Straumann Sla: Scientific Evidence First Edition (2011)

Straumann SlA
Scientific Evidence
First Edition (2011)
Straumann Dental Implant System
The ITI (International Team for Implantology) is academic partner of Institut Straumann AG
in the areas of research and education.
Contents
2 Introduction
3 Study overview
4 Preclinical studies
12 Clinical studies
26 Additional studies
30 References
Introduction
Straumann SLA reliable and scientifically well documented
Roughened surfaces for dental implants have consistently demonstrated advantages over the older machinedtype titanium surfaces. Significantly greater success rates, enhanced bone-to-implant contact (BIC) and greater biomechanical and functional stability have all been demonstrated by rough surface implants compared
to those with smoother surfaces1. Straumanns proprietary Sandblasted, Large-grit, Acid-etched (SLA) surface
has become one of the best documented rough surfaces in implantology, having shown advantages over
other roughened implant surfaces1. In particular, preclinical analysis has shown the superiority of SLA over
the previously most common rough surface, titanium plasma-sprayed (TPS), with better maintenance of vertical bone height2 and significantly greater BIC3. Shear strength of the bone-to-implant interface has also been
shown to be greater with SLA compared to TPS and machined surfaces4, and compared to a machined
and acid-etched surface5 in preclinical studies; a biomechanical comparison using implants of the same design showed that the better bone anchorage was a result of the surface topography rather than the implant
design.6
Sandblasted, Large-grit, Acid-etched (SLA)

The extent of the bone-to-implant interface appears to increase with increasing surface roughness,7,8 but problems have been noted with surfaces that are very rough, suggesting that there may be an optimum range
of moderate surface roughness9. The SLA surface is sandblasted with large-grit (250500 m), which results
in a peak-to-peak macro-roughness of approximately 2040 m, followed by micro-roughness of approximately 24 m upon acid etching. Micro-rough surfaces increase the rate of cell spreading and the number
of cells attached to the surface, and increase the rate that cells produce factors regulating the differentiation
of bone-forming cells (osteoblasts) and reduce the activity of bone-destroying cells (osteoclasts).10,11
The clinical benefit

The advent of the SLA surface, with its proven osseointegration properties, therefore revolutionized the conventional timing of provisionalization, allowing it to be cut by half, from 12 weeks for the previous TPS surface
to just 6 weeks*12,13,14; subsequently, even earlier loading (e.g. early and immediate) have been shown to be
successful and predictable.14,15,16,17,18,19 The longevity of Straumann Soft Tissue Level implants with the SLA
surface has also been demonstrated by success in numerous long-term investigations (e.g. 5 years and
over).20,21,22,23,24 The substantial level of evidence for SLA also acts as a proven foundation for the SLActive
surface, which is based on the SLA technology.
The SLA surface is available and has proven to be successful on various Straumann implant designs, Narrow Neck implants,25 Wide Neck implants,26 Tapered Effect implants27 and short implants28. The SLA surface is also available on BL implant.
The 20 years of investigation and 10 years of clinical evidence for SLA24 have provided a wealth of information, and implant survival rates of > 98 % have consistently been observed.12,14,15,20,21,22,29,30 The following
information shows data from selected key preclinical and clinical studies with Straumanns SLA -surfaced
implants, representing a range of indications, loading protocols and implant types. The excellent data demonstrate the advantages and versatility of the SLA surface.
* With good bone quality and adequate bone quantity and implants of 4.1 mm or 4.8 mm, over 8.0 mm lengths.
Please note that this Straumann Scientific Evidence document contains a selection of studies and makes no claim to be a complete study list. Articles were selected on
merit from the results of a literature search using combinations of the following key words: sand-blasted and grit-blasted, sand-blasted and particle blasted, tapered
effect, standard implant, standard plus, narrow neck implant, sand-blasted and large-grit and acid-etched, wide neck implant, ITI implant, sand-blasted and acid-etched,
Straumann, rough surfaces, blasted SLA, surface topography, dental implant, surface chemistry, surface modification, surface roughness, acid-etching, titanium,
synOcta, Locator, IPS e.max, preshaped abutment
Study overview
Preclinical Studies
#
Topic
Authors
Reference
Interface shear strength
Wilke HJ et al.
Clinical Implant Materials (Heimke G, Soltsz U, Lee AJC,

eds). Advances in Biomaterials; 9, 1990: 309314.
04
Surface characteristics on bone reactions
Buser D et al.
J Biomed Mater Res 1991;25(7):889902.
05
Implant surface under loaded /

unloaded conditions
Cochran DL et al.
Clin Oral Implants Res 1996;7(3):240252.
06
Histometric analysis SLA
Cochran DL et al.
07
Comparative Removal Torque Evaluation
Buser D et al.
Int J Oral Maxillofac Implants 1998;13(5):611619.
08
Interface shear strength
Buser D et al.
09
Immediate and early loading
Quinlan P et al.
10
Comparative study to investigate bone healing

around 4 different implant systems
de Sanctis M et al.
J Clin Periodontol 2009;36(8):705711.
11
Page
Clinical Studies
#
Topic
Authors
Reference
Page
Early healing (6 weeks)
Cochran DL et al.
12
10
Early loading in partially edentulous patients

(6 weeks)
Bornstein MM et al.
13
11
Early loading in posterior mandible

(2 or 6 weeks)
Salvi GE et al.
14
12
Early loading in edentulous posterior maxilla and

mandible 12-month follow-up
Nordin T et al.
15
13
Immediate loading with 3-unit fixed

partial dentures
Cornelini R et al.
Int J Oral Maxilliofac Implants 2006;21(6):914918.
16
14
5-year life table analysis on WN SLA implants
Bischof M et al.
17
15
Clinical field trial with Soft Tissue Level

SLA implants
Cochran D et al.
J Periodontol 2007;78(56):974982.
18
16
Clinical performance of WN SLA 3-year

follow-up
Bornstein MM et al.
19
17
5-year follow-up RCT in the edentulous maxilla
Fischer K et al.
Clin Oral Implants Res 2008;19(5):433441
20
18
Staged sinus floor elevation in partially edentulous

patients
Bornstein MM et al.
21
19
Kaplan-Meier curve for TPS and SLA implants
De Boever AL et al.
Clin Oral Implants Res 2009 ;20(12) :13411350.
22
20
Mandibular overdentures supported by 2 implants:

a 5-year RCT
Cehreli MC et al.
Clin Implant Dent Relat Res 2010;12(2):114121.
23
21
10-year data on Soft Tissue Level SLA implants in

the edentulous maxilla
Fischer K
ITI World Symposium, Geneva, Switzerland,

1517 Apr 2010.
24
The influence of various titanium surfaces on the interface shear strength

between implants and bone
Wilke HJ, Claes L, Steinemann S.
Clinical Implant Materials (Heimke G, Soltsz U, Lee AJC, eds). Advances in Biomaterials; 9, 1990: 309314.
Abstract: Mechanical effects of bone healing were evaluated for implants with various surface treatments. Maximum removal torque was
shown by the SLA surface.
Introduction
Results
Bone healing around titanium implants can be influenced by the titanium surface. This investigation therefore examined the mechanical
effect of the bone healing response to various surface morphologies
of titanium implants in terms of implantation time.
SLA implants showed the maximum removal torque, and the maximum removal torque increased over time for SLA and TPS implants
(Figure 1); in contrast, no significant changes in removal torque were
observed for the remaining implants.
Methods
Preclinical studies
Titanium screws with six different surface treatments (electropolished;

sandblasted with fine grit/acid-pickled (HF/HNO3)/anodized; titanium plasma-sprayed (TPS); sandblasted with medium grit/acid-pickled (HF/HNO3); sandblasted with large grit/acid-pickled (HF/
HNO3); sandblasted with large grit/acid-etched (HCl/H2SO4)
(SLA) were placed in the tibiae of 10 sheep. Removal torque was
evaluated after 2, 9, 12, 24 and 52 weeks, and histological analysis was performed after 9, 24 and 52 weeks.
SLA
V
IV
III
Nm
II
4
SLA
III
2
V
IV
II
I
0
2 weeks
8 weeks
9 weeks
12 weeks
18 weeks
24 weeks
52 weeks
Figure 1: Removal torque (Nm) of titanium screws according to surface treatment and time in place.
I: electropolished
II: sandblasted with fine grit, acid pickled using HF/HNO3 and anodized
III: titanium plasma-sprayed
IV: sandblasted with medium grit and acid pickled using HF/HNO3
V: sandblasted with large grit and acid pickled using HF/HNO3
SLA: sandblasted with large grit and acid etched using HCl/H2SO4
Conclusions
The interface shear strength of implants can be increased
by altering the surface structure morphology.
An optimal surface can potentially be developed for various biomechanical situations, e.g. strong anchorage for
permanent implants, or weaker anchorage for temporary/removable implants.
Influence of surface characteristics on bone integration of titanium implants.

A histomorphometric study in miniature pigs
Buser D, Schenk RK, Steinemann S, Fiorellini JP, Fox CH, Stich H.

Abstract: Bone healing with various implant surface characteristics was evaluated. Rough surface promoted greater bone apposition, with an
additional effect shown by SLA.
Introduction
Results
Several techniques have been employed to improve anchorage of

titanium implants in bone by surface modification or coatings. The
aim of this study was to investigate the influence of various surface
characteristics on bone reactions in titanium implants.
Histological analysis showed direct bone-to-implant contact for all

implants, but with significant differences in the percentages obtained.
The lowest bone-to-implant contact was observed with the HF/
HNO3 implants (25.1 % 7.4 % and 21.6 % 9.3 %, respectively,
at 6 weeks), while the highest bone-to-implant contact was found
with the SLA and HA implants (57.7 % 9.5 % and 69.5 %
6.5 %, respectively, at 6 weeks). The results showed increasing
bone-to-implant contact with increasing surface roughness (Fig. 2).
Methods
Hollow cylinder implants with six different surface treatments (electropolished (E); sandblasted with medium grit/acid-pickled (HF/
HNO3) (SMP); sandblasted with large grit (SL); sandblasted with
large grit/acid-etched (HCl/H2SO4) (SLA); titanium plasma-sprayed
(TPS); hydroxylapatite plasma-sprayed (HA)) (Fig. 1) were placed in
the metaphyses of the tibia and femur in six mini-pigs. Twelve implants of each type were placed. Histomorphometric analysis was
performed after 3 and 6 weeks.
n.s.
80
3 weeks
6 weeks
Preclinical studies
% Bone Contact
60
40
20
Figure 1: Scanning electron micrographs of different implant surfaces (bar is 20

m; original magnification x1700). (A) SMP, (B) SL, (C) SLA, (D) TPS, (E) HA
SMP
SL
TPS
SLA
HA
Figure 2: Mean direct bone-to-implant contact (%) of different implant surfaces

