Towards Optimized Treatment Outcomes For Dental Implants: A Conference Report
John O'Keefe, B.Dent.Sc., M.Dent.Sc., MBA
I attended a conference entitled "Towards Optimized Treatment Outcomes for Dental Implants," held at the University of Toronto on April 24-25. Experts in the field of dental implants, from Canada and abroad, came together for the purpose of reaching a consensus on the types of treatment outcomes that should be measured in future scientific research about the efficacy and effectiveness of implant therapy.
The co-chairs of the conference organizing committee, Drs. George Zarb of Toronto and Tomas Albrekttson of Göteborg, Sweden, had previously been involved in publishing criteria for assessing successful implant treatment1,2. The Toronto conference aimed to update those previous criteria in the light of new scientific evidence. The participants in the conference were researchers and clinicians, as well as the editors of major journals that publish the most important articles about dental implants.
On the first day of the conference, the following twelve speakers presented review papers reporting on various aspects of the literature relating to implants:
Dr. J.E. Davies (Toronto). Mechanism of endosseous integration.
Dr. P.-O. Glantz (Lund, Sweden). The choice of alloplastic materials does it really matter with oral implants?
Dr. L. Sennerby (Göteborg, Sweden). Surgical determinants of clinical success of osseointegrated oral implants.
Dr. S. Koka (Lincoln, Nebraska). The implant-mucosal interface and its role in the long-term success of endosseous oral implants.
Dr. R.P. Ellen (Toronto). Microbial colonization of the peri-implant environment and its relevance to long-term success of osseointegrated implants.
Dr. C.C.L. Wyatt (Vancouver). Imaging techniques and interpretation for dental implant treatment.
Dr. D. Locker (Toronto). Patient-based assessments of the outcomes of implant therapy.
Dr. T. Dao (Toronto). Sensory disturbances associated with implant surgery.
Dr. S.R. Bryant (Toronto). The effects of age, jaw site and bone condition on oral implant outcomes.
Dr. N. Meredith (Bristol, England). Assessment of implant stability as a prognostic determinant.
Dr. A.B. Carr (Columbus, Ohio). What comprises successful long-term treatment outcomes in the field of osseointegrated implants: prosthodontic determinants.
Dr. P. Watson (Toronto). Prosthodontic components and techniques: do we need standards?
On the second day of the conference, the participants were divided into four groups and given the task of assessing the previously published criteria for implant treatment success1-3 and making adjustments on the basis of the new information presented on the first day. There was plenty of lively discussion in the groups and the subsequent plenary session allowed for further debate about various success criteria. Following the conference, the organizing committee drafted the consensus statements presented below.
(Reprinted verbatim with permission from the International Journal of Prosthodontics, Volume 11, Number 5, page 389.)
The following considerations for successful outcomes with implant - supported prostheses are proposed:
1. Implant therapy is prescribed to resolve prosthodontic problems by permitting diverse prosthodontic treatments, which in turn impact on the economics of the service. Such prostheses should meet the clinically evolved standards of function, comfort and esthetics. They should also allow for routine maintenance and should permit planned or unplanned revisions of the existing design. Treatment outcome success criteria for implant-supported prostheses should also be assessed in the context of time-dependent considerations for any required retreatment.
2. Criteria for implant success apply to individual endosseous implants, and
a. At the time of testing, the implants have been under functional loading.
b. All implants under investigation must be accounted for.
c.Since a gold standard for mobility assessment is currently unavailable, the method employed must be specifically described in operative terms.
d. Radiographs to measure bone loss should be standard periapical films with specified reference points and angulations.
The success criteria comprise the following determinants:
1. The resultant implant support does not preclude the placement of a planned functional and esthetic prosthesis that is satisfactory to both patient and dentist.
2. There is no pain, discomfort, altered sensation, or infection attributable to the implants.
3. Individual unattached implants are immobile when tested clinically.
4. The mean vertical bone loss is less than 0.2 mm annually following the first year of function.
I came away from this conference with a number of strong impressions.
1. Canadians have been and continue to be world leaders in the field of implant dentistry.
2. There was an impressive commitment displayed at the conference to base therapy on the best available scientific evidence.
3. The message came out loud and clear that patient-focused outcomes are important and should be included in future research efforts.
4. Dentists are in the business of improving the quality of life of their patients.
The full proceedings of this conference were published in the September edition of the International Journal of Prosthodontics (Volume 11, Number 5). For more information about the conference proceedings, please contact the CDA Resource Centre by e-mail (firstname.lastname@example.org) or by calling 1-800-267-6354, ext. 2223.
The conference "Towards Optimized Treatment Outcomes for Dental Implants" was funded by: the University of Toronto, the Medical Research Council of Canada, the Dentistry Canada Fund, Göteborg University Craniofacial Reconstruction Unit, and Quintessence Publishing Company Inc.
1.Albrektsson T, Zarb GA, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1986; 1:11-25.
2. Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous implants. J Prosthet Dent 1989; 62:567-72.
3. Guckes AD, Scurria MS, Shugars DA. A conceptual framework for understanding outcomes of oral implant therapy. J Prosthet Dent 1996; 75:633-9.