metadata analysIs bonetrust ® plus Implant system dr. m. claar, dr. m. parscHau, dr. K. lotZKat

gender dIstrIbutIon

Over a period of 3 ½ years (2009–2012), 3,586 implants (BoneTrust® plus, Medical Instinct® GmbH, Bovenden, Germany) have been examined in a multi-center study by three centers for implantology in Kassel, Hanover and Hamburg.

58%

The retrospective study involved 58 % female and 42 % male patients (Fig. 1). In Kassel 2,258 BoneTrust® plus implants have been placed, 841 in Hanover and 487 in Hamburg (Fig. 2).

42%

The number of implants increased annually in all three centers as shown in Fig. 3.

placed Implants

Kassel

Hanover

Hamburg

2,258

841

487

In total

3,586 Fig. 2

annual dIstrIbutIon 800 600 3,586 400 2,258

200

841 487

0 2009

2010

2 Hy

2010

1 Hy

2011

2 Hy

2011

1 Hy

2012

2 Hy

1 Hy

Fig. 3

Implants per patIent

186

1

1

0

4

1

9

3

5

31

27 1

0

38

75

78

69

150

1,003 Implants in total 3,586 Patients in total

108

225

247

300

194

In the course of the study there were 247 patients who received only one implant each and 194 were provided with 2 implants each. During this study a maximum of 18 BoneTrust® plus implants were placed in one patient (Fig. 4). In total, 2,331 implants were inserted into the patient`s maxilla (65 percent) and 1,255 into the patient’s mandible (35 percent) (Fig. 5). The implant healing rate in the maxilla was 99.18 %, and 99.20 % in the mandible (Fig. 5a).

Fig. 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Fig. 4

Implants In maxIlla and mandIble Maxilla

Mandible

2,331

1,255 65% 35%

Fig. 5

Healing rate according to specification

All 9 implant-variations (diameter/length) proved to be 100 % successful (no implant failures), except for the rarely used 3.4/6.5 mm implant. In this configuration one of five implants did not osseointegrate. Every other configuration showed a healing rate of over 99 % (Table 1).

