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Performance of threaded versus sintered porous-surfaced dental implants using open window or indirect
Jaffer Y Kermalli1, Douglas A Deporter, Jim Y Lai
1Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
Background:
The purpose of this retrospective report was to evaluate the performance of dental implants placed in a teaching environment in patients requiring maxillary sinus elevation.
Methods:
Threaded (acid-washed or sand-blasted acid-etched) and sintered porous-surfaced (SPS) press-fit implants were used. Sinuses were managed using direct (open window) or indirect (osteotome-mediated) techniques. Records were available for 97 implants in 62 patients. Preoperative subantral bone heights were determined from radiographs, primarily panoramic. Of 69 threaded implants used, 40 and 29 were placed using direct (DTH) and indirect (ITH) techniques, respectively. Twenty-eight SPS implants were placed using the indirect technique. Implant failure rates using the Kaplan-Meier method of analysis and cumulative crestal bone loss (the latter based on bone levels seen in the most recent radiographs) were determined for both types of implants.
Results:
The mean preoperative subantral bone height for DTH implants was 5.0 mm (range, 1 to 12 mm). Preoperative bone heights for ITH implants and SPS implants placed using the indirect approach were 7.2 mm (range, 4 to 12 mm) and 4.2 mm (range, 3 to 6 mm), respectively. Significant differences in preoperative bone height were seen between DTH and ITH implants (P <0.0001) and between ITH and SPS implants (P <0.0001). Average functional times were 18.7 months and 16.3 months for DTH and ITH implants, respectively, whereas the average functional time for SPS implants was 49.9 months. Time in function was significantly greater (P <0.0001) for SPS than DTH and ITH implants. Significant differences in implant length were also seen, with SPS implants significantly shorter than DTH or ITH implants. Three implants failed to integrate, one in each of the three treatment groups, giving initial survival rates of 97.5%, 96.6%, and 96.4% for DTH, ITH, and SPS implants, respectively. Mean cumulative crestal bone loss measurements were 1.84, 1.90, and 0.57 mm for DTH, ITH, and SPS implants, respectively. Bone loss was significantly less with SPS implants than with DTH or ITH implants. A second SPS implant failed after 7 years in function, likely because of prosthetic deficiencies. This late failure reduced the Kaplan-Meier survival rate to 80.4% for the SPS group.
Conclusion:
Results from this teaching clinic suggest that the use of dental implants with sinus elevation procedures is a predictable treatment for the resorbed posterior maxilla.
