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GUEST EDITORIAL N S87 GUEST EDITORIAL n S87 Guest editorial Oral rehabilitation of complete edentulism by means of implants to support a fixed dental prosthesis with Wilfried Wagner, Prof Dr Dr of implants is, and has been for decades, a predict- a long-term predictable outcome. The key question University Medical Center able treatment option. It provides an improved qual- is whether a more limited number of implants, than of the Johannes Gutenberg University Mainz, Mainz, ity of life, clearly superior to what can be achieved by the classical 5 to 6 and more, suffice. A more limited Germany mucosally retained dentures. But when the question number of implants could avoid the invasiveness of is raised of how many implants one needs to properly bone augmentation/grafting procedures. A review deal with the rehabilitation of edentulous patients, of the literature (Nkenke and Neukam) underlined opinions are sometimes country-specific, while sci- that, as an intraoral donor site for autologous bone ence should be borderless. grafting, the mandibular ascending ramus is pref- The Foundation for Oral Rehabilitation (F O R) erable. The symphyseal area leads to the highest took up the challenge. Being a global network of (incidence of) morbidities. The posterior iliac crest experts and clinicians it always refers to scientifically is a good alternative but implies mostly general an- sound and well-proven data, which are universally aesthesia. accepted. A number of reputed researchers and cli- Another meta-analysis (Al-Nawas and Schieg- Daniel van nicians were selected to tackle the question of the nitz) proved that the survival rate of oral implants Steenberghe, MD, PhD, Drhc, number of implants needed, in a thoroughly scien- placed in conjunction with augmentation procedures HFRCS (Irl) tific manner. Their selection was based on exper- is as good with bone substitute material as with au- em. Professor, Faculty of Medicine, Catholic tise, number of publications and their citation index tologous bone grafts. Nevertheless, the bone aug- University Leuven, Belgium related to this theme. Each one received a specific mentation procedure by itself is more invasive and subject to critically review in the literature, and if more prone to postoperative pain and discomfort data were sufficiently available to provide a meta- than the straightforward (flapless) placement of analysis. After exchanging their manuscripts, the implants. Thus, if the treatment is patient-centred, experts met during 2 days at the University of Mainz. avoiding bone augmentation should be considered. Travel and hotel expenses were taken care of by Patient satisfaction with graftless solutions is indeed F O R, but no other compensation was provided. very high and patients’ preference to minimally inva- For any elective surgery, the patient should be sive implant surgery well established (Pommer and involved in opting among the wide range of treat- Watzek). ment alternatives. All participants chose the patient- The key question then becomes what should be centred viewpoint as a starting point. For a remov- the minimal/optimal number of implants to insure a able overdenture, one can choose whether to have reliable long-term outcome for the (fixed) prosthetic it on 2 or 4 implants in the mandible and 4 or more rehabilitation. Two decades ago (Brånemark et al1), implants in the maxilla. Fixed prostheses are gener- it was shown in a large-scale retrospective study that ally placed on 5 or 6 implants and sometimes even the 10-year survival in edentulous patients of fixed more in the maxilla. dental prostheses on either 4 or on 6 implants was When only a limited jawbone volume remains, not significantly different. The tradition to insert at it can be necessary to consider bone augmentation least 5 to 6 implants in edentulous jaws thus became procedures to (optimally) place a sufficient number questionable. Since very high survival rates are pres- Eur J Oral Implantol 2014;7(Suppl2):S87–S88 S88 n GUEST EDITORIAL The group of experts from left to right: Drs Gerry Raghoebar, Bernhard Pommer, Claudia Dellavia, John Brunski, Wilfried Wagner, Daniel van Steenberghe, Emeka Nkenke, Massimo Del Fabbro, Bilal Al-Nawas, Regina Mericske-Stern, Georg Watzek. ently reached by implants with moderately rough When segmentation of the fixed cross-arch surfaces, the concept of inserting supplementary framework is necessary, more than 4 implants are implants just to avoid a revision surgery should one needed (Mericske-Stern and Worni), which raises implant fail became more or less obsolete. the treatment cost and can render a bone augmenta- Furthermore, biomechanical calculations prove tion procedure indispensable. One may wonder why that with 4 implants to support