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Table of Contents
ORIGINAL ARTICLE
Year : 2013  |  Volume : 3  |  Issue : 1  |  Page : 3-8

Success of Brånemark system dental implants and implant-supported prostheses: A 1 year retrospective clinical and radiological study of 232 implants of 60 patients


1 Department of Oral Diagnosis, School of Dentistry of Paulista University, Brasília, DF, Brazil
2 Department of Oral Rehabilitation, School of Dentistry of Brazilian Association of Dentistry, Goiânia, Brazil
3 Department of Oral Rehabilitation, School of Dentistry of Federal University of Goias, Goiás, Brazil

Date of Web Publication10-May-2013

Correspondence Address:
Claudio M Pereira
Department of Oral Diagnosis, Coordenação de Odontologia, Institute of Sciences of the Health, Dentistry, UNIP, SGAS Quadra 913, Conjunto B, Asa Sul
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.111659

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   Abstract 

Background: The successful replacement of missing tooth by titanium implants duly integrated into the tissues is a major breakthrough in Dentistry. From the moment that implant systems with rigorous scientific methodology were introduced, eliminating the pre-existent empiricism, long-term studies of effectiveness have been presented.
Objective: The aim of this study was to evaluate the success rates of osseointegrated implants and implant-supported prostheses performed by students of implant dentistry at the Brazilian Dental Association - Goiás Section - between 2006 and 2007.
Materials and Methods: Sixty patients who received 232 implants were evaluated. These patients were followed up by clinical and radiographic examination to evaluate the survival rate of implants and prostheses. Also, the patients answered a questionnaire regarding their satisfaction with the treatment.
Results: Clinical signs and radiographic findings showed the following: No implant had mobility, one patient reported pain in the region of one implant, eight implants had exposure of the head, one patient complained of paresthesia mandibular, five implants had exudate, one implant had exposure of the threads, and no implant showed radiolucency in radiographic image. 57.9% of patients who answered the questionnaire considered the treatment "excellent." The complications of prostheses showed the occurrence of fracture of porcelain in two prostheses, fracture of the resin in one prosthesis, loosening of one screw implant, abutment misfit in three prostheses, two abutments released from the crown, and and there was oral exposure of the abutments teeth in 2 prostheses. Of the 232 implants evaluated in 60 patients, 4 implants were lost and removed, corresponding to a survival rate of 98.28%.
Conclusions: The use of Brånemark system implants seems to be a successful alternative in the treatment of various types of edentulism.

Keywords: Brånemark system, follow-up, survival rate


How to cite this article:
Pereira CM, Sulaimen AM, Decurcio RA, Chaer MM, Ribeiro Filho SA. Success of Brånemark system dental implants and implant-supported prostheses: A 1 year retrospective clinical and radiological study of 232 implants of 60 patients. J Dent Implant 2013;3:3-8

How to cite this URL:
Pereira CM, Sulaimen AM, Decurcio RA, Chaer MM, Ribeiro Filho SA. Success of Brånemark system dental implants and implant-supported prostheses: A 1 year retrospective clinical and radiological study of 232 implants of 60 patients. J Dent Implant [serial online] 2013 [cited 2020 Sep 18];3:3-8. Available from: http://www.jdionline.org/text.asp?2013/3/1/3/111659


   Introduction Top


The use of implant in order to replace lost teeth represents a development in contemporary dentistry. The advent of osseointegrated implants presented a plausible solution to certain clinical situations that professionals previously considered as having a very poor and frustrating prognosis. [1],[2],[3]

Initially, the use of osseointegrated implants had been proposed only for fully edentulous patients. Gradually, this design was extrapolated to the partially edentulous, and finally for the replacement of individual teeth. Parallel to this progress, several implant systems have been developed with the goal of obtaining osseointegration. [4],[5] Treatment with oral implants of the Brånemark system has been performed for over 35 years. [6] Studies of medium and long term have shown success rates between 91% and 100% for osseointegration when this system was used.

