longitudinal studies of dental implant systems 1

Dr. Mohammed AlshehriBDS, AEGD ,SSC-ARD

Longitudinal Studies of Various Dental Implant

Systems

Dental Implant Fellowship Program (DIFP)

Fellow’s Topic Presentation


Dental Implant Designs

Endosseous

Subperiosteal

Transosteal


Endosseous Dental Implants

In 1970 studies with 10 years clinical results presented by a research group in Sweden directed by Dr Per-Ingvar Branemark. Their studies demonstrated that pure titanium integrates with bone tissue if it is carefully prepared surgically.


Scientific Literature

Systematic searched of various electronic databases (Medline, Embase, Google scholar, Central and the Cochrane Oral Health Group specialist register) to identify randomized controlled clinical trials (RCT’s) Comparing different dental implant systems.



10 randomized controlled clinical trials (RCT’s) were identified.

1. Geertman et al J Prosthet Dent 1996.

Multicenter randomized clinical trial (88 patients), comparing the effect of overdentures on different implant systems ” transmandibular implant (TMI), the IMZ (IMZ), and the Brånemark system” in patients with severely resorbed mandibles 1 year after the insertion of new dentures. Evaluation included peri-implant soft tissue and radiographic parameters. The results revealed no significant differences between the three implant systems.



2. Boerrigter et al Oral RehabiI1997

Controlled clinical trial (60 patients), comparing the effect of mandibular overdentures on two different implant systems “Brånemark system and the IMZ-system” in edentulous patients were compared one year after insertion of the new dentures. Evaluation included peri-implant and radiographical parameters. During the osseointegration period, five Brånemark and one IMZ-implants were lost. The results were less favorable for the Brånemark group than for the IMZ-group; however, these differences were not significant.



3. Jones et al OralSurg Oral Med Oral Pathol Oral Radiol Endod 1997

Prospective clinical trial “Sixty-five subjects” comparing titanium plasma-sprayed versus hydroxyapatite-coated titanium plasma-sprayed cylinder (press fit) implants in different regions of the mouth “anterior maxilla, posterior maxilla, anterior mandible, and posterior mandible”. Patients were assigned to either titanium plasma-sprayed or hydroxyapatite-coated implants on the day of surgery.There were a total of 15 failures (4.26%). Overall, titanium plasma-sprayed implants showed a higher but not significant failure rate compared with hydroxyapatite-coated implants (p = 0.06). Hydroxyapatite-coating of an implant allows superior initial integration when compared with a titanium plasma-sprayed surface.



4. Batenburg et al Clin Oral Implants Res 1998

prospective randomized comparative study “90 patients” to evaluate the condition of the peri-implant tissues of three different implant systems “30 patients were treated with 2 Brånemark implants, 30 patients with 2 IMZ implants and 30 patients with 2 ITI implants” supporting a mandibular overdenture. A standardized clinical and radiographic evaluation was performed 6 and 12 months after insertion of the denture. The pocket depth in the Brånemark group decreased significantly whereas the mucosa recession increased significantly in both the Brånemark as well as in the IMZ group. After 12 months, there was significantly less bone loss in the ITI group. The ITI implant appears to be the implant of choice for mandibular overdenture therapy, because only one operation is required for a comparable result.



5. Karlsson et al Oral Implants Res 1998

In 50 partially edentulous patients, 133 (48 maxillary; 85 mandibular) Astra Tech dental implants of 2 different surface textures (machined; TiO-blasted) were alternately installed, supporting 52 fixed partial dentures (FPDs). the cumulative survival rates were 97.7% and 95.7% for implants and prostheses, respectively. There was no statistically significant difference in survival rate between the 2 types of implants, 100% (TiO-blasted) vs 95.3% (machined). After 2 years in function, when both jaw and type of implants were combined, the mean marginal bone loss was 0.24 (0.69) mm. No statistically significant difference in bone loss was found between the 2 types of implant after 2 years of loading.



6. Astrand et al Clin Implant Dent Relat Res 1999

Prospective randomized study comparing two implant systems (Astra Tech and Brånemark System implants). Sixty-six patients were equally distributed between the two implant systems; 184 Astra Tech and 187 Brånemark System implants were used. Result:

The abutment procedure was found to be easier and less time-consuming with Astra Tech than with Brånemark implants.

The failure rate for Astra Tech implants was 0.5% and for Brånemark implants 4.3%. the difference was significant.

The total bone loss during the observation period did not differ significantly between the systems

The survival rate of Astra Tech implants was higher than that of Brånemark system implants.



