|Year : 2016 | Volume
| Issue : 4 | Page : 214-218
Evaluation of interproximal crestal bone loss around Straumann implants after the 1 st year of loading in panoramic radiography
Mehrdad Abdinian1, Morteza Bonakdarchian2, Reyhaneh Faghihian3, Marzieh Yousefian4
1 Department of Oral Maxillofacial Radiology, Dental Implant Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Prosthodontics, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
3 School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
4 Dentist, Isfahan, Iran
|Date of Web Publication||13-Dec-2016|
Source of Support: None, Conflict of Interest: None
Background: The marginal bone loss (MBL) around implants following restoration is used as a reference for evaluating implant success and survival. The aim of this study was to measure MBL around Straumann implants after 1 year of loading. Materials and Methods: The subjects of this prospective cross-sectional study were 81 patients (46 men, 35 women) receiving 289 Straumann implants. They were treated at a private office in Isfahan. The MBL was measured by two panoramic radiographs: the first one was taken immediately after loading and the second one was taken 1 year later. The data were analyzed by SPSS 11.5 (SPSS Inc., Chicago, Illinois, USA) software. Paired samples t-test and independent samples t-test were used to analyze the data. Results: The mean distal, mesial, and overall bone losses around implants were calculated 0.598, 0.688, and 0.643 mm, respectively (P > 0.157). Conclusion: This study has shown no significant differences of MBL regarding implant sides (mesial and distal) and location (maxilla and mandible).
Keywords: Alveolar bone loss, dental implants, panoramic
|How to cite this article:|
Abdinian M, Bonakdarchian M, Faghihian R, Yousefian M. Evaluation of interproximal crestal bone loss around Straumann implants after the 1 st year of loading in panoramic radiography. SRM J Res Dent Sci 2016;7:214-8
|How to cite this URL:|
Abdinian M, Bonakdarchian M, Faghihian R, Yousefian M. Evaluation of interproximal crestal bone loss around Straumann implants after the 1 st year of loading in panoramic radiography. SRM J Res Dent Sci [serial online] 2016 [cited 2023 Feb 9];7:214-8. Available from: https://www.srmjrds.in/text.asp?2016/7/4/214/195621
| Introduction|| |
The people lose their teeth because of many reasons and the result is problem in mastication, phonetic, and esthetics. ,,,,, Therefore, replacement of lost teeth with acceptable function and esthetics prostheses is the main goal of dentists in treatment of edentulous area.  The more teeth a patient is missing, the more arduous this goal becomes with traditional dentistry.  Decrease of treatment time and patient discomfort, higher predictability, excellent esthetics, less bone loss, and less damage to adjacent teeth are the advantages of implant in comparison with fixed and removable restorations. ,,,,,,
In implantology, the success of implants depends on osseointegration and adhesion of soft tissue to the titanium surface of implants. , Marginal bone loss (MBL) is one of the important indices of implant health.  Radiographic images are the most important sources to evaluate the MBL around implants.  The accepted MBL during the 1 st year of loading is maximum 1.5 mm and 0.2 mm annually for subsequent years. ,
One of the clinical effects of MBL is the formation of black triangle (a black triangular area around an implant formed as a result of bone and gum resorption) around implant supported restorations. It causes not only phonetic difficulties but also food impaction and unpleasant esthetics.  Therefore, if the MBL is more on the mesial side of implants, the esthetics will be more affected. In addition, previous studies presented different results about the comparison of MBL in jaws and implant surfaces. Therefore, the aim of the present study was to compare MBL on the mesial and distal sides of the implants and compare results in maxilla and mandible by eliminating disturbing factors and increasing the number of implants and patients. To eliminate disturbing factors, the surgeries were performed by two experienced surgeons and one skillful prosthodontist and also radiographs were taken in the similar conditions.
| Materials and Methods|| |
This study was a prospective cross-sectional descriptive research with convenience sampling. A total of 310 implants in 81 patients were studied. However, in some radiographs, there were unclear regions. Finally, 81 patients (46 men, 35 women with average age of 38) receiving 289 Straumann implants (supplied by Straumann AG, Waldenberg, Switzerland) participated in the study. In this research, inclusion criteria were patients who were free of systemic disorders, which may affect their periodontal tissue. In addition, they were not smokers and showed acceptable periodontal status (plaque index <15). Exclusion criteria were treatment fail and low-quality radiography. All patients were treated at a private office in Isfahan. Two-stage implant technique was applied. The surgeries were performed by two experienced surgeons and one skillful prosthodontist. The patients were assessed 1 year after abutment connection and functional loading. During the follow-up examination, two panoramic radiographs were taken using panoramic device (Planmeca CC, Proline, Finland). The first radiograph was taken exactly after functional loading. The second one was taken 1 year after loading, with the same condition including position, exposure, and processing. To keep the patient's position, Frankfort plane was parallel to horizon and light localizators of panoramic device were adjusted on the midline and canine region, so that the patient was in the focal trough. Then, the radiographs were scanned using AZTEK X-Scan III device (AZTEK Inc., Isfahan, Iran). To be certain about similarity of radiographs, the magnificence of two radiographs was compared. It is noted that the magnificence of radiograph was understood by considering the real length of an implant and comparing with its length in the radiograph.
