Three-year treatment outcomes with three brands of implants placed in the

posterior maxilla and mandible of partially edentulous patients

Yasar Ozkan, PhD,a Mutlu Ozcan, DMD, PhD,b Burcin Akoglu, DDS,c Mert Ucankale, DDS,c
and Yasemin Kulak-Ozkan, PhDd
University of Marmara, Istanbul, Turkey; University Medical Center Groningen, University of
Groningen, Groningen, The Netherlands
Statement of problem. Survival rates of implants in posterior regions vary among clinical studies. Problems
occur more often in the posterior segment of the maxilla due to proximity of the maxillary sinus and reduced
quality or quantity of alveolar bone.
Purpose. This clinical study evaluated the treatment outcomes of 3 brands of implants in the posterior maxillae
and mandibles of 63 patients. Treatment outcomes of all implants were assessed according to implant type,
location, patient gender, periodontal status, and prosthesis type.
Material and methods. A total of 203 implants—105 ITI (ITI), 53 Camlog (CAM), and 45 Frialit (FRI)—
were placed in 63 patients (38 women, 25 men). One hundred twelve implants were located in the posterior
mandible and 91 in the posterior maxilla. All implants were longer than 10 mm and had a diameter larger
than 3.5 mm. Implants in the ITI group were placed in a 1-stage surgery. The CAM and FRI groups were
treated with a 2-stage surgical protocol. Implants were not loaded until osseointegration was complete, which
was determined clinically and radiographically. At that point, implants were restored with 50 single crowns and
81 fixed partial dentures (FPDs). While 11 FPDs connected implants to natural teeth, 70 FPDs were supported
by implants only. Standardized radiographs were made, and clinical parameters were recorded at prosthesis in-
sertion (baseline) and at each recall evaluation (6, 12, 24, and 36 months). Plaque index (PI), sulcus bleeding
index (SBI), peri-implant probing depth (PD), and radiographic marginal bone loss (MBL) levels were recorded
at baseline, along with any biological and mechanical complications. Repeated-measures ANOVA, Kruskal-
Wallis test, Wilcoxon signed rank test, and paired samples tests were used for statistical analysis (a=.05).
Results. One implant was lost during the osseointegration period in 1 woman due to infection. The cumulative
implant treatment outcome was 99.3%. At the 3-year recall, plaque accumulation was significantly higher than
baseline scores (P=.01, Wilcoxon signed rank test). Eight percent of the patients presented .2 mm PD at 2-year
recall. The influence of observation time was found to be significant for the mean MBL values between groups
(P=.001). When MBL values were compared between groups, no significant differences were found. For 1 pa-
tient in the FRI group, abutment loosening was observed and both the crown and the abutment were replaced.
Patient satisfaction in all groups was high.
Conclusion. The 3 brands of implants evaluated in this study exhibited similar positive treatment outcomes
after 3 years. (J Prosthet Dent 2007;97:78-84.)

CINICAL IMPLICATIONS
Undisturbed peri-implant bone healing prior to prosthetic treatment resulted in clinically suc-
cessful outcomes in terms of prosthetic and peri-implant tissue stability for the 3 types of implants
evaluated in this study.

C onventional prosthetic therapy for partially eden-

tulous patients has changed dramatically since the
introduction of dental implants. Favorable, functional,
esthetic, physiological outcomes and psychological
a
Assistant Professor, University of Marmara, Department of Oral Surgery.
b
Adjunct Professor and Research Associate, University Medical Center
Groningen, University of Groningen, Department of Dentistry and
Dental Hygiene.
c
Research Associate, University of Marmara, Department of Prosthetic
Dentistry.
d
Professor and Chairman, University of Marmara, Department of
Prosthetic Dentistry.
benefits of implant-supported fixed partial dentures
(FPDs) in patients who object to the use of removable
partial dentures have been reported.1-3 Moreover, the
possibility of maintaining healthy tooth structure is
one of the biggest advantages of implant-supported
FPDs. Especially when compared to tooth-supported
cantilever FPDs, implant-supported FPDs for the treat-
ment of distal extension base situations are less prone
to biological and technical problems.1-3 However, in
the posterior quadrants of the maxilla or mandible, the
survival rates for implants vary among studies.4-11
Generally, the success rates of implants in those regions