Maxilla Size

▲

▲

99.18%

99.20%

Mandible

Implant

Loss

Success

Implant

Loss

Success

3.0/ 11.5 mm

5

0

100.00 %

12

0

100.00 %

3.0/ 13.0 mm

15

0

100.00 %

14

0

100.00 %

3.4/ 6.5 mm

5

1

80.00 %

12

1

91.67 %

3.4/ 8.0 mm

12

1

91.67 %

32

1

96.88 %

3.4/ 10.0 mm

143

4

97.20 %

98

1

98.98 %

3.4/ 11.5 mm

383

3

99.22 %

133

1

99.25 %

3.4/ 13.0 mm

379

1

99.74 %

108

1

99.07 %

3.4/ 14.5 mm

10

0

100.00 %

14

0

100.00 %

4.0/ 6.5 mm

12

0

100.00 %

36

0

100.00 %

4.0/ 8.0 mm

78

1

98.72 %

66

1

98.48 %

4.0/ 10.0 mm

337

1

99.70 %

171

1

99.42 %

4.0/ 11.5 mm

458

4

99.13 %

293

2

99.32 %

4.0/ 13.0 mm

372

0

100.00 %

208

0

100.00 %

4.0/ 14.5 mm

25

0

100.00 %

3

0

100.00 %

5.0/ 6.5 mm

2

0

100.00 %

2

0

100.00 %

5.0/ 8.0 mm

15

0

100.00 %

7

0

100.00 %

5.0/ 10.0 mm

28

2

92.86 %

20

1

95.00 %

5.0/ 11.5 mm

40

0

100.00 %

18

0

100.00 %

12

1

91.67 %

8

0

100.00 %

2,331

19

99.18 %

1,255

10

99.20 %

5.0/ 13.0 mm

Table 1

5 of 5

15 of 15

4 of 5

11 of 12

139 of 143

12 of 12

14 of 14

11 of 12

31 of 32

97 of 98

3.0/11.5 mm

3.0/13.0 mm

3.4/6.5 mm

3.4/8.0 mm

3.4/10.0 mm

3.0/11.5 mm

3.0/13.0 mm

3.4/6.5 mm

3.4/8,0 mm

3.4/10.0 mm

380 of 383

378 of 379

10 of 10

12 of 12

77 of 78

132 of 133

107 of 108

14 of 14

36 of 36

65 of 66

3.4/11.5 mm

3.4/13.0 mm

3.4/14.5 mm

4.0/6.5 mm

4.0/8.0 mm

3.4/11.5 mm

3.4/13.0 mm

3.4/14.5 mm

4.0/6.5 mm

4.0/8.0 mm

336 of 337

454 of 458

372 of 372

25 of 25

2 of 2

170 of 171

291 of 293

208 of 208

3 of 3

2 of 2

4.0/10.0 mm

4.0/11.5 mm

4.0/13.0 mm

4.0/14.5 mm

5.0/6.5 mm

4.0/10.0 mm

4.0/11.5 mm

4.0/13.0 mm

4.0/14.5 mm

5.0/6.5 mm

15 of 15

26 of 28

40 of 40

11 of 12

7 of 7

19 of 20

18 of 18

8 of 8

5.0/8.0 mm

5.0/10.0 mm

5.0/11.5 mm

5.0/13.0 mm

5.0/8.0 mm

5.0/10.0 mm

5.0/11.5 mm

5.0/13.0 mm

Osseointegrated Implants

Non-osseointegrated Implants

Osseointegrated Implants

Non-osseointegrated Implants

Fig. 5a

Trans-/subgingivally healing

68% 32% transgingival

subgingival

Of 2,438 healed in

2,419 = 99.22 % Of 1,148 healed in

1,138 = 99.13 %

▲

It has also been examined whether the implants healed either subgingivally or transgingivally. In total, 1,148 were placed following a transgingival protocol, and 2,438 implants healed below the soft tissue (Fig. 6). The possible reason for the difference within the healing rate of submerged and transgingivally placed implants has also been analyzed. The study revealed that 1,138 of 1,148 transgingivally placed implants successfully integrated (99.13 %) and 2,419 of 2,438 subgingivally positioned implants succeeded (99.22 %).

Mandible

Maxilla

implant Healing rate in maxilla and mandible

Fig. 6

▲

What about immediate loading or restoration? In 5.88 % of the cases the clinician loaded the BoneTrust ® plus implants immediately (number of implants 211) (Fig. 7). In total, 207 of those osseointegrated. This corresponds to a healing rate of 98.10 percent. The implants of the other patients had not been loaded immediately, but followed a regular sub- or transgingival protocol. 3,350 of 3,375 implants, which had been placed according to a late loading protocol, osseointegrated (99.26 %).

Immediate loading/restoration

5,88 % Immediate loading Of 3,375 healed in

3,350 = 99.26 % 94.12%

Late restoration

Of 211 healed in

207 = 98.10 % Fig. 7

Grafting proportion With grafting

Without

1,678 = 72 %

653

▲

Defects of the alveolar ridge and/or loss of vertical bone height make grafting procedures necessary. By doing so, a long-term implant success can be ensured. The study revealed that grafting procedures had to be taken in 58 % (728 implants) when implants were placed into the mandible, and in 72 % (1,687 implants), when the maxilla was restored. (Fig. 8)

With grafting

Without

728 = 58 %

527 Fig. 8

Sinus floor elevation

Furthermore, it has been checked how many patients were in need of a sinus floor elevation (externally or internally). In total, 908 sinus floor elevations were performed, 628 were performed externally, 280 internally. (Fig. 9) ▲

20 %

Sinus floor elevation in total

908 ×

sinus lift

80 % without sinus lift

Extern

Intern

628 ×

280 × Fig. 9

▲

The examination showed that especially in combination with the open (external) surgical approach, the BoneTrust® sinus implant design, which has been specifically developed for the sinus floor elevation and was used in 98 cases, worked in 100 %. (Fig. 10)

Bonetrust® sinus Pre-molar 1×

39 × 59 × D4.0/12

1st molar

2nd molar

21 ×

17 ×

thereof healed in: 39 ×

D5.0/12

Pre-molar 1st molar

2nd molar

15 × 30 ×

14 ×

thereof healed in: 59 ×

Fig. 10

▲

Attention was also paid to the question on how much an augmentation increases the risk of implant failure. A total of 2,406 implants have been placed in combination with grafting measures. 24 of those were lost, which corresponds to about one percent. This can be compared to the success rate of implantations which had been placed without bone grafting. (Fig. 11)

▲

The time of an implant failure also plays an important role from a therapeutic and economic point of view. In general, an early failure can be corrected with fewer complications and in a more economic way as a failure later on after the prosthetic care of the patient. Therefore, it has been examined when an implant failure occurs. Within the group of the early failures only the non-osseointegrated implants, which were lost up to the beginning of the seventh month after implant insertion, were evaluated. Implants, which have been in situ for more than six months were evaluated as late failures. Fig. 12 demonstrates that in the maxilla as well as in the mandible early failures predominated and late failures are more or less observed rarely.

Results: According to the analyzed data of more than 3,500 implants, the BoneTrust® plus implant shows a clinical healing rate of 99.18 % in the maxilla, and 99.20 % in the mandible. No significant differences concerning the healing process of sub- or transgingival approaches have been observed. Even in cases of immediate restoration or loading, a healing rate of 98 % could be proven. In combination with more important grafting measures a success rate of 99 % could be observed.

Grafting losses 2,382 implants osseointegrated

24 implants did not osseointegrate

Success rate:

2,406

99 %

of 3,586 implants have been used in combina­ tion with grafting procedures

Success rate:

1 %

Fig. 11

Early/late failures ration Early failure

Late fail.

14

5

Early failure

Late fail.

7

3 Fig. 12

Mailing address Zahnarztpraxis am Leipziger Platz Dres. Claar & Kollegen Leipziger Straße 164 34123 Kassel Medical Instinct® Deutschland GmbH Graseweg 24 37120 Bovenden www.medical-instinct.com