High Success in full arch implants - a classic study

PREFACE:
     This is one of the original literatures that introduced the osseointegration concept being an acceptable treatment modality for dentistry.  Did you know that the original treatment for dental implants was full mouth rehabilitation?  The "All-on-X" concept was how dental implantology made it's first impact.

PURPOSE:
     Update the survival rates for fixtures (implants) and prostheses for total edentulism after 25 years of osseointegration concept use.

MATERIALS & METHODS:

• 4636 Branemark fixtures
• 759 Edentulous jaws for 700 patients
• 56.8% Females vs 43.2% Males with mean age 55.3 (19-79yo)
• 4 Groups by time of fixture placement (Development, Routine 1, Routine 2, & Routine 3)
• After osseointegration, uncovered implants, and provided with abutments to support fixed prosthesis - "Standardized Branemark Guidelines"
• Development and Routine 1 groups with 10mm implants
• Routine 2 and 3 groups had fixtures of different lengths depending on bone volume
• Follow-up at least once every year, standardized radiographs at 1, 3, 5, 7, and 10 years
  • Prosthesis stability checked every year - defined by no saliva movement by manual prosthesis pivoting & percussion test with asymptomatic, high-pitched metallic sound
  • Maintain osseointegration - stable abutment connection, no peri-fixture radiolucency
• Mobile fixture removed, sites curetted and closed

RESULTS:

• Continuous prosthesis stability
  • Maxilla was 95% or more at 5 & 10 years, then 92% at 15 years
  • Mandible was 99% at all intervals
• Jaws requiring no supplementary fixtures
  • Maxilla routine groups
    • 5 years 88%, 89%, & 98%
    • 10 years 80%, 89%
    • 15 years 76%
  • Mandible routine groups
    • 5 years 91%, 97%, 99%
    • 10 years 86%, 96%
    • 15 year 83%
• Individual fixture survival rates
  • Maxilla routine groups
    • 5 years 89%
    • 10 years 81%
  • Mandible routine groups
    • 5 years 87%
    • 10 years 95%
• Fixture fractures < 5% (except Routine 1 group, maxilla had 13% and 16% fracture rates at 10 and 15 years)

CONCLUSION:

• For the past studies on osseointegration, Branemark's team method is basically unchanged, and provides sufficiently long observation period of success
• Routine treatment of edentulism with implant supported fixed prosthesis can provide predictable long-term success, represented by large population results in this study
• Mandible presents with better results than maxilla

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