after 3 and 6 weeks; E = electro-polished; SMP = sandblasted with medium grit
(0.120.25 m) and acid pickling with HF/HNO3; SL = sandblasted with large
grit (0.250.50 m)
A narrow band of bone was often seen around SLA and HA implants as an extension of perpendicularly oriented bone trabeculae;
however, the HA coating consistently showed signs of resorption,
predominantly in areas without bone covering.
Conclusions
Greater bone apposition was observed with rough surfaces compared to polished or fine structured surfaces.
The SLA surface showed an additional effect on bone
apposition compared to the sandblasted surface.
The highest bone-to-implant contact was found with SLA
and HA surfaces.
The HA coating consistently showed signs of resorption.
* Reproduced with permission of John Wiley & Sons, Inc.
Evaluation of an endosseous titanium implant with a sandblasted and

acid-etched surface in the canine mandible: radiographic results
Cochran DL, Nummikoski PV, Higginbottom FL, Hermann JS, Makins SR, Buser D.
Abstract: SLA and TPS implants were compared under loaded and unloaded conditions in vivo. SLA implants showed advantages in early
healing and showed less crestal bone loss.
Introduction
Results
Surface characteristics of titanium implants have a direct impact on

integration with hard and soft tissues, and radiography is the only
non-invasive method to assess the bone reaction. The aim of this
study was to compare titanium implants with TPS and SLA surfaces
in a dog mandible model under loaded and unloaded conditions
over 15 months.
Excellent tissue integration with ankylotic stability and no signs of

peri-implant infection were observed for all implants, and the radiography showed no signs of continuous peri-implant radiolucency
around the implants. Stability was maintained after loading, and no
complications were observed.
Methods
SLA
1.4
TPS
1.2
% Bone Contact
Preclinical studies
Cylindrical implants with either a TPS or an SLA surface (Fig. 1) were

placed in the mandibles of six dogs after 3 months of healing following tooth extraction. A total of 69 implants were placed. In four dogs
(groups B and C), impressions were taken 2 months after implant
placement for the fabrication of screw-retained gold crowns, and the
implants (48 implants) were loaded 3 months after implant placement. Radiographic analysis was performed for assessment of boneto-implant contact, by measuring the distance from the implant shoulder to the most coronal bone-to-implant contact, and bone density,
measured using computer-assisted densitometric image analysis (CADIA). Measurements were taken 3 months after implant placement
for the unloaded implants (group A, 2 dogs), 3 and 6 months after
implant placement in group B (2 dogs), and 3, 6, 9, 12 and
15 months after implant placement (12 months of loading) in group
C (2 dogs).
Mean crestal bone loss at the preload and 3-month evaluations were
0.52 mm and 0.73 mm, respectively, for SLA implants and 0.69 mm
and 1.06 mm, respectively, for TPS implants. All crestal bone loss
occurred during the first 6 months after implant placement, 65 % before loading and 35 % in the first 3 months after loading, regardless
of implant surface. Bone loss was significantly less with the SLA implants at both preload and after 3 months of loading, and this was
maintained during the 1-year follow-up period (Fig. 2).
1.0
0.8
0.6
0.4
*p<0.05
0.2
0
Preload
3 mo
Load
6 mo
Load
9 mo
Load
12 mo
Load
Figure 2: Interaction line plot for mean crestal bone loss for SLA versus TPS
implants, from preload to 12 months of loading
Bone density values were also significantly greater for SLA implants
than TPS implants, comparing both preload and 3 months to baseline, but no detectable changes in bone density were observed in
the apical areas between SLA and TPS implants.
Figure 1: Electron micrographs of SLA (above) and TPS

(below) surfaces; original magnification x 1700; bar = 10 m
(images courtesy of D Buser)
* R eproduced with permission of Clinical Oral Implants Research.
Conclusions
SLA implants showed a distinct advantage in early healing periods compared to TPS implants due to reduced
crestal bone loss.
SLA implants were shown to be superior to TPS implants
as measured via radiographic bone loss under both
loaded and unloaded conditions.
Bone response to unloaded and loaded titanium implants with a sandblasted

and acid-etched surface: a histometric study in the canine mandible
Cochran DL, Schenk RK, Lussi A, Higginbottom FL, Buser D.

Abstract: SLA and TPS implants were evaluated under loaded and unloaded conditions in vivo. Greater bone-to-implant contact was
observed with SLA implants.
Introduction
Results
Many investigations of titanium implants focus on the surface characteristics, and BIC has been shown to be greater with an SLA surface
compared to a TPS surface. This study was designed to evaluate the
SLA implant surface by histometric analysis in the canine mandible,
compared to TPS surface implants.
All implants were stable after 3 months, with healthy peri-implant tissues and no significant peri-implant inflammation. Bone-to-implant
contact was significantly greater for the unloaded SLA implants versus the unloaded TPS implants after 3 months and after 12 months
of loading, but there was no significant difference after 3 months of
loading (Fig. 2). No qualitative differences in bone tissue were observed between the SLA and TPS implants.
Surface
Group A
Surface
Group C
TPS
*p<0.01
n.s.
80
60
40
20
Unloaded
3 mo Loaded
12 mo Loaded
Figure 2: Bone-to-implant contact (%) for SLA and TPS implants for unloaded
implants and implants after 3 and 12 months of loading
Extr.
-3
100
Surface
Group B
Implants
SLA
Preclinical studies
Cylindrical implants with either a TPS or an SLA surface were

placed in the mandibles of six dogs after 3 months of healing following tooth extraction. A total of 69 implants were placed. Implants
were left unloaded in two dogs (Group A), while the implants in the
remaining four dogs were loaded with screw-retained gold crowns
after 3 months (Groups B and C). Histometric analysis of the boneto-implant contact was performed 3 months after implant placement
in the unloaded group and 6 and 15 months after implant placement
(3 and 12 months of loading, respectively) in the loaded groups
(Fig. 1).
Total bone contact (%)
Methods
15 (mo)
Figure 1: Study plan, showing implant placement and evaluation of the various
groups
Conclusions
The SLA surface promoted greater bone-to-implant contact at 3 months u nloaded and 12 months loaded compared to the TPS s urface.
SLA showed the potential for superior osseointegration
results compared to the existing TPS surface.
Removal torque values of titanium implants in the maxilla of miniature pigs
Buser D, Nydegger T, Hirt HP, Cochran DL, Nolte NP.

Abstract: Removal torque was evaluated for SLA and Osseotite implants in vivo over 12 weeks, and was found to be significantly higher
for SLA.
Introduction
Results
After the introduction of SLA, another acid-etched implant surface,

Osseotite, was introduced onto the market, but there were no available data comparing this and other rough titanium surfaces. The aim
of this investigation, therefore, was to compare an implant with this
acid-etched surface (Osseotite) with the sandblasted and acidetched surface (SLA) by measurement of removal torque values.
Both surfaces showed similar features under scanning electron microscopy (i.e. small micropits of 12 m in diameter), although the
Osseotite surface appeared to exhibit a flatter profile. Average
roughness (Ra) was greater for the SLA surface (Ra = 2.0 m versus
1.3 m). The mean removal torque was significantly higher for SLA
implants compared to Osseotite implants at all time points (Fig. 3).
Methods
Preclinical studies
In the maxilla of each of nine adult miniature pigs, a total of 70 implants were placed (six to eight implants per animal) at least 6
months after tooth extraction. Biomechanical testing was performed
on 54 of these implants by evaluation of removal torque after 4, 8
or 12 weeks. The implants had either a sandblasted and acid-etched
(SLA) surface or a machined and acid-etched (Osseotite) surface
(Fig. 1, Fig. 2). A commercially available standard hex device was
used for removal of the Osseotite implants, while a specially manufactured adapter was used for removal of the SLA implants. Since
the hex connection of the Osseotite implants was rather short and
unable to withstand the shear stresses during removal torque testing,
the failure torque of these implants was also assessed. Torque rotation curves were recorded for each test and the removal torque was
defined as the maximum torque on the curve.
Figure 2: The two implants evaluated: the 8 mm long

SLA implant without apical grooves (left) and the 10 mm
long Osseotite implant with four apical grooves (right)
SLA
240
Osseotite
210
*
Torque (Ncm)
180
150
120
90
60
* *p<0.01
30
0
4 weeks
8 weeks
12 weeks
Figure 3: Mean removal torque values for SLA and Osseotite implants after 4,
8 and 12 weeks
The removal torque curve of SLA implants showed a high slope to

the maximum level at 1012 and a subsequent clear reduction following fracture at the bone-to-implant interface; in contrast, Osseotite
implants showed a flatter removal torque curve, with no clear reduction following failure torque after 1218.
Figure 1: Electron micrographs of the Osseotite (above) and
SLA (below) surfaces
Osseotite is a registered trademark of Biomet 3i, USA.

* Reproduced with permission of Quintessence Publishing Co Inc., Chicago.
Conclusions
Mean removal torque was 75125 % higher for SLA
implants versus Osseotite implants.
In vitro and in vivo evaluation of new implant surfaces is
therefore essential prior to clinical application in patients.
Interface shear strength of titanium implants with a sandblasted and

acid-etched surface: a biomechanical study in the maxilla of miniature pigs
Buser D, Nydegger T, Hirt HP, Cochran DL, Nolte NP.

Abstract: Interface shear strength was evaluated for SLA, TPS and machined implants in vivo. Removal torque was significantly higher for
SLA and TPS, and was higher for SLA versus TPS at 4 weeks.
Introduction
Methods
A total of 54 implants with an SLA, TPS or machined surface (Fig. 1)
were placed in the maxillae (three implants on each side) of nine
adult miniature pigs at least 6 months after tooth extraction. The anterior-posterior position of each implant type was varied so that no
preference was given for any one implant type. Shear strength was
evaluated by removal torque testing after 4, 8 and 12 weeks; torque
rotation curves were recorded for each test and the removal torque
was defined as the maximum torque on the curve. Histologic and
histomorphometric analysis was also performed.
2.0
8
Healing periods (weeks)
12
Figure 2: Removal torque values for SLA, TPS and machined surface implants
after 4, 8 and 12 weeks
Removal torque (Nm)
anterior
middle
posterior
Preclinical studies
Mean removal torque for the machined surface implants varied from
0.13 to 0.26 Nm, while mean values for the rough surfaced implants
were between 1.14 and 1.56 Nm. Mean removal torque was higher for the SLA surface after 4 weeks compared to the TPS surface,
while mean values were similar for both surfaces at 8 and 12 weeks
(Fig. 2). Implant position had a significant influence on removal
torque lower removal torque values were found for more posterior
locations (Fig. 3), which correlated significantly with decreasing
bone density from anterior to posterior sites. Histological analysis
showed a separation between the bone and implant surface for machined surface implants. Bone trabeculae fractures were often observed for TPS and SLA implants, but the bone-to-implant interface
was maintained.
0.5
2.0
Results
TPS
1.0
Figure 1: The three tested implants, which had the same design but different
surfaces: SLA (left), TPS (center) and machined (right)
SLA
1.5
Removal torque (Nm)
The SLA titanium surface has demonstrated enhanced bone apposition versus the TPS surface. This study was designed to evaluate the
interface shear strength of the SLA surface in the maxilla of miniature
pigs versus TPS and machined surfaces.
1.5
1.0
0.5
SLA
TPS
Figure 3: Removal torque values for SLA, TPS and machined surface implants
according to implant position
Conclusions
Interface shear strength of titanium implants is significantly
influenced by the surface characteristics.
SLA and TPS surfaces showed significantly higher removal torque values than machined surface implants.
Mean removal torque was higher for SLA compared to
TPS implants after 4 weeks.
* R eproduced with permission of John Wiley & Sons, Inc.
Immediate and early loading of SLA ITI single-tooth implants: an in vivo study.
Quinlan P, Nummikoski P, Schenk R, Cagna D, Mellonig J, Higginbottom F, Lang K, Buser D, Cochran D.
Abstract: SLA implants were loaded immediately or early in vivo; no significant differences were found between the loading protocols.
Introduction
Results
A healing time of 6 weeks has been suggested for SLA surfaced

implants, indicating the potential for the implants to be loaded immediately or early. The aim of this study was to determine whether
immediate or early loading of SLA implants has any adverse effects
compared to conventional loading, as assessed by clinical, radiographic and histological examination.
All implants were well osseointegrated; implant survival was 100 %.

