Marginal Bone Loss and Clinical Evaluation of Angled Implants: A Retrospective Study

Year 2024, Issue: 3, 60 - 69, 15.10.2024

Beyza Öztaş , Doğan Ilgaz Kaya

Abstract

Aim: The volume of the edentulous crest and its proximity to critical anatomical structures are important limiting factors for implant surgery. Surgical procedures with complications can be avoided by placing angled implants. The aim of this clinical study was to evaluate marginal bone loss and the complications of angled implants.
Materials and Methods: Fifty-eight dental implants were examined in 32 patients (16 females, 16 males) with cone beam computed tomography (CBCT) images from patients with angled implants and complete edentation. The marginal bone loss in angled implants that were functional for 15 to 30 months was evaluated according to factors such as implant angle, connection type, opposing arch restoration type and planning of superstructure restoration. Marginal bone loss measurements were recorded from CBCT sections.
Results: It was determined that 3.44% of the implants placed had an inclination of less than 15°, 75.86% had an inclination between 15° and 30° and 20.68% had an inclination of more than 30°. While there was no marginal bone loss on the mesial and distal surfaces, the average marginal bone loss was 0.66 on the buccal surfaces and 0.93 in the lingual region. Only one of the implants examined failed. No pain or infection was observed in any of the implants examined.
Conclusion: According to the results of this retrospective clinical study, further clinical studies with larger sample sizes are needed to evaluate angled implants supported by full arch fixed prostheses as a predictable and valid treatment method in the prosthetic rehabilitation of edentulous jaws.

Keywords

dental implant, marginal bone loss, tilted implant

Açılı Yerleştirilmiş İmplantların Marjinal Kemik Kaybı ve Klinik İncelenmesi: Retrospektif Çalışma

Abstract

Amaç: Dişsiz kretin hacmi ve kritik anatomik yapılara komşuluğu, implant cerrahisinin önemli limitleyicilerdendir. Açılı implantlar yerleştirilerek komplikasyonlara sahip cerrahi işlemlerden kaçınılabilmektedir. Bu klinik çalışmanın amacı açılı yerleştirilmiş implantların marjinal kemik kaybını ve komplikasyonları değerlendirmektir.
Gereç ve Yöntem: Açılı implant yerleştirilmiş hastalardan konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleri bulunan, tam dişsizliğe sahip 32 hastada (16 kadın-16 erkek), 58 dental implant incelenmiştir. 15 ila 30 aylık süre boyunca fonksiyonda olan açılı implantlarda meydana gelen marjinal kemik kaybının implant açısı, bağlantı tipi, karşıt ark restorasyon tipi ve üst yapı restorasyonunun planlanması gibi faktörlere göre değerlendirilmesi yapılmıştır. Marjinal kemik kaybı ölçümü KIBT’tan alınan kesitlerden kaydedildi.
Bulgular: Yerleştirilen implantların %3,44’u 15° den daha az eğimli, % 75,86’ı 15°- 30° eğimleri arasında, %20,68’i 30° den fazla eğimde olduğu belirlenmiştir. Mesial ve distal yüzeylerde marjinal kemik kaybı yokken bukkal yüzeylerde ortalama 0,66 lingual bölgede 0,93’dür. İncelenen implantların sadece bir tanesinde başarısızlık gözlenmiştir. İncelenen hiçbir implantta ağrı, enfeksiyon gözlenmedi.
Sonuç: Bu retrospektif klinik çalışmanın sonuçlarına göre, tam dişsiz çenelerin protetik rehabilitasyonunda, tam ark sabit protezlerle desteklenen açılı implantların öngörülebilir ve geçerli bir tedavi yöntemi olarak değerlendirilebilmesi için daha büyük örneklem büyüklüğüne sahip ileri klinik çalışmalara ihtiyaç vardır.

