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  • 1.
    Albrektsson, Tomas
    Malmö universitet, Odontologiska fakulteten (OD). Department of Biomaterials, Gothenburg University, Gothenburg, Sweden.
    On Implant Prosthodontics: One Narrative, Twelve Voices - 1.2018Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 31, nr Suppl 2018, s. s11-s14Artikel i tidskrift (Refereegranskat)
  • 2.
    Albrektsson, Tomas
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Department of Biomaterials, University of Gothenburg, Gothenburg, Sweden.
    Becker, William
    Department of Periodontics, University of Southern California School of Dentistry, Los Angeles, California; Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington.
    Coli, Pierluigi
    Private Clinic, Edinburgh, Scotland.
    Jemt, Torsten
    Department of Prosthodontics, University of Gothenburg, Gothenburg, Sweden.
    Mölne, Johan
    Department of Pathology and Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sennerby, Lars
    Department of Oral & Maxillofacial Surgery, University of Gothenburg, Gothenburg, Sweden.
    Bone loss around oral and orthopedic implants: An immunologically based condition2019Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 21, nr 4, s. 786-795Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background Marginal bone resorption has by some been identified as a "disease" whereas in reality it generally represents a condition. Purpose The present article is a comparison between oral and orthopedic implants, as previously preferred comparisons between oral implants and teeth seem meaningless. Materials and Methods The article is a narrative review on reasons for marginal bone loss. Results and Conclusions The pathology of an oral implant is as little related to a tooth as is pathology of a hip arthroplasty to a normally functioning, pristine hip joint. Oral as well as orthopedic implants are recognized as foreign bodies by the immune system and bone is formed, either in contact or distance osteogenesis, to shield off the foreign materials from remaining tissues. A mild immune reaction coupled to a chronic state of inflammation around the implant serve to protect implants from bacterial attacks. Having said this, an overreaction of the immune system may lead to clinical problems. Marginal bone loss around oral and orthopedic implants is generally not dependent on disease, but represents an immunologically driven rejection mechanism that, if continuous, will threaten implant survival. The immune system may be activated by various combined patient and clinical factors or, if rarely, by microbes. However, the great majority of cases with marginal bone loss represents a temporary immune overreaction only and will not lead to implant failure due to various defense mechanisms.

  • 3.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Brunski, John
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    "A requiem for the periodontal ligament" revisited. Invited commentary2009Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 22, nr 2, s. 120-122Artikel i tidskrift (Refereegranskat)
  • 4.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Buser, Daniel
    Sennerby, Lars
    Crestal Bone Loss and Oral Implants2012Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, nr 6, s. 783-791Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background A consensus meeting was arranged to critically analyze whether the high figures of peri-implantitis at machined implants that recently have been reported in the literature are valid also for modern implants. Purpose The aims of this paper were to present the outcomes from the consensus meeting and to evaluate recent long-term clinical studies on modern implants with regard to frequency of peri-implant infection. Materials and Methods Ten different studies of three modern implant brands of moderately rough surfaces with 10-year or longer follow-up times were found through a PubMed and manual search. Results It was concluded that bleeding on probing or probing depths are weak indicators of crestal bone loss (CBL); that CBL occurs for many other reasons than infection; that implant-, clinician-, and patient-related factors contribute to CBL; and that modern oral implants outperform older devices. Based on a literature search, the frequency of implants with reported peri-implant infection and significant bone loss leading to implant removal or other surgical intervention was on average 2.7% during 7 to 16 years of function. Conclusion The summed frequency of peri-implantitis and implant failure is commonly less than 5% over 10 years of follow-up for modern implants when using established protocols.

  • 5.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Fakulteten för teknik och samhälle (TS), Institutionen för materialvetenskap och tillämpad matematik (MTM).
    Buser, Daniel
    Sennerby, Lars
    On Crestal/Marginal Bone Loss Around Dental Implants2012Ingår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 27, nr 4, s. 736-738Artikel i tidskrift (Övrigt vetenskapligt)
  • 6.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Buser, Daniel
    Sennerby, Lars
    On crestal/marginal bone loss around dental implants2012Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 25, nr 4, s. 320-322Artikel i tidskrift (Refereegranskat)
  • 7.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, University of Gothenburg, Gothenburg, Sweden.
    Canullo, Luigi
    Department of Biomaterials, University of Gothenburg, Sweden; Private practice, Rome, Italy.
    Cochran, David
    Department of Periodontics, The University of Texas Health Science Center, San Antonio, TX, USA.
    De Bruyn, Hugo
    Malmö högskola, Odontologiska fakulteten (OD). Research cluster Periodontology, Oral implantology, removable and implant prosthodontics, Dental School University hospital, Faculty of Medicine and Health sciences, University of Ghent, Ghent, Belgium.
    "Peri-Implantitis: A Complication of a Foreign Body or a Man-Made "Disease". Facts and Fiction"2016Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 18, nr 4, s. 840-849Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: The discrepancy between some scientific views and the daily clinical experience with dental implants has made the topic of "periimplantitis" highly controversial, especially the discussion whether "periimplantitis" should even be considered a "disease" or whether marginal bone loss instead would represent a complication of having a foreign body placed in the oral cavity. Purpose: The aim of the present paper was to present the outcomes from a consensus meeting on "peri-implantitis" in Rome, Italy (January 8-10, 2016). Materials and Methods: Seventeen clinical scientists were invited to, based on prepared reviews of the literature, discuss topics related to "periimplantitis." Results and conclusions: Oral implants may lose bone or even display clinical failure. However, progressive bone loss threatening implant survival is rare and limited to a percent or two of all implants followed up over 10 years or more, provided that controlled implant systems are being used by properly trained clinicians. There is very little evidence pointing to implants suffering from a defined disease entity entitled "peri-implantitis." Marginal bone loss around implants is in the great majority of cases associated with immune-osteolytic reactions. Complicating factors include patient genetic disorders, patient smoking, cement or impression material remnants in the peri-implant sulcus, bacterial contamination of the implant components and technical issues such as loose screws, mobile components or fractured materials. These reactions combine to result in cellular responses with the end result being a shift in the delicate balance between the osteoblast and the osteoclast resulting in bone resorption. However, the great majority of controlled implants display a foreign body equilibrium resulting in very high survival rates of the implants over long term of follow-up.

  • 8.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Chrcanovic, Bruno
    Malmö högskola, Odontologiska fakulteten (OD).
    Jacobsson, Magnus
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Osseointegration of Implants: A Biological and Clinical Overview2017Ingår i: JSM Dental Surgery, ISSN 2573-1548, Vol. 2, nr 3Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Osseointegration was discovered in 1962 and coined as a term in 1977. Original definitions implied direct contact between foreign materials and bone without any interposed soft tissue layers. Today, osseointegration is regarded to be a foreign body response to separate foreign elements from bone. A new definition of the term is suggested in this paper; “Osseointegration is a foreign body reaction where interfacial bone is formed as a defense reaction to shield off the implant from the tissues”. Excellent clinical results of osseointegrated implants have been reported from dentistry and Ear Nose Throat surgery, the latter with the indications of a stable anchorage of hearing aids or facial epistheses in cases of facial trauma. In Orthopaedic surgery a randomized controlled clinical trial has been undertaken demonstrating very good clinical results supported by positive radiostereo-photogrammetical data.

