Since the advent of osseointegration approximately 20 years ago, there has been a great deal of scientific data developed on two-stage integrated implant systems. Although these implants were originally designed primarily for fixed prostheses in the mandibular arch, they have been used in partially dentate patients, in patients needing overdentures, and in single-tooth restorations. In addition, this implant system has been placed in extraction sites, in bone-grafted areas, and in maxillary sinus elevations. Often, the documentation of these procedures has lagged. In addition, most of the reports use survival criteria to describe results, often providing overly optimistic data. It can be said that the literature describes a true adhesion of the epithelium to the implant similar to adhesion to teeth, that two-stage implants appear to have direct contact somewhere between 50% and 70% of the implant surface, that the microbial flora of the two-stage implant system closely resembles that of the natural tooth, and that the microbiology of periodontitis appears to be closely related to peri-implantitis. In evaluations of the data from implant placement in all of the above-noted situations by means of meta-analysis, it appears that there is a strong case that two-stage dental implants are successful, usually showing a confidence interval of over 90%. It also appears that the mandibular implants are more successful than maxillary implants. Studies also show that overdenture therapy is valid, and that single-tooth implants and implants placed in partially dentate mouths have a success rate that is quite good, although not quite as high as in the fully edentulous dentition. It would also appear that the potential causes of failure in the two-stage dental implant systems are periimplantitis, placement of implants in poor-quality bone, and improper loading of implants. There are now data addressing modifications of the implant surface to alter the percentage of osseointegration. New types of reinforcements for dental implants and the use of growth factors to augment bone regeneration so that implants can be placed more easily are now being actively investigated.
Adell R., Lekholm U., Rockler B., Branemark P-I.( 1981) A15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg10 :387-416.
2.
Albrektsson T. , Hansson H-A. , Ivarsson B. (1985) Interface analysis of titanium and zirconium bone implants. Biomaterials6 :97-101.
3.
Avivi-Arber L. , Zarb GA (1996) Clinical effectiveness of implant-supportde single-tooth replacement: The Toronto Study. Int J Oral Maxillofac Implants11 :311-321.
4.
Bahat O., Handelsman M. (1996). Use of wide implants and double implants in the posterior jaw: a clinical report. Int J Oral Maxillofac Implants11:379-386.
5.
Barzilay I., Graser GN, Iranpour B., Proskin HM (1996). Immediate implantation of pure titanium implants into extraction sockets of Macaca fascicularis. Part I: Clinical and radiographic assessment. Int J Oral Maxillofac Implants11:299-310.
6.
Becker W., Becker B., Newman M., Nyman S. (1990). Clinical and microbiologic findings that may contribute to dental implant failure. Int J Oral Maxillofac Implants5:31-38.
7.
Becker W., Becker BE, Israelson H., Lucchini JP, Handelsman M., Ammons W., et al. (1997). One-step surgical placement of Branemark implants: a prospective multicenter clinical study. Int J Oral Maxillofac Implants12:454-462.
8.
Bergendal T., Ekstrand K., Karlsson U. (1995). Evaluation of implant-supported carbon/graphite fiber-reinforced poly (methyl methacrylate) prostheses. A longitudinal multicenter study. Clin Oral Impl Res6:246-253.
9.
Branemark P-I. (1985). Introduction to osseointegration. In: Tissue-integrated prostheses osseointegration in clinical dentistry . Branemark P-I, Zarb G , Albrektsson T, editors. Chicago: Quintessence Publ. Co., Chap. 1.
10.
Branemark P-I., Hansson BO, Adell R., Breine U., Lindstrom J., Hallen O., et al.(1977). Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg11 (Suppl 16).
11.
Buser D., Dula K., Hirt HP, Schenk RK (1996). Lateral ridge augmentation using autografts and barrier membranes: a clinical study with 40 partially edentulous patients . J Oral Maxillofac Surg54:420-432.
12.
Cochran D. (1996). Implant therapyI. Ann Periodontol1:707-791.
13.
DeBruyn H., Collaert B. (1994). The effect of smoking on early implant failure . Clin Oral Impl Res5:260-264.
14.
Edgerton M., Lo SE, Scannapieco FA (1996). Experimental salivary pellicles formed on titanium surfaces mediate adhesion of streptococci. Int J Oral Maxillofac Implants11:443-449.
15.
Eke P., Braswell L., Fritz M. (1995). Succession of putative peri-implant pathogens after root-form and plate-form implant placement in partially dentate adult monkeys. J Periodont Res30:88-96.
