2009 Effects of Different Implant Surfaces

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Effects of different implant surfacesand designs on marginal bone-levelalterations: a review

Ingemar AbrahamssonTord Berglundh

Authors afliations:Ingemar Abrahamsson, Tord Berglundh ,Department of Periodontology, The SahlgrenskaAcademy, University of Gothenburg, Go teborg,Sweden

Correspondence to:Ingemar AbrahamssonDepartment of PeriodontologyThe Sahlgrenska AcademyUniversity of GothenburgBox 450S-405 30 GoteborgSwedenTel.: 46 31 786 3585Fax: 46 31 786 3791e-mail: [email protected]

Conicts of interest: The authors have declared no

conicts of interest.

Key words: ankylos, bone level, bone loss, dental implants, implant design, implant

geometry, implant surface, machined, micro-thread, OsseoSpeed, Osseotite, platform-switch, SLA, TiOblast, TiUnite and turned

AbstractObjective: The purpose of this review was to evaluate the effect of different implantsurfaces and designs on marginal bone-level (MBL) alterations.Material and methods: A MEDLINE search (PubMed) was performed to identify clinical,prospective and controlled studies using a sufcient sample size ( 4 10 subjects) and with afollow-up time of ! 3 years.Results: Ten publications fullled the inclusioncriteria. Two studies evaluated the inuenceof implant surface characteristics and two studies reported on the effect of implant designon MBL changes. Six publications analyzed the combined effect of different implantsurfaces and designs on MBL alterations. As revealed from available studies, there is noevidence that modied surfaces are superior to non-modied implant surfaces in marginalbone preservation. One study reported on signicantly improved MBL preservation forimplants with a conical and micro-threaded marginal collar than implants with a cylindricaland non-threaded marginal portion after 3 years in function. No implant system was foundto be superior in marginal bone preservation.

Marginal bone-level (MBL) alterationsaround implants are a frequently used out-come variable in longitudinal studies eval-uating implant therapy. Absence of signs ofmarginal bone loss in radiographs indicatesmaintained integration between the im-plant device and the surrounding tissues.The nding of marginal bone loss, how-ever, should be interpreted in relation tothe function time for the implant. Thus,the bone remodeling that occurs early afterimplant installation should be distin-guished from the marginal bone loss thatmay be detected around implants duringfunction. Although the question on thecauses of marginal bone loss around im-plants in function remains to be unraveled,the traditional concept of load as a reason

for bone loss has to be addressed in relationto bone loss as a result of onset and pro-gression of peri-implant disease. In thiscontext, it is relevant to examine the pos-sible inuence of specic implant charac-teristics on marginal bone preservation. Forthe purpose of this review on the effectof different implant surfaces and designson MBL alterations, the type of studies tobe selected for data extraction is critical.

Longitudinal cohort studies representthe most common clinical study design inimplant dentistry. Information from suchstudies may be useful in descriptive researchon implant therapy using e.g. implant lossand other biological complications as out-come variables. In the attempt to analyzethe potential inuence of different surface

Date:Accepted 20 May 2009

To cite this article:Abrahamsson I, Berglundh T. Effectsof different implantsurfacesand designson marginalbone-levelalterations: asystematic review.Clin. Oral Impl. Res . 20 (Suppl. 4), 2009; 207215.doi: 10.1111/j.1600-0501.2009.01783.x

c 2009 John Wiley & Sons A/S 207
mailto:[email protected]:[email protected]


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modications or certain designs of dentalimplants, however, a study design usingadequate controls is required. In addition,the types of implants to be compared shouldhave been placed using a randomizationprotocol and, in the case of an intra-indivi-dual study design, the possible inuenceof implant position and subject varianceis eliminated. When using a two-samplestudy design, however, the subjects in thegroup to receive test devices must exhibitsimilar characteristics regarding the distri-bution of age, gender, systemic health,smokers, socioeconomic status and recipi-ent sites for implants as those in a controlgroup. It is obvious that retrospectivestudies suffer from the risk of bias in theselection of subjects and the control ofsubject-related factors as presented abovemay be insufcient. The desired type of

studies for the specic question in thecurrent review should therefore be prospec-tive and controlled.

