Some issues related to evidence-based implantology

Abstract

This article reviews relevant dental literature to answer some frequent questions related to evidence-based implantology. There are hundreds of implant systems on the market, but the majority lack clinical documentation. Recommended number of implants for full-arch fixed prostheses is four or five in the mandible but at least six in the maxilla. Less expensive implant-retained overdentures make implant treatment available to a greater portion of edentulous subjects. Mandibular overdentures on two implants, and even one implant, have shown excellent long-term outcomes. In the maxilla, less than four implants are not recommended for good results. Single implant restorations have good prognosis, but placement of the implant should be postponed until adulthood. Osseointegrated implants have revolutionized clinical dentistry. However, in a global perspective, implants make up only a small part of all prosthodontic treatment. Knowledge and skill in conventional prosthodontics must be maintained as it will remain the most common part of the specialty.

Keywords: Alternatives to implant treatment; fixed implant restorations; mandibular implant overdentures; maxillary implant overdentures; single implant restoration; single midline implant overdenture.

Figure 1

Lateral cephalograph showing fixed implant prostheses ad modum Brånemark on six implants in the anterior part of each jaw. No posterior implants but cantilevers supporting the prostheses to the first molar

Figure 2

(a and b) Single midline implant with a ball attachment to retain a mandibular overdenture

Figure 3

Maxillary implant overdenture with a bar on four implants; (a) inner surface of the overdenture showing the bar retainers; (b) horseshoe type of prosthesis design with open palate. (c) Reprinted from Feine and Carlsson[18] with permission

Figure 4

Edentulous subject treated (in the 1970s) with a mandibular implant overdenture on six anteriorly placed implants and a complete maxillary complete denture

Figure 5

Mean mandibular peri-implant bone loss with respect to prosthetic status in the maxilla. CD = complete denture during the follow-up period of 15 years (n = 31); ISFP = Implant-supported fixed prosthesis place on average after 4.5 years (n = 13)

Figure 6

Panoramic radiographs before and after implant treatment in the right edentulous mandible (a and b); clinical view after treatment (c)

Figure 7

Palatal view of the two-unit bridge (22 pontic, 23 abutment) (a); radiograph of the construction (b); clinical view (c). All pictures are taken 10 years after the insertion of the bridge. Courtesy of Dr. K-G Olsson, Gothenburg, Sweden