16.
Eke P., Braswell LD, Fritz ME (1998). Microbiota associated with experimental peri-implantitis and periodontitis in adult Macaca mulatta monkeys. J Periodontol69:190-194.
17.
Engquist B., Nilson H., Astrand P. (1995). Single-tooth replacement by osseointegrated Branemark implants. A retrospective study of 82 implants. Clin Oral Impl Res6:238-245.
18.
Eriksson A., Albrektsson T. (1983). Temperature threshold levels for heat-induced bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent50:101-107.
19.
Eriksson A., Albrektsson T., Grane B., McQueen D. (1982). Thermal injury to bone. A vital-microscopic description of heat effects. Int J Oral Surg11:115-121.
20.
Fritz ME (1996). Implant therapy II. Ann Periodontol1:796-815.
21.
Fritz ME (1997). Overview of clinical trials on endosseous implants . Ann Periodontol2:270-283.
22.
Fritz M., Lemons J., Jeffcoat M., Braswell L., Reddy M. (1994). Evaluation of consecutively placed unloaded root-form and plate-form implants in adult Macaca mulatta monkeys. J Periodontol65:788-795.
23.
Fritz ME, Braswell LD, Koth D., Jeffcoat M., Reddy M., Cotsonis G. (1997). Experimental peri-implantitis in consecutively placed loaded root-form and plate-form implants in adult Macaca mulatta monkeys . J Periodontol68:1131-1135.
24.
Geertman ME, Boerrigter EM, Van Waas MAJ, van Oort RP (1996). Clinical aspects of a multicenter clinical trial of implant-retained mandibular overdentures in patients with severely resorbed mandibles. J Prosthet Dent75:194-204.
Gottlander M., Albrektsson T. (1991). Histomorphometric studies of hydroxylapatite-coated and un-coated CP titanium threaded implants in bone. Int J Oral Maxillofac Implants6:399-404.
27.
Gottlander M., Albrektsson T., Carlsson L. (1992). A histomorphometric study of unthreaded hydroxyapatite-coated and titanium-coated implants in rabbit bone. Int J Oral Maxillofac Implants7:485-490.
28.
Gould T., Westbury L., Brunette D. (1984). Ultrastructural study of the attachment of human gingiva to titanium in vivo. J Prosthet Dent52:418-420.
Haas R., Mensdorff-Pouilly N., Mailath G., Watzek G. (1995). Branemark single tooth implants: a preliminary report of 76 implants. J Prosthet Dent73:274-279.
31.
Hansson H-A., Albrektsson T., Branemark P-I. (1983). Structural aspects of the interface between tissue and titanium implants. J Prosthet Dent50:108-113.
32.
Hickey J., O'Neal R., Scheldt M., Strong S., Turgeon D., Van Dyke T. (1991). Microbiologic characterization of ligature-induced peri-implantitis in the micro-swine model. J Periodontol62:548-553.
33.
Higuchi KW, Folmer T., Kultje C. (1995). Implant survival rates in partially edentulous patients: a 3-year prospective multicenter study. J Oral Maxillofac Surg53:264-268.
34.
Holmes DC, Haganman CR, Aquilino SA (1994). Deflection of superstructure and stress concentrations in the IMZ implant system. Int J Prosthodont3:239-246.
35.
Hooghe M., Naert I. (1997). Implant supported overdentures-the Leuven experience . J Dent25(Suppl 1):25S-32S.
36.
Hutton JE, Heath MR, Chai JY, Harnett J., Jemt T., Johns RB, et al. (1995). Factors related to success and failure rates at 3-year follow-up in a multicenter study of overdentures supported by Branemark implants. Int J Oral Maxillofac Implants10:33-42.
37.
James RA, Schultz RL (1973). Hemidesmosomes and the adhesion of junctional epithelial cells to metal implants. A preliminary report. J Oral Implantol4:294-230.
38.
Jemt T., Chai J., Harnett J., Heath MR, Hutton JE, Johns RB, et al. (1996), A 5-year prospective multicenter follow-up report on overdentures supported by osseointegrated implants. Int J Oral Maxillofac Implants11:291-298.
39.
Johansson C., Albrektsson T. (1987). Integration of screw implants in the rabbit: a 1-year follow up of removal torque of titanium implants. Int J Oral Maxillofac Implants2:69-75.
40.
