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On the Clinical Outcome of Different Single Implant Treatment Modalities
Malmö universitet, Odontologiska fakulteten (OD).ORCID-id: 0000-0001-6186-4804
2020 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Today there are several treatment techniques available to replace a missing tooth. Since the beginning of the 1990s, it has become increasingly common to treat individual tooth loss with dental implants. Important patient factors are survival, success, functionality, aesthetics, oral health and quality of life.

The range of indications and possibilities for implant treatment has broadened compared to the originally proposed treatment indications. A variety of methods, components and materials are available today. Improvements of the implant surface have led to shorter healing periods, which has affected the overall treatment time. Methods for computer-assisted implant planning and surgical guides have been developed to improve treatment planning. Several techniques are involved in the manufacturing of implant-supported single crowns, from the traditional plaster models, wax, casting and porcelain veneering to 3D scanning, computer aided design and manufacturing. It is important that all these treatment modalities are evaluated in a systematic and scientific way to ensure that the treatment given is the best one possible according to the individual conditions that exist.

The general aim of this project was to evaluate the treatment outcome between different treatment modalities for single dental implants. Study I aims to retrospectively evaluate implant survival. Patient reported outcome measures, marginal bone loss (MBL), clinical and esthetic outcomes following conventional single implant treatment. The aim of study II, a prospective randomized clinical study, was to compare the overall treatment outcome following immediate loading (IL) and delayed loading (DL) of single implants. In study III the aim was to in a vitro setting evaluate the deviation in final dental implant position after the use of surgical guides fabricated from two different desktop 3D printers using a digital workflow. For study IV the aim was to, in a non-randomized study, compare clinical and aesthetic outcomes between immediately loaded single implants placed with and without a fully guided-surgery procedure (DIL). In study I a total of 85 implants were examined after a mean follow-up time of 7.51 years. The 5-year implant survival rate was98.4% (95% CI: 96.3% - 100%), with a crown survival rate of91.8% (95% CI: 86.3%-97.3%). Overall mean MBL was -0.13 mm. Final and initial total Pink esthetic score (PES) were 9.61 and 11.49 (P<.001) Mean White esthetic score (WES) was 6.48 at final follow-up. Visual analog scale (VAS) score for soft tissue and implant-supported crown aesthetics were 73.5 and 82.1 (maximum score 100). A oral health impact profile-14 (OHIP-14) 14 score of 16.11 was observed at the final follow-up. Study II and IV found implant survival rates of 100%, 96% and 90.5 % for IL, DL and DIL, respectively, after 1-year. No statistically significant differences were found for MBL, PES, WES and OHIP-14after 1-year. Statistically significant lower papilla index scores were found for the IL. Overall statistically significant improvement inPES, WES and OHIP-14 were found over time. In the DIL group a moderate correlation between aesthetics and deviation in fixture position was found. For Study III a statistically significant difference between stereolithography and direct light processing (DLP) was found fordeviation at entry point (P = .023) and the vertical implant position(P = .009). Overall lower deviations were found for the guides from the DLP printer, with the exception of deviation in horizontal implant position.The results from these studies suggest that good clinical results can be achieved with different treatment modalities for single implants. Positive advantages with immediate loading and guided surgery is primarily seen in the early faces of the treatment procedure only. Care needs to be exerted with technically complicated treatment procedures as the effect on implant survival should not be underestimated. Further studies have to be performed to evaluate guided surgery and immediate loading to identify possible factors effecting survival.

