After MDI insertion, immediate follow-up radiographs were done to validate the correct implant position. The long-cone paralleling technique (Minray Soredex Intraoral, Tuusula, Finland, 70 kV, 0.16 mAs) was used to obtain digital intraoral radiographs. For reproducible projections, a film holder (X-ray holder, Super-Bite®, Kerr USA, Orange, CA, USA) with a customized silicone index for each participant was used. The marginal bone level (MBL) was measured using Scanora software (v. 5.1, Soredex, Tuusula, Finland) at 10× zoom-in at the mesial and distal sites of each MDI rounding up the values to the nearest 0.1 mm. The mesial and distal bone height measurements were averaged to obtain the mean MBL change. The magnification error was corrected using the formula reported by Yoo RH et al. [44 (link)]. The bone level at an RPD delivery was considered as the baseline. When any part of the smooth MDI surface was slightly submerged during surgery, bone loss until it reached the roughened threaded surface was considered bone remodeling. The bone loss was measured apically from the roughened threaded surface. In cases when any of the roughened threads were not in the bone after surgery, the first bone-to-implant contact was considered as the baseline. Successive intraoral radiographs are presented in Figure 3 .
Modified Plaque Index (MPI) and Modified Bleeding Index (MBI), according to Mombelli (scores 0–3) were also assessed [45 (link)]. Any problems with MDIs during the follow-up period (pain, exudate, mobility, fracture, loss) or with retention elements (loss or “o”-ring changes, metal housing loosening) were recorded. Implant success and survival rates were assessed at the 1-year, 3-year, and 5-year follow-up examinations. The assessments were based on the Consensus Conference of the International Congress of Oral Implantology in Pisa, Italy in 2007 [46 (link)]. Implants were considered successful when participants had no ongoing pain or history of pain, no foreign body sensation or dysesthesia, no recurrent peri-implant infections, no implant mobility, or continuous radiolucency > 2 mm, and when the implant would be suitable for a prosthodontic restoration. Two different survival categories were satisfactory survival or compromised survival. Successful survival was described as a peri-implant marginal bone loss slightly > 2 mm either at the mesial or distal site, but not requiring any clinical management. An implant having less than ideal conditions and requiring serious clinical treatment to reduce the risk of failure was considered to have a compromised survival. Implant failure was specified when an implant required removal or had already been lost.
Modified Plaque Index (MPI) and Modified Bleeding Index (MBI), according to Mombelli (scores 0–3) were also assessed [45 (link)]. Any problems with MDIs during the follow-up period (pain, exudate, mobility, fracture, loss) or with retention elements (loss or “o”-ring changes, metal housing loosening) were recorded. Implant success and survival rates were assessed at the 1-year, 3-year, and 5-year follow-up examinations. The assessments were based on the Consensus Conference of the International Congress of Oral Implantology in Pisa, Italy in 2007 [46 (link)]. Implants were considered successful when participants had no ongoing pain or history of pain, no foreign body sensation or dysesthesia, no recurrent peri-implant infections, no implant mobility, or continuous radiolucency > 2 mm, and when the implant would be suitable for a prosthodontic restoration. Two different survival categories were satisfactory survival or compromised survival. Successful survival was described as a peri-implant marginal bone loss slightly > 2 mm either at the mesial or distal site, but not requiring any clinical management. An implant having less than ideal conditions and requiring serious clinical treatment to reduce the risk of failure was considered to have a compromised survival. Implant failure was specified when an implant required removal or had already been lost.
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