Cecile Dagorne Jacques Malet Geoffray Bizouard Francis Mora Helene Rang e Philippe Bouchard
Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study
Authors’ affiliations: Cecile Dagorne, Jacques Malet, Francis Mora, Helene Rang e, Philippe Bouchard, Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 – Denis Diderot University, U.F.R. of Odontology, Paris, France Geoffray Bizouard, Research Clinic Unit, Mondor Hospital, AP-HP, Cr eteil, France Philippe Bouchard, EA 2496, Paris Descartes University, France
Key words: dental implants, implant macrostructure, peri-implant bone level, retrospective
Corresponding author: Prof. Philippe Bouchard U.F.R. d’Odontologie 5, rue Garanci ere 75006 Paris, France Tel.: +33 1 53 10 50 10 Fax: +33 1 40019 39 86 e-mail: [email protected]
analyzed to evaluate mean bone level changes around implants during a mean follow-up of
study Abstract Objectives: To compare the effect of two implant macrostructures on peri-implant bone level. Material and methods: This retrospective cohort study was conducted in a private practice. Patients received test (Nobel Speedy Groovy implants) or control implants (Mk III implants) or both. Baseline and corresponding follow-up radiographs, taken with a long-cone technique, were 69 19 months. A chi-squared test was performed to compare the bone level changes between the two types of implants. A multivariate analysis was used to explain the difference between the two groups. Results: After controlling for inclusion and exclusion criteria, 144 dental implants corresponding to 68 implants in the test group and 76 implants in the control group were placed in 59 patients. Nine dental implants (6.25%) were lost during the observation period: five implants in the test group and four implants in the control group. Consequently, a total of 135 implants placed in 58 patients were available for analysis. Our study shows a significant difference of peri-implant bone level overtime between the test and control groups (P < 0.01). At the end of the observation period, a bone growth was observed in the control group (0.02 0.80 mm), whereas a bone loss was found in the test group ( 0.43 1.11 mm). The mean bone level at baseline and the type of periodontal therapy and the maintenance care program were involved in this difference (P < 0.001, P = 0.035, P < 0.001, respectively). Conclusion: Our study demonstrates a significant difference in peri-implant bone level between test and control groups. The mean bone level at baseline, the type of periodontal therapy, and the maintenance program may explain peri-implant bone level changes overtime.
Date: Accepted 16 September 2014 To cite this article: Dagorne C, Malet J, Bizouard G, Mora F, Rang e H, Bouchard P. Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study. Clin. Oral Impl. Res. 00, 2014, 1–7 doi: 10.1111/clr.12498
One of the major topics of research in implant dentistry aims to improve dental implant shapes to accelerate the osseointegration process, to preserve marginal bone, and to prevent peri-implantitis. So far, there is no consensus on the ideal shape. Thus, most dental implants are commercially available in different shapes and dimensions (Malet et al. 2012). In a review about the effect of different surfaces and designs on marginal bone level alterations, Abrahamsson & Berglundh (2009) found only one study showing significant improvement of the crestal bone preservation for implants with conical and microthreaded marginal collar compared to implants with cylindrical and non-threaded marginal portion after 3 years in function. In 2011, in
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
another systematic review, Bateli et al. failed to show the effectiveness of any specific modification in the implant neck area in preserving marginal bone after 5 years of loading. However, there is controversial data in the literature of the superiority, in preserving crestal bone, of the rough and microthreaded collar compared to the machined neck (Lee et al. 2007; Bratu et al. 2009; Nickenig et al. 2009). The thread design can also influence the alterations of marginal bone level and the progression of peri-implantitis. Threaded implants have shown better bone implant contact and better bone fixation than nonthreaded implants (Bolind et al. 2005). Furthermore, it seems that bone implant contact and reverse torque measurements are
1
Dagorne et al Implant macrostructure and marginal bone level
significantly better with square threads than with V or reverse buttress threads (Steigenga et al. 2004). Many macrostructures have been proposed to improve bone integration and stability. To evaluate the influence of the macrostructure on marginal bone level overtime, two types of implant made by the Nobel Biocareâ company (Nobel Biocare, Z€ urich-Flughafen, Switzerland) have been compared: a control implant, the Mk III (an evolution of the original one) and a test implant the Nobel Speedy Groovy. Those two implants have the same moderately rough TiUnite oxidized surface but different shape and design. The Mk III is a parallel implant, with a wide-machined neck and V threads on the body. The Nobel Speedy Groovy implant has a tapered apex to improve the initial stability. The TiUniteâ surface and threads are closer to the implant shoulder and abutment seating surface, this have been made to preserve crestal bone and enhance marginal osseointegration. Finally, those threads are different, they have larger edges, and grooves have been added to the threads to promote bone growth; the idea is that those grooves increase the implant surface in contact with bone (Fig. 1). The aim of this retrospective study was to compare the effect of implant macrostructure on peri-implant bone level overtime.
Material and methods Study design
This retrospective study was conducted in a private practice specializing in periodontology and implant surgery in Paris, France. One surgeon operated all the patients (JM).