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  • 9.
    Albrektsson, Tomas
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces. Department of Biomaterials, University of Gothenburg, Sweden.
    Chrcanovic, Bruno
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces.
    Mölne, Johan
    Department of Pathology and Genetics, Sahlgrenska Academy, Sweden; University of Gothenburg, Sweden.
    Wennerberg, Ann
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces. Department of Biomaterials, University of Gothenburg, Sweden.
    Foreign body reactions, marginal bone loss and allergies in relation to titanium implants2018Ingår i: European Journal of Oral Implantology, ISSN 1756-2406, E-ISSN 1756-2414, Vol. 11, nr Suppl 1, s. S37-S46Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aim: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy. Materials and methods: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy. Results: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult. Conclusions: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present.

  • 10.
    Albrektsson, Tomas
    et al.
    Gothenburg Univ, Dept Biomat, Gothenburg, Sweden.
    Chrcanovic, Bruno
    Malmö högskola, Odontologiska fakulteten (OD).
    Östman, Per-Olov
    Univ Ghent, Sch Dent, Fac Med & Hlth Sci, Dept Periodontol & Oral Implantol, Ghent, Belgium.
    Sennerby, Lars
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden.
    Initial and long-term crestal bone responses to modern dental implants2017Ingår i: Periodontology 2000, ISSN 0906-6713, E-ISSN 1600-0757, Vol. 73, nr 1, s. 41-50Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Successful osseointegration is the result of a controlled foreign body reaction to dental implants. Osseointegrated implants have demonstrated excellent long-term survivability, although they may be subject to limited marginal bone loss. Marginal bone loss during the first few years after implant placement seldom represents disease, but is instead the result of an adaptive bone response to surgical trauma and implant loading. It is not uncommon for implants with early marginal bone loss to enter a long-lasting state of bone stability. Extensive bone resorption after the first year is generally due to an exacerbation of adverse body reactions caused by non-optimal implant components, adverse surgery or prosthodontics and/or compromised patient factors. Disease in the form of peri-implantitis is a late complication that affects some implants with suppuration and rapid loss of crestal bone, and is probably caused by bacterial pathogens and immunological reactions. Unfortunately, the literature is not consistent with respect to the type or magnitude of clinical implant problems, including how they are defined and diagnosed. If the peri-implantitis diagnosis is confined to cases with infection, suppuration and significant bone loss, the frequency of the disease is relatively low, which is in sharp contrast to the frequencies reported with unrealistic definitions of peri-implantitis. We suggest that when modern implants are placed by properly trained individuals, only 1–2% of implants show true peri-implantitis during follow-up periods of 10 years or more. Peri-implantitis must be separated from the initial and self-limiting marginal bone loss.

  • 11.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Dahlin, Christer
    Jemt, Torsten
    Sennerby, Lars
    Turri, Alberto
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Is Marginal Bone Loss around Oral Implants the Result of a Provoked Foreign Body Reaction?2014Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 16, nr 2, s. 155-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body. Purpose The aim of this paper is to suggest an alternative way of looking at the reason for marginal bone loss as a complication to treatment rather than a disease process. Materials and Methods The present paper is authored as a narrative review contribution. Results The implant-enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm-mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm-mediated infection may follow as a complication to the already established bone loss. Conclusions The present authors regard researchers seeing marginal bone loss as a periodontitis-like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis-balanced foreign body response.

  • 12.
    Albrektsson, Tomas
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces. Univ Gothenburg, Dept Biomat, Gothenburg, Sweden.
    Dahlin, Christer
    NU Hosp Org, Dept Oral & Maxillofacial Surg ENT, Trollhattan, Sweden; Univ Gothenburg, Dept Biomat, Gothenburg, Sweden.
    Reinedahl, David
    Univ Gothenburg, Dept Prosthodont, Gothenburg, Sweden.
    Tengvall, Pentti
    Univ Gothenburg, Dept Biomat, Gothenburg, Sweden.
    Trindade, Ricardo
    Univ Gothenburg, Dept Prosthodont, Gothenburg, Sweden.
    Wennerberg, Ann
    Univ Gothenburg, Dept Prosthodont, Gothenburg, Sweden.
    An Imbalance of the Immune System Instead of a Disease Behind Marginal Bone Loss Around Oral Implants: Position Paper2020Ingår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 35, nr 3, s. 495-502Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this paper is to present evidence that supports the notion that the primary reason behind marginal bone loss and implant failure is immune-based and that bacterial actions in the great majority of problematic cases are of a secondary nature. Materials and Methods: The paper is written as a narrative review. Results: Evidence is presented that commercially pure titanium is not biologically inert, but instead activates the innate immune system of the body. For its function, the clinical implant is dependent on an immune/inflammatory defense against bacteria. Biologic models such as ligature studies have incorrectly assumed that the primary response causing marginal bone loss is due to bacterial action. In reality, bacterial actions are secondary to an imbalance of the innate immune system caused by the combination of titanium implants and ligatures, ie, nonself. This immunologic imbalance may lead to marginal bone resorption even in the absence of bacteria. Conclusion: Marginal bone loss and imminent oral implant failure cannot be properly analyzed without a clear understanding of immunologically caused tissue responses.

  • 13.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Donos, N.
    Working group 1,
    Implant survival and complications: The Third EAO consensus conference 20122012Ingår i: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 23, nr s6, s. 63-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives The task of this working group was to analyze biological, technical and aesthetic complications of single crowns on implants and fixed dental prostheses with or without cantilevers on implants over 5 years or more. In addition, the group analyzed economic aspects on such implant treatment. Materials and methods A systematic search of the relevant literature was conducted and critically reviewed. Four manuscripts were presented to cover the topics. Results The consensus statements prepared by the group and later accepted at the plenary session as well as suggestions for future research are presented in this article. The four reviews by Jung et al., Pjetursson et al., Romeo & Storelli and Scheuber et al. are printed separately and present detailed analyses of the research topics.

  • 14.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Franke-Stenport, Victoria
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Healing response2008Ingår i: Osseointegration: On Continuing Synergies in Surgery, Prosthodontics, and Biomaterials, Quintessence Publishing Co, Inc , 2008, s. 51-57Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 15.
    Albrektsson, Tomas
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jemt, Torsten
    The Brånemark Clinic, Public Dental Health Service, Gothenburg, Sweden; Department of Prosthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Mölne, Johan
    Department of Pathology and Genetics, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Tengvall, Pentti
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wennerberg, Ann
    Department of Prosthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    On inflammation-immunological balance theory-A critical apprehension of disease concepts around implants: Mucositis and marginal bone loss may represent normal conditions and not necessarily a state of disease2019Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 21, nr 1, s. 183-189Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background Oral implants have displayed clinical survival results at the 95%-99% level for over 10 years of follow up. Nevertheless, some clinical researchers see implant disease as a most common phenomenon. Oral implants are regarded to display disease in the form of mucositis or peri-implantitis. One purpose of the present article is to investigate whether a state of disease is necessarily occurring when implants display soft tissue inflammation or partially lose their bony attachment. Another purpose of this article is to analyze the mode of defense for implants that are placed in a bacteria rich environment and to analyze when an obtained steady state between tissue and the foreign materials is disturbed. Materials and Methods The present article is authored as a narrative review contribution. Results Evidence is presented that further documents the fact that implants are but foreign bodies that elicit a foreign body response when placed in bone tissue. The foreign body response is characterized by a bony demarcation of implants in combination with a chronic inflammation in soft tissues. Oral implants survive in the bacteria-rich environments where they are placed due to a dual defense system in form of chronic inflammation coupled to immunological cellular actions. Clear evidence is presented that questions the automatic diagnostics of an oral implant disease based on the finding of so called mucositis that in many instances represents but a normal tissue response to foreign body implants instead of disease. Furthermore, neither is marginal bone loss around implants necessarily indicative of a disease; the challenge to the implant represented by bone resorption may be successfully counteracted by local defense mechanisms and a new tissue-implant steady state may evolve. Similar reactions including chronic inflammation occur in the interface of orthopedic implants that display similarly good long-term results as do oral implants, if mainly evaluated based on revision surgery in orthopedic cases. The most common mode of failure of orthopedic implants is aseptic loosening which has been found coupled to a reactivation of the inflammatory- immune system. Conclusions Implants survive in the body due to balanced defense reactions in form of chronic inflammation and activation of the innate immune system. Ten year results of oral and hip /knee implants are hence in the 90+ percentage region. Clinical problems may occur with bone resorption that in most cases is successfully counterbalanced by the defense/healing systems. However, in certain instances implant failure will ensue characterized by bacterial attacks and/or by reactivation of the immune system that now will act to remove the foreign bodies from the tissues.