Ort, förlag, år, upplaga, sidor
Malmö: Malmö universitet, 2020. , s. 122
Kanal
978-91-7877-088-5
Serie
Doctoral Dissertation in Odontology
Nationell ämneskategori
Odontologi
Identifikatorer
URN: urn:nbn:se:mau:diva-18188DOI: 10.24834/isbn.9789178770892ISBN: 978-91-7877-088-5 (tryckt)ISBN: 978-91-7877-089-2 (digital)OAI: oai:DiVA.org:mau-18188DiVA, id: diva2:1464489
Disputation
2020-09-18, D131, Nordenskiöldsg. 10, Malmö, 09:15
Opponent
Tillgänglig från: 2020-09-07 Skapad: 2020-09-07 Senast uppdaterad: 2022-06-27Bibliografiskt granskad
Delarbeten
1. Esthetic and Patient-Centered Outcomes of Single Implants: A Retrospective Study
Öppna denna publikation i ny flik eller fönster >>Esthetic and Patient-Centered Outcomes of Single Implants: A Retrospective Study
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2017 (Engelska)Ingår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 32, nr 5, s. 1065-1073Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: The aims of this clinical study were to retrospectively evaluate implant survival, patient satisfaction, and radiographic, clinical, and esthetic outcomes following single-implant treatment. Materials and Methods: Eighty-seven patients, with a total of 126 implants (XiVE S, Dentsply Implants), who received single implant-retained crowns between 2004 and 2011 were retrospectively evaluated. Implant survival, marginal bone levels (MBL), changes in implant/mesial tooth vertical relationship, pink esthetic score (PES), white esthetic score (WES), patient assessment of the esthetics (visual analog scale), and oral health impact profile (OHIP-14) were evaluated. Results: Altogether, 59 patients with a total of 85 implants attended a final clinical and radiographic follow-up examination. The mean ages of males and females at implant placement were 19.78 and 22.58 years, respectively. The mean total follow-up time from the implant surgical date was 7.51 years. The 5-year implant clinical survival rate (CSR) was 98.4% (95% CI: 96.3%–100%), and crown CSR was 91.8% (95% CI: 86.3%–97.3%). The overall mean change in MBL was –0.19 mm. No significant differences were found between the different implant diameters (3.0, 3.4, and 3.8 mm) with regard to change in MBL. Mean increase in implant infraposition was 0.13 mm. With regard to esthetics, mean initial and final total PES were 9.61 and 11.49, respectively (P < .001). The mean WES was 6.48 at follow-up. Patients’ mean assessment of soft tissue esthetics and implant-supported crown appearance were 73.5 and 82.1 (maximum score 100). At the follow-up examination, the additive OHIP-14 score was 16.11. Conclusion: This retrospective study of XiVE S implants found excellent survival rates and showed good clinical outcomes concerning patient-centered findings, esthetics, and marginal bone preservation. In context, it is important to stress that this study consisted of mostly young patients with agenesis who were treated by experienced clinicians.

Ort, förlag, år, upplaga, sidor
Quintessence, 2017
Nyckelord
Agenesis, Esthetics, Infraposition, Marginal Bone Level, Patient satisfaction, Patient-centered outcome, PES, Pink Esthetic Score, Single Implant, WES, White Esthetic Score
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-15411 (URN)10.11607/jomi.5495 (DOI)000413190400015 ()28334057 (PubMedID)2-s2.0-85029602934 (Scopus ID)22674 (Lokalt ID)22674 (Arkivnummer)22674 (OAI)
Tillgänglig från: 2020-03-30 Skapad: 2020-03-30 Senast uppdaterad: 2025-10-09Bibliografiskt granskad
2. Clinical and radiographic outcome following immediate loading and delayed loading of single-tooth implants: Randomized clinical trial
Öppna denna publikation i ny flik eller fönster >>Clinical and radiographic outcome following immediate loading and delayed loading of single-tooth implants: Randomized clinical trial
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2017 (Engelska)Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 19, nr 3, s. 549-558Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Immediate loading of single implants is generally considered a reliable procedure. Purpose: The objective of the present prospective randomized clinical study was to compare the overall treatment outcome following immediate loading (IL) and delayed loading (DL) of single implants after 1 year of follow-up. Materials and Methods: Patients with a missing maxillary tooth (15-25) were randomly assigned to IL or DL. The protocol included implant installation in healed sites, immediate loading, delayed loading, temporary screw-retained restoration, and replacement with a permanent single implant crown. Outcome measures were implant survival, marginal bone level, soft tissue changes, papillae index, pink, and white esthetic score (PES and WES), patient judged aesthetics, and oral health impact profile (OHiP-14). Results: Implant survival rate was 100% and 96% for IL and DL, respectively. Implant success rate was 96% and 88% for IL and DL, respectively. Statistically significant lower papilla index scores were found in the IL group at temporary crown and definitive crown placement. An overall statistically significant improvement after 12 months for PES, WES and OHIP-14 was found. Conclusion: This prospective randomized study showed that single implants in the maxilla can present satisfactory results with respect to either immediate loading or delayed loading after 12 months.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2017
Nyckelord
Immediate function, Immediate loading, Implant, Implant-supported crown, Implant survival, Patient satisfaction, Randomized controlled trial
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-15624 (URN)10.1111/cid.12479 (DOI)000402629900017 ()28217883 (PubMedID)2-s2.0-85013498541 (Scopus ID)22404 (Lokalt ID)22404 (Arkivnummer)22404 (OAI)
Tillgänglig från: 2020-03-30 Skapad: 2020-03-30 Senast uppdaterad: 2025-10-09Bibliografiskt granskad
3. Accuracy of surgical guides from 2 different desktop 3D printers for computed tomography-guided surgery
Öppna denna publikation i ny flik eller fönster >>Accuracy of surgical guides from 2 different desktop 3D printers for computed tomography-guided surgery
2019 (Engelska)Ingår i: The Journal of prosthetic dentistry (Print), ISSN 0022-3913, E-ISSN 1097-6841, Vol. 121, nr 3, s. 498-503, artikel-id S0022-3913(18)30677-2Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