78 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 97 NUMBER 2

OZKAN ET AL
Table I. Distribution of implants according to each tooth position and implant group
Implant location per tooth area
Group MaxR2M MaxR1M MaxR2P MaxR1P MaxL1P MaxL2P MaxL1M MaxL2M ManR2M ManR1M ManR2P ManR1P ManL1P ManL2P ManL1P ManL2M
ITI 4 7 12 10 9 4 6 5
CAM 2 7 3 5 3 3
FRI 2 1 2 1 2 1
Total 6 16 16 17 13 6 9
Max, Maxillary; Man, mandibular; R, right; L, left; M, molar; P, premolar.
are inferior to implants in anterior jaw locations.12 In the
maxillary posterior region, the proximity of the maxillary
sinus and insufficient quality and quantity of alveolar
bone may create problems during implant therapy.13
The residual ridge of the posterior maxilla is usually
composed of spongy (type III–IV) bone, which is prone
to faster physiologic resorption.14
A 2-stage surgical technique was originally advocated
to optimize osseointegration. The predictable outcome
of this technique was verified in several clinical trials with
high implant success rates.2,7,8,15 In subsequent studies,
it was reported that proper osseointegration and long-
term success could also be obtained with nonsubmerged
implants.5,16-18 The purpose of this study was to evaluate
the clinical and radiographic outcomes with 3 brands of
implants and implant-supported restorations in poste-
rior maxillary and mandibular sites of partially edentu-
lous patients.
MATERIAL AND METHODS
Sixty-three patients (38 women and 25 men; mean
age 46.9 years, minimum 18 years, maximum 63 years)
with a need for replacement of missing maxillary or man-
dibular posterior teeth participated in this study. Infor-
mation was given to each patient regarding alternative
treatment options. All patients were treated at the De-
partment of Oral Surgery and Department of Prosthetic
Dentistry, University of Marmara, Istanbul, Turkey, af-
ter signing the appropriate informed consent form
approved by the university institutional review board. All
subjects were required to be at least 18 years old, able to
read and sign the informed consent document, physically
and psychologically able to tolerate conventional surgical
and restorative procedures, and willing to return for
follow-up examinations as outlined by the investigators.
Exclusion criteria included any general health-com-
promising prognosis prohibiting implant surgery, such
as stroke, recent heart attack, severe bleeding disorders,
diabetes, osteoporosis, cancer, history of bruxism, or
surgical sites consisting of type IV bone that may have
jeopardized the treatment outcome as assessed by the
surgeon during implant surgery.14 Inclusion criteria were
the presence of natural teeth adjacent to the edentulous
space, and opposing natural teeth, FPD, or removable
prosthesis. Diagnostic impressions were made with
FEBRUARY 2007
THE JOURNAL OF PROSTHETIC DENTISTRY
1 8 1 3 1 11 14 9
2 4 4 4 1 2 6 5 2
7 3 8 2 1 4 6 5
8 12 15 13 6 4 21 25 16
irreversible hydrocolloid (Phase Plus; Zhermack Spa,
Badia Polesine, Rovigo, Italy). Impressions were poured
with type II dental stone (GC Fujirock EP; GC Europe
N.V., Leuven, Belgium). Periapical and panoramic radi-
ographs were obtained before surgery for all patients.
At the time of implant placement, patients were given
local anesthesia (Ultracain D-S forte Ampul; Aventis
Pharma, Istanbul, Turkey). One surgeon with 10 years
of surgical experience in placing implants performed
all surgical procedures. A midcrestal incision and ob-
lique-releasing incisions were made, followed by the
elevation of a full-thickness flap. The flap was elevated
on the palatal and buccal aspects of the alveolar ridge,
and sutures were used for retraction.