  • 16.
    Albrektsson, Tomas
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Sennerby, Lars
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    State of the art of oral implants2008Ingår i: Periodontology 2000, ISSN 0906-6713, E-ISSN 1600-0757, Vol. 47, nr 1, s. 15-26Artikel, forskningsöversikt (Övrigt vetenskapligt)
    Abstract [en]

    Objectives: The aim of this prospective study was to evaluate the Nobel Direct® and Nobel Perfect® one-piece implants (OPIs) when used for immediate function. Material and methods: Forty-eight patients were provided with 115 OPIs for loading with a provisional crown or a bridge within 24 h and followed for at least 12 months with clinical and radiographic examinations. A group of 97 patients previously treated under identical conditions by the same team with 380 two-piece implants (TPIs) for immediate loading in the mandible and maxilla served as the reference group. Results: Six (5.2%) OPIs failed during the follow-up due to extensive bone loss. Five (1.3%) implants failed in the reference group. After 1 year, the mean marginal bone loss was 2.1 mm (SD 1.3) for OPIs and 0.8 mm (SD 1) for TPIs. 20% of OPIs showed more than 3 mm of bone loss compared with 0.6% for TPIs. When compensating for vertical placement depth, OPIs still showed a lower marginal bone level and thus more exposed threads than TPIs. Depending on the criteria used, the success rate for OPIs was 46.1% or 72.2% compared with 85% or 91.6% for TPIs. Conclusions: The Nobel Direct® and Nobel Perfect® OPIs show lower success rates and more bone resorption than TPIs after 1 year in function. Factors such as implant design, insertion depth, rough surface towards the mucosa, in situ preparation and immediate loading may have an influence on the clinical outcome.

  • 17.
    Albrektsson, Tomas
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Univ Gothenburg, Dept Biomat, Gothenburg, Sweden.
    Wennerberg, Ann
    Univ Gothenburg, Dept Prosthodont, Gothenburg, Sweden.
    On osseointegration in relation to implant surfaces2019Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 21, nr S1, s. 4-7Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background The understanding of mechanisms of osseointegration as well as applied knowledge about oral implant surfaces are of paramount importance for successful clinical results. Purpose The aim of the present article is to present an overview of osseointegration mechanisms and an introduction to surface innovations with relevance for osseointegration that will be published in the same supplement of Clinical Implant Dentistry and Related Research. Materials and Methods The present article is a narrative review of some osseointegration and implant surface-related details. Results and Conclusions Osseointegration has a changed definition since it is realized today that oral implants are but foreign bodies and that this fact explains osseointegration as a protection mechanism of the tissues. Given adequate stability, bone tissue is formed around titanium implants to shield them from the tissues. Oral implant surfaces may be characterized by microroughness and nanoroughness, by surface chemical composition and by physical and mechanical parameters. An isotropic, moderately rough implant surface such as seen on the TiUnite device has displayed improved clinical results compared to previously used minimally rough or rough surfaces. However, there is a lack of clinical evidence supporting any particular type of nanoroughness pattern that, at best, is documented with results from animal studies. It is possible, but as yet unproven, that clinical results may be supported by a certain chemical composition of the implant surface. The same can be said with respect to hydrophilicity of implant surfaces; positive animal data may suggest some promise, but there is a lack of clinical evidence that hydrophilic implants result in improved clinical outcome of more hydrophobic surfaces. With respect to mechanical properties, it seems obvious that those must be encompassing the loading of oral implants, but we need more research on the mechanically ideal implant surface from a clinical aspect.

  • 18.
    Aparicio, Carlos
    et al.
    ZAGA Ctr Barcelona, Dept Zygomat Implantol, Hepler Bone Clin, Roman Macaya 22-24, Barcelona 08022, Spain..
    Lopez-Piriz, Roberto
    Adv Oral Surg Inst ICOA, Madrid, Spain..
    Albrektsson, Tomas
    Malmö universitet, Odontologiska fakulteten (OD).
    ORIS Criteria of Success for the Zygoma-Related Rehabilitation: The (Revisited) Zygoma Success Code2020Ingår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 35, nr 2, s. 366-378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Zygomatic-related implant rehabilitation differs from traditional implant treatment in biomechanics, clinical procedures, outcomes, and eventual complications such as soft tissue incompetence or recession that may lead to recurrent sinus/soft tissue complications. The extreme maxillary atrophy that indicates the use of zygomatic implants prevents use of conventional criteria to describe implant success/failure. Currently, results and complications of zygomatic implants reported in the literature are inconsistent and lack a standardized systematic review. Moreover, protocols for the rehabilitation of the atrophic maxilla using zygomatic implants have been in continuous evolution. The current zygomatic approach is relatively new, especially if the head of the zygomatic implant is located in an extramaxillary area with interrupted alveolar bone around its perimeter. Specific criteria to describe success/survival of zygomatic implants are necessary, both to write and to read scientific literature related to zygomatic implant-based oral rehabilitations. The aim of this article was to review the criteria of success used for traditional and zygomatic implants and to propose a revisited Zygomatic Success Code describing specific criteria to score the outcome of a rehabilitation anchored on zygomatic implants. The ORIS acronym is used to name four specific criteria to systematically describe the outcome of zygomatic implant rehabilitation: offset measurement as evaluation of prosthetic positioning; rhino-sinus status report based on a comparison of presurgical and postsurgical cone beam computed tomography in addition to a clinical questionnaire; infection permanence as evaluation of soft tissue status; and stability report, accepting as success some mobility until dis-osseointegration signs appear. Based on these criteria, the assessment of five possible conditions when evaluating zygomatic implants is possible.

