Long Term Clinical Survival of Two Tissue Level ... - Blue Sky Bio

Verban et alGraph 1: Implant Size Distributioncal survival rate of these two similarly designedtissue level implants. The similarity of the macroscopictopography and surgical protocol of thetwo systems offers an opportunity to comparethe effect of the different surface modification.MethodsRecords of all patients who had implants placedbetween December 5, 2005 and June 11, 2008were evaluated. The implants were placedand restored by one clinician in a single privatepractice setting. A total of 124 patientswere evaluated. All patients treated duringthat period were included in this study.Patients were screened for medical and dentalcontraindications to implant placement by submittingto a medical questionnaire and completingmedical and dental interview. Patients with incompletejaw growth or reported history of intravenousbisphosphonate therapy, radiation therapyto the jaw, uncontrolled diabetes, severe metabolicbone disorders, uncontrolled systemic diseaseand metastatic cancer with involvement ofbone were categorically excluded from treatment.In addition, other patients with chronic complexmedical, emotional and psychological conditionswere excluded either based on the judgment ofthe dentist or the consulting physician. PatientsThe Journal of Implant & Advanced Clinical Dentistry • 31

Verban et alFigure 3: Blue Sky Bio ® implants at time of immediatesurgical placement.Figure 4: Blue Sky Bio ® radiograph at 11 months post-op.Figure 5: Photo of Blue Sky Bio ® restorations at 11 monthspost-op.adequate bone width and height with periapicaland panoramic radiographs, digital palpationand/or bone mapping. For implants placed intofresh extraction sites, visual and tactile inspectionof extraction sockets provided more information.A total of 247 tissue-level dental implants wereplaced in the reviewed period. Implant diametersand lengths varied based on site and prostheticconsiderations. (Implant size distribution is sum-Figure 6: Straumann ® implant at time of immediatesurgical placement.The Journal of Implant & Advanced Clinical Dentistry • 33

Verban et alFigure 8: Photo of Straumann ® restoration at 18 monthspost-op.Figure 7: Straumann ® implant at 18 months post-op.marized in Graph 1). Of these, 133 were Straumann® Standard Plus SLA ® and 114 were BlueSky Bio ® One Stage resorbable blast media. Ofthe Straumann ® , 43 were placed into fresh extractionsites and 90 were placed into healed edentuloussites. Of the Blue Sky Bio ® group, 52 wereplaced into fresh extraction sites at the time ofextraction and 62 into healed edentulous sites.Implant site location, and placement protocol issummarized in Table 2. Straumann ® instrumentationwas used for both groups following the manufacturersrecommendations when possible. Thiswas possible because Blue Sky Bio ® implants aredesigned to be surgically compatible with Straumann® instrumentation. Surgery was performedunder sterile conditions and site appropriate localanesthesia was administered. All implants wereplaced with a one-stage protocol with a healingabutment or immediate provisional restoration toavoid second stage surgery to uncover implants.Permanent restorations were placed after a healingperiod ranging from 10 weeks to 54 weeks.Patients were seen for follow-up evaluations atapproximately 1 week, 3 weeks, 2 months, whenabutments were torqued for final restoration, andat periodic dental recall appointments thereafter.Abutments for final restorations were torquedaccording to manufacturer’s recommended torquebetween 0 and 52 weeks. Prior to final restoration,implant integration was manually evaluatedwith percussion and palpation, visual inspectionand radiographic appearance (Figures3-8). Clinical survival was defined as absenceof mobility upon manual testing, and applica-34 • Vol. 3, No. 4 • May/June 2011

