case series of wide diameter (6 mm) implants immediately loaded with posterior single restorations

A

Immediate loading of implants replacing single molars are of high interest as first and second molars are the most commonly missing teeth in posterior jaw. Wide platform (WP) implants offer greater surface area for osseointegration and are more capable of handling higher occlusive forces in the posterior regions of jaw compared to regular diameter implants. Few studies have evaluated 6 mm wide diameter implants for posterior single tooth restorations.

AIM The present study aimed at evaluating clinical and

radiological outcomes of wide diameter (6 mm) implants used for cement-retained prosthetic restorations of single molars in immediate function.

Forty eight consecutive patients were treated between April 2007 and October 2010. All patients included in the study underwent a complete preoperative evaluation comprising a detailed medical history, clinical, and radiographic examinations.

SURGICAL PROTOCOL A total of 53 NobelSpeedy WP 6 mm implants were placed. A flapless implant surgery was performed on twenty on patients and for the remaining patients, a flap surgery.

PROSTHETIC PROTOCOLAll provisionals were cement-retained acrylic crowns delivered immediately after surgery (within 48 hours of implant placement). Measures were taken to minimize the intraoral intervention time and to keep the surgical site clean.

CLINICAL & RADIOGRAPHIC ASSESSMENTS

Patients were followed clinically and radiologically for a minimum of 1 year and up to 3 years. Patients were assessed radiographically for bone level measurements and clinically for occlusion, papilla volume (papilla index), and bleeding on probing (BOP) at the time of implant placement surgery (baseline) and at each follow-up visit, when visual signs of inflammation was also assessed.The mesial and distal marginal bone level change over time was assessed by comparing intra-oral radiographs taken at implant insertion and those up to 3 years later.Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21.0.

MATERIAL AND METHODS

INTRODUCTION RESULTS

H. Antoun, P. Cherfane, B. Sojod (Paris, France)

CONCLUSION

This prospective study demonstrates a good predictability for wide diameter (6 mm) implants when used to replace of single molars. Its use is associated with good outcomes in terms of implant survival, marginal bone changes and soft tissue health at the end of one year. It also confirms effectiveness of use of immediate loading protocol in terms of good 1-year implant stability. A longer follow up study is necessary to evaluate the long term success of this technique. Contact: www.ificia.fr

Table 1 Cumulative Survival Rate (CSR) for Implants

Time Period Implants Failed Withdrawn CSR %

Placement - 4 weeks 53 0 0 100.0

4 weeks - 6 months 53 1 1 98.1

6 months - 1 year 51 0 0 98.1

Table 2 Bleeding on Probing and Inflammation at 12 Months

  Bleeding on probing Signs of inflammation

  Number of implant sites % Number of implant sites %

Yes 2 4.4 2 4.3

No 43 95.6 45 95.7

 Total 45 100 47 100

Table 3: Marginal Bone Remodeling at All Sites

 Implant insertion to

3 month

Implant insertion to

6 month

Implant insertion to

12 month

3 month to

6 month

6 month to

12 month

Mean (mm) -0.20 -0.45 -0.17 -0.01 -0.19

SD (mm) 1.57 0.66 1.84 0.39 0.69

N 38 30 34 26 25

Frequency N % N % N % N % N %

> 3 1 2.6 0 0.0 2 5.9 0 0.0 0 0.0

2.1 - 3.0 1 2.6 0 0.0 0 0.0 0 0.0 1 4.0

1.1 - 2.0 0 0 1 3.3 2 5.9 1 3.8 0 0.0

0.1 - 1.0 3 7.9 1 3.3 3 8.8 8 30.8 8 32.0

0 5 13.2 4 13.3 1 2.9 4 15.4 1 4.0

-1 - -0.1 25 65.8 21 70.0 19 55.9 13 50.0 13 52.0

-2 - -1.1 2 5.3 2 6.7 7 20.6 0 0.0 2 8.0

-3 - -2.1 0 0.0 1 3.3 0 0.0 0 0.0 0 0.0

-4 - -3.1 1 2.6 0 0.0 0 0.0 0 0.0 0 0.0

Total 38 100 30 100 33 100 26 100 24 100

At the end of 1 year, cumulative survival rate was 98.1% (table 1), and there were no mechanical or biological complications (table 2). The mean marginal bone remodeling was -0.17 ± 1.84 mm. Marginal bone level changes with distribution frequencies for all sites are presented in table 3.

Occlusal view of the Snappy abutment directly after implant placement (Nobel Speedy 6x13) using the flapless technique

A temporary light-cured composite resin crown (Protemp) was adjusted in mouth and tightly adapted

A prefabricated cap was peformed over the sappy abutment

resin was used to achieve properly sealed margins between the cap and the provisional crown and to establish a proper emergence profile. The

provisional crown was meticulously polished  and perforated to evacuate excess cement

Vestibular view at final prosthesis insertion Vestibular view at 3 years follow-upOcclusal view of the povisional crown

X-ray at implant insertionX-ray at 3 years follow-up

X-ray at 1 year follow-up X-ray at 2 years follow-up

This work was supported by a Nobel Biocare grant number 2006-485.

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