A Review Of Selected Dental Literature On Evidence-Based Treatment Planning For

A review of selected dental literature on evidence-based treatment planning for dental implants: Report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics
Melanie R. Wood, DMD,a and Stanley G. Vermilyea, DMD, MSb College of Dentistry, The Ohio State University, Columbus, Ohio
This literature review summarizes research with the aim of providing dentistswith evidence-based guidelines to apply when planning treatment with osseointegrated implants. Peer-reviewed literature published in the English language between 1969 and 2003 was reviewed using Medline and hand searches. Topics reviewed include systemic host factors such as age, gender, various medical conditions, and patient habits, local host factors involving the quantity and quality of boneand soft tissue, presence of present or past infection and occlusion, prosthetic design factors, including the number and arrangement of implants, size and coatings of implants, cantilevers and connections to natural teeth, and methods to improve outcomes of implant treatment in each category. The review demonstrated that there is no systemic factor or habit that is an absolute contraindication tothe placement of osseointegrated implants in the adult patient, although cessation of smoking can improve outcome significantly. The most important local patient factor for successful treatment is the quality and quantity of bone available at the implant site. Specific design criteria are provided, including guidelines for spacing of implants, size, materials, occlusion, and fit. Limitations in thecurrent body of knowledge are identified, and directions for future research are suggested. (J Prosthet Dent 2004;92:447-62.)

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n 1969, Branemark et al1 published landmark research documenting the successful osseointegration of endosseous titanium implants. Since then, these methods for surgical placement of dental implants have had a profound influence on the practice of dentistry. Implantshave become the treatment of choice in many, if not most, situations when missing teeth require replacement.2-7 However, implants are not without potential problems. A tangible number of implants do not integrate or do not survive for long-term function.8-11 Complications and loss of implants can be costly, both in terms of time and financial resources. Loss of integration can be troublesome,resulting in an edentulous space more difficult to restore than prior to implant placement. The ability to reliably identify patients and conditions with greater potential for failure would be valuable. The placement of implants should not be undertaken without careful consideration of many variables, including systemic and local host factors and the design of a prosthesis. Treatment planning decisionsshould, whenever possible, be based on evidence-based predictions of the best long-term success. This article reviews the dental literature to provide clinically relevant guidelines for the dentist to aid in planning implant treatment. English-language peer-reviewed articles published between 1969 and 2003 were identified using Medline, as well as a hand search, and reviewed.

This article willreview implant success and failure. For this purpose, a successful implant is defined as an osseointegrated dental implant that is successfully restored and contributing to the functional success of a dental restorative treatment or one that could be used for such purposes. An implant failure is defined as a dental implant that is not fulfilling this criterion. Early failure refers to an implant thatfails to osseointegrate before second-stage surgery or uncovering of the implant. Late failure refers to loss of osseointegration or mechanical failure of an implant after second-stage surgery. Most research on the success of dental implants concentrates on the first few years after placement. Research to date suggests that when implants do fail, they tend to do so soon after placement,12 and the...