In order to be considered successful, an implant must fulfill basic requisites relative to mechanical function, through the rehabilitation of masticatory function, and the physiology of adjacent soft and hard tissues. In most cases, the concept of implant survival has been confused with the success of the implant, and the terms are often used to mean the same thing. However, the term survival means only that the implant that was placed is still in the patient's mouth, regardless of the quality, function, and the supporting bone tissue. The classification of success is applied to implants that fit in with the established criteria applicable to the entire implant placed. The concept of success would therefore be, by broader definition, of greater value for evaluation of osseointegrated implants. [2]

Many authors [4],[5],[7],[8] support the assumption that failures of implants do not increase over time. Instead the losses would be concentrated mainly in the period between the first surgery until the second year after the implant placement. The aim of this study was to evaluate the success rates of osseointegrated implants and implant-supported prostheses performed by students of implant dentistry at the specialization school of the Brazilian Dental Association - Goiás Section - between the years 2006 and 2007.


   Materials and Methods Top


Sixty patients who received a total of 232 implants were evaluated. These patients were previously submitted to surgical and prosthetic procedures in compliance with the protocol of complete control of biosafety, use of diagnostic images, complementary exams, prophylactic and postoperative medication, and the use of surgical cutters, implants, and prosthetic components of the Nobel Biocare® brand.

The patients were invited to attend an appointment to be re-evaluated, bringing the panoramic and periapical radiographs of the implant areas performed so far.

The patients answered a questionnaire about their satisfaction with the treatment performed, which was divided into four questions: (1) overall satisfaction with the work, (2) overall satisfaction with chewing, (3) satisfaction with esthetics, and (4) satisfaction with phonetics. For each question, the patient had to tick one of the following: (1) excellent, (2) very good, (3) good, (4) regular, and (5) poor.

For each patient, a form with the following information was filled out:

  1. general patient data: Age and gender;
  2. health habits: smoking, diabetes, osteoporosis, bruxism, and others;
  3. with regard to number of implants: Region, size (diameter × height), block bone graft area, and sinus lift area;
  4. regarding implants' success: Presence or absence of pain, mobility, exudate, exposure of implant head, exposure of implant threads, radiolucency, and vertical bone loss in millimeters;
  5. regarding evaluation of prostheses: Region, single denture, multiple united, multiple individual, multiple with pontic, complete dentures, immediate loading, and late loading; and
  6. regarding success of dentures: Region, porcelain fracture, acrylic resin fracture, screw fracture, abutment fracture, implant fracture, screw loosening, and others.
On clinical examination, the criteria - presence or absence of pain, mobility, inflammatory exudate, implant head exposure, implant screw exposure, porcelain fracture, acrylic resin fracture, screw fracture, abutment fracture, implant fracture, screw loosening, and others - were evaluated.

Radiolucency was evaluated by observation in periapical radiographs. Vertical bone loss was evaluated by periapical radiographs in the mesial and distal regions of each implant, with the use of aHu-Friedy® brand millimetric periodontal probe, model PNCU15, measuring the distance from the bone crest to the implant head. The other information was extracted from the patients' clinical record charts.


   Results Top


Of the 60 patients evaluated, 68.33% were women and 31.67% were men, with a mean age of 54 years. Only four patients were smokers, one had diabetes, three patients reported having osteoporosis, and four patients had bruxism.

It was observed that 98 implants were placed in the maxilla and 134 in the mandible. Records showed that 33 implants were placed in a bone block region and 8 implants in a sinus lift area.

From a total of 232 implants evaluated in 60 patients, 4 loss and removal of implants was recorded, which corresponds to a survival rate of 98.28%.