Clinically normal peri-implant tissues were observed, with no signs of
inflammation or suppuration. Changes in crestal bone height (combined mesial and distal aspects) for implants loaded after 2, 10 and
21 days and 3 months were 0.35 0.18 mm, 0.15 0.08 mm,
0.30 0.08 mm and 0.02 0.07 mm, respectively. The differences were not statistically significant, suggesting that loading time
does not adversely affect the peri-implant crestal bone. There were
also no significant differences in primary or secondary BIC, total BIC
(Fig. 1) or total connective tissue-to-implant contact. For bone marrow-to-implant contact, the amount was marginally significantly greater for the implants placed 2 days before loading (19.16 35 %)
compared to those placed 3 months before loading (13.98
2.02 %), but no other differences were observed.
Preclinical studies
Methods
Mandibular premolars and first molars were removed from four dogs
and a total of 48 SLA surfaced implants (12 per dog) were placed
4 months later. The implants were loaded with single screw-retained
gold crowns 2, 10 or 21 days or 3 months after implant placement
and placed in functional occlusion. Block sections were obtained for
histologic examination and the changes in crestal bone height mesially and distally at each implant, and the change in bone density of
the coronal 3 mm of crestal bone, were recorded. Histological evaluation included primary, secondary and total BIC as well as bone
marrow-to-implant contact and connective tissue-to-implant contact.
Primary bone
100
Secondary bone
90
Bone-to-implant contact (%)
80
70
60
50
40
30
20
10
0
Figure 1: Total BIC for implants placed 3 months (group A), 21 days (group B),
10 days (group C) and 2 days (group D) before loading
Conclusions
No significant differences were observed between the
four loading protocols.
Immediate and early loading of SLA implants is therefore
possible with no adverse peri-implant tissue effects.
10
Immediate implants at fresh extraction sockets: bone healing in four different

implant systems.
de Sanctis M, Vignoletti F, Discepoli N, Zucchelli G, Sanz M.

J Clin Periodontol 2009;36(8):705711.
Abstract: Bone healing in extraction sockets was evaluated for SLA, OsseoSpeed, Osseotite and SPI Element implants. Healing
patterns were similar in all groups, but bone-to-implant contact was highest with SLA.
Introduction
Results
Implant placement immediately after tooth extraction has become a

common procedure, but the outcomes may depend on implant design and/or surface. The aim of this study, therefore, was to investigate the differences in bone healing around four different implant
systems placed in fresh extraction sockets in the dog, and to observe
the influence on modelling of the buccal plate.
BIC proved to be highly variable, ranging from 39.84 % to 78.63 %

for 3i implants (3i Osseotite Certain straight miniplant), 35.78 % to
76.58 % for Astra Tech implants (Astra Tech MicroThread
OsseoSpeed 3.5 mm), 50.13 % to 86.88 % for Thommen implants (Thommen SPI ELEMENT 3.5 mm) and 58.14 % to 83.40 %
for Straumann implants (Straumann Standard Plus 3.3 mm); BIC
was therefore most consistent around Straumann implants. Mean BIC
was also highest for Straumann implants (Fig. 2), although the difference was not statistically significant. Marked bone remodelling of the
buccal plate of approximately 2.5 mm was observed, regardless of
the implant system. Similar bone area percentages and amounts of
new bone formation were observed for all implant systems.
Methods
Preclinical studies
Third and fourth premolars were removed in each of eight dogs and
four different implant types were randomly placed in the distal extraction sockets: Thommen SPI ELEMENT 3.5 mm; Straumann
Standard Plus 3.3 mm; Astra Tech MicroThread OsseoSpeed
3.5 mm; 3i Osseotite Certain straight miniplant (Fig. 1). Histologic, histometric and histomorphometric analysis was performed after 6 weeks of healing to assess BIC, bone area, new bone formation and ridge alterations.
90.0
Bone to implant contact (%)
*
67.5
45.0
22.5
0
Figure 1: The four implant systems evaluated: (from left to right) Thommen SPI
ELEMENT; Straumann Standard Plus; Astra Tech MicroThread OsseoSpeed; 3i
Osseotite Certain
3i
Astra Tech
Straumann
Thommen
Figure 2: Mean BIC ( SD) for the four implant systems: 3i Osseotite Certain;
Astra Tech MicroThread OsseoSpeed; Straumann Standard Plus; Thommen
SPI ELEMENT
Conclusions
Healing patterns for implants placed in fresh extraction
sockets after 6 weeks were similar for all four implant
systems.
The highest BIC was observed with SLA implants.
SPI is a registered trademark of Thommen Medical AG, Switzerland.

OsseoSpeed is a trademark of Astra Tech AB, Sweden.
Osseotite is a registered trademark of Biomet 3i, USA.
* Reproduced with permission of John Wiley & Sons, Inc.
11
The use of reduced healing times on ITI implants with a sandblasted and
acid-etched (SLA) surface: early results from clinical trials with ITI SLA implants
Cochran DL, Buser D, ten Bruggenkate CM, Weingart D, Taylor TM, Bernard JP, Peters F, Simpson JP.
Abstract: SLA implants were placed in 133 patients and restored after 6 weeks (12 weeks in class IV bone). The cumulative survival rate
after 2 years was 99.3 %.
Introduction
Results
Since the SLA surface has demonstrated advantages in earlier healing following implant placement, the aim of this investigation was to
determine whether SLA implants could be predictably and safely
restored after 6 weeks after placement in class I to III bone and after
12 weeks in class IV bone.
There were 80 patients (198 implants), 21 patients (46 implants and

32 patients (139 implants) in groups A, B and C, respectively. At the
time of publications, 110 patients with 326 implants had completed
the 1-year follow-up evaluation, and 47 patients with 138 implants
had completed the 2-year recall. Three implants were lost before
abutment connection, giving a success rate of 99.3 %, for a mean
implant loading time of 49 days. No implant failures or implant-related adverse events were reported after abutment connection. The
cumulative implant success rate, as determined by life table analysis,
was 99.1 % for both the 1-year and 2-year evaluations (Table 1).
clinical studies
Methods
This was a prospective multicenter trial to evaluate the success of
abutment connection by descriptive analysis and implant success by
life table analysis. A total of 133 patients were recruited into the trial,
and 383 implants were placed. Abutments were placed and torqued
to 35 Ncm 4263 days after implant placement for implants in bone
class I, II and III, and after 84105 days in bone class IV. The patient
groups were as follows: at least one tooth missing in the posterior
mandible and a fixed implant-to-implant restoration on at least two
implants (group A); at least one tooth missing in the posterior maxilla
and a fixed implant-to-implant restoration on at least two implants
(group B); at least 1 tooth missing in the posterior mandible and
either a fixed restoration on at least four implants or a removable
denture on at least four implants (group C). Implants were placed in
a non-submerged technique and restorations were either cement- or
screw-retained. Implant mobility, radiographic bone loss, gingival
health and plaque accumulation were assessed.
Group
A, B, C
Interval
(mo)
No implants at
start interval
No drop-outs
during intervals
No implants lost
during interval
CSR (%)
012
383
99.1
1224
326
99.1
012
198
99.4
1224
165
99.4
012
46
100
1224
35
100
012
139
98.4
1224
126
98.4
Table 1: Life table analyses
Conclusions
Implants with an SLA surface can be restored after 6
weeks with high levels of predictability and success.
Very high implant success rates were observed after 1
and 2 years.
The results confirm the concept of enhanced bone formation around SLA surfaced implants and confirm the possibility of reduced healing times prior to restoration.
12
Early loading on nonsubmerged titanium implants with a sandblasted and

acid-etched (SLA) surface: 3-year results of a prospective study in partially
edentulous patients
10
Bornstein MM, Lussi A, Schmid B, Belser UC, Buser D.

Abstract: Non-submerged SLA implants were evaluated in 51 partially edentulous patients after 3 years; the success rate was 99 %.
Introduction
Results
To evaluate the success rate of SLA implants loaded after 6 weeks

of healing in posterior sites in partially edentulous patients, and to
determine whether the success rate is comparable to previous studies
for implants with the TPS surface.
One implant failed to osseointegrate and became unstable during

healing, so was consequently removed; A second implant was
placed 3 months later and osseointegrated with no complications.
One patient was lost to follow-up and considered a drop-out from
the study. The remaining 102 implants were successfully osseointegrated after 3 years, resulting in a success rate of 99.03 %.
Methods
A local peri-implant infection as a result of excess cement was noted

at two implants at the 3-month follow-up; the cement was removed
and the infection successfully treated (Fig. 1). All other implants were
firmly osseointegrated with no signs of peri-implant infection or radiolucency. Mean values for the clinical and radiographic examinations
are shown in Table 1. Mean PLI significantly decreased at 1, 2 and
3 years compared to 3 months, and the mean decreases in mSBI
from 3 months were also significant. PD, DIM, CAL and DIB remained stable throughout the study period, while there was a tendency for decreasing PTV score.
clinical studies
In 51 partially edentulous patients, 104 implants (89 mandibular, 15

