- Email: [email protected]
Short implants
Short implants Background.—More short implants (10 mm or less) are being used for extremely resorbed posterior regions in partially edentulous patients. Previously, short implants were associated with reduced survival rates because of the diminished amount of bone-to-implant contact, because their posterior location has a poorer quality of alveolar bone, and because of a higher crown-to-implant ratio. To avoid using short implants, extremely resorbed bone can be augmented using bone-grafting techniques, but this additional surgical intervention also leads to higher patient morbidity, higher costs, and longer treatment times. New developments in implant systems and surface treatment techniques have provided better results with larger surface areas even for short implants. The clinical outcome of implants measuring <10 mm for partially edentulous patients was evaluated in a systematic review of the literature, also noting the sources of heterogeneity between studies through subgroup analysis. Methods.—The systematic search used the MEDLINE and EMBASE databases covering the period from 1980 through October 2009. Twenty-nine studies were selected, covering a total of 2611 short implants that ranged from 5 to 9.5 mm in length. Results.—The estimated survival rate after 2 years was 93.1% for 5-mm, 97.4% for 6-mm, 97.6% for 7-mm, 98.4% for 8-mm, 98.8% for 8.5-mm, 98.0% for 9-mm, and 98.6% for 9.5-mm implants. Cumulative estimated survival rates for the maxilla and mandible were 0.010 and 0.003 implants/ year, respectively. The failure rate in studies that included smokers was 0.008, but for studies that excluded smokers,
it was 0.004. Neither surface topography nor augmentation procedure was a source of heterogeneity. Discussion.—Partially edentulous patients may do well with short implants, although the longer the implant, the higher the survival rate. Patients who do not smoke tend to have better outcomes. Implants placed in the mandible appear to have a better prognosis than those placed in the maxilla.
Clinical Significance.—In the range of implants from 5 to 8.5 mm, the longer the implant, the higher the survival rate. Thus, the shortest implants should be used with caution. Mandibular implants fare better than maxillary ones, and smoking has a significant deleterious effect on implant survival. Implants with a rough surface have survival rates comparable with those with a smooth turned surface. Augmentation procedures do not appear to have any impact on the longevity of short implants. All these facts need to be considered when advising patients about the choices for improving their dentition.
Telleman G, Raghoebar GM, Vissink A, et al: A systematic review of the prognosis of short (<10 mm) dental implants placed in the partially edentulous patient. J Clin Periodontol 38:667-676, 2011 Reprints available from G Telleman, Dept of Oral and Maxillofacial Surgery, Univ Medical Ctr Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; e-mail: [email protected]
Oral Cancer Delayed presentation Background.—About 40% of patients with oral cancer are first seen with advanced disease, with the delay in coming for treatment attributable to the patient. Advanced disease requires more radical treatment and has a poorer prognosis. In addition, there is more treatment needed, more patient and caregiver distress, and worse healthrelated quality-of-life outcomes, along with added healthcare costs, with late presentation. The public has a generally poor awareness of oral cancer, with oral symptoms seldom seen as being an indicator of any type of cancer. Thus, patients delay seeking help and are often unconcerned about
symptoms, often only changing the way they eat, using personal remedies, or simply talking to their family or friends rather than to an oral healthcare professional. Barriers to seeking treatment may hinder early reporting of symptoms. Patients who were treated for oral cancer were interviewed to help identify measures that may promote earlier presentation for care. Methods.—Seventy-one individuals completed a short survey, and 44 responded to a telephone interview. All had been treated within the past 2 years for oral and
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2012
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it was 0.004. Neither surface topography nor augmentation procedure was a source of heterogeneity. Discussion.—Partially edentulous patients may do well with short implants, although the longer the implant, the higher the survival rate. Patients who do not smoke tend to have better outcomes. Implants placed in the mandible appear to have a better prognosis than those placed in the maxilla.
Clinical Significance.—In the range of implants from 5 to 8.5 mm, the longer the implant, the higher the survival rate. Thus, the shortest implants should be used with caution. Mandibular implants fare better than maxillary ones, and smoking has a significant deleterious effect on implant survival. Implants with a rough surface have survival rates comparable with those with a smooth turned surface. Augmentation procedures do not appear to have any impact on the longevity of short implants. All these facts need to be considered when advising patients about the choices for improving their dentition.
Telleman G, Raghoebar GM, Vissink A, et al: A systematic review of the prognosis of short (<10 mm) dental implants placed in the partially edentulous patient. J Clin Periodontol 38:667-676, 2011 Reprints available from G Telleman, Dept of Oral and Maxillofacial Surgery, Univ Medical Ctr Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; e-mail: [email protected]
Oral Cancer Delayed presentation Background.—About 40% of patients with oral cancer are first seen with advanced disease, with the delay in coming for treatment attributable to the patient. Advanced disease requires more radical treatment and has a poorer prognosis. In addition, there is more treatment needed, more patient and caregiver distress, and worse healthrelated quality-of-life outcomes, along with added healthcare costs, with late presentation. The public has a generally poor awareness of oral cancer, with oral symptoms seldom seen as being an indicator of any type of cancer. Thus, patients delay seeking help and are often unconcerned about
symptoms, often only changing the way they eat, using personal remedies, or simply talking to their family or friends rather than to an oral healthcare professional. Barriers to seeking treatment may hinder early reporting of symptoms. Patients who were treated for oral cancer were interviewed to help identify measures that may promote earlier presentation for care. Methods.—Seventy-one individuals completed a short survey, and 44 responded to a telephone interview. All had been treated within the past 2 years for oral and
Volume 57
Issue 3
2012
149