Juan Mesquida, Jaime L. Lozada, Aladdin Al-Ardah, Chun-Xiao Sun and Charles J. Goodacre

Chapter Outline

Clinical Outcomes

Based on the high success rates achieved with implants placed as described by Brånemark et al. for the restoration of edentulous and partially edentulous arches,¹⁶ some thought that single tooth replacement by a dental implant could overcome the limitations observed in classic prosthodontic therapies.^17–19 Outcomes of this technique have been evaluated using various survival and success criteria,^20–24 but the criteria elaborated by Albrektsson et al.²⁰ are probably the most commonly used in dental implant literature. These researchers defined a successful implant as one that:

The Albrektsson criteria were developed at a time when determining the biologic outcomes of titanium implants was important to prove their higher reliability over alternatives made of other materials. Initially, restorative and patient-based parameters received less attention. Mechanical and esthetic parameters were later evaluated,25–27 as practitioners’ demands for greater predictability and natural-looking restorations increased. However, criteria that analyze a wider number of parameters are far from being established as performance indicators in dental implant literature.

Two main approaches have been used for the replacement of a failing tooth, based on the timing of implant placement in relation to tooth extraction. In general, if the implant is placed during the same surgical procedure as the extraction, the approach is referred to as immediate implant placement. If the implant is placed during a separate surgical procedure after the extraction has been performed, the approach is referred to as delayed implant placement. Studies have evaluated the outcomes of both of these approaches.

Complications

The information on success, failure, and complications presented in the following sections was developed by combining the raw data from clinical studies that evaluated implant single crowns. A mean was calculated for each type of complication by combining the data from each study. The purpose of the information is to suggest clinical trends rather than provide statistically valid incidence data. Table 11-2 identifies the types of complications that have been encountered in the clinical studies and provides a mean based on the number of studies that provided raw data related to that complication.

Psychosocial Outcomes

The psychosocial effects of single implant treatment have been described in scientific studies. Patient satisfaction and pain perception have been studied in the dental implant literature. However, studies focusing on those two parameters in relation to single implant replacement therapies are scarce. Interestingly, fewer than 2% of publications on dental implants deal with patient-centered issues.⁷⁶

Patient satisfaction is one of the most important goals in oral rehabilitation with dental implants and could be used as a success evaluator for such therapies.

Few studies have evaluated patient satisfaction in single implant restorations. In a recent study by Vermylen et al.,⁷⁷ a sample of 48 patients (52 implants) was studied after treatment with single implant restoration. The patients in this study were mailed a post-treatment questionnaire requesting information on their satisfaction with the treatment provided. The study observed that the patient opinion on the treatment was positive. Although all the patients were positive in recommending the treatment to others, almost a quarter of them responded negatively when asked whether they would be willing to undergo a similar treatment again. The authors of this study hypothesized that this result was probably related to the time elapsed between implant placement and cementing of the restoration, describing this issue as the major disadvantage perceived by patients. Other studies have shown that a one-stage surgical procedure may reduce healing time and enhance patient acceptance.⁷⁸

Similar results were observed in a later study by Bacarat et al.⁷⁹ In this study, patient expectations before treatment and satisfaction after treatment were rated on a visual analog scale and correlated; the satisfaction value was about 40% higher than the expectations value. The results of this study confirm that single tooth replacement is a very satisfactory procedure that may surpass patients’ expectations.

Pain may be defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.⁸⁰ Given the surgical nature of the dental implant procedure, different degrees of pain in relation to the extent of the procedure can be expected. Limited published data are available on the pain associated with the surgical placement of dental implants^80,81 or on factors associated with such pain.⁸² These authors know of no study that has evaluated pain perception in single implant therapy. However, some studies have reported a significant association between the number of implants placed and pain during the surgery.⁷⁴ In a study by Al-Khabbaz et al.,⁸³ patients with multiple implants were found to be 1.3 times more likely to experience pain during surgery than those who received a single implant. In the same study, the mean postoperative pain scores were highest 24 hours after surgery and decreased gradually after 1 week. With regard to the intensity of the reported pain, most patients reported mild pain (69.7% after 24 hours, 56.5% after 1 week, and 5.1% after 6 weeks), and a few patients reported moderate or severe pain (10.6% after 24 hours, 3.8% after 1 week, and none after 6 weeks). In general, studies have shown that maximum pain levels appear 6 to 24 hours after implant placement, and most patients rate pain as mild.^80,81 Factors associated with pain perception are listed in Table 11-3.