Of the lost implants, three were located in the mandible and one in the maxilla, in three different patients, and had a length of 15 mm (three implants) and 10 mm (one implant), respectively. The implant survival rate was 98.98% in the maxilla, 97.76% in the mandible, with a total of 98.3% [Table 1] and [Table 2].
Table 1: Ratio of implants placed and lost

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Table 2: Survival rate of implants

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The research demonstrated that the dimensions of implants varied in length and diameter as shown in [Table 3] and [Table 4], respectively. There was no information about the dimension of eight implants in the dental record charts.
Table 3: Length of implants placed

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Table 4: Diameter of implants placed

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With regard to the clinical and radiographic signs of implants, these were observed and recorded according to data shown in [Table 5].
Table 5: Clinical and radiographic signs of implants evaluated

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The vertical bone loss observed in periapical radiographs and measured in millimeter by means of the distance from the mesial and distal bone crests up to the implant head were recorded according to the data shown in [Table 6].
Table 6: Vertical bone loss

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Data shown in [Table 7], according to the results of the questionnaires answered by patients, demonstrate the subjective index of satisfaction with the treatment performed.
Table 7: Patient satisfaction with the treatment

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A survey was conducted about the types of implant-supported dentures placed, and the results showed a total of 43 individual dentures, 28 multiple united dentures, 15 multiple dentures with pontics, and 9 complete dentures. Only two individual multiple dentures were observed, both performed outside of Brazilian Association of Dentistry, Goiás. Of a total of 114 dentures placed, 105 received late and 9 received immediate loading. Of the nine complete dentures placed, eight received immediate loading. Concerning the complications related to implant-supported dentures, these were evaluated and recorded as shown in [Table 8].
Table 8: Complications in implant prostheses

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   Discussion Top


The successful replacement of missing tooth by titanium implants duly integrated into the tissues is a major breakthrough in Dentistry. They represent an alternative offering significant functional and esthetic improvements, and great predictability, revolutionizing treatment perspectives in advanced cases. [1],[2],[3]

From the moment that implant systems with rigorous scientific methodology were introduced, eliminating the pre-existent empiricism, long-term studies of effectiveness have been presented. Besides the use of well-defined criteria of success, so that the effectiveness of different types of implants could be evaluated, it became necessary to establish a method of screening base, common to all studies. [1],[2],[3]

The implants were evaluated according to clinical and radiographic findings and the criteria to consider survival rate were: Absence of mobility, absence of pain, radiolucency, and progressive marginal bone loss. [9],[10],[11] Dentures were evaluated, and dentures were considered successful if there was absence of technical complications, such as screw loosening, porcelain or resin fracture, among others. [9],[11] Lekholm et al.[10] (1999) affirmed that the follow-up parameters must include at least one implant mobility and/or bone loss test using standardized radiographs.

In recent studies Friberg et al. [12] and Turkyilmaz et al., [11] also used implants regular platform, as was done in the present study, 97.71% of MK III implants measuring 3.75 mm and 4.00 mm. The study of Widmark et al.[13] showed that only one complete denture structure was fractured after 6 months of function. This was re-fabricated and the function remained for 9 months of evaluation. All the other dentures survived after 1 year of follow-up, resulting in a success rate of 98% for the dentures. The majority (n = 53) of dentures performed were of the single cemented type. The study of Scheller et al.[14] demonstrated that stable long-term results could be reached when individual teeth are replaced by Brånemark system implants and crowns cemented on CeraOne type abutments.

Friberg et al.[12] using Brånemark system implants with one-stage surgery and early loading observed a survival rate of 92% for 170 implants placed in 40 patients, which demonstrates a good prognosis for the treatment of edentulous mandibles. Our results showed that 12 patients received fixed complete dentures with five implants each. Two of these implants were removed.

Of the total of 232 implants evaluated in 60 patients, the loss and removal of 4 implants was recorded, which corresponds to a survival rate of 98.3%. This result is in agreement with other authors, such as Lekholm et al.[10] who attained success rate of 92.6%, Glauser et al.[15] whose success rate was 97.1%, Kohavi et al.[16] with a success rate of 94.9%, and Astrand et al.[17] whose success rate was 97.3%. Friberg et al.[18] affirmed that the existence of a failure rate is probably due to the learning curve involving treatment. Of the implants lost, three were located in the mandible and one in the maxilla, which presented a survival rate of 98.98% and 97.76%, respectively, a result similar to that of another study by Widmark et al.[13]

Scheller et al.[14] conducted a study with 99 implants and recorded the loss of 2 implants placed in the maxilla and a third implant placed in the mandible. While no implant located in the mandible was lost in the study of Friberg et al.,[6] in the present study the survival rates were not 100% for both arches.