Keywords

açılı implant, dental implant, marjinal kemik kaybı

References

• Lemos CA, Ferro-Alves ML, Okamoto R, Mendonça MR, Pellizzer EP. Short dental implants versus standard dental implants placed in the posterior jaws: a systematic review and meta-analysis. J Dent. 2016;47:8-17.
• Malo P, de Araújo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142:310-20.
• Chrcanovic BR, Kisch J, Larsson C. Analysis of technical complications and risk factors for failure of combined tooth-implant-supported fixed dental prostheses. Clin Implant Dent Relat Res. 2020;22:523-32.
• Ramezanzade S, Aeinehvand M, Khurshid Z, Keyhan SO, Fallahi HR, Abbasi A. Treatment options for oral rehabilitation of the atrophic maxilla: a literature review. Avicenna J Dent Res. 2023;15:122-33.
• Schmid E, Roccuzzo A, Morandini M, Ramseier CA, Sculean A, Salvi GE. Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extension in posterior areas: a retrospective study with a follow-up of at least 10 years. Clin Implant Dent Relat Res. 2021;23:189-96.
• Vinci R, Teté G, Lucchetti FR, Capparé P, Gherlone EF. Implant survival rate in calvarial bone grafts: a retrospective clinical study with 10-year follow-up. Clin Implant Dent Relat Res. 2019;21:662-8.
• Eshaweirf E, Sougei A. Short dental implants versus standard dental implants placed in the posterior jaws. Int J Med Arts. 2023;5:3572-82.
• Gherlone EF, D’Orto B, Nagni M, Capparè P, Vinci R. Tilted implants and sinus floor elevation techniques compared in posterior edentulous maxilla: a retrospective clinical study over four years of follow-up. NATO Adv Sci Inst Ser E Appl Sci. 2022;12:6729.
• Del Fabbro M, Pozzi A, Romeo D, de Araújo Nobre M, Agliardi E. Outcomes of fixed full-arch rehabilitations supported by tilted and axially placed implants: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2022;37:1003-25.
• Asawa N, Bulbule N, Kakade D, Shah R. Angulated implants: an alternative to bone augmentation and sinus lift procedure: a systematic review. J Clin Diagn Res. 2015;9:ZE10-ZE13.
• De Vico G, Bonino M, Spinelli D, Schiavetti R, Sannino G, Pozzi A, et al. Rationale for tilted implants: FEA considerations and clinical reports. Oral Implantol. 2011;4:23-33.
• Buser HP, Dula K, Lang NP. Tissue integration of non-submerged implants: 1-year results of a prospective study with 100 ITI hollow-screw and hollow-cylinder implants. Clin Oral Implants Res. 1990;1:33-40.
• Albrektsson T, Zarb GA. Determinants of correct clinical reporting. Int J Prosthodont. 1998;11:355-61.
• Agliardi E, Panigatti S, Clericò M, Villa C, Malò P. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study. Clin Oral Implants Res. 2010;21:459-65.
• Ata-Ali J, Peñarrocha-Oltra D, Candel-Marti E, Peñarrocha-Diago M. Oral rehabilitation with tilted dental implants: a meta-analysis. Med Oral Patol Oral Cir Bucal. 2012;17:7.
• Sharaf MA, Wang S, Mashrah MA, Xu Y, Haider O, He F. Outcomes that may affect implant and prosthesis survival and complications in maxillary fixed prosthesis supported by four or six implants: a systematic review and meta-analysis. Heliyon. 2024 Feb 15;10(3)
• Chrcanovic BR, Albrektsson T, Wennerberg A. Tilted versus axially placed dental implants: a meta-analysis. J Dent. 2015;43:149-70.
• Pomares C. A retrospective clinical study of edentulous patients rehabilitated according to the “all on four” or the “all on six” immediate function concept. Eur J Oral Implantol. 2009;2:55-60.
• Maló P, Rangert B, Nobre M. All-on-4 immediate-function concept with Brånemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7:1-94.
• Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. “All-on-4” immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and long-term (5 years) outcomes. Clin Implant Dent Relat Res. 2012;14:1-50.
• Pelekos G, Acharya A, Tonetti MS, Bornstein MM. Diagnostic performance of cone beam computed tomography in assessing peri-implant bone loss: a systematic review. Clin Oral Implants Res. 2019;29:443-64.
• González-Martín O, Oteo C, Ortega R, Alandez J, Sanz M, Veltri M. Evaluation of peri-implant buccal bone by computed tomography: an experimental study. Clin Oral Implants Res. 2016;27:950-5.
• Misch KA, Yi ES, Sarment DP. Accuracy of cone beam computed tomography for periodontal defect measurements. J Periodontol. 2006;77:1261-6.
• Li F, Jia PY, Ouyang XY. Comparison of measurements on cone beam computed tomography for periodontal intrabony defect with intra-surgical measurements. Chin J Dent Res. 2015;18:171-6.
• Barnea E, Tal H, Nissan J, Tarrasch R, Peleg M, Kolerman R. The use of tilted implants for posterior atrophic maxilla. Clin Implant Dent Relat Res. 2016;18:788-800.
• Rosén A, Gynther G. Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study. J Oral Maxillofac Surg. 2007;65:1010-6.
• Krennmair S, Seemann R, Weinländer M, Krennmair G, Piehslinger E. Immediately loaded distally cantilevered fixed mandibular prostheses supported by four implants placed in both fresh extraction and healed sites: 2-year results from a prospective study. Eur J Oral Implantol. 2014;7:73-84.
• Chochlidakis K, Einarsdottir E, Tsigarida A, Papaspyridakos P, Romeo D, Barmak AB, et al. Survival rates and prosthetic complications of implant fixed complete dental prostheses: an up to 5-year retrospective study. J Prosthet Dent. 2020;124:539-46.
• Aanenson JW, Till JE, Grogan HA. Understanding and communicating radiation dose and risk from cone beam computed tomography in dentistry. J Prosthet Dent. 2018;120:353-60.
• Pauwels R. Cone beam CT for dental and maxillofacial imaging: dose matters. Radiat Prot Dosimetry. 2015;165:156-61.