https://www.championsimplants.com/upload/files/studien/2010_study_19.pdf

The role of primary stability for successful immediate loading of dental implants. A literature review.

Background: 

The original Branemark protocol for dental implant treatment was based on submerged healing prior to loading. However, immediate loading has been reported possible with high success rates for various indications, provided that good bone quality and quantity are present. In many of these studies, machined-surface implants have been used. Recently, a new surface texture has been developed, based on an oxidation processing, that aims to enhance the early bone response (Branemark System® Mk IV TiUnite™, Nobel Biocare AB, Gothenburg, Sweden). It has been documented that this surface texture may help to better maintain primary implant stability during the early healing period and that secondary implant stability can be reached earlier compared with results when using a machined surface. Such a positive influence on implant stability might be an advantage when applying an immediate-loading protocol, especially in soft bone regions where a tendency toward reduced success rates has been reported.



Purpose: 

The aim of this report was to present the short-term success rates of TiUnite-surfaced immediate occlusally loaded Branemark System Mk IV implants placed in various regions of the jaws.



Materials and Methods: 

Thirty-eight patients received a total of 51 prosthetic reconstructions, all of which were connected on the day the implants were inserted. Of these, 20 were single-tooth restorations, 30 were fixed partial dentures, and 1 was a complete fixed lower jaw restoration. These prostheses were supported by 102 Branemark System Mk IV TiUnite implants (38 maxillary and 64 mandibular), the majority of which were placed in posterior regions (88%) and mainly in soft bone (76%). Cutting resistance measurements were performed during implant insertion, and resonance frequency measurements were conducted during the course of the study. Furthermore, radiographic examinations were performed in connection with the delivery of the prostheses and at the 1-, 6-, and 12-month follow-up visits. This article reports on the results after 1 year of loading.



Results: 

Three maxillary implants were removed, although stable, in one patient at the 8-week follow-up because of postoperative infection in the adjacent area of guided bone regeneration (GBR). This resulted in a cumulative success rate of the implants of 97.1% after 1 year of prosthetic loading. The mean marginal bone resorption after 1 year of loading was 1.2±0.9 mm (SD).



Conclusions: 

The applied immediate loading protocol in combination with a slightly tapered implant and a modified implant surface texture was shown to be a successful treatment alternative even in regions exhibiting soft bone.

Immediate Occlusal Loading of Brånemark TiUnite™ Implants Placed Predominantly in Soft Bone: 1-Year Results of a Prospective Clinical Study

A secure implant primary (mechanical) stability is positively associated with a successful implant integration and long-term successful clinical outcome. Therefore, it is essential to assess the initial stability at different time-points to ensure a successful osseointegration. The present study critically reviews the factors that may play a role in achieving a successful initial stability in dental implants. Databases were searched from 1983 up to and including October 2013 using different combinations of various keywords. Bone quality and quantity, implant geometry, and surgical technique adopted may significantly influence primary stability and overall success rate of dental implants.

Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation.

den Hartog L, Huddleston Slater JJR, Vissink A, Meijer HJA, Raghoebar GM. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol 2008; 35: 1073-1086. doi: 10.1111/j.1600-051X.2008.01330.x. This study evaluated, through a systematic review of the literature, the outcome of single-implant restorations in the aesthetic zone with natural adjacent teeth, thereby addressing immediate, early and conventional implant approaches. MEDLINE (1950-2008), EMBASE (1966-2008), and CENTRAL (1800-2008) were searched to identify eligible studies. Two reviewers independently assessed the methodological quality using specific study-design-related assessment forms. Out of 86 primarily selected articles, 19 studies fulfilled the inclusion criteria. A meta-analysis showed an overall survival rate of 95.5% [95% confidence interval: (93.0-97.1)] after 1 year. A stratified meta-analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri-implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies. The included literature suggested that promising short-term results could be achieved for immediate, early and conventional single-implants in the aesthetic zone. However, important parameters as aesthetic outcome, soft-tissue aspects, and patient satisfaction were clearly underexposed. The question whether immediate and early single-implant therapies would result in better treatment outcomes remained inconclusive due to lack of well-designed controlled clinical studies.

Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction.

The purpose of this literature review is to present the outcomes of clinical studies on immediate and early loading protocols, identify shortcomings, and suggest a number of questions that still require exploration. English language clinical studies, limited to peer-reviewed journals between 1975 and 2004, were reviewed to identify treatment outcomes with these loading protocols. The data were tabulated from studies reporting on patients treated with fixed and overdenture prostheses. The former included partially edentulous patients treated with single or multi-unit prostheses. Within the limitations of this review, it can be concluded that these treatment protocols are predictable in the anterior mandible, irrespective of implant type, surface topography, and prosthesis design (success rates 90%-100%). Limited evidence for the edentulous maxilla (success rates 90%-100%) and the partially edentulous patient (success rates 93%-100%) are available, underscoring the need for further research. Studies suggest that to achieve predictable results in extraction sites, implant placement should be restricted to sites without a history of periodontal involvement (success rates 61%-100%). A number of questions require further exploration. There is a need to thoroughly investigate clinical outcomes to measure the economic benefit of these protocols and the impact of treatment on a patient's quality of life. Furthermore, more accurate long-term studies reporting on treatment protocols for separate clinical situations are required to allow meaningful comparisons.

Immediate and early implant loading protocols: a literature review of clinical studies.