  • 19.
    Aparicio, Carlos
    et al.
    Hepler Bone Clinic-Barcelona, Zygoma ZAGA Center Barcelona, Barcelona, Spain.
    López-Piriz, Roberto
    Advance Oral Surgery Institute(ICOA)-Madrid, Zygoma ZAGA Center Madrid, Madrid, Spain.
    Albrektsson, Tomas
    Malmö universitet, Odontologiska fakulteten (OD). Department of Biomaterials, University of Gothenburg, Gothenburg, Sweden.
    Success Criteria in Zygomatic Implant Dentistry2020Ingår i: Zygomatic Implants: Optimization and Innovation / [ed] James Chow, Springer, 2020, s. 211-233Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    The extreme maxillary atrophy that indicates the use of zygomatic implants (ZI) is associated with resorptive changes in both alveolar and basal bone, and prevents direct placement of conventional endosseous implants. Therefore, using conventional criteria to describe implant success/failure is not sensible for ZI. Moreover, protocols for the rehabilitation of the atrophic maxilla using ZI have been continuously evolving to overcome initial shortcomings of early initial shortcomings of early techniques. The current zygomatic approach is relatively new, especially if the head of the ZI is located in an extra-maxillary buccal position to the alveolar crest with no alveolar bone around its perimeter. The zygomatic-related rehabilitation protocol differs from conventional implant therapy with respect to biomechanics, clinical procedures, outcomes, and eventual complications such as soft tissue incompetence or recession that may lead to recurrent sinus/soft tissue infections and aesthetic patient complaints. Currently, the way in which results and complications of ZI are reported in the scientific literature is inconsistent and lacks a standardized approach. Specific criteria to describe success/survival of ZI, including a standardized way to report on rhinosinus pathology associated with ZI, is necessary. The aim of this chapter is to critically review success criteria used for conventional and zygomatic implants. Finally, a revisited Zygomatic Success Code describing specific criteria to score the outcome of a rehabilitation anchored on ZI is proposed. The authors use the ORIS acronym to name four specific criteria to systematically describe the outcome of ZI rehabilitation:

    • Offset: evaluation of prosthetic success based on the final positioning of the zygomatic implant with respect to the middle of the alveolar crest in the horizontal dimension.
    • Rhinosinus status report: a pre, and postsurgical cone-beam computed tomography comparative approach to evaluating whether sinuses are healthy; a clinical questionnaire where “yes” and “no” answers can be given.
    • Infection permanence related to dehiscence: an evaluation of soft tissue signs of infection or dehiscence on a grading scale based on reference photographs.
    • Stability report: accepting as success some mobility until dis-osseointegration signs of rotation or apical pain present.
  • 20. Buser, Daniel
    et al.
    Chen, Stephen T.
    Cochran, David
    Debruyn, Hugo
    Jemt, Torsten
    Koka, Sreenivas
    Nevins, Myron
    Sennerby, Lars
    Simion, Massimo
    Taylor, Thomas D.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Statements from the Estepona Consensus Meeting on Peri-implantitis2012Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, nr 6, s. 781-782Artikel i tidskrift (Refereegranskat)
  • 21.
    Choi, Jung-Yoo
    et al.
    Dental Research Institute, Seoul National University, Seoul 03080, Korea.
    Albrektsson, Tomas
    Malmö universitet, Odontologiska fakulteten (OD). Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg.
    Jeon, Young-Jun
    Dental Research Institute, Seoul National University, Seoul 03080, Korea.
    Yeo, In-Sung Luke
    Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea.
    Osteogenic Cell Behavior on Titanium Surfaces in Hard Tissue2019Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 8, nr 5, artikel-id 604Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is challenging to remove dental implants once they have been inserted into the bone because it is hard to visualize the actual process of bone formation after implant installation, not to mention the cellular events that occur therein. During bone formation, contact osteogenesis occurs on roughened implant surfaces, while distance osteogenesis occurs on smooth implant surfaces. In the literature, there have been many in vitro model studies of bone formation on simulated dental implants using flattened titanium (Ti) discs; however, the purpose of this study was to identify the in vivo cell responses to the implant surfaces on actual, three-dimensional (3D) dental Ti implants and the surrounding bone in contact with such implants at the electron microscopic level using two different types of implant surfaces. In particular, the different parts of the implant structures were scrutinized. In this study, dental implants were installed in rabbit tibiae. The implants and bone were removed on day 10 and, subsequently, assessed using scanning electron microscopy (SEM), immunofluorescence microscopy (IF), transmission electron microscopy (TEM), focused ion-beam (FIB) system with Cs-corrected TEM (Cs-STEM), and confocal laser scanning microscopy (CLSM)which were used to determine the implant surface characteristics and to identify the cells according to the different structural parts of the turned and roughened implants. The cell attachment pattern was revealed according to the different structural components of each implant surface and bone. Different cell responses to the implant surfaces and the surrounding bone were attained at an electron microscopic level in an in vivo model. These results shed light on cell behavioral patterns that occur during bone regeneration and could be a guide in the use of electron microscopy for 3D dental implants in an in vivo model.

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  • 22.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Bisphosphonates and dental implants: A meta-analysis2016Ingår i: Quintessence International, ISSN 0033-6572, Vol. 47, nr 4, s. 329-342Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To test the null hypothesis of no difference in the implant failure rates, marginal bone loss, and postoperative infection for patients receiving or not receiving bisphosphonates, against the alternative hypothesis of a difference. METHOD AND MATERIALS: An electronic search was undertaken in October 2015 in PubMed/Medline, Web of Science, and Embase, plus hand-searching and databases of clinical trials. Eligibility criteria included clinical human studies, either randomized or not. RESULTS: A total of 18 publications were included in the review. Concerning implant failure, the meta-analysis found a risk ratio of 1.73 (95% confidence interval [CI] 1.21-2.48, P = .003) for patients taking bisphosphonates, when compared to patients not taking the medicament. The probability of an implant failure in patients taking bisphosphonates was estimated to be 1.5% (0.015, 95% CI 0.006- 0.023, standard error [SE] 0.004, P < .001). It cannot be suggested that bisphosphonates may affect the marginal bone loss of dental implants, due to a limited number of studies reporting this outcome. Due to a lack of sufficient information, meta-analysis for the outcome "postoperative infection" was not performed. CONCLUSION: The results of the present study cannot suggest that the insertion of dental implants in patients taking BPs affects the implant failure rates, due to a limited number of published studies, all characterized by a low level of specificity, and most of them dealing with a limited number of cases without a proper control group. Therefore, the real effect of BPs on the osseointegration and survival of dental implants is still not well established.

  • 23.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Albrektsson, Tomas
    Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Bone Quality and Quantity and Dental Implant Failure: A Systematic Review and Meta-analysis2017Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 30, nr 3, s. 219-237Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to test the null hypothesis that there is no difference in implant failure rates, marginal bone loss, and postoperative infection for implants inserted in bone with different qualities and quantities according to the classification of Lekholm and Zarb. Materials and Methods: An electronic search was undertaken in January 2015 for randomized and nonrandomized human clinical studies. Results: A total of 94 publications were included. When bone sites of different qualities were considered, the results suggested the following comparative implant failure rates: 1 > 2, 1 > 3, 3 > 2, 4 > 1, 4 > 2, and 4 > 3. Sensitivity analyses suggested that when implants inserted in bone qualities 1 and 2 and 1 and 3 were compared, oxidized and sandblasted/acid-etched surfaces showed a decrease in significant difference in failures compared with turned implants. The same is not true for failure of implants inserted in bone quality 4 compared to failure of implants in all other bone qualities. When bone sites of different quantities were considered, the following comparative implant failure rates were observed: A > B, A > C, A < D, B < C, B < D, C < D, E > A, E > B, E > C, E > D. Due to insufficient information, meta-analyses for the outcomes postoperative infection and marginal bone loss were not performed. Conclusion: Sites with poorer bone quality and lack of bone volume may statistically affect implant failure rates. Implant surfaces may play a role in failure of implants in different bone qualities.