Kemppainen P., Eskola S., Ylipaavalniemi P. (1997). A comparative prospective clinical study of two single-tooth implants: a preliminary report of 102 implants. J Prosthet Dent77:382-387.
41.
Klinge B. (1991). Implants in relation to natural teeth. J Clin Periodontol18:482-487.
42.
Koka S., Razzoog M., Bloem T., Syed S. ( 1993). Microbial colonization of dental implants in partially edentulous subjects. J Prosthet Dent70:141-144.
43.
Kraut RA, Kirsch A. (1993). Practical stress absorption by means of modified abutments. Case presentations. Pract Perio Aesthet Dent5:67-74.
44.
Lang N., Bragger U., Walther D., Beamer B., Kornman K. (1993). Ligature-induced peri-implant infection in cynomolgus monkeys. I. Clinical and radiographic findings. Clin Oral Implant Res4:2-11.
45.
Lazzara R., Siddiqui AA, Binon P., Feldman SA, Weiner R., Phillips R., et al. (1996). Retrospective multicenter analysis of 3i endosseous dental implants placed over a five-year period. Clin Oral Impl Res7:73-83.
46.
Lekholm U., Sennerby L., Roos J., Becker W. (1996). Soft tissue and marginal bone conditions at osseointegrated implants that have exposed threads: a 5-year retrospective study. Int J Oral Maxillofac Implants11:599-604.
47.
Lemons J. (1997). Biomechanical and biomaterial considerations of root form dental implants. In: Science and practice of occlusion . McNeil C, editor. Chapter 16. Chicago: Quintessence Publ. Co., pp. 195-205.
48.
Leonhardt A., Berglundh T., Ericsson I., Dahlen G. (1992). Putative peridontal pathogens on titanium implants and teeth in experimental gingivitis and periodontitis in beagle dogs. Clin Oral Impl Res3:112-119.
49.
Lindhe J., Berglundh T., Ericsson I., Liljenberg B., Marinello C. (1992). Experimental breakdown of peri-implant and periodontal tissues. A study in the beagle dog. Clin Oral Impl Res3:9-16.
50.
Lindquist LW, Carlsson GE, Jemt J. ( 1996). A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Impl Res7:329-336.
51.
Listgarten MA, Lai C. (1975). Ultrastructure of intact interface between an endosseous epoxy-resin dental implant and host tissues. J Biol Buccale3:13-28.
52.
Malmstrom H., Fritz M., Timmis D., Van Dyke T. (1990). Osseointegrated implant treatment of a patient with rapidly progressive periodontitis. A case report. J Periodontol61:300-304.
53.
McKinney R., Steflik D., Koth D. ( 1985). Evidence for a junctional epithelial attachment to ceramic dental implants. A transmission electron microscopic study. J Periodontol56:579-591.
54.
Meffert RM (1993). Periodontitis and periimplantitis; one and the same?. Pract Perio Aesthet Dent5:79-80, 82.
55.
Meijer HJ, Starmans FJ, Steen WH, Bosman F. (1996). Loading conditions of endosseous implants in an edentulous human mandible: a three-dimensional, finite-element study. J Oral Rehabil23:757-763.
56.
Meijer GJ, Cune MS, Van Dooren M., De Putter C., Van Blitterswijk CA (1997a). A comparative study of flexible (Polyactivel) versus rigid (hyroxylapatite) permucosal dental implants. I. Clinical aspects. J Oral Rehabil24:85-92.
57.
Meijer GJ, Dalmeijer RA, De Putter C., Van Blitterswijk CA (1997b). A comparative study of flexible (Polyactive®) versus rigid (hyroxylapatite) permucosal dental implants. II. Histological aspects. J Oral Rehabil24:93-101.
58.
Mombelli A., Lang NP ( 1992). Antimicrobial treatment of peri-implant infections. Clin Oral Impl Res3:162-168.
59.
Naert I., Quirynen M., Hooghe M., van Steenberghe D. (1994). A comparative prospective study of splinted and unsplinted Branemark implants in mandibular overdenture therapy: a preliminary report. J Prosthet Dent71:486-492.
60.
Naert IE, Gizani S., Vuylsteke M., van Steenberghe D. (1997). A randomised clinical trial on the influence of splinted and unsplinted oral implants in mandibular overdenture therapy. A 3-year report. Clin Oral Invest1:81-88.
61.
Ong E., Newman H., Wilson M., Bulman J. (1992). The occurrence of periodontitis-related microorganisms in relation to titanium implants. J Periodontol63:200-205.
