systematic review on success of narrow implants

8/10/2019 Systematic Review on Success Of Narrow Implants

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OBJECTIVE

To determine the survival and success rates o

diameter dental implants (NDI) in differentindications compared to standard diameter i


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Standard diameter implant: 3.75 mm and 4.1 mm

Excellent long-term results

Fracture of the abutment or implant body is a ra

Review bySanchez-Perez et al

Risk of two fractures per 1,000 implant

INTR


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DisadvantageStandard-diameter

implant

Available horizontal crestal dimensions of t

ridge is relatively small Limited spaces between adjacent teeth and

implants

Successful dentalimplant

At least 1mm residual bone adjacent to the surface

Horizontal crestal alveolar width of 6 mm foimplant

Previous studies:3 mm inter-implant distance is beneficial for adequate papillary fil


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Optimal implant diameter smaller tstandard diameter for many indicat

Narrow-diameter implants (NDI)

WHY?

Decrease rate of augmentation procedures for implant insertion

Beneficial for elderly or medical risk patients

Reduced surgical invasiveness (time-consuming; pain/complication

Smaller dental or interimplant gaps (premolar/incisor region)

Employment of NDI


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Biomechanical risk factors for ND

Stress Crestal cortical boneD

Small diameterimplants

Stress Peaks

Stress values at the implant-bone interface riseby reducing the diameter from 4.1 mm to 3.3

mm rather than 4.8 mm to 4.1


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Biological Risk Factors

Inadequate overloading of NDI might lead to peri-implant creresorption resulting in clinical complications.


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Other disadvantagesFATIGUE FRACTURE

Alloy

Less biocompatible in cell cultures and animalexperiments

Titanium-zirconium (TiZr) alloy with increasedfatigue resistance and better biocompatibilitycompared to cpTi.

Commercial pu

(cpT

How to increase resistance to implant fracture?

Most available NDIs are made of Ti-Al-V


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PRESENT USE OF NDI

R e s t r i c t e d I n d i c a t i o n s


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MATERIALS AND ME

(Patient, Intervention, Control or Comparison, Outcome


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Raising of a full-thickness flap

Trans-mucosal implant insertion

Su

Tr

Fixed

Overdenture


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ControlGroups

Groups with conventional sized dental implants (>

Outcome

Dental implant Survival:

Follow-up 12 months

In situ or not planned for removal

Implant Success:

Clinical Success (implants in function, no sign of p

Marginal bone level under functional loading


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Selection Criteria

INCLUSION CRITERIA EXCLUSION CRITE

Clinical studies of at least 10 treated patients,published in English

Studies in languages other than E

Prospective: randomized-controlled, non-randomized-controlled, cohort studies

Studies with < 10 patients, case remodels, or experimental in vitro s

Retrospective: controlled, case control, single

cohort

Reviews

Mini-implants for orthodontic anc

Studies dealing with simultaneousaugmentation procedures

Studies with mean follow-up time


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Search Strategy for Identification of S

Small diameter dental implants: 107 hits

Narrow diameter dental implants: 68 hits

Narrow dental implants: 225 hits

Small dental implants: 720 hits

Diameter dental implants: 1,107 hits

Mini-implants: 767 hits


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Study Selection, DataExtraction, and Quality

Assessment


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RES


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N. Of selectedarticles

Category Diameter Impla

10 1 < 3.0 mm 3,65

12 2 3.0 3.25 mm 67

16 3 3.3 3.5 mm 3,41

Dental Implants by Diameter Category

*< 3mm implants were all made of Ti-Al-V*Category 3: TiZr alloys were described in three studies


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Results of Quality Assessment o

Selected Studies

Quality and level of evidence of the investigated articles were lo

Most of the studies were retrospective analyses

Data interpretationDrawing general conclusio

out of theses studies


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RESIMPLANT SURVIVAL, IMPLANT SUCCESS, A

BONE LEVEL UNDER FUNCTIO

Diameter Category 1


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Diameter Category 1

Mean follow-up 12-96 months Indications Edentulous Arch (I) Nonloaded frontal region (III) Narrow tooth gap without loading

5 out of 7 studies: open pro Survival rates: 90.9% - 100 Implant success: 92.9% (1 Radiological assessment: a

implant bone loss 0.980.

Di t C t


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Diameter Category 2

Mean follow-up 12-63

months

Indications:

Narrow tooth gap without

loading (III)

Frontal region

Flap was raised for implantinsertion

Survival rates: 93.8%-100%

Average peri-implant

bone loss after 12months: 0.780.48


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Diameter Category 3

Follow-up of 12-144months

Indications: Load-bearing

posterior region Flap raised for implant

insertion Survival rates: 88.9%-

100% Success rates: 91.4%-

97.6% Radiological assessment:

average peri-implant boneloss of 0.310.003


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Few comparative

prospective clinicalstudies

SURVIVALOR

SUCCESS

Most of these studies did notclearly report a follow-up rate


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Survival rates of NDI similar compared to reguimplants (>3.5mm)

Survival rates > 95%

No studies reporting


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Factors that impact peri-implant ma

bone stability

Intrinsic Factors Extrinsic Factor

Quantity and quality of surrounding hard and softtissue

Implant design (dimensions, implainterface)

Crestal alveolar dimensions Insertion depth

Distances between adjacent teeth and dentalimplants

Implant angulation

*Important for maintaining a stable biologicalwidth

Number of inserted implants

Parafunctional activities like bruxi


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Category 1 (


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No differencesrate using the f

Implants witwere used in

Very narrow diameter belowflapless procedhealing mode


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Two-piece dentflap elevation

he

Lengths of imwere i

Implant-retainedistance, and dibe significance

developme

SPLINTED


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SPLINTEDIMPLANTS

1.8 mm indiameter

Rigidsuperstructure

Decreased the bonestress levelcompared to singlemini implants

Effect of splinting mini-implants on marginal bone loss: a biomechanical model andrandomized study with mandibular overdentures.Jofre J1, Cendoya P, Munoz P.

1Center for Advanced Prosthodontic and Implantology, CRAI, University of Concepcion,[email protected]

Splinted mini-implants supportoverdenture showed less margcompared with non-splinted m
http://www.ncbi.nlm.nih.gov/pubmed?term=Jofre%20J[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Cendoya%20P[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Munoz%20P[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Munoz%20P[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Cendoya%20P[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Cendoya%20P[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Cendoya%20P[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Jofre%20J[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Jofre%20J[Author]&cauthor=true&cauthor_uid=21197490http://www.ncbi.nlm.nih.gov/pubmed?term=Jofre%20J[Author]&cauthor=true&cauthor_uid=21197490


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CONCLUSIONS

Dental implants with narrow diameter of 3.3 to 3.5 mm are indindications including load-bearing posterior regions

Smaller implants of 3.0 to 3.25 mm in diameter are indicated otooth non-load-bearing regions

Mini-implants 1 year are missing

Information on patient specific risk factors are missing

systematic review on success of narrow implants

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