  • 24.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Bruxism and dental implants: a meta-analysis2015Ingår i: Implant Dentistry, ISSN 1056-6163, E-ISSN 1538-2982, Vol. 24, nr 5, s. 505-516Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss after the insertion of dental implants in bruxers compared with the insertion in non-bruxers against the alternative hypothesis of a difference. METHODS: An electronic search was undertaken in June 2014. Eligibility criteria included clinical studies, either randomized or not. RESULTS: Ten publications were included with a total of 760 implants inserted in bruxers (49 failures; 6.45%) and 2989 in non-bruxers (109 failures; 3.65%). Due to lack of information, meta-analyses for the outcomes "postoperative infection" and "marginal bone loss" were not possible. A risk ratio of 2.93 was found (95% confidence interval, 1.48-5.81; P = 0.002). CONCLUSIONS: These results cannot suggest that the insertion of dental implants in bruxers affects the implant failure rates due to a limited number of published studies, all characterized by a low level of specificity, and most of them deal with a limited number of cases without a control group. Therefore, the real effect of bruxing habits on the osseointegration and survival of endosteal dental implants is still not well established.

  • 25.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental implants in irradiated versus non-irradiated patients: a meta-analysis2016Ingår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 38, nr 3, s. 448-481Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background/Methods. The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus non-irradiated patients, against the alternative hypothesis of a difference. Results/Conclusion. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs. mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed a tendency to lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies.

  • 26.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental Implants in Patients Receiving Chemotherapy: A Meta-Analysis2016Ingår i: Implant Dentistry, ISSN 1056-6163, E-ISSN 1538-2982, Vol. 25, nr 2, s. 261-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being versus not being submitted to chemotherapy, against the alternative hypothesis of a difference. Methods: An electronic search without time or language restrictions was undertaken in May 2014 in PubMed/MEDLINE, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. Eligibility criteria included clinical human studies, either randomized or not. Results: Nine publications were included. The results suggested that the insertion of dental implants in patients submitted or not submitted to chemotherapy did not affect the implant failure rates (risk ratio 1.02, 95% confidence interval 0.56-1.85; P = 0.95). Because of lack of enough information, meta-analyses for the outcomes "postoperative infection" and "marginal bone loss" were not performed. Conclusion: These results cannot suggest that the insertion of dental implants in patients submitted to chemotherapy may or may not affect the implant failure rates, because of a limited number of published studies, most of them characterized by a low level of specificity and dealing with a limited number of cases without a control group. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study.

  • 27.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental implants inserted in fresh extraction sockets versus healed sites: a systematic review and meta-analysis2015Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, nr 1, s. 16-41Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection and marginal bone loss for the insertion of dental implants in fresh extraction sockets compared to the insertion in healed sites, against the alternative hypothesis of a difference. METHODS: An electronic search was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomized or not. RESULTS: The search strategy resulted in 73 publications, with 8241 implants inserted in sockets (330 failures, 4.00%), and 19,410 in healed sites (599 failures, 3.09%). The difference between the procedures significantly affected the failure rates (RR 1.58, 95% CI 1.27-1.95, P<0.0001). The difference was not statistically significant when studies evaluating implants inserted in maxillae or in mandibles were pooled, or when the studies using implants to rehabilitate patients with full-arch prostheses were pooled; however, it was significant for the studies that rehabilitated patients with implant-supported single crowns and for the controlled studies. There was no apparent significant effect of implants inserted in fresh extraction sockets on the occurrence of postoperative infection or on the magnitude of marginal bone loss. CONCLUSION: It is suggested that the insertion of implants in fresh extraction sockets affects the failure rates. However, it does not affect the marginal bone loss or the occurrence of postoperative infection. The results should be interpreted with caution due to the potential for biases and to the presence of uncontrolled confounding factors in the included studies, most of them not randomized. CLINICAL SIGNIFICANCE: The question whether immediate implants are more at risk for failure than implants placed in mature bone has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 28.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental implants inserted in male versus female patients: a systematic review and meta-analysis2015Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 42, nr 9, s. 709-722Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The aim of this meta-analysis was to test the null hypothesis of no difference in the failure rates, marginal bone loss (MBL) and post-operative infection for implants inserted in male or female patients, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in December 2014. Eligibility criteria included clinical human studies, either randomized or not. Ninety-one publications were included, with a total of 27,203 implants inserted in men (1185 failures), and 25,154 implants inserted in women (1039 failures). The results suggest that the insertion of dental implants in male patients statistically affected the implant failure rates (RR 1.21, 95% CI 1.07-1.37, P = 0.002). Due to the limited number of studies reporting results on MBL, it is difficult to estimate the real effect of the insertion of implants in different sexes on the marginal bone level. Due to lack of satisfactory information, meta-analysis for the outcome 'post-operative infection' was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

  • 29.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Diabetes and oral implant failure: a systematic review2014Ingår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 93, nr 9, s. 859-867Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The aim of this systematic review and meta-analysis was to investigate whether there are any effects of diabetes mellitus on implant failure rates, postoperative infections, and marginal bone loss. An electronic search without time or language restrictions was undertaken in March 2014. The present review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included clinical human studies. The search strategy resulted in 14 publications. The I (2) statistic was used to express the percentage of total variation across studies due to heterogeneity. The inverse variance method was used for the random effects model when heterogeneity was detected or for the fixed effects model when heterogeneity was not detected. The estimates of an intervention for dichotomous outcomes were expressed in risk ratio and in mean difference in millimeters for continuous outcomes, both with a 95% confidence interval. There was a statistically significant difference (p = .001; mean difference = 0.20, 95% confidence interval = 0.08, 0.31) between diabetic and non-diabetic patients concerning marginal bone loss, favoring non-diabetic patients. A meta-analysis was not possible for postoperative infections. The difference between the patients (diabetic vs. non-diabetic) did not significantly affect implant failure rates (p = .65), with a risk ratio of 1.07 (95% confidence interval = 0.80, 1.44). Studies are lacking that include both patient types, with larger sample sizes, and that report the outcome data separately for each group. The results of the present meta-analysis should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.

  • 30.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Flapless versus conventional flapped dental implant surgery: a meta-analysis2014Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 9, nr 6, artikel-id e100624Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 23 publications. The I2 statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for random-effects model or fixed-effects model, when indicated. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. Sixteen studies were judged to be at high risk of bias, whereas two studies were considered of moderate risk of bias, and five studies of low risk of bias. The funnel plots indicated absence of publication bias for the three outcomes analyzed. The test for overall effect showed that the difference between the procedures (flapless vs. open flap surgery) significantly affect the implant failure rates (P = 0.03), with a RR of 1.75 (95% CI 1.07-2.86). However, a sensitivity analysis revealed differences when studies of high and low risk of bias were pooled separately. Thus, the results must be interpreted carefully. No apparent significant effects of flapless technique on the occurrence of postoperative infection (P = 0.96; RR 0.96, 95% CI 0.23-4.03) or on the marginal bone loss (P = 0.16; MD -0.07 mm, 95% CI -0.16-0.03) were observed.