Another prerequisite for the evaluationprocess of the current review is the follow-up period. As pointed out above, boneremodeling that can be related to a healingprocess after implant installation should, inthis case, be disregarded. Thus, resultsfrom clinical and experimental studies re-vealed that most pronounced bone-levelchanges were identied after the surgical

trauma elicited during implant installationand abutment connection, while after theconnection of prosthesis, i.e. start of func-tional load, only minor signs of bone loss

occurred (A strand et al. 2004b; Berglundhet al. 2005). The study inclusion criteria inthe present review therefore also included afollow-up period of at least 3 years. Thus,studies considered to be eligible for thisreview were clinical prospective, controlledstudies using a subject sample of a suf-cient size and with a follow-up time of! 3 years. Given the prerequisites, thepurpose of this review was to evaluate theeffect of different implant surfaces and de-signs on MBL alterations.

Material and methods

Search strategyA MEDLINE search (PubMed) was per-formed forarticles published in EnglishuntilNovember 2008. The following searchterms were used in different combinations:dental implants, bone level, TiUnite,TiOblast, Osseotite, OsseoSpeed,SLA, micro-thread, Ankylos, Ma-chined, Turned, implant design, implantsurface, implant geometry and platform-switch. In addition, publications related tothe retrieved articles and relevant reviewpublications were screened for studies thatwere not identied in the electronic search.

Titles and abstracts were screened for

information on the type of study, follow-uptime, sample size and evaluation methods.Thus, studies included in the analyses wereclinical, prospective and controlled using a

sufcient sample size ( 4 10 subjects) andwith a follow-up time of ! 3 years.

Studies that were excluded from theanalyses were reports that lacked (i) a pros-pective study design, (ii) appropriate con-trols, (iii) results from MBL alterationsassessed in radiographs, (iv) data from fol-low-up of ! 3 years and (v) sufcientsample size (number of subjects).

Results

The search resulted in a list of 69 publi-cations and following screening of abstractsthe number was reduced to 39. A full-textanalysis that was performed to identifypotentially relevant publications that ful-lled the inclusion criteria resulted in10 publications, which are presented inTables 13. The studies that were notincluded after the full-text analyses andthe reasons for exclusion are outlined inTable 4. The main reasons for exclusion ofpublications were: (i) function-time o 3years, (ii) insufcient controls, (iii) retro-spective study design and (iv) absence ofdata or incomplete data presentation re-garding MBL changes.

The study target of the included prospec-tive studies varied regarding factors thatpotentially inuenced the outcome vari-

able MBL change. Thus, two studies re-ported data on implants that differedwith respect to surface characteristics andtwo studies reported on the inuence of

Table 1 . Implant surface characteristicsAuthors Type of study Time for

follow-up(yrs)

No. of subjects/ implants

Study target Findings

Gotfredsen &Karlsson (2001)

Prospective,randomized,controlled(intra-individual),multicenter(6 centers)

5 50/133Astra Tech implantsTurned vs. TiOblastsurfaceFPD

Comparing two differentsurface typesMarginal bone levels onintra-oral radiographs

Drop-outs: 5 subjects (5 yrs)MBL change (TiOblast/Turned)BL-2 yrs: 0.22/0.26 mm (NS)BL-5 yrs: 0.52/0.22 mm (NS)

Wennstro met al. (2004)

Prospective,randomized,intra-individualcontrols

5 51/149TioblastTurnedFPDPeriodontitis-susceptible patients

Comparing two differentsurface typesMarginal bone level changeassessed on intra-oralradiographs (implant &subject level)

Drop-outs: 4 subjects (5 yrs)Failure rate (5 yrs): 5.9% and 2.7%(subject and implant level)MBL change: TiOblast/TurnedBL-1 yr: 0.33/0.29 mm (NS)BL-2 yrs: 0.28/0.22 mmBL-3 yrs: 0.4/0.27mmBL-4 yrs: 0.46/0.32 mmBL-5 yrs: 0.48/0.33 mm (NS)46% and 41% of Turnedand TiOblast implants exhibitedno bone loss at 5 yrs

FPD, xed partial dentures; MBL, marginal bone level; yrs, years.