A total of 203 implants were placed in posterior
maxillary and mandibular locations: 105 single-stage
(Straumann Dental Implants; Institut Straumann AG,
Waldenburg, Switzerland) (ITI) implants; 53 two-stage
(Camlog; Camlog Biotechnologies AG, Basel, Switzer-
land) (CAM) implants (25 in the maxilla, 28 in the man-
dible); and 45 two-stage (Frialit; Friatec AG, Mannheim,
Germany) (FRI) implants (14 in the maxilla, 31 in the
mandible). One hundred twelve implants were inserted
in mandibular sites and 91 implants in maxillary sites.
For 13 patients implants were inserted in the mandible,
and for 15 patients implants were inserted in the maxilla.
Eighteen patients received implants in both the maxilla
and the mandible. The distribution of the 203 implants
according to type and tooth and jaw location is depicted
in Tables I and II. All implants were at least 10 mm long
and had a diameter of at least 3.5 mm. Implant dimen-
sions were selected according to the available bone
volume. Eighty implants were 13 mm or more, and 123
implants ranged between 10 to 12 mm in length.
Seventy-five implants had a diameter of 3.5 mm, and 128
were greater than 3.5 mm in diameter. Fifty implants
received single crowns, and 81 received FPDs.
Standardized radiographs were made after implant
placement and each recall evaluation using the long cone
paralleling technique.19 An occlusal index made of vinyl
polysiloxane (Exabite; GC America, Alsip, Ill) was at-
tached to a standard film holder as previously described9
to minimize variations in exposure geometry. A similar
film type (Kodak Ultra-speed DF-58; Eastman Kodak
Co, Rochester, NY) was used for all patients. Radiographs
were made at 70 kV(p), 10 mA for 0.5 second, and then
79
THE JOURNAL OF PROSTHETIC DENTISTRY
Table II. Number of implants according to patients and group
Number of implants
Group 1 2 3 4 5 6 7 8 9 Total
ITI 9 9 7 – 6 3 – – 1 105
CAM 2 4 – 5 2 1 – – – 53
FRI 1 5 – 4 – 3 1 – – 45
Total 12 36 21 36 40 42 7 – 9 203
developed in an automatic radiograph film processor (810
Plus; Velopex Intl Inc, St. Cloud, Fla).
Peri-implant marginal bone levels were determined
at baseline and recall evaluations. Measurements were
obtained from successive radiographs, which were then
digitized and analyzed at 320 magnification using a
software program (CorelDRAW 9.0; Corel Corp and
Coral Ltd, Ottawa, Canada). The implant-abutment
junction was used as reference point. The distance
from implant-abutment junction to crestal bone level
as well as the implant inter-thread distance was mea-
sured on the magnified radiographs. The actual bone
level measurement was calculated by 2 examiners sepa-
rately, using the known thread distance according to
manufacturer’s dimensions of the respective implants.
The average from both examiner calculations was used
as marginal bone level value. During the osseointegra-
tion period, patients wore interim removable partial
dentures, or previous FPDs were modified as provisional
restorations and cemented with provisional cement
(Temp-Bond; Dentsply Caulk, Milford, Del) on the
previously prepared teeth. In nonesthetic critical areas,
no interim prosthetic treatment was performed during
the osseointegration period.
The FPDs were fabricated with an occlusal scheme
that provided simultaneous contact in maximal inter-
cuspation, canine protected articulation, or group func-
tion during working side movements, and absence of
interferences during non–working side movements. All
50 single crowns and 81 FPDs were fabricated and ce-
mented with zinc polycarboxylate cement (Adhesor
Carbofine; Spofa Dental a.s., Prague, Czech Republic)
or retained with a titanium occlusal screw (Table III).