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    FULLTEXT01
  • 31.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Immediate nonfunctional versus immediate functional loading and dental implant failure rates: a systematic review and meta-analysis2014Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 42, nr 9, s. 1052-1059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated using dental implants with immediate nonfunctional loading (INFL) compared to immediate functional loading (IFL), against the alternative hypothesis of a difference. METHODS: An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. RESULTS: 1059 studies were identified and 11 studies were included, of which 7 were of high risk of bias, whereas four studies were of low risk of bias. The results showed that the procedure used (nonfunctional vs. functional) did not significantly affect the implant failure rates (P=0.70), with a RR of 0.87 (95% CI 0.44-1.75). The wide CI demonstrates uncertainty about the effect size. The analysis of postoperative infection was not possible due to lack of data. No apparent significant effects of non-occlusal loading on the marginal bone loss (MD 0.01mm, 95% CI -0.04-0.06; P=0.74) were observed. CONCLUSIONS: The results of this study suggest that the differences in occlusal loading between INFL and IFL might not affect the survival of these dental implants and that there is no apparent significant effect on the marginal bone loss. CLINICAL SIGNIFICANCE: There has been a controversy concerning whether dental implants should be subjected to immediate functional or nonfunctional loading. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 32.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Immediately loaded non-submerged versus delayed loaded submerged dental implants: a meta-analysis2015Ingår i: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 44, nr 4, s. 493-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the present meta-analysis was to test the null hypothesis of no difference in the implant failure rate, postoperative infection, and marginal bone loss for patients being rehabilitated with immediately loaded non-submerged dental implants or delayed loaded submerged implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 28 publications. The inverse variance method was used for a random- or fixed-effects model, depending on the heterogeneity. The estimates of an intervention were expressed as the risk ratio (RR) and mean difference (MD) in millimetres. Twenty-three studies were judged to be at high risk of bias, one at moderate risk of bias, and four studies were considered at low risk of bias. The difference between procedures (submerged vs. non-submerged implants) significantly affected the implant failure rate (P = 0.02), with a RR of 1.78 (95% confidence interval (CI) 1.12-2.83). There was no apparent significant effect of non-submerged dental implants on the occurrence of postoperative infection (P = 0.29; RR 2.13, CI 0.52-8.65) or on marginal bone loss (P = 0.77; MD -0.03, 95% CI -0.23 to 0.17).

  • 33.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Periodontally compromised vs. periodontally healthy patients and dental implants: a systematic review and meta-analysis2014Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 42, nr 12, s. 1509-1527Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for the insertion of dental implants in periodontally compromised patients (PCPs) compared to the insertion in periodontally healthy patients (PHPs), against the alternative hypothesis of a difference. METHODS: An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. RESULTS: 2768 studies were identified in the search strategy and 22 studies were included. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimetres. All studies were judged to be at high risk of bias, none were randomized. A total of 10,927 dental implants were inserted in PCPs (587 failures; 5.37%), and 5881 implants in PHPs (226 failures; 3.84%). The difference between the patients significantly affected the implant failure rates (RR 1.78, 95% CI 1.50-2.11; P<0.00001), also observed when only the controlled clinical trials were pooled (RR 1.97, 95% CI 1.38-2.80; P=0.0002). There were significant effects of dental implants inserted in PCPs on the occurrence of postoperative infections (RR 3.24, 95% CI 1.69-6.21; P=0.0004) and in marginal bone loss (MD 0.60, 95% CI 0.33-0.87; P<0.0001) when compared to PHPs. CONCLUSIONS: The present study suggests that an increased susceptibility for periodontitis may also translate to an increased susceptibility for implant loss, loss of supporting bone, and postoperative infection. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, none of them randomized. CLINICAL SIGNIFICANCE: There is some evidence that patients treated for periodontitis may experience more implant loss and complications around implants including higher bone loss and peri-implantitis than non-periodontitis patients. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 34.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Platform switch and dental implants: a meta-analysis2015Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, nr 6, s. 629-646Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL) and postoperative infection in patients who received platform-switched implants or platform-matched implants, against the alternative hypothesis of a difference. DATA: Main search terms used in combination: dental implant, oral implant, platform switch, switched platform, platform mismatch, and dental implant-abutment design. SOURCES: An electronic search without time or language restrictions was undertaken in December/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. STUDY SELECTION: Eligibility criteria included clinical human studies, either randomized or not. CONCLUSIONS: Twenty-eight publications were included, with a total of 1216 platform-switched implants (16 failures; 1.32%) and 1157 platform-matched implants (13 failures; 1.12%). There was less MBL loss at implants with platform-switching than at implants with platform-matching (mean difference -0.29, 95% CI -0.38 to -0.19; P<0.00001). An increase of the mean difference of MBL between the procedures was observed with the increase in the follow-up time (P=0.001) and with the increase of the mismatch between the implant platform and the abutment (P=0.001). Due to lack of satisfactory information, meta-analyses for the outcomes 'implant failure' and 'postoperative infection' were not performed. The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them with short follow-up periods. CLINICAL SIGNIFICANCE: The question whether platform-matched implants are more at risk for failure and loose more marginal bone than platform-switched implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures, forming a basis for optimum treatment.

  • 35.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Prophylactic antibiotic regimen and dental implant failure: a meta-analysis2014Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 41, nr 12, s. 941-956Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this meta-analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post-operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I(2) statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed- or random-effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non-use of antibiotics) significantly affected the implant failure rates (P = 0·0002), with a RR of 0·55 (95% CI 0·41-0·75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33-100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post-operative infections in healthy patients receiving implants (P = 0·520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

  • 36.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Reasons for failures of oral implants2014Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 41, nr 6, s. 443-476Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.

  • 37.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Smoking and dental implants: a systematic review and meta-analysis2015Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, nr 5, s. 487-498Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus non-smokers, against the alternative hypothesis of a difference. DATA: Main search terms used in combination: dental implant, oral implant, smoking, tobacco, nicotine, smoker, and non-smoker. SOURCES: An electronic search was undertaken in September/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. STUDY SELECTION: Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 1432 publications, of which 107 were eligible, with 19,836 implants placed in smokers, with 1259 failures (6.35%), and 60,464 implants placed in non-smokers, with 1923 failures (3.18%). CONCLUSIONS: The insertion of implants in smokers significantly affected the failure rates, the risk of postoperative infections as well as the marginal bone loss. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies. CLINICAL SIGNIFICANCE: Smoking is a factor that has the potential to negatively affect healing and the outcome of implant treatment. It is important to perform an updated periodic review to synthesize the clinical research evidence relevant to the matter.

  • 38.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces. Department of Biomaterials, Göteborg University, Göteborg.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Survival and complications of zygomatic implants: an updated systematic review2016Ingår i: Journal of oral and maxillofacial surgery (Print), ISSN 0278-2391, E-ISSN 1531-5053, Vol. 74, nr 10, s. 1949-1964Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Purpose. To assess the survival rate of zygomatic implants (ZIs) and the prevalence of complications based on previously published studies. Methods. An electronic search was performed in December/2015 in three databases and was supplemented by hand-searching. Clinical series of ZIs were included. Interval survival rate (ISR) and cumulative survival rate (CSR) were calculated. The untransformed proportion of complications (sinusitis, soft tissue infection, paresthesia, oroantral fistulas) was calculated, considering the prevalence reported in the studies. Results. Sixty-eight studies were included, comprising 4556 ZIs in 2161 patients, with 103 failures. The 12-year CSR was 95.21%. Most failures were detected within the six-month postsurgical period. Studies (n=26) that exclusively evaluated immediate loading showed a statistically lower ZI failure rate than studies (n=34) evaluating delayed loading protocols (P=0.003). Studies (n=5) evaluating ZIs for the rehabilitation of patients after maxillary resections presented lower survival rates. The probability of presenting postoperative complications with ZIs was as follows: sinusitis 2.4% (95%CI 1.8-3.0), soft tissue infection 2.0% (95%CI 1.2-2.8), paresthesia 1.0% (95%CI 0.5-1.4), oroantral fistulas 0.4% (95%CI 0.1-0.6). However, these numbers may be underestimated, as many studies failed to mention the prevalence of these complications. Conclusion. ZIs present a high 12-year CSR, with most failures occurring at the early stages postoperatively. The main observed complication related to ZIs was sinusitis, which may appear several years after ZI installation surgery.

