presenter: dr. sana ehsen supervisors: dr. farhan raza khan 1
TRANSCRIPT
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OUTCOME OF DENTAL IMPLANTS PLACED IN
TERTIARY CARE HOSPITAL
Presenter: Dr. Sana Ehsen
Supervisors: Dr. Farhan Raza Khan
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DENTAL IMPLANTS• A dental implant (also known as an endosseous
implant or fixture) is a surgical component that interfaces with the bone of the jaw to support a dental prosthesis.
Palmer R .Introduction to dental implants. Br Dent J. 1999 Aug 14;187(3):127-32.
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SUCCESS CRITERIA FOR DENAL IMPLANT
• Immobile when tested clinically.
• Radiographically- no peri-implant radiolucency.
• After first year in function, radiographic vertical bone loss of <0.2 mm per annum.
• Absence of signs and symptoms.
• Implant fully functioning according to its intended prosthodontic purpose
Goodacre C J, Bernal G, Rungcharassaeng K, Kan J Y. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003; 90: 121-132.
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Esposito, M.; Grusovin, M. G.; Talati, M.; Coulthard, P.; Oliver, R.; Worthington, H. V. (2008). "Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications" Cochrane Database of Systematic Reviews .
Javed, F.; Romanos, G. E. (2010). "The role of primary stability for successful immediate loading of dental implants. A literature review". Journal of Dentistry 38 (8): 612–620
Post-operative
complications
Infection
Excessive bleeding
Flap breakdow
n
Failure to
integrate
Atrophic bone
Loss of retentio
n
Poor crown
root ratio
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CLASSIFICATION OF DENTAL IMPLANTS
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6IMPLANT SIZES
• Mini/ Narrow Body dental implants
• Standard Implant Platform
• Wide Implant Platform
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7IMPLANT SURFACE MODIFICATIONS
Esposito, M; Coulthard, P; Thomsen, P. & Worthington, HV. (2005). The role of implant surface modifications, shape and material on the success of osseointegrated dental implants. A Cochrane systematic review. Eur J Prosthodont Restor Dent, 13, 15-31.
Machined Titanium
Acid Etched Titanium
Plasma Spray Coated
HA Coated Titanium
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TIME OF INSTALLATION
• Immediate implants
• Delayed implants
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9TIME OF PROSTHETIC LOADING
Immediate loading: Application of functional or nonfunctional load to an implant at the time of placement or within 48 hours
Early loading: 4 - 8 weeks.
Delayed loading implant:
after 3-6 months.Laney WR. Glossary of Oral and Maxillofacial Implants. Chicago, IL: Quintessence; 2007:73.
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IMPLANT PLACEMENT
3 million people in the US have implants placed.
Approximately 1 million dental implants placed annually.
Crest® Oral-B® at dentalcare.com Continuing Education Course, Revised March 6, 2013 .Moldovan S, Lyle DM. The Failing Implant: Reducing Risk- Addressing modifiable risk factors to help avoid complications. Inside Dentistry June 2014, Volume 10, Issue 6.
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RATIONALE
• Since local data is lacking on success of this treatment modality, therefore we wanted to explore the outcome of implant service in our center.
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12STUDY
OBJECTIVE
To assess the outcome of dental implant placement at AKUH.
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MATERIALS AND METHODS
• Study design : Retrospective charts review
• Study duration : 2010-2014
• Setting : AKUH dental clinics
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• Inclusion criteria:• Patients receiving implants since 2010 under
local anesthesia
• Patients who received dental implants with all surgical and prosthetic work done within AKUH.
• Exclusion criteria:• Patients whose data was missing.
• Implant procedure done by other faculty.
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DATA ANALYSIS
• SPSS version 19.0
• Descriptive statistics & frequency distribution were computed.
• Chi square test was applied to explore association of implant success with other factors such as jaw type, dentate status, need for grafting.
• P-value of 0.05 was taken as statistically significant.
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RESULTS
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17Study duration: 2010-2014
Total number of implants placed at AKU n ≈ 300
165
Placed by other
consultants 173
Surgically successful butYet to be loaded prosthetically n=55
Failed to osseointegrate n=6
Successful casesProsthetic data available n=
104
159
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Implants placement acc to Gender
Malesn=68
Fe-malesn=97
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MEAN AGE OF THE PATIENTSStd.
deviation
mean maximum
Minimum
n
73 17 165 Age(years)
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MEDICAL STATUSn=165
Health
y
Diabe
tes Mel
l...
