Long term study on dental implants like more than 20 years?

I used to tell patients to expect 20 years, now I am much wiser. Back when I started, I still have cases back 23years still in function. Now we are seeing peri implantitis at the 6-8 year mark. I don't have referenced studies for you and I'm sure other posters will. I honestly tell patients that I don't know since there are many factors that determine longevity of implants. I give them some reasonable expectations but I don't quote studies since they will most likely hold you to them. I have seen such variation in patient results over the years and I can't predict the future. There are just too many things that we as dentists can't control. I do tell them my philosophy of trying to maintain natural teeth with root canals but that the usual lifespan of any restoration is finite and implants have definite indications, every case is different.

There are several studies extending out to 20 years. But you must use caution when referencing data from any study from that period. Remember that you are looking retrospectively at implant designs that are anywhere from 25 to 40 years old. Poor implant surfaces (machined titanium, TPS), inadequate abutment connections leading to microleakage (flat to flat, external hex), stress fracture of implant bodies (CP1-4 titanium), flared emergence profile, and less than adequate surgical execution are parameters that we have more control over today. If you are using these same tired implant systems, then expect complications occuring at the 5-10 year period. If you are using a more current design that addresses these shortcomings, expect far fewer long term complications. The industry has learned alot over the past 50 years; let's hope that the prudent clinician will make appropriate choices as to implant design that reflect that wisdom. RJM

Thanks for all the comments. Yes, it makes a lot of sense. Implant, unlike the gold restoration ( crown, onlay, inlay) changes so fast in terms of surface, prosthetic design and surgical design. That's probably why there is difficulty and also not much sense to follow up some of the old implants for 30,40 years.

Intoss Implants have a long term University study from the mid 80s when they were first designed but the abutment design ( study was with cementable hex ) has changed since then . Dr Millar agreed, a lot has been learned and as a more seasoned surgeon you know that the more we learn the more we realise we still have to discover . But I feel a big issue that is always glossed over is patient host factors and varying physiology . Some with equally poor OH are more prone to bone loss than others , this is seen both in natural dentition and Implants . This variation in physiology blithes most research making most papers unreliable . Newer developments as mentioned may help even in these cases but again they have not stood the test of time yet . A friend said he saw an unusual implant and asked the patient when it was placed ,he responded by saying it was placed in 1972 by my mentor and he had no issues with it since then. Nice , but we know in fact how scary things were then. Peter

Two retrospective studies of over 20 years are from Sweden. One study look at the implant survival in the edentulous jaws and the other one is the follow-up studies of implants in partially edentulous jaws. The implants used (at that time and place!), not surprisingly, are turned Brånemark® implants (Nobel Biocare AB, Göteborg, Sweden): 1) Outcome of Oral Implant Treatment in Partially Edentulous Jaws Followed 20 Years in Clinical Function Ulf Lekholm DDS, Odont Dr/PhD1,*, Kerstin Gröndahl DDS, Odont Dr/PhD2, Torsten Jemt DDS, Odont Dr/PhD3 Article first published online: 8 NOV 2006 DOI: 10.1111/j.1708-8208.2006.00019.x 2) Implant Treatment of Patients with Edentulous Jaws: A 20-Year Follow-Up Per Åstrand DDS, PhD1, Jan Ahlqvist DDS, PhD2, Johan Gunne DDS, PhD3,*, Hans Nilson DDS3 Article first published online: 1 APR 2008 DOI: 10.1111/j.1708-8208.2007.00081.x Although the materials, technology and treatment protocols have changed, longe-term retrospective studies are important to show us what actually works ! From these long-term studies, it was realized that turned implants have less periimplantitis and are more amenable to treatment. We basically created a porous, hard to clean metal surface in modern implants ! david