maxillary) were placed in posterior sites in bone densities of class I,
II or III. Solid abutments were connected and torqued to 35 Ncm
and the implants functionally loaded with cement-retained single
crowns (39 implants), splinted single crowns (43 implants) or fixed
partial dentures (21 implants) after 6 weeks. Clinical and radiographic examination was performed after 3, 12, 24 and 36 months the
parameters measured were modified plaque index (mPLI), modified
sulcus bleeding index (mSBI), probing depth (PD), distance from implant shoulder to mucosal margin (DIM), clinical attachment level
(CAL), mobility assessed by Periotest (PTV), and distance from implant
shoulder to most coronal visible BIC (DIB).
Conclusions
Early loading of SLA implants after 6 weeks leads to
highly successful and predictable tissue integration in
partially edentulous patients.
Successful tissue integration is maintained for up to 3
years of follow-up.
An excellent 3-year success rate of 99.03 % was
observed.
Figure 1: The two implants with previous peri-implantitis
following successful treatment at the 3-year examination both implants fulfilled the success criteria (Picture
courtesy of M Bornstein).
Time
mPLI
mSBI
PD (mm)
DIM (mm)
CAL (mm)
PTV
DIB (mm)
3 mo
10.49
0.65
4.29
1y
0.28
0.49
4.47
-1.12
3.18
-2.08
2.64
-1.24
3.22
-3.57
2.76
2y
0.24
0.33
3y
0.28
0.26
4.32
-1.12
3.19
-4.08
2.82
4.23
-1.09
3.15
-3.17
2.72
Table 1: Mean values for clinical and radiographic parameters at 3, 12, 24 and 36 months
13
11
Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA) ITI implants

in the posterior mandible. A 1-year randomized controlled clinical trial
Salvi GE, Gallini G, Lang NP.
Abstract: SLA implants were placed in 27 patients and loaded after 2 or 6 weeks. No implants were lost after 1 year, showing that 2-week
loading does not jeopardize osseointegration.
Introduction
Results
Implants placed in a two-stage surgical protocol are traditionally restored after a non-loaded healing period of 36 months, but evidence suggests that the SLA surface can promote faster osseointegration. The aim of this investigation, therefore, was to assess clinical
and radiographic outcomes of SLA surfaced implants in the posterior mandible loaded after 2 or 6 weeks.
The implant survival rate after 1 year was 100 %. For three implants
(two in the test group and one in the control group), abutment rotation
occurred at abutment connection, so the final impression was not
taken and the abutments were successfully re-tightened to 35 Ncm
12 weeks later. There were no significant differences between the
test and control groups for any of the clinical or radiographic parameters measured (Table 1).
clinical studies
Methods
The study enrolled 27 patients with bilateral posterior mandibular
edentulous areas requiring prosthetic reconstruction. A total of 67
implants were placed, 31 in one side of the mandible (test) and 36
in the contralateral side (control). In the control group, abutment
placement was carried out after 35 days and single-tooth crowns
were placed after 42 2 days. Abutments were placed after 7 days
in the test group and single-tooth crowns were placed after 14 1
days. All abutments were torqued to 35 Ncm and all crowns were
porcelain-fused-to-metal and were cemented. Clinical data (CAL, PD,
bleeding on probing (BOP), implant stability by Periotest (PTV) were
assessed 2, 6, 12, 24 and 52 weeks after implant placement; width
of keratinized mucosa (KM) was evaluated at implant placement and
after 1 year. Distance from implant shoulder to most coronal BIC was
evaluated radiographically at baseline and after 6 weeks and 1
year to assess bone loss (BL).
Test sites
(N=31)
Control sites
(N=36)
Statistic
PPD (mmSD)
2.60.5
2.70.5
ns
CAL (mmSD)
3.10.4
3.20.5
ns
9.7
8.3
ns
BOP (%)
Width of KM (mmSD)
1.80.4
1.90.5
ns
PTV (SD)
-1.40.9
-1.60.8
ns
0.570.49
0.720.5
ns
BL (mmSD)
Table 1: Clinical and radiographic parameters at test and control sites at the
12-month follow-up evaluation
14
Conclusions
Loading of SLA surfaced implants as early as 2 weeks
does not jeopardize the process of osseointegration.
Proper handling of implant abutment rotation does not adversely affect tissue integration or implant stability.
Clinical and radiographic outcomes are similar for implants in the posterior mandible loaded after 2 weeks as
for those loaded after 6 weeks.
A 3-arm study of early loading of rough-surface implants in the completely

edentulous maxilla and in the edentulous posterior maxilla and mandible:
results after 1 year of loading
12
Nordin T, Nilsson R, Frykholm A, Hallman M.

Abstract: A total of 234 SLA implants were placed in patients with an edentulous maxilla or mandible. Cumulative survival after 1 year was
99.1 %, with favourable results for both immediate and early loading.
Introduction
Results
Previous studies have indicated that early loading of SLA implants

may be feasible. The aim of this study was to investigate early loading of SLA implants in the edentulous maxilla and posterior edentulous maxilla and mandible using a larger patient population than
previously studied.
Two of the 234 implants were lost, giving an overall cumulative survival rate of 99.1 %; survival rates for groups A, B and C were
99.2 %, 98.3 % and 100 %, respectively. Implant placement torque
varied from 29 to 35 Ncm among the groups, and no significant
differences were observed between placement torque for implants
(Fig. 1). The mean reduction in marginal bone level from baseline to
implant placement was -0.75 0.13 mm (range 0 to 3.5 mm); the
mean changes in marginal bone level were -0.63 mm, -1.03 mm
and -0.96 mm for groups A, B and C, respectively. No significant
differences were found between the groups or between implants
placed in extractions sockets and those placed in healed bone.
Methods
Immediate
43
Conclusions
Favorable results were obtained for immediate and early
loading of SLA implants in this patient population.
Early loading with SLA implants can have predictable
outcomes for the rehabilitation of the edentulous maxilla
and edentulous posterior maxilla and mandible.
clinical studies
The study enrolled 54 patients in three groups: patients with a completely edentulous maxilla (20 patients, group A); patients with an
edentulous posterior left and/or right maxilla (19 patients, group B);
and, patients with an edentulous posterior left and/or right mandible
(15 patients, group C). Patients each received from 2 to 7 implants
234 implants were placed (122 implants in group A, 59 in group
B and 53 in group C); 58 of the implants were placed immediately
after tooth extraction. Straumann synOcta abutments were mounted
prior to flap suture and impressions were taken immediately after surgery. Placement torque was measured at all implant sites at the time
the abutments were mounted. Sixty screw-retained prosthetic restorations were used to restore 212 teeth and were loaded after a mean
period of 9 days (range 4 to 22 days). Intraoral radiographs were
obtained at baseline and after 1 year of functional loading to evaluate change in marginal bone level, measured as the change in distance from the implant shoulder to the first bone apposition.
Healed
Torque (Ncm)
36
30
23
17
10
B
Group
Figure 1: Implant placement torque for implants placed in extraction sockets and
in healed bone for the three groups (A edentulous maxilla; B edentulous
posterior left and/or right maxilla; C edentulous posterior left and/or right
mandible)
15
13
Immediate loading of implants with 3-unit fixed partial dentures: a 12-month

clinical study
Cornelini R, Cangini F, Covani U, Barone A, Buser D.
Abstract: SLA implants were immediately loaded with 3-unit fixed partial dentures in 20 patients. The survival rate after 1 year was 97.5 %.
Introduction
Results
Studies have shown that shortened treatment times (e.g. loading after
6 weeks) with SLA implants can be predictable and have advantages for both patients and clinician. The aim of this investigation
was to evaluate implant success after 12 months for immediately
loaded SLA implants in the posterior mandible supporting 3-unit
fixed partial dentures (FPDs).
One implant was removed 2 months after placement due to acute

infection at the implant site a new implant was placed, which was
subsequently successful. The remaining 39 implants were successful,
giving a 1-year success rate of 97.5 %. No significant differences
were observed between implant placement and 12 months for DIB,
KM or ISQ (Table 1). No technical complications (e.g. screw loosening, resin fracture, pain during chewing) were observed.
clinical studies
Methods
Twenty patients with missing mandibular molars or premolars were
enrolled, and a total of 40 implants were placed. Copings were
connected to the implants, wound closure was achieved and impressions were taken. Healing caps were then placed and temporary
screw-retained acrylic resin 3-unit FPDs in functional occlusion were
connected to the implants within 24 hours, i.e. immediate loading.
Definitive abutments and metal-ceramic restorations were placed after 6 months. Implant stability (ISQ), width of keratinized mucosa
(KM) and distance from implant should to point of first BIC (DIB) were
measured at implant placement and after 12 months. Implants were
included in the study only when the primary stability exceeded an
ISQ measurement of 62.
Baseline
DIB
Mesial
12 months
Mean
SD
Mean
SD
P-value
2.4
0.4
2.5
0.4
ns
2.6
0.6
3.1
0.6
ns
2.0
0.5
2.0
0.5
ns
Distal
Width of keratinized mucosa
Midbuccal
Middlingual
ISQ
2.4
0.5
2.2
0.6
ns
72.0
5.7
74.5
7.3
ns
Table 1: Changes in clinical and radiographic parameters between baseline (implant placement) and 12-month follow-up
Conclusions
Immediate functional loading of SLA implants resulted in
an excellent survival rate.
The placement of SLA implants in the mandible and immediate loading with 3-unit FPDs has been shown to be a
successful procedure in this study.
16
A five-year life table analysis on wide neck ITI implants with prosthetic
evaluation and radiographic analysis: results from a private practice
14
Bischof M, Nedir R, Abi Najm S, Szmukler-Moncler S, Samson J.

Abstract: A 5-year life table analysis was performed for 263 wide neck SLA implants in 212 patients. The cumulative survival rate after
5 years was 97.9 % and the mean bone loss after 2 years was comparable to standard SLA implants.
Introduction
Results
Implants with diameters in the range of 3.75 to 4.1 mm have been