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  • 39.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD).
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Tilted versus axially placed dental implants: a meta-analysis2015Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, nr 2, s. 149-170Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rate, marginal bone loss, and postoperative infection for patients being rehabilitated by tilted or by axially placed dental implants, against the alternative hypothesis of a difference. METHODS: An electronic search without time or language restrictions was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational. The estimates of an intervention were expressed in risk ratio (RR) and mean difference (MD) in millimetres. RESULTS: The search strategy resulted in 44 publications. A total of 5029 dental implants were tilted (82 failures; 1.63%), and 5732 implants were axially placed (104 failures; 1.81%). The difference between the procedures did not significantly affect the implant failure rates (P=0.40), with a RR of 1.14 (95% CI 0.84-1.56). A statistically significant difference was found for implant failures when studies evaluating implants inserted in maxillae only were pooled (RR 1.70, 95% CI 1.05-2.74; P=0.03), the same not happening for the mandible (RR 0.77, 95% CI 0.39-1.52; P=0.45). There were no apparent significant effects of tilted dental implants on the occurrence of marginal bone loss (MD 0.03, 95% CI -0.03 to 0.08; P=0.32). Due to lack of satisfactory information, meta-analysis for the outcome 'postoperative infection' was not performed. CONCLUSIONS: It is suggested that the differences in angulation of dental implants might not affect the implant survival or the marginal bone loss. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study. CLINICAL SIGNIFICANCE: The question whether tilted implants are more at risk for failure than axially placed implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.

  • 40.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces. Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Turned versus anodised dental implants: a meta-analysis2016Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, nr 9, s. 716-728Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this meta-analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post-operative infection for patients being rehabilitated by turned versus anodised-surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty-eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95–4·06, P < 0·00001) for failure of turned implants, when compared to anodised-surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference-MD 0·02, 95%CI −0·16–0·20; P = 0·82) in comparison to anodised implants. The results of a meta-regression considering the follow-up period as a covariate suggested an increase of the MD with the increase in the follow-up time (MD increase 0·012 mm year−1), however, without a statistical significance (P = 0·813). Due to lack of satisfactory information, meta-analysis for the outcome ‘post-operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

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  • 41.
    Chrcanovic, Bruno
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces.
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces. Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Department of Prosthodontics, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    A retrospective study on clinical and radiological outcomes of oral implants in patients followed up for a minimum of 20 years2018Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 20, nr 2, s. 199-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Very long-term follow-up of oral implants is seldom reported in the literature. Purpose: To assess oral implant failure rates and marginal bone loss (MBL) of patients followed up for a minimum of 20 years. Materials and Methods: Implants placed in patients followed up for 20+ years were included. Descriptive statistics, survival analyses, generalized estimating equations were performed. Three-hundred implants were randomly selected for MBL. Results: 1,045 implants (227 patients) were included. Implant location, irradiation, and bruxism affected the implant survival rate. Thirty-five percent of the failures occurred within the first year after implantation, and another 26.8% in the second/third year. There was a cumulative survival rate of 87.8% after 36 years of follow-up. In the last radiological follow up, 35 implants (11.7%) had bone gain, and 35 implants (11.7%) presented at least 3 mm of MBL. Twenty-six out of 86 failed implants with available radiograms presented severe MBL in the last radiological register before implant failure. Conclusions: Most of the implant failures occurred at the first few years after implantation, regardless of a very long follow up. MBL can be insignificant in long-term observations, but it may, nevertheless, be the cause of secondary failure of oral implants in some cases.

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  • 42.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces. Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Analysis of risk factors for cluster behavior of dental implant failures2017Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 19, nr 4, s. 632-642Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Some studies indicated that implant failures are commonly concentrated in few patients. Purpose: To identify and analyze cluster behavior of dental implant failures among subjects of a retrospective study. Materials and Methods: This retrospective study included patients receiving at least three implants only. Patients presenting at least three implant failures were classified as presenting a cluster behavior. Univariate and multivariate logistic regression models and generalized estimating equations analysis evaluated the effect of explanatory variables on the cluster behavior. Results: There were 1406 patients with three or more implants (8337 implants, 592 failures). Sixty-seven (4.77%) patients presented cluster behavior, with 56.8% of all implant failures. The intake of antidepressants and bruxism were identified as potential negative factors exerting a statistically significant influence on a cluster behavior at the patient-level. The negative factors at the implant-level were turned implants, short implants, poor bone quality, age of the patient, the intake of medicaments to reduce the acid gastric production, smoking, and bruxism. Conclusions: A cluster pattern among patients with implant failure is highly probable. Factors of interest as predictors for implant failures could be a number of systemic and local factors, although a direct causal relationship cannot be ascertained.

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  • 43.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Bruxism and dental implant failures: a multilevel mixed effects parametric survival analysis approach2016Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 43, nr 11, s. 813-823Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recent studies have suggested that the insertion of dental implants in patients being diagnosed with bruxism negatively affected the implant failure rates. The aim of the present study was to investigate the association between the bruxism and the risk of dental implant failure. This retrospective study is based on 2670 patients who received 10 096 implants at one specialist clinic. Implant- and patient-related data were collected. Descriptive statistics were used to describe the patients and implants. Multilevel mixed effects parametric survival analysis was used to test the association between bruxism and risk of implant failure adjusting for several potential confounders. Criteria from a recent international consensus (Lobbezoo et al., J Oral Rehabil, 40, 2013, 2) and from the International Classification of Sleep Disorders (International classification of sleep disorders, revised: diagnostic and coding manual, American Academy of Sleep Medicine, Chicago, 2014) were used to define and diagnose the condition. The number of implants with information available for all variables totalled 3549, placed in 994 patients, with 179 implants reported as failures. The implant failure rates were 13·0% (24/185) for bruxers and 4·6% (155/3364) for non-bruxers (P < 0·001). The statistical model showed that bruxism was a statistically significantly risk factor to implant failure (HR 3·396; 95% CI 1·314, 8·777; P = 0·012), as well as implant length, implant diameter, implant surface, bone quantity D in relation to quantity A, bone quality 4 in relation to quality 1 (Lekholm and Zarb classification), smoking and the intake of proton pump inhibitors. It is suggested that the bruxism may be associated with an increased risk of dental implant failure.

  • 44.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Bruxism and dental implant treatment complications: a retrospective comparative study of 98 bruxer patients and a matched group2017Ingår i: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 28, nr 7, s. e1-e9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives. To analyze the complications of dental implant treatment in a group of patients with bruxism in comparison with a matched group of non-bruxers. Material and methods. Patients being diagnosed as bruxers were identified within a group of patients consecutively treated with implant-supported prostheses at one specialist clinic, based on the most recent listed sign and symptoms of bruxism according to the International Classification of Sleep Disorders. A diagnostic grading system of “possible,” “probable,” and “definite” sleep or awake bruxism was used, according to a recent published international consensus. A case–control matching model was used to match the bruxers with a group of non-bruxers, based on five variables. Implant-, prosthetic-, and patient-related data were collected, as well as 14 mechanical complications, and compared between groups. Results. Ninety-eight of 2670 patients were identified as bruxers. The odds ratio of implant failure in bruxers in relation to non-bruxers was 2.71 (95% CI 1.25, 5.88). Considering the same number of patients with the same total number of implants equally distributed between groups, the bruxers group had a higher prevalence of mechanical complications in comparison with the non-bruxers group. Conclusions. This study suggests that bruxism may significantly increase both the implant failure rate and the rate of mechanical and technical complications of implant-supported restorations. Other risk factors may also have influenced the results.

