Received: 7 February 2018 Revised: 15 August 2018 Accepted: 21 August 2018

DOI: 10.1111/cid.12673

ORIGINAL ARTICLE

A retro-prospective long-term follow-up of Brånemark single

implants in the anterior maxilla in young adults. Part 1: Clinical
and radiographic parameters
Nicole Winitsky DDS1,2 | Kerstin Olgart DDS1 | Torsten Jemt DDS, PhD3,4 |
Jan-Ivan Smedberg DDS, PhD1,2

1
Department of Prosthetic Dentistry,
Folktandvården Eastman Institute, Stockholm, Abstract
Sweden Background: Single implant restorations have become the primary treatment option for young adults
2
Division of Prosthetic Dentistry, Department with missing anterior teeth. Yet, long-term studies of single-implants are limited in the literature.
of Dental Medicine, Karolinska Institute,
Purpose: To report long-term survival, success, and complications in young adults with single-
Stockholm, Sweden
3
implants in the anterior maxilla.
Department of Prosthetic Dentistry/Dental
Material Science, Institute of Odontology, Materials and Methods: A group of 42 patients (mean age 20.7 years) received 53 anterior max-
Sahlgrenska Academy at Göteborg University, illary single-implants during 1996 and 1997. Data were collected at delivery of the crown, at
Göteborg, Sweden 1-year examination, and at 14-20-year examination. Descriptive statistics, estimated cumulative
4
Brånemark Clinic, Public Dental Health survival rates, Pearson correlation test, and t-test were performed.
Service, Region of Västra Götaland, Sweden
Results: After 14-20 years, 40 out of 42 patients were examined. Two patients were lost to
Correspondence
follow-up, two implants failed and ten original single-crown restorations were replaced. Esti-
Nicole Winitsky, Department of Prosthetic
Dentistry, Folktandvården Eastman Institute, mated cumulative survival rates were 96.1% for implants and 80.4% for implant-supported
Box 6031, SE-102 31 Stockholm, Sweden. crowns. Complications were seen in 21 patients. Mean probing depth was 4.0  1.8 mm and
Email: nicole.winitsky@sll.se
mean marginal bone loss was 0.1  1.1 mm. No correlation was found between marginal bone
Funding information
loss and probing depth, occlusal contact in maximal intercuspal position or usage of nicotine.
Folktandvården, Stockholms läns landsting
Conclusions: Long-term prognosis of single implant treatments in the anterior maxilla in young
adults must be regarded as good, with high survival and success rates.

KEYWORDS

complications, long-term success, long-term survival, marginal bone levels, single implants,
young adults

1 | I N T RO D UC TI O N or auto-transplantation.11–13 Single implant treatment has become a

more frequently used treatment option in young adults when ortho-
The etiologies of missing teeth in young permanent dentitions are dontic space closure is contraindicated or to avoid preparation of
generally partial agenesia or trauma. Prevalence of agenesia of the intact teeth.
maxillary lateral incisor in school children has been reported to range Single implant treatment based on osseointegration principles
1–3
from 1.6% to 3.1%, while prevalence of anterior tooth loss due to was first described by Jemt in 198614 and has been a treatment
1
trauma has been reported to be as low as 0.3%. However, single option for almost 35 years. The first single implant was placed in
implant studies have shown trauma (31%-62%)4–7 to exceed partial 198214,15 and this treatment method is now considered routine
agenesia (12%-18%)4–7 as the etiologic factor for implant treatment. among Swedish clinicians. However, factors such as time-consuming
Besides implants, treatment options for adolescent patients with miss- procedures, costs, risk of damage to hard and soft tissue as well as to
ing single anterior teeth have been orthodontic space closure8,9 con- adjacent teeth, possible prosthodontic and surgical complications and
10 10
ventional three-unit fixed partial prosthesis, resin-bonded bridges, implant failures must be taken into consideration.16–18 CeraOne

Clin Implant Dent Relat Res. 2018;1–8. wileyonlinelibrary.com/journal/cid © 2018 Wiley Periodicals, Inc. 1
2 WINITSKY ET AL.