extensively used and investigated, but conflicting clinical data have
been reported for implants with wider diameters (e.g. 56 mm). The
aim of this investigation was to report on the follow-up of SLA Wide
Neck implants (4.8 mm) in a 5-year life table analysis, including
prosthetic outcomes.
The 1- and 2-year implant survival rates, based on 259 implants and
174 implants, respectively, were 98.8 % and 97.7 %; the 5-year cumulative survival rate was 97.89 %.Two early failures occurred before
loading, and three late failures occurred after loading. A total of 157
single crowns and 80 FPDs were placed; the majority of prosthetic
restorations were cement-retained. Over 5 years, 93 % of the single
crowns and 95 % of FPDs were free from complications. Porcelain
fracture was noted for 11 prostheses supported by 11 implants in 11
patients; all of these were cement-retained. Of these, five were major
fractures, all of which occurred on single crowns, and six were minor
fractures, four with single crowns and two with FPDs. After 2 years,
mean crestal bone loss mesially and distally was 0.71 0.62 mm
and 0.60 0.64 mm, respectively. Crestal bone loss > 1 mm was
observed at 21.3 % of mesial and distal sides, and only 2.5 %
showed crestal bone loss > 2 mm (Table 1).
Methods
CBL
Mesial side
Distal side
Sum
6 (6 %)
11 (10.8 %)
17 (8.4 %)
00.5
33 (33 %)
41 (40.2 %)
74 (36.6 %)
0.51
30 (30 %)
21 (40.6 %)
51 (25.2 %)
11.5
22 (22 %)
21 (40.6 %)
43 (21.3 %)
1.52
6 (6 %)
6 (5.9 %)
12 (5.9 %)
Gain (mm)
01
clinical studies
Over a 5-year period, 263 SLA Wide Neck implants were placed
in 212 patients; 61.2 % were placed in the maxilla and 38.8 % in
the mandible. The majority (97 %) were placed in the molar region,
with only 3 % in the premolar region. The mean implant lengths used
were 8.9 mm and 9.7 mm in the maxilla and mandible, respectively.
Single crowns were used to replace single missing molars, and
bridges (two splinted crowns, FPDs with pontics and/or unit extensions) were used in larger edentulous spaces. The width of the vestibular and buccal lamellae was 1 mm in 89 % of cases (234 implant sites), while 9.1 % (24 implant sites) had one lamellae < 1 mm
and 1.9 % (five implant sites) had both lamellae < 1 mm. Sinus perforation of 12 mm was tolerated and occurred with 52 % of the
maxillary implants placed. Simultaneous bone augmentation was
performed at 37 sites, 28 of which were vertical and 9 of which
were lateral. Slightly detectable mobility was observed for 20 implants (7.6 %); the remaining 92.4 % were stable.
Conclusions
Wide Neck SLA implants supporting single crowns and
FPDs in molar regions are highly predictable.
Mean bone loss after 2 years was comparable to standard SLA implants.
The safe and predictable use of Wide Neck implants simplified implant treatment.
Very few prosthetic complications were noted.
Loss (mm)
>2
3 (3 %)
2 (2.0 %)
5 (2.5 %)
Sum
100 (100 %)
102 (100 %)
202 (100 %)
Table 1: Crestal bone loss distribution after 2 years
17
15
Clinical field trial examining an implant with a sand-blasted, acid-etched

surface
Cochran D, Oates T, Morton D, Jones A, Buser D, Peters F.
J Periodontol 2007;78(6):974982.
Abstract: A clinical field trial was performed with 990 implants in 509 patients. Survival and success after 5 years were 99.3 % and 97.4 %,
respectively, comparable to those achieved in formal clinical trials.
Introduction
Results
Traditionally, dental implants required 3 to 6 months of undisturbed

healing before the prosthetic restoration could take place. Formal
clinical trials have demonstrated that implants with the SLA surface
can be successfully restored after 6 weeks. The aim of this study,
therefore, was to evaluate the use of SLA surfaced implants and a
reduced healing time (68 weeks) in a large number of patients
treated in predominantly private practice settings.
A total of 509 patients with 990 implants (270 in the maxilla and
720 in the mandible) were treated according to the protocol. There
were four early implant failures (i.e. prior to or at abutment connection), and another implant failed 3 months after abutment placement;
of these five, one was still in function after 3 years and was rated as
successful by the investigator. One late implant failure occurred after
49 months of function. The cumulative survival rates after 3 and
5 years were 99.56 % and 99.26 %, respectively, while the corresponding success rates were 99.12 % and 97.38 % (Table 1). Complications noted included gingivitis in two patients (four and two
implants),l recurrent peri-implant infection in two patients (one implant
each) and pain/discomfort in one patient (one implant). Successfully
treated complications included implant rotation on abutment placement (12 patients/15 implants), pain/discomfort on abutment placement (22 patients/34 implants), gingival recession (one patient), paresthesia of the lower lip (two patients) and gingival hyperplasia (one
patient).
clinical studies
Methods
The study was designed to include over 500 patients and over
800 implants. The patients were to be treated no differently to any
other implant patients in the private practice setting. Requirements for
treatment included good general health and sufficient bone at the
implant site (crest width > 6 mm and height > 10 mm). The implants
were placed in a non-submerged technique and had abutments
placed and restored in full occlusion by 63 days following placement. Follow-up examinations were performed after 3 months and
annually thereafter. A total of 86 investigators worldwide placed
1,406 implants in 706 patients; 27 patients (79 implants) were excluded because six investigators did not return documentation, and
170 patients (337 implants) were excluded due to implant restoration
after > 63 days (Fig. 1).
Implant survival
Interval
(months)
Failures
Cumulative
success rate
(%)
012
990
99.56
99.56
1224
809
99.56
99.42
2436
686
99.56
99.12
603
99.56
98.56
4860
462
99.26
97.38
Compliance with study protocol?
6072
202
99.26
97.38
> 72
11
99.26
97.38
No
79 implants
27 patients
6 investigators
Implants restored within 63 days?
18
Cumulative
survival rate
(%)
3648
1'327 implants
679 patients
86 investigators
No
990 implants
509 patients
337 implants
170 patients
Per protocol set
Off protocol
Figure 1: Study plan
Failures
1'406 implants
706 patients
92 investigators
Yes
Yes
Imlants at
baseline
Implant success
Table 1: Cumulative implant survival and success rates life table analysis
Conclusions
SLA implants can be successfully restored after 68
weeks in a private practice setting.
Very high survival and success rates were documented
(99.26 % and 97.38 % after 5 years).
Cumulative survival rates were comparable to those from
formal clinical trials with stricter inclusion criteria.
The high numbers of investigators and patients suggested
that the characteristics of the SLA surface are such that
critical aspects of the healing process are accounted for.
Clinical performance of wide-body implants with a sandblasted and

acid-etched (SLA) surface: results of a 3-year follow-up study in a referral clinic
16
Bornstein MM, Harnisch H, Lussi A, Buser D.

Abstract: A total of 116 patients received SLA wide body implants in a specialist clinic. Survival and success rates of 99.3 % were achieved
after 3 years.
Results
The aim of this investigation was to evaluate the clinical performance

of SLA wide-body implants with a regular or wide neck in a referral
clinic to assess whether the success rates were similar to those
achieved under strict, well-defined conditions.
One implant in the left maxilla became unstable during the healing
period due to a peri-implant infection and was removed; no signs of
peri-implant infection or mobility were observed for the remaining
150 implants. Six patients with 11 implants did not attend the
36-month examination and were therefore lost to follow-up. Clinical
and radiographic analysis therefore included 109 patients with
139 implants, all of which were successfully integrated. The 3-year
survival and success rate was 99.3 %. All 139 implants showed favorable clinical and radiographic findings mean mPI and mSBI
were 0.26 and 0.6, respectively. Mean PD and CAL were 3.87 mm
and 2.79 mm, respectively. Mean DIM at 3 years was -1.13 mm,
and the mean DIB increased from 2.52 mm at implant insertion to
2.85 mm after 3 years; the difference was significant, but progressive bone loss was not detected at any implant over the 3-year
evaluation period (Fig. 1). Frequency analysis showed that most implants had a DIB between -0.5 and +0.5 mm (Fig. 2), corresponding
to < 0.2 mm bone gain or loss per year.
Methods
This was a prospective investigation of patients referred by their private dentist to a specialist clinic for implant therapy. The study enrolled 116 partially edentulous patients, including smokers and those
with defects requiring bone augmentation. A total of 151 wide-body
implants with either a regular neck or wide neck configuration were
placed (75 in distal extension situations, 56 in single-tooth gaps and
20 in extended edentulous spaces). Prosthetic rehabilitation took
place after 68 weeks for implants placed without bone augmentation and after 1014 weeks for implants with local bone augmentation. Single crowns were used for 95 implants, 29 were restored with
splinted single crowns and 20 were used as abutments for implantsupported FPDs. After 36 months, clinical and radiographic followup was performed, and the following parameters were evaluated:
modified plaque index (mPI); modified sulcus bleeding index (mSBI);
probing depth (PD); distance from implant shoulder to mucosal margin (DIM); clinical attachment level (CAL); mobility, as measured by
Periotest (PTV); and, distance from implant shoulder to first visible BIC.
clinical studies
Introduction
< 1.0 mm
+0.5 mm to
1.0 mm
0 mm to
+0.5 mm
0 mm to
-0.5 mm
-0.5 mm to
-1.0 mm
-1.0 mm
0
10
20
30
40
50
Implants
60
70
80
Figure 2: Frequency analysis of bone gain or loss around 134 implants using
DIB values
Figure 1: 36-month peri-apical radiograph showing normal bone structures

around implants, with no signs of peri-implant radiolucencies
Conclusions
Wide body SLA implants with regular or wide neck configurations achieved successful integration and high predictability in patients referred for implant therapy.
Favorable clinical and radiographic results were observed.
The 3-year survival and success rates was 99.3 %.
The implant survival compares well with that from clinical
studies with standard diameter SLA implants in selected
patient populations.
19
17
Five-year results from a randomized, controlled trial on early and delayed

loading of implant supporting full-arch prosthesis in the edentulous maxilla
Fischer K, Stenberg T, Hedin M, Sennerby L.
Abstract: SLA implants were placed in the edentulous maxillae of 24 patients and loaded with full-arch prostheses either early or conventionally.
The 5-year cumulative survival rate was 95.1 %, indicating that early loading in the maxilla is a viable treatment option.
Introduction
Results
Studies with SLA implants have shown stable radiographic bone

levels, but few studies have presented long-term radiographic data.
The aim of this investigation, therefore, was to compare the clinical
outcome and stability of early and delayed loaded one-stage implants with the SLA surface in the edentulous maxilla.
During the 5-year study period, seven implants were lost (five in the
test group and two in the control group); three were early failures
(before loading) and four were late failures. In addition, one patient
with six implants did not attend the 5-year follow-up evaluation. The
5-year cumulative survival rate was 95.1 % (94.7 % and 95.7 % in
the test and control groups, respectively). There were no significant
differences between the groups for RFA values. Plaque and bleeding
on probing were greater in the control patients, and more control
implants showed probing depths > 3 mm. Mean marginal bone
level after 5 years was 2.9 1.1 mm in the test group and 3.7
1.2 mm in the control group (Fig. 1); mean bone loss was 0.8
1.2 mm and 0.3 1.0 mm for test and control implants, respectively
the difference was significant. It was noted, however, that the early loaded implants were generally placed deeper into the bone. The
numbers of patients with > 2 mm bone loss was similar in both
groups, but more patients in the test group showed > 3 mm bone
loss. Resin-related technical complications were also more prevalent
in the test group (18 versus 12 in the control group), but implant, abutment, abutment screw or assembly screw fractures did not occur in
either group.
clinical studies
Methods
The study included 24 patients with totally edentulous maxillae requiring implant treatment. Each patient received five or six implants
(diameter 4.1 mm, length 812 mm). The patients were assigned to
either early implant loading (16 patients with 95 implants loaded
after 918 days) or delayed loading (eight patients with 47 implants
loaded after 2.55.1 months). Prostheses were fabricated from cast
titanium alloy with acrylic resin crowns. Clinical and radiographic
evaluations (sulcus bleeding index, plaque index, probing depth,
distance from implant shoulder to crestal bone level) were performed
after 1, 3 and 5 years of loading; the prostheses were removed on
each occasion. Implant stability was also recorded in mesial-distal
and buccal-palatal directions for each implant using resonance frequency analysis (RFA).
Conclusions
Survival rates for early and delayed loaded SLA implants
in the edentulous maxilla were not significantly different
after 5 years.
Minimal bone resorption indicated favorable long-term
marginal bone response to the SLA surface.
Early loading of SLA implants to support full-arch prostheses in the edentulous maxilla is therefore a viable treatment option.
Technical complications were mainly resin-related, which
may be improved by the use of a lingual gold onlay.
4.5
Control
Test
Bone level (mm)
4.0
3.5
3.0
2.5
2.0
1.5
Baseline
1-year
2-year
3-year
5-year
Figure 1: Marginal bone levels in relation to the upper part of the implant
shoulder for test and control implants from baseline to 5 years
20
Performance of dental implants after staged sinus floor elevation procedures:

5-year results of a prospective study in partially edentulous patients
18
Bornstein MM, Chappuis V, von Arx T, Buser D.