Metal-ceramic single crowns and FPDs were fabricated
using a precious metal alloy (VMK-95 Metall Keramik;
VITA Zahnfabrik, Bad Sackingen, Germany), which was
veneered with feldspathic porcelain (Vita Omega; VITA
Zahnfabrik). Patient satisfaction with implant surgery
and prosthetic treatment was evaluated with a self-
administered questionnaire after prosthetic treatment
and once annually thereafter. Patients answered questions
on a scale from 1 (poor) to 4 (excellent). After prosthesis
insertion, patients were recalled at 6, 12, 24, and 36
months. At each recall, a clinical examination was per-
formed, digital photographs were made, and periapical
as well as panoramic radiographs were obtained.
80
OZKAN ET AL
Table III. Distribution of FPD and units according to jaw
location
SC FPD-2 FPD-3 FPD-4 TIFPD
Maxilla 24 5 23 4 3
Mandible 26 9 24 5 8
Total 50 14 47 9 11
SC, Single crown; FPD-2, 2-unit; FPD-3, 3-unit; FPD-4, 4-unit; TIFPD, tooth-
implant–supported FPD.
Complications regarding abutment teeth (caries, per-
iodontal disease, and recession), implants (screw loosen-
ing and/or fracture, bone level, infection, and mobility),
and prosthesis (metal fracture, porcelain fracture) were
recorded. The following clinical parameters were re-
corded: plaque index (PI), sulcus bleeding index
(SBI), peri-implant probing depth (PD), and peri-
implant marginal bone loss (MBL). The PI was recorded
visually with the aid of a probe moved along the abut-
ment surfaces. For each implant, the presence of plaque
was scored on 4 surfaces (0 = no plaque; 1 = plaque on
probe; 2 = plaque on implant seen by the naked eye; 3 =
abundance of soft matter).20 The SBI, defined as bleeding
elicited 20 seconds after moving a periodontal probe
1 mm into the mucosal sulcus parallel to the abutment
wall, was scored (0 = no bleeding; 1 = isolated bleeding
spots visible; 2 = blood forms a confluent red line on
margin; 3 = heavy or profuse bleeding). The PD was
measured with a periodontal probe (PCPUNC No15;
Hu-Friedy, Leiman, Germany) at 4 sites around each
abutment. The actual bone level measurement (MBL)
was calculated by 2 examiners separately, using the known
thread distance according to manufacturer’s dimensions
of the respective implants. The average from both exam-
iner calculations was used as marginal bone level value. An
implant was considered a failure when one of the follow-
ing conditions was present: (1) peri-implant radiolucency,
(2) slightest sign of mobility, or (3) signs or symptoms of
pain or infection were detected.20,21
The implant system data were statistically analyzed
with respect to PI, SBI, PD, MBL, and success rates or
frequency of adverse events. For statistical computa-
tions, 1 patient was considered as a unit. The differences
in frequency of implant losses were analyzed using the
Fisher exact probability test (patient as the unit) and
the binominal test (implant as the unit).
For the statistical analysis of PI and SBI, Wilcoxon
signed rank test and Mann-Whitney U tests were
used. The PD and MBL measurements were evaluated
using time-dependent repeated-measures analysis of
variance (ANOVA). For comparison of patient satisfac-
tion responses before and after treatment, the Wilcoxon
signed rank test was again used. All tests were per-
formed using statistical software (SPSS version 11.5;
SPSS Inc, Chicago, Ill) at a level of significance of
a=.05.
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Table IV. Plaque index (PI) (%) for 63 patients at baseline Table V. Evaluation of PI and SBI in 3 implant groups in
and follow-up visits 63 patients according to Wilcoxon signed rank test
ITI CAM FRI Total P values
n % n % n % n % Measurement time ITI CAM FRI Total