7. Tawse-Smith et al Implant Dent Relat Res 2001

Randomized clinical trial “24 edentulous subjects” to examine the feasibility and success of using two different dental implant systems “machined titanium implant surface (Steri-Oss, Nobel Biocare, Göteborg, Sweden) and a roughened titanium surface (Southern Implants, Ltd., Irene, South Africa)” using a one-stage operative procedure in patients being rehabilitated with implant mandibular overdentures. Result show a successful application of this one-stage approach for unsplinted implants supporting mandibular overdentures with Steri-Oss and Southern Implant Systems.



8. Geurs et al lnt J Oral Maxillofac Implants 2002

Multicenter trial, 120 healthy edentulous patients received 5 or 6 implants in the anterior mandible and were followed for 3 years. A total of 634 implants were placed ” threaded titanium plasma-sprayed (TPS), threaded hydroxyapatite-coated (HA), and cylindric HA-coated”. Each type of implant were placed and that they were uniformly distributed over the arch. Result show that HA-coated implants exhibit a more rapid decrease in micromobility than do TPS implants of identical geometry.



9. Mau J et al Clin Oral Implants Res 2002

In a randomized multicenter clinical trial comparing intramobile cylinder (IMZ) implants with either of two coatings, hydroxyapatite (HA) or titanium plasma-flame (TPF), as distal abutments for combined tooth implant-supported restorations, were compared in 313 partially edentulous mandibles. Result show no relevant statistically significant difference between the two coatings.



10.Tawse-Smith et al Clin Implant Dent Relat Res 2002

Randomized clinical trial “Forty-eight edentulous participants” to compare the success rates of two different dental implant systems “machined titanium implant surface (Sterioss, Nobel Biocare, Yorba Linda, California, USA) and a roughened titanium surface (Southern Implants, Irene, South Africa)” following conventional or early loading protocols in patients being rehabilitated with mandibular overdentures. Result show no statistically significant difference in the success rates of the two systems .


Geertman et al


• 6 randomized controlled clinical trials (RCT’s) were excluded.

Data of 2 different RCTs were combined.No separate data.

Esposito et al lnt J Oral Maxillofac Implants 2005


Boerrigter et al



Number of enrolled patients unclear.



Jones et al



Study not classified as a RCT.



Karlsson et al



Not all patients were participating in a split Mouth study.



Geurs et al



Unclear which implant type(s) failed. Numberof dropouts also unclear.



Mau et al



Unusual high dropout rate (only data of 189 of the 313 patients admitted in the trialwere presented). Dropouts often classified

as such for questionable reasons. Early failures counted as dropouts.




• 3 out of 11 follow up publications included..

1. Meijer et al J Clin Periodontol 2004

prospective comparative study was to evaluate the survival rate and the condition of the peri-implant tissues of the IMZ implant system (two-stage cylindertype), the Brånemark implant system (two-stage screwtype) and the ITI implant system (one-stage screwtype) supporting a mandibular overdenture during a 5-year follow-up period. After 5 years no clinically relevant and statistically significant radiographic changes had developed between the three implant systems.



.2. Engquist et al. Clin Oral Implants Res 2002

Follow up for Astrand et al 1999 which demonstrated high survival rates and small marginal bone changes for Astra Tech when compared with Brånemark System implants.Result :There was no significant marginal bone change between baseline and the 1-year examination or between the 1- and 3-year examinations. The survival rate of Astra Tech implants was significantly higher (98.9%) than for Brånemark System implants



3. Astrand et al Clin Oral Implants Res 2004

Follow up for Astrand et al 1999 which demonstrated high survival rates and small marginal bone changes for Astra Tech when compared with Brånemark System implants.Result :Between baseline and the 5-year examination, the marginal bone level changes were small, with no difference between the implant systems.At the 5-year examination, the survival rate for Astra Tech implants was 98.4% and for the Brånemark implants it was 94.6%. The difference was not statistically significant.


Comparative Analysis of Various Dental Implant

Systems• In term of implant failures and marginal bone level

Astra versus Branemark Implants

Astrand et al compared submerged Astra screw-type implants and submerged Branemark screw-type implants using a parallel group design

in totally edentulous patients. Thirty-three fully edentulous patients (17 maxillae and 16 mandibles)



Systems• In Conclusion

Considering the patient as the unit for the analysis, there was no statistically significant difference between the implant systems in

regard to either failure or marginal bone level change after 5 years of function.




Branemark versus IMZ Implants.

Batenburg et al compared 2 submerged Branemark implants used to support mandibular overdentures with 2 IMZ submerged implants used

to support mandibular overdentures using a parallel group design. Thirty patients were included in each group.





regard to either failure or marginal bone level change .




Branemark versus ITI Implants.