Abrahamsson & Berglundh Effects of implant surfaces and designs on MBL alterations

208 | Clin. Oral Impl. Res. 20 (Suppl. 4), 2009 / 207215 c 2009 John Wiley & Sons A/S


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implant design. In the remaining six pub-lications, the combined effect of differentimplant surface and design on MBL changewas analyzed.

Implant surface characteristics (Table 1)Gotfredsen & Karlsson (2001) reported onMBL changes between baseline (BL) and 5years on Astra Tech (Astra Tech AB, Mo ln-dal, Sweden) Implants in 50 partially eden-

tulous subjects who received xed partialdentures (FPDs). Implants with a TiOblastor a turned surface were placed alternatelyin each patient, with the rst implant typechosen at random. Five subjects did notshow up at the 5-year follow-up visit.The MBL change between baseline (BL delivery of the prosthetic construction) and 2years was 0.22mm for the TiOblast im-plants and 0.26mm for the turned implants.The corresponding change between BL and5 years was 0.52 and 0.22 mm, respectively.The difference in MBL between implantswith a TiOblast surface and a turned surfaceat 5 years was not statistically signicant.

A similar study design with intra-indivi-dual controls was used by Wennstro m et al.(2004). They reported on MBL alterationsbetween BL and 5 years at Astra Techimplants with either a TiOblast surface ora turned surface in 51 subjects. Four of thesubjects were lost to follow-up at 5 years.The MBL change between BL and 1 yearwas 0.33 mm for the TiOblast surface im-plants and 0.29mm for the implants with a

turned surface. After 3 and 5 years offunction, the MBL change had increasedto 0.4 and 0.48 mm at the TiOblast sitesand to 0.27 and 0.33 mm at the turnedsurface sites. The different MBL changebetween the two surface types at 5 yearswas not statistically signicant. It wasreported that 41% of the TiOblast im-plants and 46% of the turned implantsexhibited no MBL alteration between BL

and the 5-year examination.

Implant design (Table 2)Two publications evaluated the effect ofimplant design on MBL alterations. In amulticenter, prospective study, the originalself-tapping (ST) Biomet 3i implant wascompared with a modied self-cutting im-plant, i.e. the incremental cutting edges(ICE) implant (Davarpanah et al. 2001).Eighty-ve partially edentulous subjects re-ceived 277 ST implants while 337 ICEimplants were placed in 104 subjects. Fivesubjects were lost to follow-up at 3 years.While no MBL change data from BL werereported, the number of implant threadscoronal to the MBL were counted on intra-oral radiographs representing 3 years. After 3years in function, the MBL at implantsavailable for analysis was found betweenthe reference point and the rst thread (01.8 mm) in 91.6% of the ST implants and89.6% of the ICE implants. In 4.6% of bothimplant types, the MBL waslocated betweenthe rst and the secondthread (1.82.4mm).

The MBL at the remaining implants (3.8%and 5.8% of the ST and ICE implants,respectively) was found between the secondand the fourth thread (2.43.6mm). Nostatistical analysis was reported.