Kohavi et al.[16] investigated the influence of clinical experience on the success of osseointegrated implants placed by dentistry students and found a survival rate of 94.9% for Brånemark system implants in 36 months of follow-up. According to the authors, clinical experience does not appear to influence the prognosis of implants.

Lekholm et al.[10] affirmed that short implants with regular platforms were lost with greater frequency than the other types. In the present study, three of the implants lost were 15 mm long and one implant was 10 mm long. When Tawil and Younan [18] compared the success rate of 10-mm-long implants with shorter implants, no significant differences were found.

Of the patients who lost implants, only one was a smoker. Astrand et al.,[17] in their study, showed that all the implants lost were inserted in smoker patients.

General mean bone loss was 0.18 mm. Other studies, such as those of Bahat, [9] Scheller et al.,[14] and Turkyilmaz et al.,[11] found bone losses that were not very significant. Friberg and Jemt [18] found bone losses greater than 1.8 mm in only 2% of the implants. Nevertheless, Bahat [9] argues that comparisons of bone loss dimensions are complicated by the considerable variations in measurements of bone levels in non-standardized radiographs and by the technical differences between the persons who take them and the method that is used.

Alterations in soft tissue, such as bleeding and abscesses, were evaluated by means of circular probing in the follow-up consultation, as was done by Bahat. [9] There was presence of inflammatory exudate in only 2.16% of the implants evaluated here.

Evaluation of esthetics, phonetics, and chewing was performed by means of the questionnaires answered by patients with regard to satisfaction with the treatment performed. It was recorded that 57.89% of the patients who answered the questionnaire consider the work done in general to be "excellent," 15.79% answered "very good," 7.02% evaluated it as "regular," and 5.26% considered the work "poor," which is in agreement with other studies, such as that of Friberg et al.,[12] in which the results showed that esthetics were considered excellent in 18% and good in 82% of the patients. The judgments as regards function were excellent (30%) and good (70%). All the patients were shown to be completely satisfied with esthetics and function after 5 years of evaluation.

To optimize the esthetics and good positioning of implants on a resorbed alveolar ridge, bone reconstruction surgeries may be required. McCarthy et al.[19] affirmed that autogenous bone grafts have excellent osteogenic properties in comparison with the other types of allogeneic, alloplastic, or xenogenous grafts. In this study, 33 implants were placed in a block bone graft region and 8 implants in a sinus lift region. Autogenous bone grafting may be a feasible method for the reconstruction of atrophic anterior maxillae, optimizing esthetics. McCarthy et al.[19] concluded that bone grafts in the anterior maxilla enable the implant to be placed where there had previously been insufficient bone. There was no loss of implants inserted in these grafted regions. Whereas in the study of McCarthy et al.[19] one implant in a patient who had received the bone graft and implant simultaneously did not attain osseointegration. This represented a success rate of 97.1% of the implants followed up.


   Conclusions Top


The use of osseointegrated implants in the treatment of edentulous mandibles and maxillae became well established and acceptable in contemporary dentistry. Treatment with oral implants of the Brånemark system has been performed for over 35 years. Results with high success rates have been widely demonstrated in the specialized literature.

After analysis of the results obtained in this research, it could be concluded that the success rate was 98.28%, as has been demonstrated in the literature. The factors that determine the long-term success of osseointegrated implants are still poorly defined. The characteristics and behavior of patients, design and microstructure of implants, planning, and surgical technique are the determinant factors in the success of implants.