Batenburg et al compared 2 submerged Branemark MKII screw-type implants used to support mandibular overdentures with 2 ITI TPS hollow

screw-type implants used to support mandibular overdentures.Thirty patients were included in each group.




IMZ versus ITI Implants

Batenburg et al compared 2 submerged IMZ TPS cylinders supporting mandibular overdentures with 2 nonsubmerged ITI TPS hollow screws Supporting mandibular overdentures on parallel group design. Thirty

patients were included in each group.




Southern versus Steri-Oss Implants

Tawse-Smith et al in Two trials with a parallel group design compared the use of 2 nonsubmerged, unsplinted Southern implants to support an

Overdenture with the use of 2 nonsubmerged, unsplinted Steri-Oss screws.The design of the 2 trials was identical, except that in 1 trial the implants

were conventionally loaded at 12 weeks, whereas in the other, the implants were loaded early, at 6 weeks.




Meta-analyses were done of the 2 above studies.Considering the patient as the unit for the analysis, there were no

statistically significant differences in regard to failures and marginal bone level changes between the implant systems after 5 years

of function.



Systems• In term of early failures between turned and roughened

surfaces.

A meta-analysis comparing early implant failures between various implants with turned and roughened surfaces .Two trials were included

“Astrand et al & Batenburg et al “




Considering the patient as the unit for the analysis, no statistically significant differences were observed between the implants with turned surfaces and those with roughened surfaces in regard to

number of early failures.



Systems• In term of Peri-implantitis Between Turned and Roughened

Surfaces at 5 Years.

Only 1 trial “Astrand et al “ was available that compared the occurrence of peri-implantitis between various implants with turned and roughened

surfaces at 5 years..




Considering the patient as the unit for the analysis, there was no statistically significant difference in regard to occurrence of

peri-implantitis between implants with turned surfaces and thosewith roughened surfaces.


Dental Implant Systems

• Implant or implant system with extensive clinical documentation, ie, more than four prospective and/or retrospective clinical trials

3i Implant InnovationsUSA

ICE Super Self-Tapping Osseotite TG Osseotite

Osseotite Xp Osseotite NT Osseotite Certain




Astra TechSweden

AstraTech AstraTech ST Fixture MicroThread




Centerpulse DentalUSA

Taper Lock Swiss-Plus Swiss-Plus + taper

Screw-Vent Screw-Vent + taper AdVent Spline




Dentsply FriadentGermany

ANKYLOS implant system FRIALlT-2 stepped cylinder, HA

FRIALlT-2 stepped screw, TPS FRIALlT-2 stepped screw Synchro,TPS

FRIALlT®-2 stepped screw, Tiefstruktur FRIALlT®-2 stepped screw, Synchro Tiefstruktur

XiVE XiVE TG

IMZ- TwinPlus implant system Friadent CELL plus




Innova LifeSciencesCanada

Endopore Entegra




Institut Straumann AGSwitzerland

Screw Screw Esthetic Plus Hollow Cylinder Hollow Cylinder, Esthetic Plu

ITI Narrow Neck (NNI) ITI Wide Neck (WNI) ITI TE




Lifecore BiomedicalUSA

Restore, Threaded, RBM Restore, Threaded, TPS Restore, Threaded, Ti

Restore, Threaded, HA Restore, Cylinder, RBM Restore, Cylinder, TPS

Restore, Cylinder, Ti Restore, Cylinder, HA Stage-l , RBM, regular & wide,+/- Esthetic Collar

Stage-l , TPS, regular & wide,+/- Esthetic Collar

SuperCAT Super Self-Tapping Sustain, HA coated (MC) cylinder




Nobel BiocareSweden

Branemark system® Mklll Branemark system® Mklll, TiUnite Branemark system® MkIV

Branemark system® MkIV, TiUnite Replace® Select, Straight, NP, RP,WP Replace® Select, Tapered, NP, RP,WP

Replace® Select, Straight, NP, RP,WP,TiUnite Replace® Select, Tapered, NP, RP,WP,TiUnite

Replace® Select, Straight, NP, RP,WP, HA Replace® Select, Tapered, NP, RP,WP,HA NobelPerfect




Sterngold Implamed DentalImplant System USA

Implamed Turned, TPS, Regular, Wide & Narrow Implamed Turned Partial TPS, Regular,Wide & Narrow

Implamed Turned Regular, Wide & Narrow lmplamed HA, Regular, Wide & Narrow

ERA Implant System


Conclusions

high success rates can be achieved for all implant systems analyzed after 5 years of loading.

There is no strong evidence supporting the superiority of some implant systems over others.

These conclusions are based on a few RCTs, evaluating few implant systems in few patients; therefore, the possibility that clinical differences exist cannot be excluded.


Thank you

longitudinal studies of dental implant systems 1

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