ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Both Subtractive Manufactured Dental Implants and Additive Manufactured Dental Implants Have High Success Rates in Patients Over a 5-Year Period
Clinical Question In patients who need dental implants, how does the success rate of additive manufactured titanium implants compare with the success rate of subtractive manufactured titanium implants?
Clinical Bottom Line For patients needing dental implants, the success rates of additive manufactured titanium implants were comparable to the success rates of subtractive manufactured titanium implants after a 2- to 5-year follow-up. This was supported by a systematic review of mostly randomized controlled trials and case reports. Additive manufacturing, a novel method of manufacturing implants, has been shown to withstand occlusal forces and may have just as much longevity as subtractive manufactured implants. Dental implants made from both manufacturing methods may be used in dental practices with patients seeking implant therapy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24939253Chen/201420 implants in vitroLaboratory study
Key resultsSelective laser melting (SLM), an additive manufacturing process, produced dental implants with high density, strength, and good dimensional accuracy. The thread characteristic added more strength and stability to the implant, along with showing better stress distribution.
#2) 25525434Mangano/2014102 patients with 334 Direct Metal Laser Sintered Implants in 27 included studiesSystematic review of randomized trials and observational studies
Key resultsThe clinical studies in this systematic review featured direct metal laser sintered (DMLS) implants. Most of the DMLS implants were for single implant-supported crowns and fixed partial dentures. The DMLS implants had a 97.8% to 100% success rate after a 1-2 year follow up.
Evidence Search “Direct Metal Laser Sintering Dental Implants” and “Selective Laser Melting Dental Implants”
Comments on
The Evidence
Validity: The lab study took a variety of cone beam CT images and evaluated the areas of most stress for a selective laser melted titanium implant. It included two groups, one with threaded selective laser melted implants and one with non-threaded selective laser melted implants. Both groups were treated the same with adequate follow-up. The study showed that both groups stood up to applied stresses. The next step evaluated the selective laser melted implants clinically. The systematic review included a variety of types of articles, like case reports, cohort studies, and randomized control trials. It included a comprehensive detailed search, with a variety of keywords and MeSH searches, as well. Each article was included or excluded based on a variety of factors, including having a follow-up of the final restoration of at least 1 year and having at least 15 patients present in the trial. However, the systematic review did not have enough data to do a meta- analysis, but still proved to have high success rates over a 5-year span. Perspective: After analyzing the articles, I have come to the conclusion that additive manufacturing, which included both selective laser melting and direct laser melted sintering, featured high success rates with great dimensional stability and low wear rates. There is more research on the success of subtractive manufacturing, but preliminary data shows that the limited research done so far exhibits positive results on its longevity. However, my concerns with both of the manufacturing methods are that there still needs to be more research done. None of the articles that were reviewed had a follow-up of the final restoration of more than 5 years, which creates concern about the long-term viability of implants manufactured using both methods.
Applicability Overall, the review was representative of patients in a typical clinic, as they had a wide age range (20-72 years), and they were a mix of edentulous and dentate patients. Having an implant custom-made via direct metal laser sintering (DMLS) or Selective laser melting (SLM) will likely be associated with a higher cost. However, considering the early-on success of the implants, it should be a feasible treatment option because the implants been proven to be durable. The additive manufacturing methods have proven to produce implants with lasting durability and strength and are a very good option for patients on this basis.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Implants, Additive, Subtractive
ID# 3236
Date of submission: 04/26/2017spacer
E-mail adapalli@livemail.uthscsa.edu
Author Arvind Adapalli
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author E. Matthew Lamb, DDS
Faculty mentor/Co-author e-mail LambEM@uthscsa.edu
Basic Science Rationale
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