"Long term study of dental implants."........... in 2009, with my Spanish speaking dental assistant, we presented a history of dental implants to a group of dentists at the University of Havana in Cuba. Unfortunately, like most things in that country, they do not have access to information so readily. I presented a series of color slides that started with skulls from ancient civilizations that showed man's attempt to replace teeth with shells, animal teeth, etc; followed these photos with a presentation on blades, endodontic stabilizers,subperiosteal implants,intramucosal snap inserts, various types of endoseous root form implants with different shapes and coatings, minitransitional implants,etc....finally showing the very last slide of a young person's mandible, with a full dentition plus on the lingual bilaterally there were two perfectly formed bicuspid teeth....the audience were amazed with this photo....not photoshopped, but an actual untouched photo....just extra teeth.......and according to Hilt Tatum, certainly a pioneer in this field who implimented a lot of the techniques that revolutioned implantology ........that this is the future of implantology, we will be able to grow replacable autogenous teeth and bone. I later admitted to my Cuban audience, that I was not a genius, and although the photo was real.....this patient just happened to have 4 well formed supernumary teeth. So when documenting implant dentistry, the history is thousands of years.......and perhaps there is something written about implants in the Dead Sea Scrolls....

I heard there is a research group in LA doing tissue engineering of root-shaped matrix inducing bone marrow stem cells. but I never heard any clinical experiments had been achieved. If you could post some pictures or give a link to see your picture, that will be great.

With regard to the previous statement about machined titanium implants demonstrating less "peri-implantitis", how quickly we forget (and accept) that machined implants are the first to show a low grade peri-implantitis, resulting in a loss of bone to the first through third threads. The direct result of a lack of osteoblast attachment creates a zone of hard tissue loss and invasion with soft tissue. I submit that this is the earliest evidence of peri-implantitis, albeit without the typical clinical manifestation of erythema, edema, or exudate. But I can assure you, it was happening at the microscopic level. This is one of the primary reasons for creating a roughened surface. The peri-implantitis that we see today is NOT related to the surface, but rather related to the biologic events at the collar and abutment connection. The secondary result is bacterial colonization of the surface as the permucosal seal becomes diseased. The clinicians responsibility is to select implant systems that address both these early and late tissue related problems. After incorporating 16 implant systems in my practice, I have found that the Intra-Lock engineers finally got it right. My cases at 5-7 years are actually demonstrating an INCREASE in crestal bone height and a thicker biotype. Hard to argue with clinical success. RJM

This is not a study but more for information. My mother had 4 implants done by a dentist is a small town in Michigan(Plainwell). The insertion was BRUTAL. The dentist had a brace around the lower jaw so it would not fracture when the implants were..pounded in the bone. That was in 1967. She died 38 years later. The implants took about 6 or 7 months to heal. As far as I know she never had a problem once the crowns were in place. The healing was not easy. Pain for the first 3 months and swelling , ect. However when it was over they worked great. Her words..LOL. I doubt if she would have done it again. That was like the dark ages.

Establishment of "biologic width" is nothing more than an excuse to accept excessive bone loss on older implant designs. Poorly designed abutment connections, older implant surfaces, and a lack of adequate directional collagen fibers cause an inflammatory process at crest, leading to bone loss and then stabilization farther down the implant body. This IS the very definition of peri-implantitis. But not all of these processes continue to implant loss. The reason we have gone to medialized platforms and more secure abutment connections is to mitigate this early inflammatory process. Then clinicians make the statement that we have "re-engineered" the biiologic width. You cannot make the claim that we are teaching sot tissue and bone cells new tricks. It is simply preventing untoward tissue reactions arounf previously engineering-driven implant designs. We have finally accepted that implants are not teeth. The moment we realized that, we started making design deciions that, for some, were counter-intuitive. But these new designs control the biologic process more appropriately, giving the appearance of re-engineering the biologic width around implants. If you are accepting of crestal bone loss around your implants, then stay with your paradigm. If you are a serious student of the discipline, then it's time to move on to a biologically-driven implant design. RJM