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Journal of Stomatology
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vol. 73
 
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Original paper

A retrospective study of short implants with two different surfaces placed in lateral aspects of the maxilla with limited height of alveolar ridge: 36 months of follow-up

Paweł Kubasiewicz-Ross
1
,
Jakub Hadzik
1
,
Artur Pitułaj
1

1.
Department of Oral Surgery, Medical University of Wroclaw, Wroclaw, Poland
J Stoma 2020; 73, 1: 11-14
Online publish date: 2020/04/08
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INTRODUCTION

Implantological treatment of patients with reduced bone volume still remains a significant clinical challenge. In these cases, there are two treatment theories. The first concept, historically first, indicates the need to improve bone base conditions by using regenerative surgical techniques in order to enable the insertion of implants of traditional size. The second concept postulates the usage of a short or ultra-short implant [1-5].
However, the definition of short implants is still not unificated. Tawil and Younan [4] considered implants lower than 10 mm in length as short, while Nisand and Renouard [6] described implants ≤ 8 mm in length as short and implants ≤ 5 mm as ultra-short. The concept behind treatment with short implants is based on new, more active types of dental implant surfaces characteri¬zed by higher osteoconductive potential.
There are numerous concepts to improve osteoconductive features of the implant surface. The most commonly used, having extensive literature documentation is the titanium surface, which is sandblasted and additionally etched (SLA). Nowadays, it is considered as a gold standard, to which other types of surfaces that are subjected for experimental evaluation should refer [7].
In the nineties of the last century, titanium implants coated with hydroxyapatite began to be used. At first, hydroxyapatite (HA) was applied to the surfaced with plasma coating. Currently, electrochemical deposition is used for this purpose, resulting in more porous crystal structure with even higher osteoconductive potentials [8, 9].

OBJECTIVES

To provide a retrospective comparative analysis of two short implants with different surfaces in 36 months of follow-up observation.

MATERIAL AND METHODS

Thirty generally healthy patients, 16 women with a mean age of 45.2 ± 21.2, previously treated with short implants (6 mm long and 4 mm in diameter) due to individual missing teeth in the molar region of maxilla were qualified for the study. Other inclusion criteria included minimal apico-coronal height of alveolar ridge with 6 mm in the region of the implant insertion in pre-surgical qualification, minimal width of the alveolar ridge with 6-7 mm in the region of interest, approximal plaque index (API) ≤ 35, and plaque index (PI) ≤ 25. The exclusion criteria that disqualified patients from the study were previous graft procedures in the area of interest and systemic or local diseases that could compromise healing or osteointegration. Smokers and patients with bruxism were excluded from the study as well.
Patients were divided into two equal groups. The first group (G1) consisted of patients with SLA implants (Osseo¬SpeedTM, Dentsply, New York, USA), whereas the second group (G2) included patients with electrochemically hydroxyapatite-coated SGS implants (SGS Dental Implant System Holding St. Gallen, Switzerland). Each patient had single implant provided in a minimally invasive, transmucosal implant surgery. The implants were non-submerged, and 3-months loaded. The assessment was based on clinical examination using pocket depth probing (PPD), which was measured around the implants in four measurement points, with height of keratinized gingiva (HKT), clinical attachment level (CAL), and the recession depth/width (RD/RW). The evaluation of HKT was performed on the day of surgery (T0) and after 36 months (T36) from the implants’ loading. The rest of periodontal indexes were verified after 36 months of loading. Additionally, on T0 and T36, the orthopantomographic X-ray picture (OPG) (Galileos D3437, Sirona Dental, Erlangen, Germany) along with the clinical examination were performed in order to assess the marginal bone loss (MBL). The MBL was calculated as follows. First, dimensions were calibrated by known parameters of implant diameter and length. Starting from the implant shoulder, distances were measured to the mesial and distal points of bone to implant contact, parallel to the implant axis. All measurements were done by AP, a junior member of the study team, who was not involved directly in performing implant surgeries and had no knowledge about the type of implant evaluated. Statistica version 13.3 (StatSoft, Warsaw, Poland) was used to perform statistical analysis. Initially, the Shapiro-Wilk test was applied in order to evaluate normality of the distribution. Then, statistically important differences were tested using Student t-test.

RESULTS

The effectiveness of the implant therapy in 36 months of follow-up was 100%. All 30 implants survived for 36 months. Furthermore, the absence in implant’s mobility, pain, paresthesia, and inflammatory process as well as lack of resorption features of the bone structure in the direct vicinity of the implants of both groups were reported.