STATEMENT OF PROBLEM: Different factors influence the degree of deviation in dental implant position after computed tomography-guided surgery. The surgical guide-manufacturing process with desktop 3D printers is such a factor, but its accuracy has not been fully evaluated.

PURPOSE: The purpose of this in vitro study was to evaluate the deviation in final dental implant position after the use of surgical guides fabricated from 2 different desktop 3D printers using a digital workflow.

MATERIAL AND METHODS: Twenty 3D-printed resin models were prepared with missing maxillary premolar. After preoperative planning, 10 surgical guides were produced with a stereolithography printer and 10 with a digital light-processing (DLP) printer. A guided surgery was performed; 20 dental implants (3.8×12 mm) were installed, and a digital scan of the dental implants was made. Deviations between the planned and final position of the dental implants were evaluated for both the groups.

RESULTS: A statistically significant difference between stereolithography and DLP were found for deviation at entry point (P=.023) and the vertical implant position (P=.009). Overall lower deviations were found for the guides from the DLP printer, with the exception of deviation in horizontal implant position.

CONCLUSIONS: The tested desktop 3D printers were able to produce surgical guides with similar deviations with regard to the final dental implant position, but the DLP printer proved more accurate concerning deviations at entry point and vertical implant position.

Ort, förlag, år, upplaga, sidor
Elsevier, 2019
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-17194 (URN)10.1016/j.prosdent.2018.08.009 (DOI)000460655400023 ()30442377 (PubMedID)2-s2.0-85056421631 (Scopus ID)
Tillgänglig från: 2020-05-07 Skapad: 2020-05-07 Senast uppdaterad: 2025-10-09Bibliografiskt granskad
4. Immediate Loading of Single Implants, Guided Surgery, and Intraoral Scanning: A Nonrandomized Study
Öppna denna publikation i ny flik eller fönster >>Immediate Loading of Single Implants, Guided Surgery, and Intraoral Scanning: A Nonrandomized Study
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2020 (Engelska)Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 33, nr 5, s. 513-522Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: To compare clinical and esthetic outcomes between immediately loaded single implants placed with and without a fully guided surgical procedure. Materials and Methods: Patients with a missing maxillary tooth (second premolar to second premolar) were considered for inclusion in this 1-year prospective nonrandomized study. Exclusion criteria were general health contraindications for oral surgery besides the need for bone grafting or ridge augmentation. One group received digital implant planning, fully guided surgery, and immediate loading (DIL). The other group received freehand surgery and immediate loading (IL). Outcome measures were implant survival, marginal bone loss, soft tissue changes, papilla index, pink and white esthetic scores (PES and WES, respectively), and patient-reported outcome measures (PROMs). Results: Two of 21 implants failed in the DIL group soon after placement, resulting in a 1-year implant survival rate of 90.5%, while no implants failed in the IL group. Significantly higher papilla index scores and lower soft tissue changes were found for the DIL group compared to the IL group. No differences were found after 1 year regarding marginal bone loss, PES, WES, or PROMs. Conclusion: Within the limitations of this study, immediate loading in combination with fully guided surgery might negatively affect implant survival. Immediate loading, fully guided surgery, and a digital workflow appear to have a positive effect on early soft tissue adaptation.

Ort, förlag, år, upplaga, sidor
Quintessence publishing co inc, 2020
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-18620 (URN)10.11607/ijp.6701 (DOI)000571425900005 ()32956432 (PubMedID)2-s2.0-85091458761 (Scopus ID)
Tillgänglig från: 2020-10-13 Skapad: 2020-10-13 Senast uppdaterad: 2025-10-09Bibliografiskt granskad

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