Simplified methods of implant treatment in the edentulous lower jaw. A controlled prospective study. Part I: one-stage versus two-stage surgery

Abstract

Background: The original protocol for Brånemark System implants in the mandible was a two-stage procedure with 3 months healing time. With five or six implants and a cast framework of gold, the treatment is rather expensive, and simplified methods would be desirable.

Purpose: The goal of this controlled serial study was to investigate the outcome of a simplified procedure with one-stage surgery, four Brånemark implants, shortened healing time, and a new titanium-acrylic fixed full prosthesis.

Materials and methods: Eighty-two patients were treated in three different groups at two specialist centers. All patients were provided with four implants, loaded with a Procera All-in-One bridge (Nobel Biocare, Gothenburg, Sweden) after 12 weeks. In group A (n = 30), one-stage surgery was combined with two-piece implants. In group B (n = 30), the control group, two-stage surgery and two-piece implants were used. In group C (n = 22), one-stage surgery was combined with one-piece implants. Marginal bone level was rated from radiographs at implant insertion, at baseline, and after 1 year.

Results: The survival rate after 1 year for group A was 93.3%; group B, 97.5%; and group C, 93.2%. The differences were not statistically significant. Between fixture insertion and baseline, the average bone loss for group A was 1.2 mm; group B, 1.3 mm; and group C, 1.3 mm. No complications in the form of bridge loosening or acrylic fractures were recorded during the first year.

Conclusions: The survival rates and the marginal bone changes did not differ significantly between the one-stage groups and the control group. The survival rate and the marginal bone changes were similar for one-piece and two-piece implants. Four implants were sufficient to support full fixed prostheses in the mandibles. The Procera All-in-One bridges proved to be of high quality, and no complications were experienced. key words: endosseous implants, nonsubmerged implants, one-piece implants, prospective clinical study, submerged implants