TABLE 1 Distribution of patients regarding age, etiology of missing teeth, and implant position at baseline (crown delivery)

Age at crown delivery Reason for tooth loss Number of implants per position
Patients Mean SD Range Trauma Aplasia Other Central incisor Lateral incisor Canine Implants (n)
Male 24 21 3.5 18-30 16 7 1 15 12 1 28
Female 18 20.2 2.7 16-27 10 7 1 10 12 3 25
a
Total 42 20.7 3.2 16-30 26 14 2 25 24 4 53
a
Idiopathic root resorption and malformation of tooth.

(Nobel Biocare AB, Gothenburg, Sweden) single tooth abutment19 2 | M A T E R I A L S A N D M ET H O D S

was a pre-machined commercial single implant abutment introduced
on the market in the early 1990s. Compared to previous single implant The present publication is a clinical and radiological follow-up
solutions,15 this more stable mechanical screw-joint system20,21 pro- study based on one patient cohort, consecutively treated at one
vided a substantial decrease in abutment screw derotation which was specialist referral clinic (the Department of Juvenile Prosthodontics
a common complication in the early development period. 16,22
By also at the Eastman Institute, Stockholm, Sweden) from January 1996

presenting a more predictable esthetic result, the CeraOne abutment to November 1997. Prior to treatment of the first patient, a pro-

made the replacement of a missing tooth with a single implant a more spective protocol for clinical and radiographic parameters was

viable treatment option. designed. Baseline data were recorded for all included patients at

In a recent review 23
of long-term follow-up of single implants, time of crown delivery and after 1 year the same data were

Hjalmarsson and colleagues reported that fewer than 400 patients recorded. A retrospective examination was performed after a

with a follow-up period of 10 years or more could be identified in mean period of 16.7  1.7 (range 14-20) years, when biological

the literature. In relation to the several millions of single implants parameters were added. This will be referred to as the

that have been placed worldwide to date, this must be considered a 14-20-year examination. At all examinations, radiographs were

small number. 24
Accordingly, only a few single implant publications taken to measure marginal bone levels. In accordance with the

are available for observation periods exceeding 15 years. 24–30 Helsinki declaration, a written consent form was signed by all

Among these, the 15-25 years estimated cumulative survival rates examined patients prior to the examination. Approval for the