GROUP 1 (G1)

The mean measurement of HKT was 3.67 ± 1.57 mm (T0) and was reduced to 2.27 ± 0.96 mm after 36 months (T36). PPD, CAL, RD, and RW investigated in T36 were 2.53 ± 0.83 mm, 3.07 ± 1.39 mm, 0.67 ± 1.23, and 1.27 ± 1.87 mm, respectively. The mean MBL was 0.34 ± 0.25 mm.

GROUP 2 (G2)

The mean measurement of HKT was 3.40 ± 1.26 mm (T0) and was reduced to 3.30 ± 1.08 mm after 36 months (T36); however, it was significantly higher than in G1 in T36. PPD, CAL, RD, and RW prodded in T36 were 1.47 ± 0.64 mm, 2.02 ± 1.01 mm, 0.67 ± 0.72, and 0.93 ± 0.96 mm, respectively. The mean MBL was 0.33 ± 0.36 mm. The only statistically important differences between G1 and G2 group in T36 observation was in PPD and HKT36 parameters: 2.53 ± 0.83 mm vs. 1.47 ± 0.64 mm, and 2.27 ± 0.96 mm vs. 3.30 ± 1.08 mm, respectively (Table 1).

DISCUSSION

The criteria of success for implant treatment are differently formulated by various authors. According to Albrektsson, the success of implantological treatment is based, among others, on the MBL criterion. This loss, in the first year after the implantation, considered physiologically as a result of bone remodeling, should not exceed 1-2 mm and then in subsequent years, it should be no more than 0.2 mm per year [10]. Both G1 and G2 group of our study met the following criteria. The newer standards formulated by Buser indicate that the success in implantological treatment can be defined as the absence of implant’s mobility, pain, paresthesia, and inflammatory process as well as lack of resorption features of the bone structure in direct vicinity of the implants [11], which was also found in our study for all implants.
On the seventh European Workshop on Periodonto¬logy, Lang and Berglundh established the criteria based on periodontal indexes, where ppd lower than 5 mm and absence of bleeding during probing can be considered as the lack of peri-implantitis. In our study, the highest ppd at 36 months of follow-up reported in our study was 4 mm accompanied with the absence of bleeding. All implants met mentioned criteria [12].
It should be noted that there is relatively small amount of publications on the subject of short dental implants’ survival, and the results are additionally hindered by different methodologies adopted. Furthermore, the literature is dominated by the observation period shorter than three years, and the most commonly observed type of implants are SLA implants. Schincaglia [13] in a study on short SLA implants observed MBL at the level of 0.77 ± 0.38 mm per year. In a recent report by Elsyad [14] with three years of observations, MBL value of 0.51 ± 0.2 mm was observed. In the studies on short SLA implants (< 6 mm length) and three-year observations, the MBL value was found from 1.28 ± 0.37 mm [15] to 0.89 ± 0.25 mm [16].
Researches with a similar methodological approach, conducted on implants with hydroxyapatite coatings are even more rare. In such a study with annual observation, Kim et al. reported MBL value of 0.26 ± 0.59 mm [17].
Generally, the literature is dominated by the opinion on the worse survival rates of short implants. In a study based on four-year observation, statistically more frequent failures were found when using implants shorter than 8.5 mm (2.9% of lost implants) compared to implants longer than 10 mm (2.1% of lost implants) [18]. These results were also confirmed by other authors [19, 20]. However, it is worth to note of different studies with opposite results. Some authors indicate short implants as a predictable treatment option and a reasonable alternative to extensive regenerative procedures in patients with reduced volume of alveolar process [19, 21, 22]. According to Akram, short implants (< 6 mm) with 3 years of observation period were characterized by MBL of 0.42 mm in the first year of follow-up after loading, and significantly reduced to 0.14 mm in the following third year, as PD slightly reduced from 2.6 mm at the baseline to 2.4 mm at the third year of follow-up; however, CAL increased from 3.8 to 4.5 mm during this follow-up [23]. Dierens performed a retrospective study on total 50 implants and reported that 91.5% of the implants had a mean interproximal probing depth of < 5 mm with MBL at 1.7 mm after the first year of loading [24]. Kolds¬land in the study with 8 years of follow-up reported that 23.1% of implants presented with PD above or equal to 4 or 6 mm, and 8.2% of the implants showed bone loss of 2-3 mm and 3-4 mm, respectively [25]. Abduljabar evaluated implants of the same that in present study size (6 × 4 mm) with 3 years of observation period, reporting MBL of 1.1 ± 0.2 mm and PD of 1.8 ± 0.1 mm in non-smoking group of patients [26].

CONCLUSIONS

With the limitation of our study and 36 months of follow-up, short implants of both SLA and HA-coated surfaces can be considered as a reliable alternative to sinus-floor augmentation procedures and may be even preferred due to simplified protocol and reduced invasiveness.

CONFLICT OF INTEREST

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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