OF IMPLANT PERFORMANCE
MICHAEL S. REDDY*
I-CHUNG WANG
Department of Periodontics
School of Dentistry
University of Alabama at Birmingham
UAB Station 34
1919 7th Avenue South, Room 412
Birmingham, Alabama 35294-0007, USA
* Corresponding author
Adv Dent Res 13:136-145, June, 1999
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TABLE 1
RADIOGRAPHIC METHODS COMMONLY AVAILABLE IN LONGITUDINAL STUDIES OF DENTAL IMPLANTS
Radiographic Method
Application
Imaging Plane
Limitations
Periapical
(intra-oral film or direct digital)
Buccal-lingual
(1) Pre-surgical
Occlusal-apical
Commonly distorted
Buccal-lingual
Buccal-lingual
Motion tomography
(extra-oral film)
Mesial-distal
Limited availability
Repositioning is difficult
Computed tomography
(extra-oral digital)
Buccal-lingual,
mesial distal, axial,
three-dimensional
Relative cost
Access to CT services
Metal artifact
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REDDY&WANG
to the other (Fig. 2). Furthermore, the implant bone surface may
be out of the curved plane of the tomogram being created by the
panoramic machine, resulting in an inaccurate image of the
bone-to-implant interface. Fig. 2 illustrates what appears to be a
panoramic film of good diagnostic value and consistent
magnification. The panoramic film shown was made with 5mm metal ball bearings attached to an acrylic vacuum-formed
stent made from a diagnostic cast. The resultant image, which
appeared initially to have uniform magnification, is actually
unevenly distorted from right to left. The second ball bearing
from the right appears as a sphere, whereas the left side
demonstrates geometric distortion, illustrated by the oblong
appearance of the ball bearings. The errors of magnification and
geometric distortion become important in clinical research
which seeks to quantitate, from panoramic films, the amount of
bone loss over time. Panoramic films will most likely continue
to be used to evaluate implants radiographically over time
because of their availability, ease of use, and patient
acceptance. The continued development of direct digital
panoramic images may decrease some of the limitations found
with the film-based machines. In longitudinal clinical trials,
care should be taken to use a method that corrects or controls
for geometric distortion errors.
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RADIOGRAPHICIMPIANT PERFORMANCE
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TABLE 2
RADIOGRAPHIC CRITERIA FOR IMPLANT SUCCESS
Radiographic Criteria
Criteria Established
0.2 mm annually
after first year
TABLE 3
APPROACHES TO RADIOGRAPHIC EVALUATION OF DENTAL IMPLANTS IN CLINICAL STUDIES
Method
Ability to
Detect Change
(1) Measurement of %,
mm, bone loss
Moderate
Low
Low tech.
Very easy
Requires
specialized
software
Time-consuming,
requires specialized software
Standardized image
Comments
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TABLE 4
RADIOGRAPHIC METHODS FOR DIFFERENT IMPLANT STUDY DESIGNS
Type of Study/
Clinical Question
Design
Requirements
to Detect Change
Following an implant
over time, natural history
Single arm,
no blinding
Dependent on hypothesis
or criteria to be satisfied
(1) Measurement of mm
(4) Digital subtraction
(2) Thread counting
Parallel arms
(1) Measurement of mm
(4) Digital subtraction
Parallel arms
Method
Comments
Most frequently used
High resolution
Insufficient resolution
to satisfy
"No significant
difference" is not the
same as "equivalent"
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REDDY&WANG
the most part (Imrey, 1992). The fact that most implants are
successful makes determining the differences between implants
even more difficult. The methods useful for superiority
comparisons would be digital measurement of mm of bone loss
or digital subtraction radiography. A study to assess eqivalency
of two implants may be even more challenging than superiority
testing. The equivalency study needs the highest resolution that
can be achieved, and, in addition, a sufficient number of
subjects must be utilized (Imrey and Chilton, 1992). If an
insufficient number of implants is used or the resolution of the
radiographic method is too low, no significant difference
between two implants will be observed, even if a difference
actually exists.
Comparing implants of different types, surface coatings, or
design within the same subject presents an additional indication
that the highest-possible resolution should be used (McKinney
et aL, 1988). Again, since the bone loss at any modern implant
is not likely to be great, a high-resolution technique and a
subject population with sufficient power will be necessary. The
position of the implants within the arch will also need to be
determined with a random block design to ensure that the same
implant does not always get the most favorable position in the
arch.
CONCLUSION
Radiographic methods are essential for assessing bony support
in endosseous dental implants. However, each technique has its
own advantages and drawbacks. Different criteria have been
utilized to determine the success or failure of implant
performance based on radiographic appearance or
measurements. In the design of clinical trials for dental
implants, standardized radiographs should be utilized and the
highest-resolution technique available must be considered. At
present, digital subtraction radiography is an accurate and
legitimate technique for the detection of minor bony change
around dental implants.
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