for implants (CSRi) were shown to be 92%-100% and for original sin- study has been received by the regional ethical committee (EPN)
gle crowns (CSRc) 73%-84%. In contrast to implant treatment in in Stockholm (Dnr 2013/1302-31/3).
older patients, the challenge with young adults is that implants are
expected to be in use for a substantially longer period of time. Con-
2.1 | Patients and treatment
tinued facial and dental changes have been shown to occur even
after termination of pubertal growth and into adult life.31–34 These Treated patients in the original study group, provided with 1-3 single
biological changes, in combination with potential technical complica- implants each, are presented in Table 1. Implant treatments were
tions such as fracture of the porcelain, make it very likely that performed, with a standard two-stage protocol,38 at a specialist clinic
implant crowns will be repaired or replaced during the patient's life- by a single prosthodontist and a single surgeon. Brånemark implants
time. However, the implants are expected to remain osseointegrated with a turned surface (Nobel Biocare AB, Göteborg, Sweden);
for a longer period, preferably without any hard or soft tissue pathol- 3.75 mm wide, 15 (47%) or 18 (53%) mm long; were installed in bone
ogy. Few single implant studies in the anterior maxilla have been per- quality class 2 and 3 according to Lekholm and Zarb classification39
formed that include treatment of children, adolescents, or young (data not available for 10 patients/12 implants). Second stage sur-
adults, 35–37
and there is a need for more long-term studies gery was performed after a mean time of 7.5  2.1 (range 6-16)
(>10 years) on single implant treatment in these younger patient months. Length of the CeraOne abutment cylinders (Nobelpharma
populations. AB, Gothenburg, Sweden), of 1 mm (23%), 2 mm (28%), 3 mm (40%),
The primary aim of this retro-prospective study is to report long- and 4 mm (9%), were chosen according to the thickness of the
term outcome of single implant treatments in the anterior maxilla in a mucosa.14 Abutments were permanently connected and tightened
relatively young cohort, concerning survival and success of implants with gold screws21 to the implants at 32 Ncm with a torque driver
and implant crowns, biological and technical complications, and radio- (Nobel Biocare AB). Aluminum oxide crowns (VITA In-Ceram, VITA
logical findings. Furthermore, the secondary aim is to evaluate the Zahnfabrik, Bad Säckingen, Germany), all produced by the same den-
association between changes in marginal bone levels and probing tal technician (Dental Keramik M&P Vereby AB, Stockholm, Sweden)
depth, occlusal contact and usage of nicotine. were placed after a mean period of 3.2  1.8 (range 1-8) weeks. All
The hypothesis is that single implant treatment has a good long- 53 crowns were cemented with zinc phosphate cement (Harvard
term prognosis in the adolescent population with low association Cement, Harvard Dental Inter. GmbH i.G, Hoppegarten, Germany),
between marginal bone loss, probing depth, and bleeding on 49 were provided with a vent hole,40 placed cervically on the palatal
probing. surface.
WINITSKY ET AL. 3

“survivals.” Lost implants and crowns as well as replaced crowns were

recorded as “failures.” Calculations for radiological success were made
according to the criteria of Albrektsson and Isidor,41 allowing for
<1.5 mm bone loss during the first year of function and thereafter
<0.2 mm bone loss annually. If the radiologic criteria were fulfilled and
no pain or mobility was registered, the implants were considered “suc-
cessful.”41 All complications, biological and technical, found in dental
records or reported by the patient occurring up until the 14-20-year
examination were registered (Table 2).
At the 14-20-year examination, one radiologist performed radio-
graphic examination using the paralleling technique and measured all
radiographs, in accordance with the original protocol (Figure 1). A
mean value of measurements from the mesial and distal sides were
calculated and used for each implant.42 Due to peri-implant surgery
including bone augmentation one implant was excluded from assess-
ment of bone levels. To determine intra-observer variability, marginal
bone levels were measured a second time by the same observer after
about 2 months, on 13 randomly selected implants from the
14-20-year examination.
Biological parameters, plaque, bleeding on probing, probing depth
and pus, were registered on implants and contralateral teeth on
mesial, buccal, distal, and palatal surfaces (Table 3).42 When correlat-
FIGURE 1 Marginal bone levels were measured in millimeter from
the cervical part of the implant collar (A) to the first visible bone-to- ing probing depth with changes in bone levels, mean values for mesial
implant contact (BIC) (B) on the mesial and the distal side of each and distal surfaces were calculated for each implant. Occlusal contacts
implant. Mesially, A and B are at the same level between implant crowns and opposing teeth were recorded at maxi-
mal intercuspal position (MIP) using 0.8 mm occlusal strip (TrollFoil,
2.2 | Clinical and radiographic examination Trollhätteplast AB, Trollhättan, Sweden) at crown delivery and at the
14-20-year examination.
Baseline examinations (42 patients/53 implants) at crown delivery and
1-year follow-up examinations (40 patients/50 implants) were per-
formed by the treating prosthodontist (KO). The 14-20-year examina- 2.3 | Statistics
tion (40 patients/51 implants) was performed by another Descriptive statistics with mean and (m  SD) were calculated and
prosthodontist (NW). presented with ranges. Estimated CSRi and CSRc were calculated
General health nicotine use pain mobility were registered at according to Kaplan and Meier.43 The Pearson correlation test was
crown delivery and at the 14-20-year examination. Implants and used to test associations between changes in marginal bone levels in
crowns still in function, and recemented crowns were reported as relation to probing depth. T test was used to detect differences in

