The scientific basis for and clinical experiences with Straumann implants including the ITI Dental Implant System: a...

Successful endosseous implant therapy requires integration of the implant with bone, soft connective tissue and epithelium. This report from a consensus conference on Straumann dental implants including the ITI Dental Implant System documents the interaction of these nonsubmerged one-piece implants with the oral tissues and reviews clinical studies supporting the high success achievable with these implants in patients. Light and electron microscopy reveal that epithelial structures similar to teeth are found around the implants. A connective tissue zone exists between the apical extension of the junctional epithelium and the alveolar bone. This connective tissue comprises a dense circular avascular zone of connective tissue fibers surrounded by a loose vascular connective tissue. The histologic dimensions of the epithelium and connective tissue comprising the biologic width are similar to the same tissues around teeth. The nonsubmerged one-piece design of the Straumann implants, which have been used for over 20 years, has set a standard in implant dentistry, with other implants now being manufactured and placed using similar techniques. Straumann implants have an endosseous portion that is either coated with a well-characterized and well-documented titanium plasma-sprayed surface or is sandblasted and acid attacked. Both surfaces have been shown to have advantages for osseous integration compared to machined and other smoother implant surfaces. These advantages include greater amounts of bone-to-implant contact, more rapid integration with bone tissue, and higher removal torque values. The lack of component connection at or below the alveolar crest provides additional benefits. Component connection at the alveolar crest, as seen with submerged implants, results in microbial contamination, crestal bone loss and a more apical epithelial location. Numerous human clinical trials document the successful use of Straumann implants in a variety of indications and areas of the mouth. These include prospective long-term trials using strict criteria of success and life table analyses. Taken together, the clinical studies reveal that Straumann implants can be used predictably in partially edentulous and completely edentulous maxilla and mandibles with high success rates. Furthermore, the animal and microscopic studies reviewed provide a scientific basis for the integration of Straumann implants with bone, connective tissue and epithelium.