Verban et altion of restorative torque as well as absenceof mechanical failure of implants and irresolvableclinical symptoms, such as pain, discomfort,numbness, infection, or peri-implant bone loss.ResultsOf the 247 implants placed, there were a total of7 failures: 4 Straumann ® , and 3 Blue Sky Bio ®.Two of the failed Straumann ® implants wereplaced immediately one of which was also provisionallyrestored at time of placement. Oneof the failed Blue Sky Bio ® implants was placedimmediately and was also provisionally restored attime of placement. The survival rates of the comparedgroups were statistically similar: 96.9%for group Straumann ® vs. 97.3% for group BlueSky Bio ® ; 95.2% for Straumann ® Immediate vs.98.0% for Blue Sky Bio ® Immediate; 97.3% forStraumann ® Delayed vs. 96.7% for Blue Sky Bio ®Delayed. Survival data is summarized in Table 2.ConclusionWithin the observation period and the limitationsof the parameters “implant survival,” no clinicallyrelevant differences were observed betweenimplants possessing a surface modification createdby blasting with corundum particles followedby acid etching and those with a surfaceroughness produced by blasting with resorbablemedia particles followed by an acid wash. ●Correspondence:Dr. Emil M. Verban, Jr.Mclean County Dental2103 E. Washington St.Bloomington, IL 61701, USAPhone: 309-662-8448Disclosure: The authors report no conflicts of interest with anything mentionedin this article.References:1. Jones AA, Cochran DL. Consequences of implant design. Dent Clin North Am.2006 Jul;50(3):339-602. Abrahamsson I, Berglundh T. Effects of different implant surfaces and designson marginal bone-level alterations: a review. Clin Oral Implants Res. 2009Sep;20 Suppl 4:207-15.3. Buser D, Belser UC, Lang NP. The original one-stage dental implant systemand its clinical application. Periodontol 2000. 1998 Jun;17:106-18.4. Weber HP, Buser D, Fiorellini JP, Williams RC. Radiographic evaluation ofcrestal bone levels adjacent to nonsubmerged titanium implants. Clin OralImplants Res. 1992 Dec;3(4):181-8.5. Reijden WA, Van Winkelhoff AJ, Stegenga B. Two-part implants inserted in aone-stage or a two-stage procedure: a prospective comparative study. J ClinPeriodontol 2002;29(10):901-9.6. Hermann JS, Cochran DL, Nummikoski PV, Buser D. Crestal bonechanges around titanium implants. A radiographic evaluation of unloadednonsubmerged and submerged implants in the canine mandible. J Periodontol.1997 Nov;68(11):1117-30.7. Hermann JS, Buser D, Schenk RK, Cochran DL. Crestal bone changesaround titanium implants. A histometric evaluation of unloaded non-submergedand submerged implants in the canine mandible. J Periodontol. 2000Sep;71(9):1412-24.8. Weber HP, Buser D, Donath K, Fiorellini JP, Doppalapudi V, Paquette DW,Williams RC. Comparison of healed tissues adjacent to submerged and nonsubmergedunloaded titanium dental implants. A histometric study in beagledogs. Clin Oral Implants Res. 1996 Mar;7(1):11-9.9. Gross M, Abramovich I, Weiss EI. Microleakage at the abutment-implantinterface of osseointegrated implants: a comparative study. Int J Oral MaxillofacImplants. 1999 Jan-Feb;14(1):94-100.10. The Straumann SLA ® Implant Surface: Clinically Proven Reduced HealingTime Available at: http://www.straumann.us/pc_15x_526_sla_healing_time.pdf Accessed March 22, 2011.11. Cochran DL, Schenk RK, Lussi A, Higginbottom FL, Buser D. Bone responseto unloaded and loaded titanium implants with a sand-blasted and acidetchedsurface: A histometric study in the canine mandible. J Biomed MaterRes 1998;40:1–11.12. Buser D, Nydegger T, Oxland T, Cochran DL, Schenk RK, Hirt HP, SnétivyD, Nolte L-P. Interface shear strength of titanium implants with a sandblastedand acid-etched surface: a bio-mechanical study in the maxilla of miniaturepigs. J Biomed Mater Res 1999;45:75–83.13. Blue Sky Bio Surface Available at: https://www.blueskybio.com/category.php?cat=1040 accessed March 21, 2011.14. Sanz A, Oyarzún A, Farias D, Diaz I. Experimental study of bone responseto a new surface treatment of endosseous titanium implants. Implant Dent.2001;10(2):126-31.15. Novaes AB Jr, Souza SL, de Oliveira PT, Souza AM. Histomorphometricanalysis of the bone-implant contact obtained with 4 different implant surfacetreatments placed side by side in the dog mandible. Int J Oral MaxillofacImplants. 2002 May-Jun;17(3):377-83.16. Müeller WD, Gross U, Fritz T, Voigt C, Fischer P, Berger G, RogaschewskiS, Lange KP. Evaluation of the interface between bone and titanium surfacesbeing blasted by aluminium oxide or bioceramic particles. Clin Oral ImplantsRes. 2003 Jun;14(3):349-56.The Journal of Implant & Advanced Clinical Dentistry • 35