To measure the MBL, a line was traced from the most upper point adjacent to the implant on the crest of alveolar bone to one of the implant's screw (at the mesial and distal sides). Then, it was compared with such distance of radiograph taken 1 year after loading [Figure 1] and [Figure 2]. All calculations were performed in Cygnus Media software (produced by Cygnus Media, Fort Pierce, FL, USA) with the accuracy of 0.1 mm.
|Figure 1: Distance between the most upper point adjacent to the implant on the crest of alveolar bone and one of the implant's screw, exactly after functional loading|
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|Figure 2: Distance between the most upper point adjacent to the implant on the crest of alveolar bone and one of the implant's screw, 1 year after loading|
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Furthermore, to determine intraobserver reliability, radiographs were assessed again 2 weeks later and data were analyzed by intraclass correlation coefficient (ICC >85, P < 0.001). Finally, the analysis was performed on the mean of data using SPSS 11.5 software (SPSS Inc., Chicago, Illinois, USA). Paired samples t-test was employed to compare MBL on mesial and distal sides. Furthermore, to compare MBL on maxilla and mandible, independent samples t-test was employed.
| Results|| |
132 implants were placed in maxilla and 157 implants were placed in mandible. 118 implants were bridge abutment and 171 implants were single crown. The results obtained from statistics analysis are shown in [Table 1] and [Figure 3]. [Table 2] shows opposing units of implant abutments (natural teeth or pontics).
|Figure 3: Marginal bone loss in mesial and distal surfaces around implants for individual jaws|
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|Table 1: Marginal bone loss in mesial and distal surfaces around implants for individual jaws|
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The mean distal, mesial, and overall bone losses were calculated 0.598, 0.688, and 0.643 mm, respectively. There was no significant difference between mesial and distal bone loss (P > 0.157).
The mean bone loss around implants placed in maxilla and mandible was 0.590 and 0.687 mm, respectively. There was no significant difference between maxilla and mandible bone loss (P > 0.225).
| Discussion|| |
The obtained results in this study showed that mean distal and mesial bone loss around implants was 0.598 and 0.688 mm, respectively. Moreover, the mean overall bone loss of Straumann system was estimated 0.643 mm. Behneke et al. stated a mean bone loss amounting to 0.8 mm in a 1-year follow-up.  According to Hammerle's study, the mean bone loss was 1.02 mm after 1 year loading time.  Weber reported 0.6 mm bone loss for the 1 st year of loading.  In another study conducted by Behneke et al., similar findings were presented, reporting a mean bone loss of 0.7 mm.  Rasouli Ghahroudi et al. showed a mean bone loss amounting to 0.93 mm at the 1 st year.  On the other hand, Adell et al. reported a mean bone loss amounting to 1.5 mm in a 1-year follow-up.  According to Johansson and Ekfeldt's research, a mean bone loss was 0.4 mm at the 1 st year for Branemark implants.  Differences existed on the mean bone loss values reported by different authors may be attributed to the different implant designs, the surgeon's experience, sample number, oral hygiene status, and the bone quality at implant sites. In this study, all implants were placed by two highly experienced surgeons that can express a more trustable data in comparison with the other studies which used different surgeons.
In this study, there was no significant difference between bone loss on the mesial and distal sides which was similar to the research done by Rasouli Ghahroudi et al. and Hosseinzadeh et al. , Bragger reported that there is more bone resorption on the distal side of implants.  This difference may be because of longer period of Bragger's study and increased incidence of plaque deposition.
In this study, there was no significant difference between bone loss at maxilla and mandible. Rasouli Ghahroudi et al. reported that no significant difference was found in overall bone loss regarding implant location at maxillary or mandibular regions.  Similar studies showed no significant difference between bone loss around maxillary and mandibular implants. ,,, Tamizi et al. stated similar bone loss values for implant placed at the maxilla and mandible.  Pickner in another study showed larger bone loss for the upper jaw.  Similar studies found larger bone loss for maxilla. , This observation could have been the result of differences in the remodeling capacity and rate between maxillary and mandibular bone since maxillary bone provides important vascularization and a great remodeling potential in the healing phase after implant placement. In contrast, the reaction of the mandible is slower; thus, more time is required to lose the same amount of bone around the implant.  In contrast, Soardi et al. showed larger bone loss for mandible. 
| Conclusion|| |
In this study, MBL around Straumann implants for the 1 st year of loading was measured. The results showed that bone loss was less than critical value (1.5 mm during the 1 st year of loading). , Furthermore, there were no significant differences of MBL regarding implant sides (mesial and distal) and location (maxilla and mandible). More studies are required to assess long-term bone loss and other clinical parameters. It is recommended for future studies to use parallel periapical radiographies to increase the accuracy of results.
We would like to express our sincere acknowledgment in the support and help of Torabinejad Research Center and Dental Faculty of Isfahan University of Medical Sciences.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]