a complete cross- CAD-CAM technologies, which do reach the neces- arch fixed reconstruction, strains in the bone or at sary precision of fit, are not used in these instances the bone-implant interface remain within the safe to keep the treatment less invasive. range (Brunski). Tilted implants, to insure a proper We both feel privileged to coordinate this first anterior-posterior spread, can even be subject to F O R consensus conference. The multidisciplinary lower forces than axial ones (Del Fabbro and Cere- interactions favoured cross-fertilisation but never- soli). Furthermore, the marginal bone level around theless led to an iteratively written consensus docu- tilted implants does not significantly differ from that ment, which was unanimously approved. around axial implants. The latter offers the possibil- The conclusions of this workshop should lead cli- ity to achieve a good anterior-posterior spread with nicians to also consider, for the benefit of their eden- few implants. tulous patients, less invasive procedures. Established Functional aspects of implant-supported reha- scientific data, which should always prevail on tradi- bilitations have been investigated by different meth- tions, do indeed prove that for complete edentulism, odologies. The number of implants supporting the unless specific aesthetic and/or functional demands prostheses does not appear as a relevant factor in are pressing, 4 implants only can already provide a the functional qualities (Dellavia et al). predictable anchorage for fixed prostheses. Wilfried Wagner Daniel van Steenberghe [email protected] [email protected] Moderators of the Consensus meeting 1. Brånemark PI, Svensson B, van Steenberghe D. Ten-year survival rates of fixed prostheses on four or six implants ad modum Brånemark in full edentulism. Clin Oral Implants Ress1995;6:227–231. Eur J Oral Implantol 2014;7(Suppl2):S87–S88 CONTENTS n S89 European Journal of Oral Implantology Supplement 2, Summer 2014 Contents EDITORIAL Marco Exsposito GUEST EDITORIAL 87 Wilfried Wagner, Daniel van Steenberghe REVIEW article Patients’ preferences towards minimally invasive treatment alternatives for implant rehabilitation of edentulous jaws 91 Bernhard Pommer, Georg Mailath-Pokorny, Robert Haas, Dieter Busenlechner, Rudolf Fürhauser, Georg Watzek CLINICAL article Biomechanical aspects of the optimal number of implants to carry a cross-arch full restoration 111 John B. Brunski REVIEW articleS Optimal number of oral implants for fixed reconstructions: A review of the literature 133 Regina Mericske-Stern, Andreas Worni Functional jaw muscle assessment in patients with a full fixed prosthesis on a limited number of implants: A review of the literature 155 Claudia Dellavia, Riccardo Rosati, Massimo Del Fabbro, Gaia Pellegrini CLINICAL article The fate of marginal bone around axial vs. tilted implants: A systematic review 171 Massimo Del Fabbro, Valentina Ceresoli REVIEW article A systematic review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: How many implants? 191 Gerry M. Raghoebar, Henny J.A. Meijer, Wim Slot, James J.R. Huddleston Slater, Arjan Vissink CLINICAL article Autogenous bone harvesting and grafting in advanced jaw resorption: Morbidity, resorption and implant survival 203 Emeka Nkenke, Friedrich W. Neukam REVIEW article Augmentation procedures using bone substitute materials or autogenous bone – a systematic review and meta-analysis 219 Bilal Al-Nawas, Eik Schiegnitz CONSENSUS statements Patient-centred rehabilitation of edentulism with an optimal number of implants 235 Eur J Oral Implantol 2014;7(Suppl2):S89 S90 n IMPRINT European Journal of Oral Implantology Subscription information Editors Contact your nearest Quintessence office: Marco Esposito, Arcore, Italy (Editor-in-Chief) Jerome Lindeboom, Amsterdam, The Netherlands Quintessence Publishing Co. Ltd, Michele Nieri, Florence, Italy Quintessence House, Grafton Road, Søren Schou, Aarhus, Denmark New Malden, Surrey KT3 3AB, UK. Tel: +44 (0)20 8949 6087 Editorial Board Fax: +44 (0)20 8336 1484 Email: [email protected] Carlos Aparicio, Spain Torsten Jemt, Sweden www.quintpub.co.uk Karl Bishop, UK Søren Jepsen, Germany Ian Brook, UK Ronald Jung, Switzerland Quintessenz Verlags-GmbH Jason Buglass, UK Matthias Kern, Germany Ifenpfad 2–4, D-12107, Berlin, Gioacchino Cannizzaro, Italy Fouad Khoury, Germany Germany Matteo Chiapasco, Italy Ye Lin, China Tel: +49-30-761 80-5 Noel Claffey, Ireland Hassan Maghaireh, UK StJohn Crean, UK Chantal Malevez, Belgium Fax: +49-30-761 80-68-0 Rubén Davó, Spain Paulo Maló, Portugal Email: [email protected] Nikolaos Donos, UK Mauro Merli, Italy www.quintessenz.de Pietro Felice, Italy Ken Nicholson, UK Anne-Marie Glenny, UK Alan Payne, New Zealand Quintessence Publishing
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