Abstract: SLA and TPS implants were placed in 56 patients following sinus floor elevation. After 5 years, survival was 100 % for SLA and
89 % for TPS implants.
Introduction
Results
Sinus floor elevation using graft material is the most common solution
for insufficient bone volume in the posterior maxilla. The aim of this
study was to evaluate the clinical and radiographic 5-year results for
implants with either a TPS or an SLA surface placed in a two-stage
sinus floor elevation procedure in the posterior maxilla.
At the 5-year evaluation, 100 implants could be analyzed; six patients with 11 implants dropped out of the study at the 12- and
60-month examinations. There were two implant failures, both of
which were TPS implants, resulting in a 5-year survival and success
rate of 98 % (100 % for SLA implants and 88.98 % for TPS implants).
A local peri-implant infection occurred at two of the implants after
12 months both cases were successfully treated. No peri-implant
radiolucency or mobility was detected for any of the implants at any
time point. There were no significant differences in gingival parameters between 12 and 60 months except for PD, which showed a
significant decrease (Table 1).
Methods
clinical studies
A total of 59 sinus floor elevation procedures were performed in 56

partially edentulous patients. A composite graft was used, consisting
of autogenous bone chips combined with deproteinized bovine
bone mineral or synthetic -tricalcium calcium phosphate. After a
healing period of 412 months, a total of 111 implants (90 SLA and
21 TPS) were placed (93 in distal extension situations, four in singletooth gaps and 14 in extended edentulous spaces). Abutments were
placed after a healing period of 814 weeks and prostheses were
placed (41 single crowns and 71 splinted single crowns). Patients
were recalled 12 and 60 months after abutment connection for clinical and radiographic examination, consisting of modified plaque
index (mPI), modified sulcus bleeding index (mSBI), probing depth
(PD), clinical attachment level (CAL), mobility (assessed by Periotest;
PTV), distance between implant shoulder and mucosal margin (DIM)
and distance from implant shoulder to first visible BIC (DIB).
Exam
mPI
mSBI
PD (mm)
DIM (mm)
CAL (mm)
PTV
1 year (n=103)
0.34 ( 0.03)
0.35 ( 0.04)
4.43 ( 0.11)
-1.35 ( 0.11)
3.04 ( 0.06)
-2.71 ( 0.31)
5 year (n=98)
0.27 ( 0.03)
0.29 ( 0.03)
4.14 ( 0.11)
-1.22 ( 0.11)
2.89 ( 0.08)
-3.00 ( 0.28)
Table 1: Gingival parameters and mobility at 1 and 5 years (mean SE)
Conclusions
Implants with an SLA surface placed after sinus floor elevation with a composite graft achieve successful tissue integration with high predictability over 5 years of followup.
The survival and success rate for SLA implants was
100 %.
Implant placement after sinus floor elevation for single
crowns or FPDs can be considered the standard of care,
provided that the patient has no active periodontal disease, is not a smoker and is not medically compromised.
21
19
Clinical and radiographic study of implant treatment outcome in periodontally

susceptible and non-susceptible patients: a prospective long-term study
De Boever AL, Quirynen M, Coucke W, Theuniers G, De Boever JA.
Abstract: SLA and TPS implants were placed in periodontally susceptible or non-susceptible patients. Implant surface and periodontal status
significantly influenced implant survival, which was significantly greater for SLA implants.
Introduction
Results
Placement of dental implants has become a routine procedure for

tooth replacement, but clinical outcome in periodontally compromised or susceptible patients is still controversial. The aim of this investigation was to compare implant survival and periodontal and
radiographic parameters of non-submerged implants with either a
TPS or SLA surface in periodontitis-susceptible and healthy nonperiodontally susceptible patients.
There were 24 implant failures in 22 patients, 20 of which occurred

before loading and four of which occurred after loading. There were
eight, seven and three failures in the NSP, CAP and GAP groups,
respectively, giving implant failure rates of 3.06 %, 3.62 % and
15.25 %, respectively. Cumulative implant survival rates were 97 %
in the NSP group (over 140 months) and 96 % in the CAP group
(over 140 months), but was significantly lower at 80 % in the GAP
group (over 100 months). General impaired health did not adversely
affect survival for all patients combined, but led to a further decrease
in survival rate (to 71 %) in the GAP group. The survival rate for TPS
implants was lower than that for SLA implants (93 % versus 97 %,
respectively; Fig. 1). There was no difference in implant survival between current and former smokers for all patients combined, but
smoking significantly decreased implant survival in the GAP group (to
63 %). Mean marginal bone loss compared to baseline was 0.28
0.7 mm and 0.24 0.6 mm at the mesial and distal sides, respectively. Mean mesial and distal bone loss/year was 0.08 mm and
0.07 mm in the NSP group, 0.12 mm and 0.09 mm in the CAP
group and 0.17 mm and 0.17 mm in the GAP group, where bone
loss was significantly related to bleeding on probing, age, inflammation, plaque and probing depth.
clinical studies
Methods
A total of 221 patients requiring non-submerged implants and FPDs
were enrolled of these, 194 were available and were divided into
three groups: non-periodontally susceptible patients (NSP; 110 patients, 261 implants), in whom teeth required replacement due to caries or trauma; periodontally susceptible patients (CAP; 68 patients,
193 implants), in whom teeth were lost due to generalized chronic
adult periodontitis; or, patients with generalized aggressive periodontitis (GAP; 16 patients, 59 implants). TPS implants (259) were
used in the first phase of the study and SLA implants (254) were
used after this surface was introduced. At the follow-up times (at least
every 6 months), probing depth (PD), bleeding on probing (BOP),
plaque score, bone score, bone loss and implant failures were
evaluated.
1.00
Conclusions
Periodontally susceptible and non-susceptible patients
demonstrated similar peri-implant variables and implant
survival, but those with generalized aggressive periodontitis showed lower implant survival, higher marginal bone
loss and more peri-implant pathology.
Implant surface and periodontal classification had a significant influence on implant survival.
Implant survival was significantly greater for SLA versus
TPS implants.
SLA
0.95
TPS
0.9
0.85
p = 0.06
0.80
0
20
40
60
80
100
Follow-up in months
Figure 1: Kaplan-Meier survival curve for TPS and SLA implants
22
120
140
Marginal bone level changes and prosthetic maintenance of mandibular

overdentures supported by 2 implants: a 5-year randomized clinical trial
20
Cehreli MC, Uysal S, Akca K.

Clin Implant Dent Relat Res 2010;12(2):114121.
Abstract: SLA or TiUnite implants were placed in 28 patients to support mandibular overdentures. Implant survival was 100 % in both groups,
but marginal bone loss was significantly less for Straumann Soft Tissue Level SLA implants.
Introduction
Results
Success with early loading of implant-supported restorations has

been demonstrated, but documentation on early loading of mandibular overdentures is scarce. The aim of this investigation, therefore,
was to compare biologic and prosthetic outcomes of mandibular
overdentures supported by early loaded one- and two-stage implants after 5 years.
Six patients (two with Straumann implants and four with Brnemark
implants) were excluded from the study after 5 years; data were
therefore available from 22 patients (12 patients with 24 Straumann
implants and 10 patients with 22 Brnemark implants). There were
no implant failures in either group. Peri-implant parameters were comparable for both implant systems, but mean marginal bone loss was
significantly higher for Brnemark implants (Fig. 1), and the maximal
bone level change was also higher (1.8 mm compared to 1.3 mm
for Straumann implants; Fig. 1). Survival probabilities for overdentures were similar, but wear of the ball abutment was observed more
for the Brnemark implants, while occlusal adjustment, broken/
loose/lost retainers and retainer retightening were more prevalent in
the Straumann group.
Methods
1.75
clinical studies
This was a randomized, controlled, single-blind trial in 28 patients,

randomized into two groups to receive either two unsplinted
Straumann Soft Tissue Level SLA implants (14 patients) to support
mandibular overdentures (retained by retentive anchor abutment with
PVC ring covered gold matrix) or two unsplinted Brnemark (Mk III
TiUnite) implants (14 patients) to support mandibular overdentures
(retained by ball attachments with gold caps). Straumann implants
were placed so that the SLA/machined border was at the level of
the cortical bone, and Brnemark implants were placed so that the
upper outer edge of the implant neck was at the level of the cortical
bone. During a healing period of 46 weeks after implant placement, the patients existing dentures were re-lined, and the prostheses
were placed in both groups after 68 weeks. Plaque index, calculus
index, peri-implant inflammation and bleeding were recorded, and
radiographic marginal bone levels were examined 1 week and
5 years post-surgery.
Conclusions
Similar peri-implant soft tissue and prosthetic outcomes
were found for mandibular overdentures supported by
Straumann Soft Tissue Level SLA or Brnemark TiUnite
implants.
All implants survived after 5 years.
Marginal bone loss was significantly less for Straumann
SLA implants versus Brnemark TiUnite implants after
5 years.
bone loss
1.5
1.25
1.0
0.75
0.5
Straumann
implant
Brnemark
Figure 1: Marginal bone loss (mm) around Straumann and Brnemark implants
after 5 years
TiUnite is a registered trademark of Nobel Biocare AB, Sweden.
23
21
10-year outcome of SLA implants in the edentulous maxilla