Lee et al. (2007), in a study with intra-individual controls, evaluated bone-levelchanges at implants with a similar type ofsurface (TiOblast) butwith differentdesigns.One of the implant types had a conical and

micro-threaded marginal collar (ST ), whilethe second type was designed with an un-threaded cylindrical collar (TB). Each of the17 subjects was treated with one two-unitFPD supported by two implants (one im-plant of each type). The sequence of implanttypes was randomized. The MBL changebetween BL and 1 year and between BLand 2 years was 0.14 and 0.21mm for theST and 0.28 and 0.48mm for TB implants.At the 3-year examination, the MBL changefrom BL amounted to 0.24mm at ST im-plants and 0.51mm at TB implants. Thedifferent outcome in MBL change betweenthe two implant designs was statisticallydifferent for all three time periods evaluated.The MBL change during the third year infunction was, however, only 0.03 mm forboth implant types.

Combination of implant surface anddesign (Table 3)Meijer et al. (2004) reported 5-year re-sults from a prospective study on 90 sub-jects who received removable overdentures

Table 2 . Implant designAuthors Type of study Time for

follow-up(yrs)



Davarpanahet al. (2001)

Multicenterprospective(4 centers)

3 85/277 self-tapping(Turned)104/337/ICE (Turned)

Comparing two differentimplant designsExposed threads onintra-oral radiographs

Drop-out: 5 subjects/12implants (8 ST/4 ICE)MBL (# threads) (ST/ICE):01 (1.8mm): 218/275(91.6%/89.6%)12 (2.4 mm): 11/14 (4.6%/4.6%)23 (3 mm): 5/11 (2.1%/3.6%)34 (3.6 mm): 4/7 (1.7%/2.2%)No baseline data reportedDescriptive statistics only

Lee et al. (2007) Prospective,randomized,intra-individualcontrols

3 Astra implants withTiOblast surface17 subjects eachreceiving:1 single toothimplant (conicalwith microthreads)1 TiOblast (TB)implant (cylindrical)

Comparing two differentimplant designsMarginal bone level onintra-oral radiographs

Drop-outs: 0MBL change: single tooth/TB/ P -valueBL-1 yr: 0.14/0.28/0.002BL-2 yrs: 0.21/0.48/0.001BL-3 yrs: 0.24/0.51/0.001

ICE, incremental cutting edges; MBL, marginal bone level; ST, self-tapping; yrs, years.


c 2009 John Wiley & Sons A/S 209 | Clin. Oral Impl. Res. 20 (Suppl. 4), 2009 / 207215


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supported by two implants in the mand-ible. Three types of implants were used andin each of 30 subjects two implants ofeither IMZ, Bra nemark or ITI implantswere installed using a randomization pro-tocol. The mean MBL alteration at 5 yearswas 1.4, 0.7 and 0.9 mm for the IMZ,Branemark and ITI implants, respectively.

The differences between the three implanttypes were not statistically signicant.

In two publications, data from 66 subjectswho were treated with complete xed den-tures supported by Astra Tech Implantswith a TiOblast surface or Bra nemarkSystem

s

(Nobel Biocase, Gothenburg, Swe-den) implants with a turned surface were

reported (Engquist et al. 2002; A strand et al.2004a). Three subjects did not attend the5-year examination. One subject lost theimplant-supported bridge during the rstyear in function and the other two died afterthe 3-year follow-up. The mean MBL altera-tion between BL and 3 years of function was0.25 mm for the Astra Tech implants and

Table 3 . Combination of implant surface and designAuthors Type of study Time for

follow-up(yrs)



Engquist et al.(2002)Astrand et al.(2004a)

Prospective,randomized,controlled

35

66 patients184 Astra Techimplants (Tioblast)187 Bra nemarkimplants (Turned)FCP

Comparing two differentsurface types and twodifferent implant designsMarginal bone levels onintra-oral radiographs

Drop-outs: 3 subjects1 subject: 1 yr loss of bridge2 subjects: 35 yrs deceasedMBL change (Astra Tech/Bra nemark)BL-3 yrs: 0.28/0.08mm (maxilla) (NS)BL-3 yrs: 0.22/0.22mm (mandible) (NS)BL-3 yrs: 0.25/0.15 mm(maxilla mandible) (NS)BL-5 yrs: 0.44/0.1mm (maxilla) (NS)BL-5 yrs: 0.13/0.29mm (mandible) (NS)BL-5 yrs: 0.29/0.2mm(maxilla mandible) (NS)