 
   References Top

1.Albrektsson T. A multicenter report on osseointegrated oral implants. J Prosthet Dent 1988;60:75-84.  Back to cited text no. 1
    
2.Bränemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410.  Back to cited text no. 2
    
3.Bränemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 1969;3:81-100.  Back to cited text no. 3
    
4.Cordioli G, Castagna S, Consolati E. Single-tooth implant rehabilitation: A retrospective study of 67 implants. Int J Prosthodont 1994;7:525-31.  Back to cited text no. 4
    
5.Higuchi KW, Folmer T, Kultje C. Implant survival rates in partially edentulous patients: A 3-year prospective multicenter study. J Oral Maxillofac Surg 1995;53:264-8.  Back to cited text no. 5
    
6.Laney WR, Jemt T, Harris D, Henry PJ, Krogh PH, Polizzi G, et al. Osseointegrated implants for single-tooth replacement: Progress report from a multicenter prospective study after 3 years. Int J oral Maxillofac Implants1994;9:49-54.  Back to cited text no. 6
    
7.Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants: The Toronto study. Part I: Surgical results. J Prosthet Dent 1990;63:451-7.  Back to cited text no. 7
    
8.Bahat O. Brånemark system implants in the posterior maxilla: Clinical study of 660 implants followed for 5 to 12 years. Int J Oral Maxillofac Implants 2000;15:646-53.  Back to cited text no. 8
    
9.Lekholm U, Gunne J, Henry P, Higuchi K, Lindén U, Bergström C, et al. Survival of the Brånemark implant in partially edentulous jaws: A 10-year prospective multicenter study. Int J Oral Maxillofac Implants 1999;14:639-45.  Back to cited text no. 9
    
10.Turkyilmaz I, Avci M, Kuran S, Ozbek EN. A 4-year prospective clinical and radiological study of maxillary dental implants supporting single-tooth crowns using early and delayed loading protocols. Clin Implant Dent Relat Res 2007;9:222-7.  Back to cited text no. 10
    
11.Friberg B, Raghoebar GM, Grunert I, Hobkirk JA, Tepper G. A 5-year prospective multicenter study on 1-stage smooth-surface Brånemark System implants with early loading in edentulous mandibles. Int J Oral Maxillofac Implants 2008;23:481-6.  Back to cited text no. 11
    
12.Widmark G, Friberg B, Johansson B, Sindet-Pedersen S, Taylor A. Mk III: A third generation of the self-tapping Brånemark System implant, including the new Stargrip internal grip design. A 1-year prospective four-center study. Clin Implant Dent Relat Res 2003;5:273-9.  Back to cited text no. 12
    
13.Scheller H, Urgell JP, Kultje C, Klineberg I, Goldberg PV, Stevenson-Moore P, et al. A 5-year multicenter study on implant-supported single crown restorations. Int J Oral Maxillofac Implants 1998;13:212-8.  Back to cited text no. 13
    
14.Glauser R, Lundgren AK, Gottlow J, Sennerby L, Portmann M, Ruhstaller P, et al. Immediate occlusal loading of Brånemark TiUnite implants placed predominantly in soft bone: 1-year results of a prospective clinical study. Clin Implant Dent Relat Res 2003;5:47-56.  Back to cited text no. 14
    
15.Kohavi D, Azran G, Shapira L, Casap N. Retrospective clinical review of dental implants placed in a university training program. J Oral Implantol 2004;30:23-9.  Back to cited text no. 15
    
16.Astrand P, Engquist B, Anzén B, Bergendal T, Hallman M, Karlsson U, et al. A three-year follow-up report of a comparative study of ITI Dental Implants and Brånemark System implants in the treatment of the partially edentulous maxilla. Clin Implant Dent Relat Res 2004;6:130-41.  Back to cited text no. 16
    
17.Friberg B, Jemt T. Rehabilitation of edentulous mandibles by means of five TiUnite implants after one-stage surgery: A 1-year retrospective study of 90 patients. Clin Implant Dent Relat Res 2008;10:47-54.  Back to cited text no. 17
    
18.Tawil G, Younan R. Clinical evaluation of short, machined-surface implants followed for 12 to 92 months. Int J Oral Maxillofac Implants 2003;18:894-901.  Back to cited text no. 18
    
19.McCarthy C, Patel RR, Wragg PF, Brook IM. Dental implants and onlay bone grafts in the anterior maxilla: Analysis of clinical outcome. Int J Oral Maxillofac Implants 2003;18:238-41.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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