  • 45.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Factors Influencing Early Dental Implant Failures2016Ingår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, nr 9, s. 995-1002Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the present study was to assess the influence of local and systemic factors on the occurrence of dental implant failures up to the second-stage surgery (abutment connection). This retrospective study is based on 2,670 patients who received 10,096 implants and were consecutively treated with implant-supported prostheses between 1980 and 2014 at 1 specialist clinic. Several anatomic-, patient-, health-, and implant-related factors were collected. Descriptive statistics were used to describe the patients and implants. Univariate and multivariate logistic regression models were used at the patient level as well as the implant level to evaluate the effect of explanatory variables on the failure of implants up to abutment connection. A generalized estimating equation method was used for the implant-level analysis to account for the fact that repeated observations (several implants) were available for a single patient. Overall, 642 implants (6.36%) failed, of which 176 (1.74%) in 139 patients were lost up to second-stage surgery. The distribution of implants in sites of different bone quantities and qualities was quite similar between implants lost up to and after abutment connection. Smoking and the intake of antidepressants were the statistically significant predictors in the multivariate model (ClinicalTrials.gov NCT02369562).

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  • 46.
    Chrcanovic, Bruno
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces.
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces. Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Department of Prosthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
    Factors influencing the fracture of dental implants2018Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 20, nr 1, s. 58-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Implant fractures are rare but offer a challenging clinical situation. Purpose: To determine the prevalence of implant fracture and the possible risk factors predisposing an implant to a higher fracture risk. Materials and Methods: This retrospective study is based on 2670 patients consecutively treated with implant-supported prostheses. Anatomical-, patient-, and implant-related factors were collected. Descriptive statistics and survival analyses were performed. Generalized estimating equations (GEE) evaluated the effect of explanatory variables on implant fracture. Results: Forty-four implants (out of 10 099; 0.44%) fractured. The mean ± standard deviation time for fracture to occur was 95.1 ± 58.5 months (min-max, 3.8-294.7). Half of the occurrences of fracture happened between 2 and 8 years after implantation. Five factors had a statistically significant influence on the fracture of implants (increase/decrease in fracture probability): use of higher grades of titanium (decrease 72.9%), bruxism (increase 1819.5%), direct adjacency to cantilever (increase 247.6%), every 1 mm increase in implant length (increase 22.3%), every 1 mm increase in implant diameter (decrease 96.9%). Conclusions: It is suggested that 5 factors could influence the incidence of implant fractures: grade of titanium, implant diameter and length, cantilever, bruxism.

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  • 47.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Impact of Different Surgeons on Dental Implant Failure2017Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 30, nr 5, s. 445-454Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To assess the influence of several factors on the prevalence of dental implant failure, with special consideration of the placement of implants by different dental surgeons. Materials and Methods: This retrospective study is based on 2,670 patients who received 10,096 implants at one specialist clinic. Only the data of patients and implants treated by surgeons who had inserted a minimum of 200 implants at the clinic were included. Kaplan-Meier curves were stratified with respect to the individual surgeon. A generalized estimating equation (GEE) method was used to account for the fact that repeated observations (several implants) were placed in a single patient. The factors bone quantity, bone quality, implant location, implant surface, and implant system were analyzed with descriptive statistics separately for each individual surgeon. Results: A total of 10 surgeons were eligible. The differences between the survival curves of each individual were statistically significant. The multivariate GEE model showed the following variables to be statistically significant: surgeon, bruxism, intake of antidepressants, location, implant length, and implant system. The surgeon with the highest absolute number of failures was also the one who inserted the most implants in sites of poor bone and used turned implants in most cases, whereas the surgeon with the lowest absolute number of failures used mainly modern implants. Separate survival analyses of turned and modern implants stratified for the individual surgeon showed statistically significant differences in cumulative survival. Conclusion: Different levels of failure incidence could be observed between the surgeons, occasionally reaching significant levels. Although a direct causal relationship could not be ascertained, the results of the present study suggest that the surgeons’ technique, skills, and/or judgment may negatively influence implant survival rates.

  • 48.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Göteborg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Intake of Proton Pump Inhibitors Is Associated with an Increased Risk of Dental Implant Failure2017Ingår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 32, nr 5, s. 1097-1102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To investigate the association between the intake of proton pump inhibitors (PPIs) and the risk of dental implant failure. Materials and Methods: The present retrospective cohort study is based on patients consecutively treated between 1980 and 2014 with implant-supported/retained prostheses at one specialist clinic. Modern endosseous dental implants with cylindrical or conical design were included, and only complete cases were considered; ie, only those implants with information available for all variables measured were included in the regression model analysis. Zygomatic implants and implants detected in radiographies but without basic information about them in the patients’ files were excluded from the study. Implant- and patient-related data were collected. Multilevel mixed-effects parametric survival analysis was used to test the association between PPI exposure (predictor variable) and risk of implant failure (outcome variable), adjusting for several potential confounders. Results: A total of 3,559 implants were placed in 999 patients, with 178 implants reported as failures. The implant failure rates were 12.0% (30/250) for PPI users and 4.5% (148/3,309) for nonusers. A total of 45 out of 178 (25.3%) failed implants were lost up to abutment connection (6 in PPI users, 39 in nonusers), with an early-to-late failure ratio of 0.34:1. The intake of PPIs was shown to have a statistically significant negative effect for implant survival rate (HR 2.811; 95% CI: 1.139 to 6.937; P = .025). Bruxism, smoking, implant length, prophylactic antibiotic regimen, and implant location were also identified as factors with a statistically significant effect on the implant survival rate. Conclusion: This study suggests that the intake of PPIs may be associated with an increased risk of dental implant failure.

  • 49.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces. Department of Biomaterials, Gothenburg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Is the intake of selective serotonin reuptake inhibitors associated with an increased risk of dental implant failure?2017Ingår i: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 46, nr 6, s. 782-788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this retrospective study was to investigate the association between the intake of selective serotonin reuptake inhibitors (SSRIs) and the risk of dental implant failure. Patients were included if they were taking SSRIs only and no other medication, did not present any other systemic condition or compromising habits (bruxism, smoking, snuff), and complied with the use of prophylactic antibiotics for implant surgery. The multivariate generalized estimating equation (GEE) method and multilevel mixed-effects parametric survival analysis were used to test the association between SSRI exposure (predictor variable) and the risk of implant failure (outcome variable), adjusting for several potential confounders (other variables). The total number of implants with information available and meeting the necessary eligibility criteria was 931 (35 failures). These were placed in 300 patients. The implant failure rate was 12.5% for SSRI users and 3.3% for non-users (P = 0.007). Kaplan–Meier analysis showed a statistically significant difference in the cumulative survival rate (P < 0.001). The multivariate GEE model did not show a statistically significant association between SSRI intake and implant failure (P = 0.530), nor did the multilevel model (P = 0.125). It is suggested that the intake of SSRIs may not be associated with an increased risk of dental implant failure.

  • 50.
    Chrcanovic, Bruno
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kisch, Jenö
    Clinic for Prosthodontics, Centre of Dental Specialist Care, Malmö, Sweden.
    Albrektsson, Tomas
    Malmö högskola, Odontologiska fakulteten (OD). Department of Biomaterials, Gothenburg University, Göteborg, Sweden.
    Wennerberg, Ann
    Malmö högskola, Odontologiska fakulteten (OD).
    Response to the Letter to the Editor: “Factors Influencing Early Dental Implant Failures”2016Ingår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 96, nr 1Artikel i tidskrift (Övrigt vetenskapligt)
12 1 - 50 av 93
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