Heijdenrijket al. (2006)

Prospective,randomized,controlled

5 40/80 divided in two groups(1) 20 subjects; two two-partTPS implants, non-submerged(IMZ)(2) 20 subjects; two one-partTPS implants, non-submerged(Straumann)Overdentures in the mandible

Comparing the effect of2 different implantdesigns and 2 (different?)implant surface typesMarginal bone levels onintra-oral radiographs

Drop-outs: 3 subjects (5 yrs)(1/2: IMZ/Straumann)MBL change (mean)BL-3 yrs: IMZ: 1.2 mmBL-3 yrs: Straumann: 1.3 mmBL-5 yrs: IMZ: 1.6 mmBL-5 yrs: Straumann: 1.8 mmNo statistically signicant difference

between groups at 3 or 5 yrsMeijer et al.2004

ProspectiveRandomizedcontrolled

5 30 subjects; 60 implants,IMZ implants (TPS surface)30 subjects; 60 implants,Branemark implants(Turned surface)30 subjects; 60 implants,ITI implants (TPS surface)

Comparing three differentsurface types and threedifferent implant designsMarginal bone levels onintra-oral radiographs

Drop-outs (5 yrs): 7 subjects(4 Branemark group and 3 ITI group)MBL change (IMZ/Branemark/ITI)BL-5 yrs: 1.4/0.7/0.9 mm (NS)

Ozkan et al.(2007)

ProspectiveControlledNotrandomized

3 (fullcohorts)

28 patients53 Camlog implants (2-stage)45 Frialit implants (2-stage)FPD

Comparing two differentimplant designs and twodifferent surface types;blasted and acid-etched/ high temperature acid-etchedMarginal bone levelchange assessed on

intra-oral radiographs

Drop-outs: 0MBL change: CAM/FRIBL-1 yr: 0.16/0.19 mmBL-2 yrs: 0.23/0.25 mmBL-3 yrs: 0.25/0.28 mmNo statistically signicantdifference between groups

Astrand et al.(2004b)

Prospective,randomized,controlled,split-mouthMulti-center(ve centers)

3 28 subjects77 ITI implants (TPS 1 stage)73 Bra nemark implants(Turned 2 stage)FPD

Comparing differentimplant designs,installation techniquesand surface types.Marginal bone levelsassessed on intra-oralradiographs

Drop-outs: 2 subjects (3 yrs)MBL change: ITI/Bra nemarkF. placement BL: 1.4/1.8 mmBL 1 yr: 0.2/0.2 mmBL 3 yrs: 0.1/0mmPeri-implantitis occurred at 9.1of the TPS-surfaced ITI implantsbut at none of the Bra nemarkimplants ( P o 0.05).Between the 1- and the 3-yrexamination 87.1% of the ITIimplants and 95.5% of theBranemark implants exhibited abone loss of 0.4 mm, indicatinga steady state of MBL

MBL, marginal bone level; yrs, years.




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Table 4 . Studies excluded after full-text analysisAuthors Type of study Time for

follow-upNo. of subjects/ implants Reasons for exclusion

Arlin (2007) Retrospective 0.89.7 years 342/836533 SLA implants303 TPS implants

Function-time o 3 yearsRetrospective designIncomplete data on MBL changes

Aalam &Nowzari (2005)

Prospective?Randomized?Controlled

2 years post-loading

74/19825/58 TiUnite implants27/52 Osseotite implants22/88 Turned implants

Function-time o 3 yearsRetrospective design?Incomplete data on MBL changes

Al-Nawaset al. (2007)

Retrospective, cohort study 4 1 year 210 MK II Nobel Biocare151 Dual acid-etched 3i implants


Batenburget al. (1998)

ProspectiveRandomizedControlled

1 year post-loading

(1) 30 subjects; 60 implants,IMZ implants (TPS surface)

