A show of hands

Another successful Dental Update Study Day was held on 15 March 2013, the topic covered being The Dental Implant – First or Last Option? A variety of experts in the fields of endodontics, implantology and treatment decision-making examined what implants and root fillings could or could not do, their survival rates and how to decide what goes best where.

For those of you who were not there, let's look at some of the evidence. The results in early publications on dental implants indicated excellent levels of osseointegration,1 and an assumption was therefore made that implants could be the panacea for a wide variety of dental problems which involved missing teeth, with success rates of circa 95% being reported.2 However, there is a dearth of long-term studies with large numbers of implants, which is not ideal when we are dealing with what are usually elective and invariably expensive restorations. I will, however, quote the results of one long-term study, by Simonis and co-workers from Strasbourg.3 They followed up 162 implants for up to 16 years, reporting a survival rate of 83%, but with biological complications (such as peri-implantitis) in 17% of cases and technical complications (such as screw loosening or fracture, implant fracture or porcelain fracture) in 31%, leading the authors to state that ‘substantial amounts of chair time were necessary after implant treatment’. They also, in common with Safii, Palmer and Wilson,4 reported a higher risk of implant failure in patients with a history of periodontal disease. In addition, the systematic review by Pjeturrson et al5 informed us that, while the survival rate of implant-supported bridges was 94% at 10 years, only 66% of the patients were free from complications after 5 years. In other words, not quite such a rosy picture as originally supposed.