62.
Papaioannou W., Quirynen M., van Steenberghe D. (1996). The influence of periodontitis on the subgingival flora around implants in partially edentulous patients. Clin Oral Impl Res7:405-409.
63.
Piattelli A., Paolantonio M., Corigliano M., Scarno A. (1997a). Immediate loading of titanium plasma-sprayed screw-shaped implants in man: a clinical and histological report of two cases . J Periodontol68:591-597.
64.
Piattelli A., Scarano A., Piattelli M., Bertolai R., Panzoni E. (1997b). Histologic aspects of the bone and soft tissues surrounding three titanium non-submerged plasma-sprayed implants retrieved at autopsy: a case report. J Periodontol68:694-700.
65.
Quirynen M., Bollen CML, Papaioannou W., Van Eldere J., van Steenberghe D. (1996). The influence of titanium abutment surface roughness on plaque accumulation and gingivitis: short-term observations. Int J Oral Maxillofac Implants11:169-178.
66.
Rosenberg E., Torosian J., Slots J. (1991). Microbial differences in 2 clinically distinct types of failures of osseointegrated implants. Clin Oral Impl Res2:135-144.
67.
Ruggeri A., Francchi M., Marini N., Trisi P., Piattelli A. (1992). Supracrestal circular collagen fiber network around osseointegrated nonsubmerged titanium implants. Clin Oral Impl Res3:169-175.
68.
Ruggeri A., Francchi M., Trisi P., Piattelli A. (1994). Histologic and ultrastructural findings of gingival circular ligament surrounding osseointegrated nonsubmerged loaded titanium implants. Int J Oral Maxillofac Implants9:636-643.
69.
Sanz M., Newman M., Nachnani S., Holt R., Stewart R., Flemmig T. (1990). Characterization of the subgingival microbial flora around endosteal sapphire dental implants in partially edentulous patients . Int J Oral Maxillofac Implants5:247-253.
70.
Schnitman PA, Wohrle PS, Rubenstein JE, DaSilva JD, Wang N.-H (1997). Ten-year results for Branemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implants12:495-503.
71.
Schou S., Holmstrup P., Hjørting-Hansen E., Lang N. ( 1992). Plaque-induced marginal tissue reactions of osseointegrated oral implants: a review of the literature. Clin Oral Impl Res3:149-161.
72.
Schou S., Holmstrup P., Reibel J., Juhl M., Hjørting-Hansen E., Kornman K. (1993a). Ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth: stereologic and histologic observations in cynomolgus monkeys (Macaca fascicularis). J Periodontol64:529-537.
73.
Schou S., Holmstrup P., Stoltze K., Hjørting-Hansen E., Kornman K. (1993b). Ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth. Clin Oral Impl Res4:12-22.
74.
Schwartz Z., Kieswetter K., Dean DD, Boyan BD (1997). Underlying mechanisms at the bone-surface interface during regeneration. J Periodont Res32:166-171.
75.
Tarnow DP, Emtiaz S., Classi A. (1997). Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants12:319-324.
76.
Tolman D., Laney W. (1992). Tissue integrated prostheses complications. Int J Oral Maxillofac Implants7:477-484.
77.
Truhlar RS, Farish SE, Scheitler LE, Morris HF, Ochi S. ( 1997). Bone quality and implant design-related outcomes through stage II surgical uncovering of Spectra-system root form implants. J Oral Maxillofac Surg55(Suppl 5):46S-54S.
78.
van Steenberghe D. (1997). Outcomes and their measurement in clinical trials of endosseous oral implants. Ann Periodontol2:291-298.
79.
van Steenberghe D., Tricio J., Naert I., Nys M. (1995). Damping characteristics of bone-to-implant interfaces. A clinical study with the Periotest device. Clin Oral Impl Res6:31-39.
80.
Van Waas MAJ, Geertman ME, Spanjaards SG, Boerrigter EM (1997). Construction of a clinical implant performance scale for implant systems with overdentures with the Delphi method. J Prosthet Dent77:503-509.
81.
Weinberg LA, Kruger B. (1995). A comparison of implant/prosthesis loading with four clinical variables. Int J Prosthodont8:421-433.
82.
Weinlaender M., Kenney E., Lekhovic V., Beumer J., Moy P., Lewis S. (1992). Histomorphometry of bone apposition around three types of endosseous dental implants. Int J Oral Maxillofac Implants7:491-496.