Baseline PI Baseline - 6 months .31 .08 .56 .20

0 23 65.7 13 86.7 10 76.9 46 73 Baseline - 1 year 1.00 .02* ,.001* .19
1 12 34.3 2 13.3 3 23.1 17 17 Baseline - 2 years .25 .02* .31 .01*
2 0 0 0 0 0 0 0 0 Baseline - 3 years .02* .01* .31 .001*
6 months
SBI Baseline - 6 months .18 .31 .18 .03*
0 21 60 10 66.7 11 84.6 42 67
Baseline - 1 year .02* .15 .06 .001*
1 14 40 5 33.3 2 15.4 21 33
Baseline - 2 years .18 .10 .03* .003*
2 0 0 0 0 0 0 0 0
Baseline - 3 years .04* .18 .06 .003*
1 year
0 23 65.7 8 53.3 10 76.9 41 65 *Significant differences for P,.05.
1 12 34.3 7 46.7 3 23.1 22 3
2 0 0 0 0 0 0 0 0
2 years the entire period. At the 1-year recall, 23 patients
0 20 57.1 8 53.3 8 61.5 36 57
(66%) in the ITI group, 8 patients (53%) in the CAM
1 15 42.9 7 46.7 4 30.8 26 41
group, and 10 patients (77%) in the FRI group were
2 0 0 0 0 1 7.7 1 2
3 years
completely plaque free, and the results changed to
0 15 42.9 6 40 8 61.5 29 46 15%, 6%, and 8%, respectively, at the 3-year recall.
1 20 57.1 9 60 5 38.5 34 54 Plaque accumulation scores of 2 and 3 were not noted
2 0 0 0 0 0 0 0 0 during the entire study. Scores of 0 decreased from
66% to 43% for the ITI group, 87% to 40% for the
CAM group, and 77% to 62% for the FRI group from
baseline to the 3-year follow-up. The figures for PB
(score 1) increased from 34% to 57% in the ITI group,
RESULTS
13% to 60% in the CAM group, and 23% to 39% in the
The average patient age was 46 6 9 years (range 18- FRI group between baseline and the 3-year follow up.
63 years). The 63 patients received a total of 50 single At the 3-year recall, plaque accumulation scores were
crowns and 81 FPDs. The mean number of prosthetic significantly higher than at baseline (P=.001, Wilcoxon
units for each FPD was 2, with a range of 1 to 4 units. signed rank test). A significant increase was observed
Eleven FPDs were implant-tooth–supported, whereas 70 in PI scores for the ITI group between baseline and 3
were only implant-supported. Table III shows the distri- years (P=.02). There was a significant difference for PI
bution of FPDs according to jaw location. The implants between baseline and 2 and 3 years for the CAM group
were loaded with the prosthesis after an average healing (P=.02 and P=.01, respectively). No significant changes
period of 3 months in the mandible and 6 months in the were observed in PI scores between time periods for
maxilla. Of the 63 patients treated in this study, 15 patients the FRI group (Table V).
smoked more than 10 cigarettes a day. No drop-outs were The SBI measurements at baseline and recall periods
recorded during the observation period. During the 3 are shown in Table VI. There was a significant increase in
years of clinical evaluation, only 1 of the 2 implants failed SBI values between baseline and subsequent years for 63
in the posterior maxilla of a woman in the ITI group due to patients (P=.001, P=.003, and P=.003 for the first, sec-
infection 2 months after insertion. In all other patients, ond, and third years, respectively). There was a significant
healing proceeded without complications and with mini- increase in SBI values for the ITI group between baseline
mal postoperative discomfort. The cumulative implant and the 1- and 3-year recalls (P=.02 and P=.04, respec-
treatment outcome after 3 years of functional loading tively). No significant changes were observed for the
was 99.3%. The surviving implants were in function and CAM group in SBI values between baseline and subse-
clinically stable when tested individually, and neither quent years. For the FRI group only, SBI values showed
pain nor soft tissue complications were noted after 3 years. a significant increase between baseline and 2 years
In one patient in the FRI group, abutment loosening was (P=.03) (Table VI). The PI and SBI values of the 3 groups
observed, and both the crown and the abutment were dependent on time were analyzed using the Mann-
replaced. Patient satisfaction in all groups was high. Whitney U test. At all time points, no significant differ-
The accumulation of plaque around the implants was ence was found for all 3 groups in PI and SBI values
recorded at baseline and at 6-month, 1-, 2- and 3-year (Table VII).
follow-up visits (Table IV). It was found that 40% to Mean and standard deviations of PD measurements
87% of the patients were plaque free (score 0) during of the 3 groups are shown in Table VIII. At baseline in