TABLE 2 Biological and technical complications on implant level. Only first complication event implant or crown has been recorded. Not
applicable for crown fracture where chipping later led to fracture. This counts as a fracture. Mean follow-up 17 years refers to the 14-20 years
follow-up
Crown delivery Year 0-1 Years 1-17
Type of complication (n = 53) (n = 50) (n = 51) Total
Biological
Fistula - 2 4 6
Pus - 2 4 6
Soft tissue recession with exposed abutment 1 1 5 7
Total 1 5 13 19
Technical
Ceramic chipping (no exchange of crown) - - 2 2
Ceramic fracture (with exchange of crown) - 1 2 3
Abutment screw loosening (no exchange of crown) - - 3 3
Abutment screw loosening (with exchange of crown) - - - -
Recemented crown - 1 2 3
Change of crown - 1 9 10
Total 0 3 18 21
4 WINITSKY ET AL.

TABLE 3 Biological parameters plaque (P), bleeding on probing (BoP), probing depth (PD), and pus at 14-20-year examination. Measurements
made on mesial, buccal, distal, and palatal surfaces. Patients with implant loss and previous peri-implant surgery (n = 3) were excluded. Implant
and contralateral tooth were registered when one surface or more were positive. Only deepest probing depth registered
P (%) BoP (%) PD < 5 mm (%) PD ≥ 6 mm (%) Pus
Implant (n = 48) 15 (31%) 38 (79%) 19 (40%) 29 (60%) 5 (10%)
Contralateral tooth (n = 48) 24 (59%) 28 (58%) 48 (100%) 0 0

bone level changes between nicotine users and non-nicotine users as patients, one crown became loose due to trauma. They were put back
well as between implant crowns with or without occlusion at MIP. and recemented. Among the patients that had their crowns put back
or replaced due to trauma (n = 7) only one patient had a single occa-
sion of trauma, the others had 2-4 occasions each. For all of these
3 | RESULTS patients, trauma was also the etiological reason for tooth loss. After
14-20 years of function, cumulative survival rates (CSRs) of 96.1%
3.1 | Patients lost to follow-up and 80.4% were calculated for implants and original crowns,
respectively.
Two patients were lost to follow-up at the 14-20-year examination
After 14-20 years of follow-up, a total of 21 patients showed
(4.8%). One patient, lost after 1 year, had crown recementation per-
complications where 17 showed one complication each, and four
formed 4 months after delivery. The other patient was lost after
showed 2-4 complications. Overall, 21% of patients had technical
2 years and had no complications reported prior to dropout.
complications and 45% had biological complications, of which 78%
had no indication for treatment (Figure 2). Among patients with one
3.2 | Patients, survival, and complications (n = 32) and two implants (n = 9) 59% and 22% showed no complica-
At the 14-20-year examination, 40 patients with a mean age of tions, while the patient with three implants showed complications.
37.5  3.6 years (range 32-47) were examined. Good general health Looking at the reasons for tooth loss 71% of patients with aplasia in
(no diseases or medical conditions) was reported in 95% of patients at the etiology showed biological complications. Type and frequency of
crown delivery and in 77% at 14-20-year examination. The number of complications at implant level are shown in Table 2. Excessive cement,
patients using nicotine (smoking or snuff ) increased from 4 patients at observed with only one implant at crown delivery, was removed surgi-
crown delivery to 16 patients at the 14-20-year examination. cally at that time. One implant, where peri-implant surgery with bone
In total, 2 implants had failed and 10 original single crowns had augmentation was performed after 11 years, was still in function at
been replaced due to trauma or poor esthetics at termination of the the 14-20-year examination.
study. One implant was removed 3.5 years after crown delivery due
to severe buccal bone loss, mucosa inflammation, and pus, and was 3.3 | Success, marginal bone levels, and biological
not replaced. The other implant, placed in a buccal position with buc- parameters
cal threads exposed already at crown delivery, was removed after
A mean bone loss of 0.2 mm was calculated during the first year of
11 years function and replaced with a new implant, due to poor
function and a continuing mean bone loss, year 1 to year 14-20, of
esthetics and 6 mm bone loss. The only patient with three implants
0.01 mm per year was calculated. Based on this the radiographic
had all crowns changed due to poor esthetics. Within the group with
success criteria36 were met. No mobility, pain, or paresthesia was reg-
two implants (n = 9) three crowns were changed and in the group
istered. loss of >2 mm was shown in one implant. Changes in marginal
with one implant four crowns were changed. In three different
bone levels and distribution are presented in more detail in Figure 3
and Table 4.
Results from registration of biological parameters at the
14-20-year examination are shown in Table 3. Mean probing depth of
implants when four surfaces were measured was 4.0  1.8 mm (range
0-9 mm). Among the 15 implants where plaque could be detected, five
showed probing depth (>6 mm)44 and all showed bleeding on probing
on one or more surfaces. In sites with probing depth >6 mm (n = 48),
only two (4%) showed plaque and 22 (46%) showed bleeding on prob-
ing. At five implants in five different patients where pus was shown,
probing depths varied from 3 to 7.5 (mean 5.3  1.9) mm. Among sur-
FIGURE 2 Example of technical complication where no treatment faces with pus, three were located on mesial and distal surfaces show-
other than polishing was performed in accordance with the patient's ing a mean bone loss of 0.5 (range −0.1-1.4) mm. Recurrent mucosal
wishes. Distoincisal fracture of the veneering ceramics of implant
swelling and pus were reported from one patient during the last
11 occurred after 11 years of function. Image after 15 years of
10 years of follow-up (Figure 4) without presence of progressive bone
function. Note the infraposition of implant crown: both shorter and in
a more buccal position in relation to neighboring tooth 21 [Color loss. Implants with probing depths of >6 mm and bleeding on probing
figure can be viewed at wileyonlinelibrary.com] have been found to show low or no bone loss (Figure 3) with mean
WINITSKY ET AL. 5

