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Purpose: To estimate implant survival and peri-implant bone resorption around long vs normal-
length implants in full-arch immediate loading rehabilitation of maxillary arches of low bone
quality (D4). Materials and Methods: A total of 45 patients received two mesial normal-
length (10 to 15 mm) or longer (18 to 20 mm) implants and two long (18 to 20 mm) distally
tilted implants. Differences in bone resorption at 24 months were assessed using the Mann-
Whitney U Test. Results: At the 24-month follow-up, no significant differences were found in
survival (global cumulative survival rate: 98.9%) or bone resorption (mean: 1.1 mm) between
long and normal implants (P = .053). Conclusion: At 24 months, the use of long implants
provides favorable survival and bone maintenance results in the immediate loading rehabilitation
of low-quality maxillary arches. Int J Prosthodont 2018;31:580–583. doi: 10.11607/ijp.5756
Statistical Analyses
Table 2 C
omparison of Bone Level Changes (mm) Table 3 C
omparison of Bone Level Changes (mm)
Between Mesial and Distal Implant Sides Between Normal and Long Implants
Side Implant length
Total Mesial Distal P Long Normal P
Bone level T0 Bone level T0
Mean –0.2 0.1 –0.6 Mean –0.2 –0.3
Standard deviation 1.4 1.4 1.3 Standard deviation 1.5 1.1
Median –0.4 0.0 –0.7 Median –0.5 0.0
Minimum –5.1 –3.5 –5.1 Minimum –5.1 –3.2
Maximum 4.0 4.0 4.0 Maximum 4.0 2.1
Bone level T1 Bone level T1
Mean –1.1 –0.8 –1.4 Mean –1.0 –1.3
Standard deviation 1.5 1.5 1.5 Standard deviation 1.6 1.1
.68 .053
Median –1.3 –1.0 –1.6 Median –1.2 –1.6
Minimum –6.0 –3.9 –6.0 Minimum –6.0 –3.6
Maximum 4.0 3.7 4.0 Maximum 4.0 1.5
Δ Δ
Mean –0.8 –0.9 –0.8 Mean –0.7 –1.1
Standard deviation 1.1 1.2 1.0 Standard deviation 1.1 1.2
Median –0.4 –0.4 –0.4 Median –0.3 –0.7
Minimum –5.5 –5.5 –4.5 Minimum –5.5 –3.8
Maximum 0.5 0.5 0.5 Maximum 0.5 0.3
T0 = prosthesis placement; T1 = 24-month follow-up; Δ = difference. T0 = prosthesis placement; T1 = 24-month follow-up; Δ = difference.
Table 4 C
omparison of Bone Level Changes (mm) CSRs and bone maintenance in full-arch immediate
Between Anterior and Posterior Implants loading rehabilitations after 24 months of follow-up.
Site Overall bone resorption at T1 was 0.8 mm (0.7 mm for
Anterior Posterior P long implants and 1.2 mm for normal implants). A sta-
Bone resorption T0 tistically significant difference in bone resorption was
Mean –0.5 0.0 found between anterior and posterior implants, but
Standard deviation 1.6 1.2 the difference in mean bone resorption was 0.1 mm.
Median –0.7 0.0 Such a small difference might be considered statisti-
Minimum –5.1 –3.5 cally but not clinically significant.
Maximum 4.0 4.0 Compared to a 15-mm implant, implants of 20- and
Bone resorption T1 18-mm length present an increase in surface area
Mean –1.3 –0.8 of approximately 33% and 20%, respectively, thus
Standard deviation 1.6 1.5 increasing bone-implant contact and primary sta-
.011 bility, especially in soft bone. Moreover, in cases of
Median –1.5 –1.1
Minimum –6.0 –3.9 immediate loading in postextraction sites, long im-
Maximum 3.0 4.0 plants could facilitate an increase in primary stability,
Δ bypassing postextraction sites, the apex reaches the
Mean –0.9 –0.8 denser residual bone of the premaxilla and allows po-
Standard deviation 1.0 1.1 tential bicortical stabilization.