(2) 30 subjects; 60 implants,Branemark implants(Turned surface)

(3) 30 subjects; 60 implants,ITI implants (TPS surface)

Function-time o 3 years

Beckeret al. (2000)

Prospective, longitudinal,multicenter

15 months post-loading (mean)Up to 3 years

29 subjects Bra nemark MS xtures1-stage29 subjects Bra nemark MS xtures2-stage

25 patients TPS xtures 1-stage


Cappielloet al. (2008)

Prospective, controlled 1 yearpost-loading

45/13175 implants narrow abutment(platform switching)56 implants with normal abutment


Davarpanahet al. (2002)

Prospective, multicenter 15 years 528/1583619 ICE545 Osseotite419 self-tapping

Function-time o 3 yearsIncomplete data on MBL changes

Finne et al.(2007)

Prospective multicenter,controlled? (Nobel Perfect& Nobel Direct)

1 year2 years

81 subjects (87)21 subjects (87)

Function-time o 3 yearsInsufcient controls

Friberg & Jemt(2008)

Retrospective, historiccontrolsEarly loading protocols

1 year 90/450 TiUnite152/750 Turned Bra nemark implants(historic controls)


Froberg et al.

(2006)

Prospective, randomized,

controlled (split-mouth)

18 months 15 subjects

TiUniteTurned


Gatti &Chiapasco(2002)

Prospective, randomized,controlled, pilot

2 years 5/20 Branemark (MKII),(2-piece)5/20 Conical transmucosal (NB),(1-piece)


Hallman et al.(2005)

RetrospectiveRestored afterinterpositional bonegrafting in the maxilla

5 years 11 subjects Bra nemark Turnedsurface11 patients Tioblast surface

Retrospective design

Hammerleet al. (1996)

Prospective randomized,controlled

1 year 11 subjects11 implants, SLA 1 mm subcrestal11 implants, SLA in level with the crest


Hanggi et al.(2005)

Retrospective Up to 3 years 68 subjects101 implants 1.8mm smooth collar100 implants 2.8mm smooth collarSLA and TPS surfaced implants

Function-time o 3 yearsRetrospective design

Karlsson et al.(1998)

Prospective, randomized,controlled (intra-individual), multicenter

2 years 50/133Astra Tech implantsTurned vs. TiOblast surface


Khang et al.(2001)

Prospective, randomized,controlled (intra-individual?)

3 years 97 subjects247 dual acid-etched implants185 Turned implants

Incomplete data on MBL changes

Machtei et al.(2006)

Retrospective 16 years 27 subjects28 implants external hex butt joint45 implants tapered Morse


Marchettiet al. (2008)

RetrospectiveRestored after LeFort Iosteotomy and bonegrafting

Mean 8.5 years(612 years)

Turned 6 subjectsTPS 6 subjects

Retrospective designInsufcient sample size




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0.15mm for the implants of the Bra nemarkSystem

s

. The corresponding changes be-tween BL and 5 years were 0.29 and0.2 mm for the Astra Tech and Bra nemarkSystem

s

implants, respectively. The differ-ences between the implant types at the 3-and 5-year examinations were not statisti-cally signicant.

Heijdenrijk et al. (2006) reported on re-sults from a study on 40 subjects who weretreated with overdentures supported by twoimplants. All 80 implants were placedusing a non-submerged technique andwere either two-part implants (IMZ) orone-part implants (ITI/Straumann, Strau-mann Waldenburg, Switzerland). Bothtypes of implants had a TPS surface, butno information regarding the specic sur-

face characteristicsof the twoimplant typeswas provided. The number of drop-outsubjects during the 5 years of follow-upwas three. From BL to 1 year in function,MBL change amounted to 0.7 mm in theone-part group and to 0.6 mm in the two-part group. The amount of additional boneloss during the second year in function was0.5 mm for both implant types. The annualbone loss during the third, fourth and fthyear of function was small and did not differbetween the one- and two-part implants.After 5 years in function, the MBL changefrom BL was 1.8mm at the ITI implant and1.6 mm at the IMZ implant. This differ-ence was not statistically signicant.