Fischer K.
ITI World Symposium; Geneva, Switzerland, 1517 Apr 2010.
Abstract: SLA implants were placed in the edentulous maxillae of 24 patients and loaded with full-arch prostheses either early or conventionally.
The implant survival rate after 10 years was 95.1 %, with no significant bone loss between 5 and 10 years.
Introduction
Results
Studies with SLA implants have shown stable radiographic bone

levels and, although some trials show data over long periods (e.g.
5 years), no 10-year follow-up data have been published. The aim
of this study, therefore, was to evaluate and compare the long-term
outcomes of two different loading protocols for SLA implants in the
edentulous maxilla.
One-year31, 3-year32 and five-year17 results of the study were previously published. Seven implants were lost between baseline and
5 years, and no further implants were lost between 5 and 10 years.
One patient with severe/aggressive periodontitis only had three implants still in place at the 5-year evaluation and dropped out of the
study before the 10-year evaluation. No other patients showed signs
of peri-implantitis. In terms of implant losses, the implant survival rate
was 95.1 %, but if implants of unknown status were also considered
(i.e. the drop-out patient with three implants), then the implant survival
rate was 93 %. The prosthesis survival rate was 96 %, and high patient satisfaction was reported. The change in mean marginal bone
level between 5 and 10 years was not significant; mean marginal
bone loss after 5 and 10 years in the test group was -0.8 1.2 mm
and -1.1 0.9 mm, respectively, and in the control group was -0.3
1.0 and -0.7 1.3 mm, respectively (Fig. 1). The majority of implants
(67.9 %) had a sulcus bleeding index of 1 and most had a plaque
index of 1 (28.6 %) or 2 (39.3 ). A total of 70 prosthesis-related complications occurred, 68 of which were resin-related and two of which
were metal-related. There were no abutment fractures.
clinical studies
Methods
This was a randomized, controlled study in 24 patients with completely edentulous maxillae. A total of 142 SLA surfaced implants*
were placed and loaded with full-arch prostheses either after
918 days (early loading test group; 16 patients with 95 implants)
or after 2.55.1 months (delayed loading control group; eight patients with 47 implants). Radiographic examination was performed
at prosthesis placement and after 6 months and 1, 2, 3, 5 and 10
years; prosthesis placement was the baseline measurement. Plaque
index (PI), sulcus bleeding index (SBI) and probing depth (PD) were
also measured.
Change in mean marginal bone from

5 to 10 years (mm)
test
control
Conclusions
There were no implant losses between 5 and 10 years.
There was no significant bone loss between 5 and
10 years.
Prosthesis survival was high (96 %) and complications
were predominantly resin-related.
No signs of peri-implantitis were noted (except in one patient with severe aggressive periodontitis).
Patient satisfaction was high.
-0.1
-0.2
-0.3
-0.4
ns
Figure 1: Marginal bone loss in the test and control group after 5 and 10 years
* SLA surface implants refers to Straumann Soft Tissue Level SLA implants.
24
25
Additional studies
The following publications indicate the scientific evidence about Straumanns SLA surface, including over 110 clinical studies (see list below),
over 140 in vitro (e.g. laboratory, cell culture) investigations and over 80 preclinical in vivo investigations:
Clinical studies:
Aouate G. Osseointegration of mobile posterior single-tooth implants

with SLA surface: report of 2 cases. Int J Oral Maxillofac Implants
2004;19(3):443-7.
Arlin ML. Short dental implants as a treatment option: results from an
observational study in a single private practice. Int J Oral Maxillofac
Implants 2006;21(5):769-76.
Arlin ML. Survival and success of sandblasted, large-grit, acid-etched
and titanium plasma-sprayed implants: a retrospective study. J Can Dent
Assoc 2007;73(9):821.
Arvidson K, Esselin O, Felle-Persson E, Jonsson G, Smedberg JI,
Soderstrom U. Early loading of mandibular full-arch bridges screw
retained after 1 week to four to five Monotype implants: 3-year
results from a prospective multicentre study. Clin Oral Implants Res
2008;19(7):693-703.
Aydin M, Yilmaz A, Ktibo lu B, Tun EP. ITI implants and Dolder bars
in the treatment of large traumatic defect of mandible: a clinical report.
Dent Traumatol 2004;20(6):348-52.
Barewal RM, Oates TW, Meredith N, Cochran DL. Resonance
frequency measurement of implant stability in vivo on implants with a
sandblasted and acid-etched surface. Int J Oral Maxillofac Implants
2003;18(5):641-51.
Bergkvist G, Sahlholm S, Karlsson U, Nilner K, Lindh C. Immediately
loaded implants supporting fixed prostheses in the edentulous maxilla:
a preliminary clinical and radiologic report. Int J Oral Maxillofac
Implants 2005;20(3):399-405.
Bergkvist G, Nilner K, Sahlholm S, Karlsson U, Lindh C. Immediate
loading of implants in the edentulous maxilla: use of an interim fixed
prosthesis followed by a permanent fixed prosthesis: a 32-month
prospective radiological and clinical study. Clin Implant Dent Relat Res
2009;11(1):1-10.
Bernard JP, Schatz JP, Christou P, Belser U, Kiliaridis S. Long-term
vertical changes of the anterior maxillary teeth adjacent to single
implants in young and mature adults. A retrospective study. J Clin
Periodontol 2004;31(11):1024-8.
Bischof M, Nedir R, Szmukler-Moncler S, Bernard JP, Samson J. Implant
stability measurement of delayed and immediately loaded implants
during healing. Clin Oral Implants Res 2004;15(5):529-39.
Bischof M, Nedir R, Abi Najm S, Szmukler-Moncler S, Samson J. A
five-year life-table analysis on wide neck ITI implants with prosthetic
evaluation and radiographic analysis: results from a private practice.
Clin Oral Implants Res 2006;17(5):512-20.
Bornstein MM, Lussi A, Schmid B, Belser UC, Buser D. Early loading
of nonsubmerged titanium implants with a sandblasted and acidetched (SLA) surface: 3-year results of a prospective study in partially
edentulous patients. Int J Oral Maxillofac Implants 2003;18(5):659666.
26
Bornstein MM, Schmid B, Belser UC, Lussi A, Buser D. Early loading of

non-submerged titanium implants with a sandblasted and acid-etched
surface. 5-year results of a prospective study in partially edentulous
patients. Clin Oral Implants Res 2005;16(6):631-638.
Bornstein MM, Harnisch H, Lussi A, Buser D. Clinical performance
of wide-body implants with a sandblasted and acid-etched (SLA)
surface: results of a 3-year follow-up study in a referral clinic. Int J Oral
Maxillofac Implants 2007;22(4):631-8.
Bornstein MM, Chappuis V, von Arx T, Buser D. Performance of dental
implants after staged sinus floor elevation procedures: 5-year results of
a prospective study in partially edentulous patients. Clin Oral Implants
Res 2008;19(10):1034-43.
Carinci F, Guidi R, Franco M, Viscioni A, Rigo L, De Santis B, Tropina
E. Implants inserted in fresh-frozen bone: a retrospective analysis
of 88 implants loaded 4 months after insertion. Quintessence Int
2009;40(5):413-9.
Carlino P, Pepe V, Pollice G, Grassi FR. Immediate transmucosal
implant placement in fresh maxillary and mandibular molar extraction
sockets: description of technique and preliminary results. Minerva
Stomatol 2008;57(10):471-83.
Caruso G, Cattaneo A. Removable prosthesis supported by implants
according to the Cagliari modified conometry technique: case report.
Int J Periodontics Restorative Dent 2007;27(3):259-65.
Cehreli MC, Uysal S, Akca K. Marginal bone level changes and
prosthetic maintenance of mandibular overdentures supported by 2
implants: a 5-year randomized clinical trial. Clin Implant Dent Relat Res
2009;12(1):114-121.
Chaddad K, Ferreira AF, Geurs N, Reddy MS. Influence of surface
characteristics on survival rates of mini-implants. Angle Orthod
2008;78(1):107-13.
Chiapasco M, Lang NP, Bosshardt DD. Quality and quantity of bone
following alveolar distraction osteogenesis in the human mandible. Clin
Oral Implants Res 2006;17(4):394-402.
Cochran DL, Buser D, ten Bruggenkate CM, Weingart D, Taylor TM,
Bernard JP, Peters F, Simpson JP. The use of reduced healing times on
ITI implants with a sandblasted and acid-etched (SLA) surface: early
results from clinical trials on ITI SLA implants. Clin Oral Implants Res
2002;13(2):144-53.
Cochran D, Oates T, Morton D, Jones A, Buser D, Peters F. Clinical
field trial examining an implant with a sand-blasted, acid-etched
surface. J Periodontol 2007;78(6):974-82.
Cordaro L, Torsello F, Mirisola Di Torresanto V, Rossini C. Retrospective
evaluation of mandibular incisor replacement with narrow neck
implants. Clin Oral Implants Res 2006;17(6):730-5.
Cornelini R, Cangini F, Covani U, Barone A, Buser D. Immediate
restoration of single-tooth implants in mandibular molar sites:
a 12-month preliminary report. Int J Oral Maxillofac Implants
2004;19(6):855-60.
Cornelini R, Cangini F, Covani U, Barone A, Buser D. Immediate

loading of implants with 3-unit fixed partial dentures: a 12-month
clinical study. Int J Oral Maxillofac Implants 2006;21(6):914-8.
Fugazzotto PA, Vlassis J, Butler B. ITI implant use in private practice:

clinical results with 5,526 implants followed up to 72+ months in
function. 'Int J Oral Maxillofac Implants 2004;19(3):408-12.
Crismani AG, Bernhart T, Schwarz K, Celar AG, Bantleon HP, Watzek

G. Ninety percent success in palatal implants loaded 1 week after
placement: a clinical evaluation by resonance frequency analysis. Clin
Fugazzotto PA. Guided bone regeneration at immediate implant

insertion and loading: a case report. Implant Dent 2004;13(3):223-7.
De Boever AL, De Boever JA. Guided bone regeneration around nonsubmerged implants in narrow alveolar ridges: a prospective long-term
clinical study. Clin Oral Implants Res 2005;16(5):549-56.
De Boever AL, Quirynen M, Coucke W, Theuniers G, De Boever
JA. Clinical and radiographic study of implant treatment outcome in
periodontally susceptible and non-susceptible patients: a prospective
long-term study. Clin Oral Implants Res 2009;20(12):1341-50.
Eliasson A, Blomqvist F, Wennerberg A, Johansson A. A retrospective
analysis of early and delayed loading of full-arch mandibular
prostheses using three different implant systems: clinical results with up
to 5 years of loading. Clin Implant Dent Relat Res 2009;11(2):13448.
Feldmann I, Bondemark L. Anchorage capacity of osseointegrated and
conventional anchorage systems: a randomized controlled trial. Am J
Orthod Dentofacial Orthop 2008;133(3):339.e19-28.
Feloutzis A, Lang NP, Tonetti MS, Brgin W, Brgger U, Buser D, Duff
GW, Kornman KS. IL-1 gene polymorphism and smoking as risk factors
for peri-implant bone loss in a well-maintained population. Clin Oral
Implants Res 2003;14(1):10-7.
Ferrigno N, Laureti M, Fanali S. Inferior alveolar nerve transposition
in conjunction with implant placement. Int J Oral Maxillofac Implants
2005;20(4):610-20.
Ferrigno N, Laureti M, Fanali S. Dental implants placement in
conjunction with osteotome sinus floor elevation: a 12-year life-table
analysis from a prospective study on 588 ITI implants. Clin Oral
Implants Res 2006;17(2):194-205. Erratum in: Clin Oral Implants Res
2006;17(4):479.
Fischer K, Stenberg T. Early loading of ITI implants supporting a
maxillary full-arch prosthesis: 1-year data of a prospective, randomized
study. Int J Oral Maxillofac Implants 2004;19(3):374-81.
Fischer K, Stenberg T. Three-year data from a randomized, controlled
study of early loading of single-stage dental implants supporting
maxillary full-arch prostheses. Int J Oral Maxillofac Implants
2006;21(2):245-52.
Fischer K, Stenberg T, Hedin M, Sennerby L. Five-year results from a
randomized, controlled trial on early and delayed loading of implants
supporting full-arch prosthesis in the edentulous maxilla. Clin Oral
Implants Res 2008;19(5):433-41.
Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten
EA, ten Bruggenkate CM. The use of Straumann Bone Ceramic in
a maxillary sinus floor elevation procedure: a clinical, radiological,
histological and histomorphometric evaluation with a 6-month healing
period. Clin Oral Implants Res 2010;21(2):201-8.
Friedmann A, Kaner D, Leonhardt J, Bernimoulin JP. Immediate
substitution of central incisors with an unusual enamel paraplasia by
a newly developed titanium implant: a case report. Int J Periodontics
Restorative Dent 2005;25(4):393-9.
Fugazzotto PA. Implant placement at the time of maxillary molar