FIGURE 3 Probing depth correlated with bleeding on probing, at 14-20-year examination, and changes in marginal bone levels from crown
delivery to 14-20-year examination. Registration on implant level. Mean values of mesial and distal surfaces measured used for probing depths
and marginal bone levels. Bleeding on probing at mesial or distal surfaces reported as positive (red dot). N = 48 [Color figure can be viewed at
wileyonlinelibrary.com]

probing depths of >6 mm (25%) showed a mean bone loss of 4 | DI SCU SSION
0.2  1.14 (range −2.0-1.4) mm. Pearson correlation analysis showed
no correlation (P > .05) between mean probing depths and mean Within the limitations of the relatively small sample size in this study,
changes in marginal bone levels (Figure 5). the low implant failure rate and stable bone levels support the hypoth-
No significant differences could be seen in mean bone loss at the esis that single implant treatment has good long-term prognosis in
14-20-year examination between implants with (n = 11) and without young adults. This long-term failure rate is comparable with earlier
occlusal contact at MIP (n = 37) where mean bone loss of −0.2  0.9 reports.24–26
(range −2.0-1.1) mm and −0.1  1.2 (range −5.1 -1.6) mm was mea- Implant failures (n = 2), due to aggressive infection and buccal
sured, respectively. Neither could any significant differences be found positioning, occurred after 3.5 and 11 years in two non-nicotine users
between implants in patients using nicotine (n = 16) and not (n = 32) with generally good health. CSRi of 96.1% in the present study con-
where mean bone loss was −0.2  0.83 (range −2.0-10) and firms CSRi of 95.8% and 96.8%24,26 and is intermediate to CSRi of
−0.1  1.3 (range −5.1-1.6), respectively.