Median –0.5 0.0 Some limits of the present research must be ac-
Minimum –5.5 –4.5 knowledged. This study was not a randomized clini-
Maximum 0.5 0.5 cal trial, and long implants were mainly tilted and
T0 = prosthesis placement; T1 = 24-month follow-up; Δ = difference.
inserted in the posterior maxilla; therefore, other
variables different from implant length may have af-
fected the results. The limited 24-month follow-up
Discussion assessment qualifies this report as a preliminary one.
Consequently, further comprehensive, long-term re-
Based on the present study results, long implants search outcomes are needed to confirm the merits of
placed in low-quality bone demonstrated favorable the present observations.
Conclusions References
At 24 months, the use of long implants provides favor- 1. Menini M, Signori A, Tealdo T, et al. Tilted implants in the im-
able survival and bone maintenance results in the im- mediate loading rehabilitation of the maxilla: A systematic re-
view. J Dent Res 2012;91:821–827.
mediate loading rehabilitation of low-quality maxillary
2. Del Fabbro M, Ceresoli V. The fate of marginal bone around ax-
arches. ial vs. tilted implants: A systematic review. Eur J Oral Implantol
2014;7(suppl):S171–S189.
Acknowledgments 3. Tealdo T, Menini M, Bevilacqua M, et al. Immediate versus
delayed loading of dental implants in edentulous patients’
maxillae: A 6-year prospective study. Int J Prosthodont 2014;
The authors declare no conflicts of interest.
27:207–214.
4. Norton MR, Gamble C. Bone classification: An objective scale
of bone density using the computerized tomography scan. Clin
Oral Implants Res 2001;12:79–84.
5. Pera F, Pesce P, Solimano F, Tealdo T, Pera P, Menini M. Carbon
fibre versus metal framework in full-arch immediate loading
rehabilitations of the maxilla—A cohort clinical study. J Oral
Rehabil 2017;44:392–397.
Literature Abstract
This in vitro study aimed to evaluate marginal and internal fit of single crowns produced from high-frequency, ultrasound-based digital
impressions of teeth prepared with finish lines covered by porcine gingiva in comparison with those obtained using optical scanners with
uncovered finish lines. A total of 10 human teeth were prepared, and 40 zirconia crowns were fabricated from stereolithography (STL) data
sets obtained from four dental scanners (n = 10 each): extraoral CS2 (Straumann), intraoral Lava COS (3M), intraoral Trios (3Shape), and
extraoral ultrasound scanner. The accuracy of the crowns was compared by evaluating marginal and internal fit by means of the replica
technique with measurements in four areas (P1: occlusal surface; P2: transition between occlusal and axial surfaces; P3: middle of axial
wall; and P4: marginal gap). Restoration margins were classified according to their mismatch as regular, underextended, or overextended.
Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test were used to evaluate the differences between groups at P < .05.
The median value of marginal gap (P4) for ultrasound (113.87 μm) differed statistically from that of CS2 (39.74 μm), Lava COS (41.98 μm),
and Trios (42.07 μm). There were no statistical differences between ultrasound and Lava COS for internal misfit (P1–P3); however, there
were statistical differences when compared with the other two scanners (Trios and CS2) at P1 and P2. The ultrasound scanner was able to
make digital impressions of prepared teeth through porcine gingiva (P4), but with less accuracy of fit than conventional optical scanners
without coverage of the finish lines. Where no gingiva was available (P1–P3), the ultrasound accuracy of fit was similar to that of at least
one optical scanner (Lava COS).
Praça L, Pekam FC, Rego RO, Radermacher K, Wolfart S, Marotti J. Dent Mater 2018. Epub ahead of print. References: 42.
Reprints: Juliana Mariotti, jmarotti@ukaachen.de —Carlo Marinello, Switzerland