This may protect the remaining teeth from overload and reduce possible rotational movements of the RPDP [ 9 ]. When an incisor is the terminal abutment in the quadrant, distal implants can reduce the use of retentive elements such as clasps, which provides better aesthetics and periodontal stability [ 8 — 10 ]. Otherwise, bone augmentation procedures are indicated, which would increase the risk of possible side effects and increase costs and treatment duration [ 20 ].
Additional advantages of mini-implants are the simplified treatment procedures with a flat learning curve, low cost, and the possible flapless surgical procedure which can decrease the post-surgical morbidity [ 20 ]. With one exception [ 26 ], mini-implants used for the retention of removable prostheses are usually one piece with a retentive ball-attachment. Therefore, no-load osseointegration is not achievable. The female matrices housings with plastic O-rings can be immediately polymerised into the prostheses after placement of implants with sufficient primary stability.
Mini-implants are mainly used for the stabilization of complete dentures. The housings were picked-up after 3—4 months.
The mean bone loss was insignificantly higher in the maxilla 0. In another study on mini-implant supported mandibular overdentures, delayed loading appeared to be preferable to immediate loading regarding implant survival and bone loss [ 30 ].
Sound data of mini-implants as strategic abutments for a better retention of PRDPs are not available [ 20 , 23 , 27 ]. However, the improvements in the immediately loaded group will occur faster than in the delayed loaded group. The Dental School at the Greifswald university hospital and three German private dental practices specializing in dental implantology and prosthodontics participate. Vital or endodontically treated abutment teeth with a sealed root filling to the apical region without apical periodontitis. No contraindication for implantation, and sufficient bone in the study jaw to place an implant without augmentation procedures.
Poor general health, e. Dentists of the centers with experience in dental implantology for more than ten years, who are familiar with the mini-implant system, perform the surgical and prosthetic treatment. Standard operating procedures were specified in a manual and imparted during the first calibration meeting.
The first implant placement in each center was supervised by the treatment coordinator TC of the leading center. The posterior MDI should be placed at the most posterior area of the dental arch according to the local bone volume.
In the mandible, the MDIs should be located always mesial of the mental foramen. Whenever possible, the region of the canine should be occupied by an MDI alternatively the regions of the first premolar and the lateral incisor should show abutments after intervention. Recesses for female matrices housings were prepared in the existing PRDP. Mini dental implants presented in Fig. Housings for the implants presented in Fig. In the case of mucosal hyperplasia around the implant before to the fourth months, the recesses should be relined earlier using the soft material.
During the study period and thereafter the participants will be treated by the dentists of the study sites according to their dental healthcare needs. Treatments could arise from study-related events, e. Treatments before study closure will be considered as outcomes. Crestal bone levels as the primary outcome of this trial will be determined at the 1- and 3-year follow-ups by panoramic radiographs and compared with the level immediately after implant placement Fig.
Implant success is the secondary outcome according to the modified criteria by Albrektsson et al. The hypothesis is tested whether immediate loaded MDIs of the test group show more bone loss and less success than the MDIs of the control group.
Periodontal and peri-implant conditions probing depths, bleeding on probing BOP , modified plaque index, modified sulcus bleeding index mod. SBI , tooth and implant mobility measured by Periotest and Osstell. Food frequency and avoidance questionnaire will be completed by the patients to evaluate the nutrition of the patients [ 35 ]. Chewing efficiency will be quantified with colour-mixing ability test using a two coloured chewing gum optoelectronical. Dental and prosthetic complications: tooth loss, caries, endodontic treatment, implant- or tooth fracture, prosthesis fracture, loss of retention, housing detachments, loss of O-rings.
We hypothesized that after the placement of MDIs there will be significant improvements only in group A and not in group B at the baseline and at the 4- month follow-up examination.
http://m3u8.savedeo.com/gi-precio-azithromycin.php After the pick-up of the housings in group B there will be also significant improvements for patients of this group. Examinations for all secondary outcomes are scheduled before implant placement pre-treatment, exclusively outcomes No. A trained examiner of the leading treatment center not involved in the treatment of participants will perform all examinations.
Additionally, a second examiner will survey the bone levels at implants on the radiographs. The examiner and the dentists of the treatment centers are committed to report the principal investigator on the occurrence of events promptly.
The criteria will be checked every six months after the inclusion of the first patient. Premature termination of the trial should be decided by principal investigator in agreement with the sponsor. The power calculation is based on bone loss data in a randomized study on mandibular overdentures [ 37 ] similar to the present study.
Delayed loaded regular-diameter implants of 15 patients showed bone loss of 0. Immediate loaded implants of 15 patients showed bone loss of 0.
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The randomization was performed centrally by the trial statistician based on a sequence of computer-generated numbers with a allocation ratio stratified by jaw maxilla, mandible and study center. However, the two examiners of the radiographs and the statistician will be blinded. The data of the paper case report forms will be entered in the electronical spreadsheet by assistants of the leading study site. Non-numeric data will be coded not only for statistical analyses but also to identify missing or erroneous values by range checks.
The cases are pseudonymized continuously counted according to a single main list.
Only the head of the department in the dental school keyholder could open the pseudonyms. The principal investigator will have access to the cleaned dataset. Other members of the research group will be given access to data for analyses and publication by request. Participant forms will be stored in locked office cabinets. A member of our board of the community medicine research net with expertise in statistical methodology will guarantee the abidance of randomization and quality assurance at the data acquisition and data base.
Because of the statistical power, we choose the continuous variable bone level to be the primary outcome measure. We differentiate confirmatory and exploratory analyses. Confirmatory analysis is related to differences between groups whereas exploratory analysis is related to the rate of change between groups interaction between time and group , which yields low power test herein.
Opel Zafira 1. Lifespan David Sinclair Inbunden. Learn More - opens in a new window or tab Any international shipping is paid in part to Pitney Bowes Inc. Brunski, Jack E. Covering the latest advances in mini dental implant technology, Mini Dental Implants: Principles and Practice makes it easy to incorporate MDIs into your practice.
However, we present the joint test of the factor group and the interaction between time and group. To ensure hierarchical levels, tooth positions within each jaw are coded from 1 to 16 instead of from 1 to 32 on patient level. The first adjustment set consists of risk factors of periodontal disease including age, gender, and smoking [ 40 ]; and design variables including centre, jaw [ 41 ], jaw classification, and time.
Because X-ray at t 0 is assessed before differentiating treatment in groups, it is a baseline measurement which can additionally be used to increase efficiency [ 42 ]. In sensitivity analyses, we allow for continuous time instead of points in time, for correlated random effects, or for random effects of other than tooth level and suspend the Kenward-Roger correction. For six time points, we allow for nonlinear change.
The nonlinear change is modelled by taking the square root of time [ 45 ] because we expect a higher rate of change in the first weeks. The confirmatory and the exploratory SBI model:.