FEBRUARY 2007 81
THE JOURNAL OF PROSTHETIC DENTISTRY OZKAN ET AL

Table VI. SBI for 63 patients at baseline and recall visits Table VII. Time-dependent evaluation of PI and SBI values
according to Mann-Whitney U test
ITI CAM FRI Total
n % n % n % n % Time P value

Baseline PI Baseline .297

0 23 65.7 12 80 11 84.6 46 73 6 months .280
1 12 34.3 3 20 2 15.4 17 27 1 year .429
2 0 0 0 0 0 0 0 0 2 years .962
6 months 3 years .451
0 20 57.1 11 73.3 8 61.5 39 62 SBI Baseline .338
1 15 42.9 4 26.7 5 38.5 24 38 6 months .563
2 0 0 0 0 0 0 0 0 1 year .506
1 year 2 years .519
0 18 51.4 10 66.7 6 46.2 34 54 3 years .766
1 17 48.6 5 33.3 7 53.8 29 46
2 0 0 0 0 0 0 0 0 Significant differences for P,.05.

2 years
0 20 57.1 8 53.3 5 38.5 33 52
1 15 42.9 7 46.7 8 61.5 30 48 Table IX. Repeated-measures ANOVA results for PD values
2 0 0 0 0 0 0 0 0 in 3 groups
3 years Type III sum Mean
0 19 54.3 9 60 6 46.2 34 54 Source Time of squares df square F P value
1 16 45.7 6 40 7 53.8 29 46
2 0 0 0 0 0 0 0 0 Time Linear 6.723 1 6.723 118.240 .001
Quadratic 2.333 1 2.333 103.503 .001
Cubic 0.254 1 0.254 18.936 .001
Order 4 0.374 1 0.374 47.353 .001
Table VIII. Mean (SD) PD measurements (in mm) for groups Time 3 Groups Linear 1.192 2 0.596 10.480 .001
at baseline and recall evaluations Quadratic 0.197 2 0.099 4.379 .017
Cubic 0.137 2 0.069 5.105 .009
Groups ITI CAM FRI Total Order 4 0.052 2 0.026 3.265 .045
Baseline 1.52 (0.11) 1.55 (0.07) 1.53 (0.10) 1.53 (0.10) Error (time) Linear 3.412 60 0.057
6 months 1.39 (0.09) 1.37 (0.13) 1.32 (0.10) 1.38 (0.10) Quadratic 1.353 60 0.023
1 year 1.57 (0.10) 1.56 (0.07) 1.57 (0.10) 1.57 (0.09) Cubic 0.806 60 0.013
2 years 1.54 (0.08) 1.63 (0.16) 1.85 (0.26) 1.63 (0.19) Order 4 0.474 60 0.008
3 years 1.80 (0.23) 1.87 (0.36) 2.16 (0.36) 1.89 (0.33) Significant differences for P,.05.

the ITI group, the mean PD value was 1.52 (0.11) mm,
and it increased to 1.57 (0.10) mm at 1 year, and 1.80
(0.23) mm at 3 years. In the CAM group, the baseline
mean PD value of 1.55 (0.07) mm increased to 1.56
(0.07) mm at 1 year and 1.87 (0.36) mm at 3 years.
However, in the FRI group, the baseline mean value of
1.53 (0.10) mm increased to 1.57 (0.10) mm and 2.16
(0.36) mm at years 1 and 3, respectively (Table VIII).
Repeated-measures ANOVA results are presented in
Table IX. The observation time was found to significantly
influence the mean PD values between groups (P,.05).
When PD values were compared between groups, the
changes over time showed significant differences (P,.05).
Mean and standard deviations of MBL measurements
of the 3 groups are shown in Table X. For the ITI group,
the difference between baseline and 1 year in mean MBL
value was 0.17 (0.08) mm, and it increased to 0.24 (0.20)
mm and 0.26 (0.13) mm at the second and third years,
respectively. In the CAM group, the difference between
baseline and 1 year was 0.16 (0.08) mm, and it increased
to 0.23 (0.18) mm and 0.25 (0.11) mm at the second
and third years, respectively. In the FRI group, the dif-
frence between baseline and 3 years was 0.28 (0.16) mm.
Repeated-measures ANOVA results for the time-
dependent groups are presented in Table XI. Observa-
tion time was found to significantly influence the mean
MBL values between groups (P=.001). When MBL
values were compared between groups, no significant
differences were found (Table XI).
All patients were satisfied with the esthetic and func-
tional outcome of their prostheses. The frequency of
distribution of patients’ responses to the questions is
displayed in Table XII. For 1 patient in group FRI, abut-
ment loosening was observed at the 2-year recall, and both
the abutment and the crown were replaced. No other
prosthetic complications such as porcelain fracture, rece-
mentation, or screw loosening were observed. All patients
were highly satisfied with their prostheses. The results re-
vealed no significant difference in treatment outcome be-
tween men and women or between maxilla and mandible.

