Ronald E Jung1, Bilal Al-Nawas2, Mauricio Araujo3, Gustavo Avila-Ortiz4, Stephen Barter5, Nadine Brodala6, Vivianne Chappuis7, Bo Chen8, Andre De Souza9, Ricardo Faria Almeida10,11, Stefan Fickl12, Gary Finelle13, Jeffrey Ganeles14,15, Hadi Gholami9, Christoph Hammerle1, Simon Jensen16, Asbjørn Jokstad17,18, Hideaki Katsuyama19,20, Johannes Kleinheinz21, Chatchai Kunavisarut22, Nikos Mardas23, Alberto Monje7,24, Panos Papaspyridakos9, Michael Payer25, Eik Schiegnitz2, Ralf Smeets26, Martina Stefanini27, Christiaan Ten Bruggenkate28, Konstantinos Vazouras9, Hans-Peter Weber9, Dieter Weingart29, Péter Windisch30. 1. Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland. 2. Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. 3. Department of Dentistry, Universidade Estadual de Maringa, Maringa, Brazil. 4. Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa. 5. Centre for Oral Clinical Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 6. Private Practice, Chicago, Illinois. 7. Department of Oral Surgery and Stomatology, University of Bern, Bern, Switzerland. 8. Department of Oral Implantology, Peking University School and Hospital of Stomatology, Beijing, China. 9. Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts. 10. University of Porto, Porto, Portugal. 11. Complutense University of Madrid, Madrid, Spain. 12. Department of Periodontology, University of Würzburg, Germany and Private Office, Nuremberg/Fuerth, Germany. 13. Gary Finelle, Private Practice, Paris, France. 14. South Florida Center for Periodontics and Implant Dentistry, Boca Raton, Florida. 15. Nova Southeastern University, Fort Lauderdale, Florida. 16. Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark. 17. Clinical Dentistry, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. 18. Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. 19. Private Practice, MM Dental Clinic, Tokyo, Japan. 20. Tokyo Medical and Dental University, Tokyo, Japan. 21. Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Münster, Germany. 22. Advanced General Dentistry Department, Faculty of Dentistry, Mahidol University, Bangkok, Thailand. 23. Adult Oral Health-Periodontology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 24. Department of Periodontology, International University of Catalonia, Barcelona, Spain. 25. Department of Oral Surgery and Radiology, Dental School, Medical University of Graz, Graz, Austria. 26. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 27. Parodontologia, Università di Bologna, Bologna, Italy. 28. OMF Surgery, Free University, VU Medical Center, Amsterdam, The Netherlands. 29. Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastisch-ästhetische Operationen, Zentrum für Implantologie, Klinikum Stuttgart, Katharinen Hospital, Stuttgart, Germany. 30. Department of Periodontology, Semmelweis Egyetem, Budapest, Hungary.
Abstract
OBJECTIVES: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed. MATERIALS AND METHODS: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. CONCLUSIONS: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.
OBJECTIVES: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed. MATERIALS AND METHODS: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. CONCLUSIONS: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.
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