Dental implants were placed following oneor two-stage procedures, according to the standard protocol of the manufacturer. The implants were placed between 2002 and 2008. Patients could have received test (Nobel Speedy Groovy implant) or control implants (Mk III implant) or both. Following the osseointegration process, the restorative procedure was performed. With regard to the processing of personal data related to the protection of individuals, a declaration to the Commission Nationale de l’Informatique et des Libert es (CNIL) was made prior to the study (agreement no 1731429 v 0). Cases and data selection
To be selected, cases had to meet the following inclusion criteria:
• • • •
The following criteria excluded the cases from the study:
• •
• • • • • • • • • 2 |
Clin. Oral Impl. Res. 0, 2014 / 1–7
Absence of the baseline radiograph or the follow-up radiograph was made after
Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study
Authors’ affiliations: Cecile Dagorne, Jacques Malet, Francis Mora, Helene Rang e, Philippe Bouchard, Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 – Denis Diderot University, U.F.R. of Odontology, Paris, France Geoffray Bizouard, Research Clinic Unit, Mondor Hospital, AP-HP, Cr eteil, France Philippe Bouchard, EA 2496, Paris Descartes University, France
Key words: dental implants, implant macrostructure, peri-implant bone level, retrospective
Corresponding author: Prof. Philippe Bouchard U.F.R. d’Odontologie 5, rue Garanci ere 75006 Paris, France Tel.: +33 1 53 10 50 10 Fax: +33 1 40019 39 86 e-mail: [email protected]
analyzed to evaluate mean bone level changes around implants during a mean follow-up of
study Abstract Objectives: To compare the effect of two implant macrostructures on peri-implant bone level. Material and methods: This retrospective cohort study was conducted in a private practice. Patients received test (Nobel Speedy Groovy implants) or control implants (Mk III implants) or both. Baseline and corresponding follow-up radiographs, taken with a long-cone technique, were 69 19 months. A chi-squared test was performed to compare the bone level changes between the two types of implants. A multivariate analysis was used to explain the difference between the two groups. Results: After controlling for inclusion and exclusion criteria, 144 dental implants corresponding to 68 implants in the test group and 76 implants in the control group were placed in 59 patients. Nine dental implants (6.25%) were lost during the observation period: five implants in the test group and four implants in the control group. Consequently, a total of 135 implants placed in 58 patients were available for analysis. Our study shows a significant difference of peri-implant bone level overtime between the test and control groups (P < 0.01). At the end of the observation period, a bone growth was observed in the control group (0.02 0.80 mm), whereas a bone loss was found in the test group ( 0.43 1.11 mm). The mean bone level at baseline and the type of periodontal therapy and the maintenance care program were involved in this difference (P < 0.001, P = 0.035, P < 0.001, respectively). Conclusion: Our study demonstrates a significant difference in peri-implant bone level between test and control groups. The mean bone level at baseline, the type of periodontal therapy, and the maintenance program may explain peri-implant bone level changes overtime.
Date: Accepted 16 September 2014 To cite this article: Dagorne C, Malet J, Bizouard G, Mora F, Rang e H, Bouchard P. Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study. Clin. Oral Impl. Res. 00, 2014, 1–7 doi: 10.1111/clr.12498
One of the major topics of research in implant dentistry aims to improve dental implant shapes to accelerate the osseointegration process, to preserve marginal bone, and to prevent peri-implantitis. So far, there is no consensus on the ideal shape. Thus, most dental implants are commercially available in different shapes and dimensions (Malet et al. 2012). In a review about the effect of different surfaces and designs on marginal bone level alterations, Abrahamsson & Berglundh (2009) found only one study showing significant improvement of the crestal bone preservation for implants with conical and microthreaded marginal collar compared to implants with cylindrical and non-threaded marginal portion after 3 years in function. In 2011, in
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
another systematic review, Bateli et al. failed to show the effectiveness of any specific modification in the implant neck area in preserving marginal bone after 5 years of loading. However, there is controversial data in the literature of the superiority, in preserving crestal bone, of the rough and microthreaded collar compared to the machined neck (Lee et al. 2007; Bratu et al. 2009; Nickenig et al. 2009). The thread design can also influence the alterations of marginal bone level and the progression of peri-implantitis. Threaded implants have shown better bone implant contact and better bone fixation than nonthreaded implants (Bolind et al. 2005). Furthermore, it seems that bone implant contact and reverse torque measurements are
1
Dagorne et al Implant macrostructure and marginal bone level
significantly better with square threads than with V or reverse buttress threads (Steigenga et al. 2004). Many macrostructures have been proposed to improve bone integration and stability. To evaluate the influence of the macrostructure on marginal bone level overtime, two types of implant made by the Nobel Biocareâ company (Nobel Biocare, Z€ urich-Flughafen, Switzerland) have been compared: a control implant, the Mk III (an evolution of the original one) and a test implant the Nobel Speedy Groovy. Those two implants have the same moderately rough TiUnite oxidized surface but different shape and design. The Mk III is a parallel implant, with a wide-machined neck and V threads on the body. The Nobel Speedy Groovy implant has a tapered apex to improve the initial stability. The TiUniteâ surface and threads are closer to the implant shoulder and abutment seating surface, this have been made to preserve crestal bone and enhance marginal osseointegration. Finally, those threads are different, they have larger edges, and grooves have been added to the threads to promote bone growth; the idea is that those grooves increase the implant surface in contact with bone (Fig. 1). The aim of this retrospective study was to compare the effect of implant macrostructure on peri-implant bone level overtime.
Material and methods Study design
This retrospective study was conducted in a private practice specializing in periodontology and implant surgery in Paris, France. One surgeon operated all the patients (JM).
Dental implants were placed following oneor two-stage procedures, according to the standard protocol of the manufacturer. The implants were placed between 2002 and 2008. Patients could have received test (Nobel Speedy Groovy implant) or control implants (Mk III implant) or both. Following the osseointegration process, the restorative procedure was performed. With regard to the processing of personal data related to the protection of individuals, a declaration to the Commission Nationale de l’Informatique et des Libert es (CNIL) was made prior to the study (agreement no 1731429 v 0). Cases and data selection
To be selected, cases had to meet the following inclusion criteria:
• • • •
The following criteria excluded the cases from the study:
• •
• • • • • • • • • 2 |
Clin. Oral Impl. Res. 0, 2014 / 1–7
Absence of the baseline radiograph or the follow-up radiograph was made after
