ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Stable Osseointegration of Implants with Rough Surface
Clinical Question In patients with sufficient quality of bone to fully encase the dental implants, would a rough surface implant have better osseointegration than a smooth surface implant?
Clinical Bottom Line Early loading of implants with a sandblasted and acid-etched surface after 6 weeks of healing in type I and II bone and 12 weeks of healing in type III bone provides stable osseointegration. Furthermore, the successful integration was maintained for 5 years. Hence, the bone-to-implant contact is significantly higher in Osseotite (acid-etched) surface than a smooth-machined surface.
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) 22167440Cochran/2011135 edentulous and partially edentulous patients, with a mean age of 55 years (range, 21 to 82 years) with sufficient native bone, total of 439 implants placed, 57% were women and 43% were men. Most patients were nonsmokers and not diabetic. Human clinical trial
Key resultsCochran and colleagues placed 439 implants (sandblasted and acid-etched) in 135 patients at six centers in four countries. Many criteria including pocket depth, bleeding index, plaque accumulation, patient satisfaction, prosthesis retention, stability and esthetics were measured over the period of 5 years. For all statistical tests done in this study, p<0.05 was considered as the threshold for significance. Adverse events during this study were recorded; however, none of the treatment related adverse events were serious. With respect to survival, only 4 implants failed in the first year and none failed in the subsequent years. With regard to success, only 5 implants were considered unsuccessful. Total of 54 implants were lost to follow up. Therefore, the survival and success rates for 385 implants after 5 years were 99.1% and 98.8% respectively.
#2) 10635177Lazzara/199911 patients with types III and IV boneClinical trial
Key resultsLazzara and colleagues compared the percentage of bone-to-implant contact (BIC) at 6 months for Osseotite and machined implant surfaces in 11 patients. The BIC value of 86.1% +/- 16.7% for the Osseotite surfaces and 60.1% +/- 18.3% for the machined surfaces. The results indicate a significantly higher percentage of bone contacts Osseotite surfaces when compared to that of opposing machined surfaces in types III and IV bones typically in maxillary posterior area. BIC values were statistically significant (p<0.05).
Evidence Search ("Dental Implants"[Mesh] AND surfaces[All Fields]) AND "Osseointegration"[Mesh] AND Clinical Trial[ptyp]
Comments on
The Evidence
Cochran and colleagues reported a 5-year prospective multi-center human clinical study on 439 implants placed in 135 patients to evaluate whether implants with sandblasted and acid-etched surface could be loaded after 6 weeks of healing in type I to type III bone and 12 weeks in type IV bone. A comprehensive and detailed research was completed. The patient populations were treated similarly with adequate follow up for 5 years. Recall bias was unlikely and there were no competing interests reported. Lazzara and colleagues conducted a study on 11 patients with poor quality bone. The patient sample was small but they were similar at the start and were treated the same. The study did not have sufficient follow up to determine the long-term effectiveness of rough implant surfaces with bone-to-implant contact. We don’t know if the study was double blind. It was not apparent if there were competing interests. The strength of evidence was insufficient. Based on the first study and the strong evidence they provide, we can claim that acid-etched rough surface implants increase osseointegration. This would result in high survival and success rates of loaded implants.
Applicability Sandblasting and acid-etching would be feasible in our clinical setting. This approach can potentially benefits our patients, successfully loading of implants in half the conventional healing time. Furthermore, other 5-year studies mentioned in this article reinforce the results of the current study. The second article is also applicable to dental implants patients. A clinician can recommend Osseotite implants to patients with poor quality bone. However, the benefits of increased contact osteogenesis were not sufficiently proved in this study with such a small patient sample size.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics)
Keywords Dental implants, implants surfaces, osseointegration, early loading, bone to implant contact
ID# 2429
Date of submission: 03/21/2013spacer
E-mail Zamani@livemail.uthscsa.edu
Author Azin Zamani
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Archie Jones, DDS
Faculty mentor/Co-author e-mail jonesA@uthscsa.edu
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