Ozkan et al. (2007) evaluated MBL changeat Camlog (Camlog Biotechnologies AB,

Basel, Switzerland) and Frialit (Friatec AG,Mannheim, Germany) implants after 1, 2and 3 years in function. Fifty-three Camlogimplants with a blasted and acid-etched sur-face were placed in 14 subjects, and 45 Frialitimplants with a high-temperature acid-etched surface were placed in another 14subjects. Both types of implants were placedusing a two-stage technique. All subjectsattended the 3-year follow-up visit. TheMBL changes between BL and 1, 2 and 3years in function were small and similar forboth implant types. The MBL change fromBL to 3 years in function was 0.25 and0.28mm for the Camlog and Frialit im-plants, respectively. No statistically signi-cant differences of mean MBL alterationsbetween the two implants types were found.

Oates et al.(2007)

Prospective, randomized,controlled

6 weeks 31 subjects31 SLA implants31 chemically modied


Puchades-Roman et al.(2000)

Retrospective 2 years 30 subjects15 Astra Tech single tooth implants15 Bra nemark single tooth implants

Function-time o 3 yearsRetrospective design

Rocci et al.(2003)

Prospective, randomized,controlledImmediate loadingprotocol in the posteriormandible

1 year 22/66 TiUnite22/55 Turned


Schincaglia etal. (2007)

Prospective, randomized,controlled, split-mouthImmediate loadingprotocol in the posteriormandible

1 year 10 subjects20 Tioblast22 Turned


Shin et al.(2006)

Prospective, randomized,controlled

1 year 68 subjects35 Turned neck (Ankylos)34 rough-surfaced neck (Stage 1)38 rough-surfaced neck withmicrothreads (Oneplant)


Spiekermannet al. (1995) Retrospective Mean 5.7 years (upto 11 years) 136/300TPS and IMZ Retrospective design

VanSteenberghe etal. (2000)

Prospective, split-mouthrandomized design

2 years TiOblastBranemark MK II


VandenBogaerde et al.(2004)

Prospective, multicenter,historic controlsEarly loading protocols

18 months 31/111 TiUnite?/? Turned Bra nemark


Vela-Nebot etal. (2006)

Prospective controlled 6 months afterabutmentconnection

30 control cases normalwidth of abutment30 test cases reducedwidth of abutment


Zechner et al.(2004)

Retrospective, controlled 4 3 years (37years)

19/76 Turned Bra nemark MKII17/68Sandblasted/acid-etchedFrios implants

Retrospective design

Ostman et al.(2007)

Prospective 1 year 48/115 (test)Nobel Direct (test)Nobel Perfect (test)97/380 Historic controls


MBL, marginal bone level.

Table 4. (continued)Authors Type of study Time for

follow-upNo. of subjects/ implants Reasons for exclusion




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those supporting partial- or complete-xedreconstructions (Berglundh et al. 2002).This observation once again points to theimportance of well-conducted and con-trolled clinical studies to elucidate the in-uence of design and other characteristicson treatment outcome in implant therapy.

Conclusions

1. Controlled prospective studies evalu-ating the effect of implant surface and

designs on MBL changes ! 3 years arefew.

2. As revealed from such studies, there isno evidence that modied surfaces aresuperior to non-modied implant sur-faces in marginal bone preservation.

3. One study reported on signicantlyimproved MBL preservation for im-plants with a conical and micro-threaded marginal collar than implantswith a cylindrical and non-threadedmarginal portion after 3 years in func-

tion. The interpretation of the resultsfrom this study is difcult due to thepresence of two differences in designand the absence of differences in MBLchanges during the third year of func-tion.

4. Comparisons between implants ofdifferent systems involve evaluationsof combinations of surface and designs.No implant system was found tobe superior in marginal bone preser-vation.

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