted, early-loaded, thermal acid-etched, hydrophilic implants over time. MATERIALS AND METHODS: Patients received a minimum of two implants: an implant with the prosthetic abutment connection at the crestal bone level (bone level) and one with the prosthetic abutment connection at a 2.5-mm supracrestal site (tissue level). Implant stability was measured at weeks 0, 2, 3, and 12 using the Osstell device. RESULTS: Seventy-six implants were placed in 32 patients. By week 2, early-loaded tissue-level implants showed a significant drop in mean ± standard deviation (SD) implant stability quotient (ISQ) values of 2.2 ± 3.6 (P < .001). Changes in ISQ values were significant between weeks 3 and 12 and also between weeks 0 and 12, with mean differences of 4.2 (P < .001) and 2.8 (P < .001), respectively. Early-loaded bone-level implants show a significant change in ISQ of 2.3 ± 3.7 at week 2 (P < .01) and -1.3 ± 4.7 at week 12 when compared to an ISQ value of 2.9 ± 4.9 at week 3 (P < .01). Bone-level implants achieved higher ISQ values compared with tissue-level implants at weeks 0, 2, 3, and 12, with mean differences being 3.8 ± 5.5 (P < .01), 3.8 ± 6.1 (P < .01), 3.7 ± 6.7 (P < .01), and 2.3 ± 5.8 (P < .05), respectively. CONCLUSION: This study found a significant dip in ISQ values, with the lowest point seen at week 2. ISQ values remained higher in bone-level implants throughout the process of healing and osseointegration.