Clinical Research Branch
Division of Clinical Research and Health Promotion
Objective: This initiative will encourage clinical research on osseointegrated dental implants regarding: 1) outcomes when using various surgical and prosthetic protocols (e.g. immediate placement vs. delayed placement; implant placement following osseous grafting and/or sinus augmentation; immediate vs. delayed prosthetic loading), 2) the role of systemic diseases in the success rate of osseointegrated implants, 3) quality of life and patient preferences for dental implants compared to other prosthetic methods for restoring the dentition, and 4) needs in children who have congenitally missing teeth or suffer from developmental disabilities.
Background: Osseointegrated dental implants are one of the options available for replacing missing teeth. The success of implants has been attributed to osseointegration or direct contact of the implant surface and bone without a fibrous connective tissue interface. Varying surgical protocols are used for placement of implants and a wide variety of implant designs are in current use.
Implant failure is reported to be higher in smokers than in non-smokers. While there are reports of similar failure rates between people with well-controlled diabetes and those without diabetes, individuals with Type 2 diabetes may have a slightly higher failure rate. No studies have documented the success of implants in individuals who develop diabetes, osteoporosis or other systemic conditions after placement. In general, the relationship between systemic health and implant success is not well documented.
The use of surgical procedures such as maxillary sinus lifts, inferior alveolar nerve transposition, and guided bone regeneration have expanded the use of implants. Although the use of dental implants has increased, few clinical trials have been conducted that have compared various surgical protocols or patient preferences for prosthetic tooth replacement. The Cochrane Oral Health Group reviewed the literature to determine if there were differences in patient satisfaction and cost effectiveness between conventional dental prostheses that require preprosthetic surgery and implant retained dental prostheses. One randomized controlled trial (RCT) was found and it was concluded that there was only weak evidence to indicate that patients were less satisfied with preprosthetic surgery and conventional dentures than with implant-retained dentures.
Research is needed to study the various surgical and prosthetic protocols for implant placement. Traditionally, osseointegrated dental implants are placed in bone and covered by mucosa during the immediate post-operative healing period. At four to eight months, a second surgical procedure is performed to expose the implant so it may be loaded with various types of dental prosthesis. In recent years, immediate prosthetic loading after surgical placement has become more common. The Cochrane Oral Health Group reviewed studies comparing immediate vs. delayed loading and found three randomized RCTs with a total of only 68 patients. It was concluded that although it is possible to successfully load dental implants immediately after placement in carefully selected patients, well-designed RCTs are needed to understand the predictability of protocols for immediate and early loading of implants.
Current Portfolio Overview: In FY 2003, 10 grants were funded by the NIDCR on the topic of dental implants. Six grants were part of the Cellular & Molecular Biology, Physiology and Biotechnology Branch, two part of the Training Program, and two grants were part of the Clinical Trials Program. The only two clinical research grants currently in the portfolio are: 1) studying surgical protocols for implant replacement of single maxillary anterior teeth and, 2) comparing four different types of implant supported overdenture prosthesis.
Recommendations From Workshops: No recent workshops on this topic
Collaborative Activities: None
Funding Mechanisms: R21, R01