Hyper
tens
ion
Smok
er
Diabe
tes,HTN
HTN, S
mok
er
115
817
59 8
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21PATIENT DENTAL STATUS
n=165
Fully Edentulous Partially Dentate
141
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22OSSEOINTEGRATION OUTCOMEn=165
Failed to Osseointegrate Osseo-integration Achieved
3.6%
96.3%
159
6
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IMPLANT DIAMETERn=165
3.7mm (Green) 4.7mm (Purple) 6mm (Golden)
74
78
13
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IMPLANT LENGTHn=165
8 mm 10 mm 11.5 mm 13 mm 16 mm
16
26
65
54
1
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TYPE OF ABUTMENTn=165
Straight Abutment Angled Abutment
155
10
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26TIME OF LOADINGn=165
Immediate Delayed
25
140
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LOADING OF IMPLANTn=127
Removed Loaded Healing Collar Submerged6
103
48
6
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FINAL PROSTHESISn=159
Single Crown Abutment of Fixed Bridge
overdenture abutment
55
101
2
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OSSEO-INTEGRATION OUTCOME
OSSEOINTEGRATION OUTCOME
PATIENT’S DENTAL STATUS
TOTAL P valueFully edentulo
us
Partially dentate
Failed to integrate 4 2 6
0.364Osseo-integration achieved
61 98 159
Total 65 100 165
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Osseo-integration outcome (Grafting)
Patient’s Dental StatusTotaln= 165
p valueFully
edentulous
Partially dentate
No graft
Failed to
integrate
4 1 5
0.09
Osseo-int
achieved
44 70 114
Minimal graft
Osseo-int
achieved
10 20 30
Considerable grafting
Failed to
integrate
0 1 1
Osseo-int
achieved
1 2 3
Total
Failed to
integrate
4 2 6
Osseo-int
achieved
50 86 159
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DISCUSSION
• Dental implants are considered as a predictable treatment option for replacement of missing dentition.
• With the achievement of high success rates, frequency of dental implant placement is increasing worldwide.
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COMPARISON WITH OTHER STUDIES
Other studie
s
n,Age Study
Implant type,
Placement
Width, Length,
Site
Restoration, Follow
up
Success of
implants
Min-Su Bae
(Korea)2011
294 implants
27-71 years2 years
RetrospectiveMIS Self Tapping
3.75 mm
11.5-13 mm
Maxillary/ Mandibular
molars
Single abutment,
FPD,Over denture.
4 years
97.3%
Renzo Guanieri
(Italy)2014
46 implants2 failed
26-60 years
2 years Retrospective,
multicenter
BioHorizon
Immediate
3.8-4.6 mm
9-15 mm
-
24 months95.6%
AKUH(Pakistan)
2014
165 implants6 failed
17-70 years
5 years RetrospectiveSingle center
Zimmer
Immediate + delayed
4.7 mm
11.5 mm
All sites
Single crown, FPD
Overdenture.
Upto 5 years
96.3%
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COMPARISON WITH OTHER STUDIES
Other studies
n, Age Study Implant type,
PlacementWidth,
Length, SiteRestoration,
Follow upSuccess
of implants
Alejandro Pachos(Spain)2005
415 implants,22 failed
21-89 years
7 yearsRetrospectiveMulticenter
Klockner.
Delayed
3.2-5.5 mm
10-18 mm
Posterior maxilla
Single, FPD, Over
denture
5 years
95.38%
Zeev Omrainer
(Israel)2012
173 implants1 failed
18-75 years
10 years Retrospective
Zimmer
Immediate+ delayed
3.7 mm13 mm
-10 years 99.0%
AKUH(Pakistan)
2014
127 implants5 failed
17-70 years
4 years Retrospective
Zimmer tapered screw vent.
Immediate + delayed
4.7 mm
11.5 mm
All sites
Single crown, FPD
Overdenture
Upto 4 years
96.1%
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CONCLUSIONS
• Most common length: 11.5mm
• Most common diameter: 4.7mm (purple)
• Most common site : LR6
• Prosthesis for more than half of the implants were fixed bridges.
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• Our results are comparable to other centers of the world in terms of success achieved in osseointegration of dental implants i.e. 96%
• Previous studies have demonstrated a decrease in the success rate of implants in patients with medical co-morbids.
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FAILURES OF IMPLANTS
• The most probable cause for the failure of 5 implants in our study group:
• Case 1: 46 Male, maxillary premolar. Atrophic maxilla, Significant deficiency in bone+ bone grafting
• Case2: Edentulous atrophic maxilla: 80 years female, diabetic, hypertensive, early loading with interim prosthesis.
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FAILURES OF IMPLANTS
• Case 3, 4: 55 years male. Diabetic, atrophic edentulous maxilla, early loading with interim prosthesis. Failure on left and right maxilla.
• Case 5: 22 years male, significant bone loss in anterior maxilla, premature loading.
• Case 6: 55 female, implant failure during removal of prosthesis.
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STRENGTHS
• Baseline statistics on current outcome of implant placement in our center.
• Complete data available on both clinical and radiographic aspects.
• Surgical and prosthetic aspects were covered.
• Rigid criteria of implant success was used.
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LIMITATIONS
• No comparison group
• Single clinician
• Single center study
• Single arm study
• No data on patient satisfaction/ esthetic aspects
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RECOMMENDATIONS
• Cases with atrophic maxilla, significant bone loss and those subjected to interim prosthesis loading should be dealt with caution.
• Multicentre studies on implants with a larger sample size should be commenced.
• For the clinicians; is to form an archive to store data for research and study purposes.
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THANK YOU