Often times at professional meetings, i am presented by well meaning colleagues with anecdotal reports of how and why the implant system they use is superior to others. But, as dentists, we need to look carefully at such claims, and evaluate things in an evidence based manner. The Cochrane review recently looked at this issue, and concluded that there may be evidence of some differences between smooth and rough surface implants, but no evidence to support the superiority of one system over another. Here is an abstract from the study.

Summary
Interventions for replacing missing teeth: different types of dental implants

There is limited evidence showing that implants with relatively smooth surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand implants with a turned (smoother) surface might be at greater risk to fail early than implants with roughened surfaces. There is no evidence showing that any particular type of dental implant has superior long-term success.

Missing teeth can sometimes be replaced with dental implants into the jaw, as bone can grow around the implant. A crown, bridge or denture can then be attached to the implant. Many modifications have been developed to try to improve the long-term success rates of implants, and different types have been heavily marketed. More than 1300 types of dental implants are now available, in different materials, shapes, sizes, lengths and with different surface characteristics or coatings. However, the review found there is not enough evidence from trials to demonstrate superiority of any particular type of implant or implant system.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 1, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

This record should be cited as: Esposito M, Murray-Curtis L, Grusovin MG, Coulthard P, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003815. DOI: 10.1002/14651858.CD003815.pub3

Editorial Group: Oral Health Group

This version first published online: October 21. 2002
Last assessed as up-to-date: August 10. 2007

The mayo clinic recently modified cpr protocol to eliminate breathing, checking for pulse, and performing chest compressions only at the rate of 100 per minute.  view this simplified technique here: http://www.youtube.com/watch?v=E5huVSebZpM

a recent study concluded that there was a lower incidence of fracture when internal hex zirconia abutments were used that maintained metal connections vs. a full zirconia engagement.  here’s the reference:

Int. Journal of Oral and Maxillofacial Implants
Vol. 24 No. 5 pp 850-858

An innovative and imho long needed implant simulation device is being beta tested at the university of georgia dental school in conjunction with nobel biocare. it allows for students to learn proper protocol on simulated jaws. more can be found at this link: http://http://www.sciencedaily.com/releases/2009/06/090611084130.htm

gary

www.pinerundental.com
ghenkel@pinerundental.com

10 The effects of smoking on the survival of smooth and rough-surface dental implants		Related articles: smoking [15] success/survival rates [64] surface topography [25] Authors and reference: Balshe A. Eckert S. Koka S. Assad D. Weaver A. December 2008 Int. Journal of Oral and Maxillofacial Implants Vol. 23 No. 6 pp 1117-1122 Correspondence to: abalshe@hotmail.com
Dental Implant Summaries: Volume 17, Number 4, January/February 2009
Cutaneous vasoconstriction with subsequent decrease in tissue microperfusion and flow rate, together with a decrease in white cell function and number may be responsible for impairment in wound healing which has been demonstrated as more prominent in smokers. Smoking has been shown to decrease the success rates for the integration of oral implants, particularly in the maxilla. Much of the previous research in this area has been on groups treated with smooth surface implants. Advancements in surface technology have led to the introduction of rough surface implants which in their various manifestations appear to show earlier histomorphometric healing. While some studies have shown no survival risk for rough surface implants in smokers, this study aimed to identify any correlation between survival rates of smooth and rough surface implants placed in smokers and non smokers. Material and Methods A retrospective review of the records of 1498 consenting patients treated in one clinic, who were labelled as either smokers or non smokers was undertaken over two distinct time periods. The first involved 593 patients who received 2182 smooth surface implants (Brånemark System, Nobel Biocare) while the second involved 905 patients who received 2425 rough surface implants (TiUnite, Nobel Biocare). Various data parameters such as age, gender, jaw etc. were recorded and the correlation between these variables determined. Results were gathered and survival time from placement to failure or review calculated. Failure was defined as the absence of an inserted implant at the time of review. The results were adjusted using hazard models and subjected to statistical analysis. Results In the smooth surface group, 17.5% were smokers, 54.3% were female and the mean age (SD) was 51.3 (±18.5) years. 111 implant losses were identified in 65 patients and the survival rate was 94.0% at 5 years. Smoking was found to be significant in implant failure (P<0.001). Of the rough surface group, 10.5% were smokers, 59.6% were female and the mean age (SD) was 48.2 (±17.8) years. 85 implant losses were identified in 64 patients and the survival rate at 5 years was 94.5%. Smoking was not found to be significant in implant failure (P=0.68). Among smokers in the study, implant losses in the smooth surface group was more than three times that of the rough surface group, especially within the first year. In both smokers and non smokers, the intraoral location of the rough surface implants was not significantly (P=0.45) associated with their loss. Conversely the intraoral location of smooth surface implants did significantly affect their survival, P=0.004, but only in smokers. Overall, the survival rate was lowest in the posterior maxilla of smokers who had received smooth surface implants. Discussion and Conclusion Smoking has long been associated with an increased risk of failure for smooth surface titanium implants. The advent of a new generation of dental implants with rough surface characteristics has been found to improve early integration and bone to implant contact, such that overall success rates are comparable between smokers and non-smokers, regardless of jaw and location. The results of the current study reinforce this. The surface characteristics of rough surface implants allow for a greater initial bone to implant contact encouraging osseoconductive bone formation at the implant surface. Optimized platelet attraction and propagation on the rough surface precedes effective osteogenic differentiation and osteogenesis. The efficiency of this process on rough surface implants may outweigh the suppressive effects of smoking on healing and osseointegration. In contrast, the decreased bone to implant contact and subsequent impact on the effectiveness of integration alongside the decreased healing ability in smokers may be responsible for the reduced success rates found with smooth surface implants particularly when placed in areas of lower bone density such as the posterior maxilla. In conclusion, while the results of this study are significant in corroborating previous findings, they incorporate many variables which necessitate further prospective studies to reinforce these conclusions.

a frequently asked question is how much of an effect smoking has on the success rates for dental implants. here is a recent publication that suggests success rates may be similar for smoking and non smoking populations of implant patients.

i’m at philadelphia airport headed for atlanta to present an all day presentation on bone grafting prior to implant procedures. we present this course about once a month all over the u.s. and canada. check the schedule at www.perio.com for a time and place convenient to you.

i will be conducting a mini implant course on the 30th of september for osstem (hiossen) dental implant company at their facility in jenkintown pa. and we have an entry level course starting in october for the regular implant, which culminates in participants placing their first implant under direct supervision. if you should have interest in either of these, please contact karen lee at 215 9889435.

gary

just completed the socket grafting presentation for the perio institute in columbus, ohio. great set of dentists who were very knowledgeable and ask a lot of very pertinent questions. unfortunately, i’m still here as there is severe weather in western pa. and all flights were cancelled.

Dr. Henkel will be teaching the first ever North American mini implant course for Osstem corporation at their Jenkintown, Pa. headquarters Sept. 29. Contact our office at 215 6726666 or info@pinerundental.com for more information. Course will be a single day with hands on model based procedures.