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Table X. Mean (SD) MBL (in mm) change in groups at Table XI. Time-dependent evaluation of MBL values
different time intervals according to repeated-measures ANOVA
Baseline - Baseline - Baseline - Type III sum Mean
Groups 1 year 2 years 3 years Total Source Time of squares df square F P value
-2 -1
ITI 0.17 (0.08) 0.24 (0.20) 0.26 (0.13) 0.08 (0.07) Time Linear 5.32 3 10 1 5.32 3 10 2446.953 .001
CAM 0.16 (0.08) 0.23 (0.18) 0.25 (0.11) 0.08 (0.07) Quadratic 1 3 10-4 1 1 3 10-3 6.343 .014
FRI 0.19 (0.11) 0.25 (0.15) 0.28 (0.16) 0.07 (0.11) Cubic 9.06 3 10-5 1 9.06 3 10-5 4.306 .0042
Time 3 Linear 2.22 3 10-6 2 1.11 3 10-5 0.051 .950
Values based on measurements for all implants.
Groups
Quadratic 2.2 3 10-5 2 1.41 3 10-5 0.330 .720
Table XII. Results of patient satisfaction questionnaire Cubic 1.71 3 10-6 2 8.53 3 10-6 0.405 .669
Excellent Good Satisfactory Poor Error Linear 1.3 3 10-2 60 1 3 10-3
(time)
n % n % n % n %
Quadratic 3 3 10-3 60 4.27 3 10-5
Esthetics 52 83 11 17 – – – – Cubic 1 3 10-3 60 2.16 3 10-5
Masticatory ability 56 89 7 11 – – – –
Significant differences for P,.05.
Phonetics 63 100 – – – – – –
Cleansability 58 92 5 8 – – – –
with those from previous studies using different
implant systems in completely and partially edentulous
patients.4,7-11,15,17,22,23 The long-term prognosis of
DISCUSSION
partially dentate patients treated with implants in the
The fundamental concern of the present study was posterior maxilla and mandible is not well documented.
to evaluate the treatment outcome of implants in the Buser et al5 performed a prospective 8-year study of 2359
posterior maxilla and mandible. In this respect, this implants (ITI, Straumann Dental Implants; Institut
study had a positive outcome. Many factors play impor- Straumann AG) with the cumulative survival rate of
tant roles in obtaining long-term implant stability. 96.7% and a cumulative success rate of 93.3%. Naert
These include systemic health problems, oral hygiene, et al15 reported that neither jaw site nor implant position
amount and quality of bone at the implant recipient had a significant effect on the outcome in partially dentate
site, forces exerted onto the implant and surrounding patients treated with implants. In the present study, the
tissues, implant design, type of implant selected, and ex- jaw site also did not have an influence on the treatment
perience and diligence of the clinician.1,2 Careful patient outcome.
selection, excluding those with medical histories that The MBL measurements after prosthesis insertion
may potentially compromise treatment results, appears and up to the 3-year recall examination exhibited a similar
to be important for success.3 In this study, surgical pro- tendency for each implant type. Based on the present
cedures were performed by 1 experienced dentist. This study, it is not possible to determine the reasons for these
fact, combined with the observation of conventional small changes. The marginal bone loss after 3 years of
healing times of 3 to 6 months depending on bone qual- function was 0.27 mm, regardless of the implant system,
ity, appear to have contributed to the favorable results. which is similar to that from other reports.6,7,14,21,22
The mean plaque-free surfaces (score 0) or small Bone loss for the maxilla and mandible was not signifi-
amounts of plaque (score 1) increased slightly through- cant, as it was at clinically acceptable levels according to
out the investigation. The SBI measurements revealed the criteria defined by Albrektsson et al.21 The authors re-
that although no bleeding was the predominant finding ported that for the first year, MBL level should be less
at baseline, a slight tendency toward increased bleeding than 1 mm and 0.2 mm for the following years. Clinical
was observed, regardless of the implant system. The studies have shown a correlation between PD and level
recall program followed a strict protocol. However, of the marginal peri-implant bone as determined on radi-
patients did not receive any special hygiene procedures ographs. In a clinical study, the mean distance between
between the follow-up visits, but were highly motivated the probe tip and the bone level was found to be 1.7
after having been informed that oral hygiene would be mm with the Straumann (single-stage) implants.6 In the
important for a successful treatment outcome. present study, the PDs were found to be 1.8 mm with
Only 1 implant was lost during the osseointegration the same implant system.
period in a nonsmoking patient. The nonintegrated im- The predictable outcome with the 2-stage placement
plant was placed in type III bone in the posterior maxilla. technique was verified in a clinical trial in which a high
The cumulative success rate obtained from the 3 types success rate was reported for implants that were initially
of implants was high, indicating the importance of submerged.15 A 2-stage surgical technique was origi-
patient selection and determining local bone quality. nally advocated to optimize osseointegration. The pre-
Although it cannot be generalized, this finding agrees dictable outcome of submerged implants was verified