TABLE 4 Changes and distribution of marginal bone levels at single

implants during different follow-up times. Mean follow-up 17 years
refers to the 14-20 year follow-up
Year Years Years
Follow-up 0-1 0-17 1-17

Patients (n) 39a 37b 35c

Implants (n) 50 48 46
Surfaces (n) 100 96 92
Bone change (mm)
Mean −0.2 −0.1 −0.2
SD 1.0 1.1 1.0
Range −6.1-1.3 −5.1-1.6 −4.4-1.9
Bone change (n) Number of implants
Bone gain > 0.1 mm 23 (44%) 24 (50%) 22 (48%) FIGURE 4 Radiographic and clinical appearance after 15 years of
0.0 mm 5 (10%) 0 0 function of implant position 11 in patient reporting recurrent swelling
0.1-0.6 mm 16 (32%) 11 (23%) 15 (33%) and pus for approximately 10 years. Probing depths of 8 mm mesially
0.7-1.2 mm 2 (4%) 6 (13%) 4 (9%) and 7 mm distally were measured. Both sites positive for bleeding on
probing. Mean marginal bone loss was 1.4 mm after 15 years with
1.3-1.8 mm 3 (6%) 5 (10%) 3 (7%)
0.4 mm occurring during the first year and 1.0 mm during the next
1.9-2.4 mm 0 1 (2%) 1 (2%)
14 years. A, Intra oral X-ray implant 11. Note BIC and deep placement
>2.4 mm 1(2%) 1 (2%) 1 (2%) of implant. B, Clinical image implant 11. Note infraposition of implant
a crown that is both shorter and in a more buccal position in relation to
3 missing.
b
2 dropouts, 2 failures, 1 peri-implant surgery. neighboring tooth 21 [Color figure can be viewed at
c
2 missing, 2 dropouts, 2 failures, 1 peri-implant surgery. wileyonlinelibrary.com]
6 WINITSKY ET AL.