According to the standard protocol, a load-free healing period is one of the most emphasized requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period for single-tooth implants and immediate loading has been proposed for the aesthetic zone in the maxilla. The present study evaluated clinical outcomes of immediately loaded FRIALIT-2 Synchro implants 12 months after placement in the maxillary incisal region. In the course of our investigation, nine patients have been treated following an immediate loading protocol. The stepped-screw type implants were inserted with an increasing torque up to 45 Ncm, thus measuring the primary stability of the implants. All implants were immediately restored with unsplinted acrylic resin provisional crowns and the patients provided with occlusal splints. Regular controls were performed at monthly intervals, intraoral radiographs were taken directly after implant placement, 6 and 12 months post insertion. The survival rate, clinical stability (Periotest) and radiographic coronal bone defects (CBD) were evaluated at delivery of the definitive superstructures (CBD 6) and 6 months later (CBD 12). Twelve FRIALIT-2 Synchro stepped screws of 3.8, 4.5 and 5.5 mm diameter and 13 and 15 mm length were placed in the incisal maxillary region. The median Periotest value 6 months post insertion was -2 with a minimum of -5 and a maximum of +2. The mean coronal bone level changes (CBD) at 6 and 12 months were 0.45 and 0.75 mm. No implant failed up to 12 months after insertion, resulting in a 100% survival rate. The presented results showed promising data for immediately loaded single-tooth implants in the anterior maxilla. Periotest values were within the range published for submerged implants. The radiographic coronal bone resorption after 6 and 12 months was even less than evaluated for implants placed in a standard two-stage procedure. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading. Additional research needs to be done to provide data in situations where problems of poor bone quality, multiple implants or augmentation procedures must be overcome.

Immediate loading of single‐tooth implants in the anterior maxilla. Preliminary results after one year

According to the Branemark protocol, a stress-free healing period is one of the most emphasised requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period and immediate loading has been proposed for the edentulous mandible. This prospective study evaluated the clinical outcomes of 14 immediately loaded FRIALIT-2® implants compared with 28 non-loaded controls in an in-patient study. The results were based on clinical stability and on changes of bone level from implant placement to abutment connection 6 months after insertion. In the course of our investigation, seven patients with edentulous mandibles have been treated with 43 implants following an immediate-loading protocol. Six FRIALIT-2® implants were placed in the interforaminal region located at positions 34, 33, 32, 42, 43, 44. Bone level in relation to implant margin was measured and recorded. In order to obtain an in-patient comparison of immediately loaded and non-loaded implants, the ones at 33 and 43 were chosen to be immediately loaded by a Dolder-bar retained overdenture. The implants in position 32, 34, 42 and 44 were covered and left to heal. After a healing period of 6 months, second stage surgery was carried out. The clinical criteria to be checked at this point were survival, Periotest values and marginal bone level at the loaded and non-loaded implants. The mean Periotest value was −2.7 for the loaded and −5.6 for the non-loaded implants. The Mann–Whitney U-test showed that the difference was highly significant (P < 0.001). The mean bone level changes at prosthetic delivery were 0.9 mm resorption for the loaded implants and 0.33 mm for non-loaded implants. The difference was highly significant (P < 0.001). No implant failures were observed up to the prosthetic restoration 6 months post insertion. The results of this investigation allowed for direct comparison of implant survival and clinical results between immediately loaded implants and standard implants. Clinical bone changes at the 6-month evaluation demonstrated significantly higher crestal resorption around loaded implants. This fact was confirmed by higher median Periotest values (−3 vs. −6) of immediately loaded implants. According to the outcome of this study, immediate loading of two interforaminal implants with a Dolder-bar resulted in an intimate bone apposition comparable with implants with submerged healing. Nevertheless, the coronal bone level as well as clinical stability (PTV) were significantly lower in the case of the immediately loaded implants. Future studies will be necessary to evaluate marginal bone resorption, Periotest values and clinical success rates of mandibular immediately loaded implants in the long-term.

In-patient comparison of immediately loaded and non-loaded implants within 6 months.

Enhanced release, export, and transport of diffuse nutrients from litter in forested watersheds with climate warming.

With the rapid development of breeding industry, the efficient treatment of dramatically increasing swine wastewater is gradually becoming urgent. In particular, the development of application technologies suitable for the relatively small piggeries is critical due to the time cost and space requirements of conventional biological methods. In this study, Electrochemical oxidation (EO) was selected to systematically explore the treatment performance of three different swine wastewaters by Ti4O7 anode. It was observed that the colors changed from dark brown to light yellow after 60 min treatment at 50 mA/cm2, and the removal rates of turbidity and suspended solids ranged from 89.36% to 93.65% and 81.31% to 92.55%, respectively. The chemical oxygen demand (COD), ammonia nitrogen (NH3-N) and total phosphorus (TP) of all the three swine wastewaters were simultaneously removed to a very low concentration in 120 min, especially for sample III, 61 ± 9 mg/L of COD, 6.6 ± 0.4 mg/L of NH3-N and 5.7 ± 1.1 mg/L of TP, which met the Discharge Standard of Pollutants for Livestock and Poultry Breeding (GB 18596-2001). Moreover, 70.93%–85.37% mineralization rates were also achieved in 120 min, confirming that EO treatment by Ti4O7 could efficiently remove the organic matters in wastewater. Excitation–emission matrix (EEM) and UV-vis spectrum characterization results further proved that aromatic compounds and macromolecules in wastewater were rapidly removed, which played important roles in the mineralization processes. The findings here provided an efficient and environment-friendly technology for swine wastewater treatment.

https://www.mdpi.com/1660-4601/19/21/13840/pdf?version=1667538385

Kehao Zhang

Papers

Immediate loading of single‐tooth implants in the anterior maxilla. Preliminary results after one year

In-patient comparison of immediately loaded and non-loaded implants within 6 months.

Enhanced release, export, and transport of diffuse nutrients from litter in forested watersheds with climate warming.

A Case Study of Swine Wastewater Treatment via Electrochemical Oxidation by Ti4O7 Anode