FEBRUARY 2007 83
THE JOURNAL OF PROSTHETIC DENTISTRY
in several clinical trials with high implant success
rates.2,7,8,15 In subsequent studies, it was reported that
proper osseointegration and long-term success could
also be obtained with nonsubmerged implants.5,16-18
In the present study, favorable results were obtained
with both submerged and nonsubmerged implants.
Appropriate soft tissue healing was achieved with non-
submerged implants, and the level of implant-abutment
connection was successfully gained for soft tissues in
both systems in this 3-year clinical study. The reasons
for this could be attributed to the meticulous method-
ology during surgical operations and prosthetic reha-
bilitation, as well as allowing a sufficient period for
osseointegration prior to loading.
All 203 implants monitored over the 3-year period
met the success criteria regarding discomfort, persistent
pain, or infection attributable to the implant. Periodon-
tal disease parameters were used to monitor soft tissue
differences around the implants. All implants were sur-
rounded by stable, healthy tissue, which reflected ade-
quate maintenance and prosthetic design.
The 3 brands of implants tested in this study, both
placed in 1- or 2-stage surgery, revealed treatment out-
comes with high success rates after 36 months of load-
ing. It could be that 36 months may not be considered
an adequate period for clinical observations. Therefore,
although the patients were highly satisfied with their im-
plants and prosthetic treatment overall, patients are con-
tinuing to be followed for a further long-term report.
CONCLUSION
The 3 brands of implants used in this study, placed
in either a 1- or 2-stage surgery and not loaded until
osseointegration was clinically complete, revealed treat-
ment outcomes with a success rate of 99.3% after 3 years.
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Reprint requests to:
DR MUTLU OZCAN
UNIVERSITY MEDICAL CENTER GRONINGEN
UNIVERSITY OF GRONINGEN
DEPARTMENT OF DENTISTRY AND DENTAL HYGIENE
CLINICAL DENTAL BIOMATERIALS
ANTONIUS DEUSINGLAAN 1
9713 AV GRONINGEN
THE NETHERLANDS
FAX: 31-50-363-2696
E-MAIL: mutluozcan@hotmail.com
0022-3913/$32.00
Copyright ! 2007 by The Editorial Council of The Journal of Prosthetic
Dentistry.
doi:10.1016/j.prosdent.2007.01.004
VOLUME 97 NUMBER 2