technical or biological complication was found that could be related to

the vent holes.
A mean bone loss of >0.7 mm found in 20% (n = 9) of the
implants from year 1 to year 14-20 (Table 4), confirms results from
previous single implants studies in the anterior maxilla where >0.7 mm
mean bone loss was found in 19% and 20% of the implants from year
1-1525 and year 1-18.26 A mean bone loss of >2 mm found in 2% of
the implants in the present study also agrees with the same studies
that show results of 0%,25 2%,26 during the same time intervals.
Probing depth measurements are commonly used to compare
changes over time. Since no baseline values were available, the pre-
sent study was limited to using probing depth to evaluate a potential
association with bone levels and bleeding on probing. Limited marginal
FIGURE 5 Pearson correlation plots showing no correlation between
bone loss after 14-20 years (0.1  1.1 mm) (Table 4) and 60% of
mean values of mesial and distal measurements regarding probing
depth (PD) and (BLC) at 14-20-year examination (P > .05) implants showing at least one surface with probing depth ≥6 mm
(Table 3) further supports earlier doubts that deep probing depth is a
pathological finding around implants, in contrast to what is observed
around teeth.25,26 It has been suggested that the clinical parameters
91.5%27 and 100%25 found in previously performed long-term
plaque,47 mucositis, and peri-implant probing depth are difficult to
(15-22 year) follow-ups on Brånemark single implants. CSRc of 80.4%
correlate with marginal bone loss.47–49 In the present study, 79% of
found in the present study correlates with CSRc of 77% and 83.8%
the implants showed bleeding on probing and 60% probing depth
found in studies using the same implant and crown system.25,26 A
≥6 mm on one or more surfaces (Table 3), despite low annual bone
meta-analysis shows 5 and 10 years CSRi of 97.2% and 95.2%, and
loss after the first year (0.01 mm/year). This confirms results from
5-year and 10-year CSRc of 96.3% and 89.4%.18 Accordingly, results
Lekholm and colleagues44 where a bone loss of 0.07 mm/year was
from the present study support earlier observations that anterior sin-
found after the first year, without association with probing depth or
gle implants have very good long-term prognosis, while the risk of
bleeding on probing (80%). When comparing with bone level changes,
changing the implant crown increases with time.
the present study found a mean probing depth on mesial and distal
Systematic reviews of 3-10 years follow-up17,18,45 of single
surfaces of 4.7  1.6 (range 2-9) mm, confirming earlier results of a
implants have reported the most common technical complications for
mean probing depth of 4.3 mm  0.8 mm on healthy Brånemark
implant-supported single crowns to be abutment or screw loosening
machined implants connected in maxillary bridges, after 7.6 years of
(8.8%), crown loosening (4.1%) and chipping of veneering material
function.44
(3.5%),18 and the most common biological complication to be peri-
Nicotine use, especially in combination with poor oral hygiene,
implant mucosal lesions (9.7%).45 With the limitations of the dental
has been regarded as and has been confirmed to be a factor that pre-
records not being complete and the patients not being able to recall
disposes to implant failure and marginal bone loss in several
all complications, the present study found technical complications
studies,50–53 hence these parameters were included in this study.
such as chipping/fracture of veneering ceramics and abutment screw
Accessible literature today is unclear about the effect of occlusion on
loosening of 9% and 6%, respectively. In relation to the previously
peri-implant conditions,52,54 and more research is needed on this mat-
used single implant solution,14 the CeraOne abutment has been
ter. In this study, no significant differences in bone levels could be
shown to have significantly fewer technical complications.16,22,46
detected neither when comparing implants in nicotine users and non-
Crown/screw loosening decreased from 45% after 3 years with the
nicotine users nor implants with and without occlusal contact at MIP.
previous single tooth abutment,14,16 to only 3% after 18 years26 with
the CeraOne abutment. This improvement may be related to the mod-
ified screw design.21 In the present study, the rate of crown/screw 5 | CONC LU SIONS
loosening was 9.8% (n = 5), where four of these were due to sport-
related trauma. Regarding the amount of implants installed per Within the limitations of this study, single implant treatment in the
patient, 5 out of 10 changed crowns, were clustered to two patients anterior maxilla—with replacement of prosthetics—can be considered
with two and three implants. These implant groups also showed a good long-term treatment with high survival and success rates, even
higher percentage of complications. The highest amount of biological in adolescents. Changes in marginal bone levels must be regarded as
complications was found in patients with aplasia as etiological factor. low. Less than 1 mm bone loss during the first year of function and
Soft tissue lesion due to excessive cement was found in one thereafter <0.3 mm/5 year could be expected for anterior single
implant. This low number may be due to the crowns being produced implant treatment in this healthy group of patients with non-
with vent holes40 to reduce the amount of excessive cement and also inflammatory etiology of tooth loss. The present study showed that
due to the usage of zinc phosphate cement that is easily detected, probing depth of >6 mm and bleeding on probing can be found around
both clinically and on radiographs, and more easily removed. No single implants without any correlation to marginal bone loss. This
WINITSKY ET AL. 7

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486-492.
14. Jemt T. Modified single and short-span restorations supported by
osseointegrated fixtures in the partially edentulous jaw. J Prosthet
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The present study has been supported by grants from Folktandvården
implant restorations ad modum Branemark. Int J Periodontics Restor
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assistance in data collection and care of study patients. Both at Folk- vival rate and incidence of biologic, technical, and esthetic complica-
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Institute, Stockholm, Sweden and language editing by Mary-Rose review of the survival rate and the incidence of biological, technical,
Hoja, Hoja Consulting AB, Stockholm, Sweden. and aesthetic complications of single crowns on implants reported in
longitudinal studies with a mean follow-up of 5 years. Clin Oral
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CONF LICT OF IN TE RE ST single tooth abutment: handling and early clinical experiences. Int J
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Biocare Services AG, Zurich, Switzerland outside the submitted work.
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