extraction: technique and report of preliminary results of 83 sites. J
Periodontol 2006;77(2):302-9.
Gallucci GO, Mavropoulos A, Bernard JP, Belser UC. Influence of
immediate implant loading on peri-implant soft tissue morphology in the
edentulous maxilla. Int J Oral Maxillofac Implants 2007;22(4):595602.
Ganeles J. Early loading with the ITI SLA surface as a predictable,
routine procedure. J Indiana Dent Assoc 2002;81(3):15-6.
Ganeles J, Rosenberg MM, Holt RL, Reichman LH. Immediate loading
of implants with fixed restorations in the completely edentulous
mandible: report of 27 patients from a private practice. Int J oral
Giancotti A, Greco M, Docimo R, Arcuri C. Extraction treatment using
a palatal implant for anchorage. Aust Orthod J 2003;19(2):87-90.
Giancotti A, Greco M, Mampieri G, Arcuri C. Clinical management
in extraction cases using palatal implant for anchorage. J Orthod
2004;31(4):288-94.
Gokcen-Rohlig B, Yaltirik M, Ozer S, Tuncer ED, Evlioglu G. Survival
and success of ITI implants and prostheses: retrospective study of cases
with 5-year follow-up. Eur J Dent 2009;3(1):42-9.
Hnggi MP, Hnggi DC, Schoolfield JD, Meyer J, Cochran DL,
Hermann JS. Crestal bone changes around titanium implants. Part I: A
retrospective radiographic evaluation in humans comparing two nonsubmerged implant designs with different machined collar lengths. J
Periodontol 2005;76(5):791-802.
Hayakawa T, Kiba H, Yasuda S, Yamamoto H, Nemoto K. A histologic
and histomorphometric evaluation of two types of retrieved human
titanium implants. Int J Periodontics Restorative Dent 2002;22(2):16471.
Hoffmann O, Beaumont C, Tatakis DN, Zafiropoulos GG. Telescopic
crowns as attachments for implant supported restorations: a case series.
J Oral Implantol 2006;32(6):291-9.
Hoshino K, Miura H, Morikawa O, Kato H, Okada D, Shinki T.
Influence of occlusal height for an implant prosthesis on the periodontal
tissues of the antagonist. J Med Dent Sci 2004;51(4):187-96.
Huwiler MA, Pjetursson BE, Bosshardt DD, Salvi GE, Lang NP.
Resonance frequency analysis in relation to jawbone characteristics
and during early healing of implant installation. Clin Oral Implants Res
2007;18(3):275-80.
Isono H, Kaida K, Hamada Y, Kokubo Y, Ishihara M, Hirashita A,
Kuwahara Y. The reconstruction of bilateral clefts using endosseous
implants after bone grafting. Am J Orthod Dentofacial Orthop
2002;121(4):403-10.
Jackson A, Lemke R, Hatch J, Salome N, Gakunga P, Cochran D. A
comparison of stability between delayed versus immediately loaded
orthodontic palatal implants. J Esthet Restor Dent 2008;20(3):174-84.
27
Jaquiry C, Rohner D, Kunz C, Bucher P, Peters F, Schenk RK,

Hammer B. Reconstruction of maxillary and mandibular defects
using prefabricated microvascular fibular grafts and osseointegrated
dental implants -- a prospective study. Clin Oral Implants Res
2004;15(5):598-606.
Jebreen SE, Khraisat A. Multicenter retrospective study of ITI implantsupported posterior partial prosthesis in Jordan. Clin Implant Dent Relat
Res 2007;9(2):89-93.
Jung BA, Wehrbein H, Hopfenmller W, Harzer W, Gedrange T,
Diedrich P, Kunkel M. Early loading of plalatal implants (ortho-type II)
a prospective multicenter randomized controlled clinical trial. Trials
2007;8:24.
Jung BA, Kunkel M, Gllner P, Liechti T, Wehrbein H. Success rate of
second-generation palatal implants. Angle Orthod 2009;79(1):85-90.
Jung UW, Choi JY, Kim CS, Cho KS, Chai JK, Kim CK, Choi
SH. Evaluation of mandibular posterior single implants with two
different surfaces: a 5-year comparative study. J Periodontol
2008;79(10):1857-63.
Mannai C. Early implant loading in severely resorbed maxilla using

xenograft, autograft, and platelet-rich plasma in 97 patients. J Oral
Maxillofac Surg 2006;64(9):1420-6.
Mnnchen R, Schtzle M. Success rate of palatal orthodontic
implants: a prospective longitudinal study. Clin Oral Implants Res
2008;19(7):665-9.
Nedir R, Bischof M, Szmukler-Moncler S, Bernard JP, Samson J.
Predicting osseointegration by means of implant primary stability. Clin
Nedir R, Bischof M, Briaux JM, Beyer S, Szmukler-Moncler S, Bernard
JP. A 7-year life table analysis from a prospective study on ITI implants
with special emphasis on the use of short implants. Results from a
private practice. Clin Oral Implants Res 2004;15(2):150-7.
Kato S, Kato M. 'Moderately roughened- and roughened-surface

implants used as rigid orthodontic anchorage: a case series. Clin
Implant Dent Relat Res 2006;8(2):87-94.
Nedir R, Bischof M, Vazquez L, Szmukler-Moncler S, Bernard JP.

Osteotome sinus floor elevation without grafting material: a 1-year
prospective pilot study with ITI implants. Clin Oral Implants Res
2006;17(6):679-86.
Kermalli JY, Deporter DA, Lai JY, Lam E, Atenafu E. Performance of

threaded versus sintered porous-surfaced dental implants using open
window or indirect osteotome-mediated sinus elevation: a retrospective
report. J Periodontol 2008;79(4):728-36.
Nedir R, Bischof M, Szmukler-Moncler S, Belser UC, Samson

J. Prosthetic complications with dental implants: from an up-to-8year experience in private practice. Int J Oral Maxillofac Implants
2006;21(6):919-28.
Kessler-Liechti G, Zix J, Mericske-Stern R. Stability measurements of

1-stage implants in the edentulous mandible by means of resonance
frequency analysis. Int J Oral Maxillofac Implants 2008;23(2):353-8.
Nedir R, Bischof M, Vazquez L, Nurdin N, Szmukler-Moncler S,

Bernard JP. Osteotome sinus floor elevation technique without grafting
material: 3-year results of a prospective pilot study. Clin Oral Implants
Res 2009;20(7):701-7.
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Notes
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Straumann SlA

Straumann Dental Implant System

Sandblasted, Large-grit, Acid-etched (SLA)

The clinical benefit

Interface shear strength

Clinical Implant Materials (Heimke G, Soltsz U, Lee AJC,

Surface characteristics on bone reactions

J Biomed Mater Res 1991;25(7):889902.

Implant surface under loaded /

Clin Oral Implants Res 1996;7(3):240252.

Histometric analysis SLA

J Biomed Mater Res 1998;40(1):111.

Comparative Removal Torque Evaluation

Int J Oral Maxillofac Implants 1998;13(5):611619.

Interface shear strength

J Biomed Mater Res 1999;45(2):7583.

Immediate and early loading

Int J Oral Maxillofac Implants 2005;20(3):360370.

Comparative study to investigate bone healing

J Clin Periodontol 2009;36(8):705711.

Early healing (6 weeks)

Clin Oral Implants Res 2002;13(2):144153.

Early loading in partially edentulous patients

Int J Oral Maxillofac Implants 2003;18(5):659666.

Early loading in posterior mandible

Clin Oral Implants Res 2004;15(2):142149.

Early loading in edentulous posterior maxilla and

Int J Oral Maxillofac Implants 2004;19(6):880886.

Immediate loading with 3-unit fixed

Int J Oral Maxilliofac Implants 2006;21(6):914918.

5-year life table analysis on WN SLA implants

Clin Oral Implants Res 2006;17(5):512520.

Clinical field trial with Soft Tissue Level

Clinical performance of WN SLA 3-year

Int J Oral Maxillofac Implants 2007;22(4):631638.

5-year follow-up RCT in the edentulous maxilla

Clin Oral Implants Res 2008;19(5):433441

Staged sinus floor elevation in partially edentulous

Clin Oral Implants Res 2008;19(10):10341043.

Kaplan-Meier curve for TPS and SLA implants

Clin Oral Implants Res 2009 ;20(12) :13411350.

Mandibular overdentures supported by 2 implants:

Clin Implant Dent Relat Res 2010;12(2):114121.

10-year data on Soft Tissue Level SLA implants in

ITI World Symposium, Geneva, Switzerland,

The influence of various titanium surfaces on the interface shear strength

Titanium screws with six different surface treatments (electropolished;

Influence of surface characteristics on bone integration of titanium implants.

Buser D, Schenk RK, Steinemann S, Fiorellini JP, Fox CH, Stich H.

Several techniques have been employed to improve anchorage of

Histological analysis showed direct bone-to-implant contact for all

Figure 1: Scanning electron micrographs of different implant surfaces (bar is 20

Figure 2: Mean direct bone-to-implant contact (%) of different implant surfaces

* Reproduced with permission of John Wiley & Sons, Inc.

Evaluation of an endosseous titanium implant with a sandblasted and

Surface characteristics of titanium implants have a direct impact on

Excellent tissue integration with ankylotic stability and no signs of

Cylindrical implants with either a TPS or an SLA surface (Fig. 1) were

Figure 1: Electron micrographs of SLA (above) and TPS

Bone response to unloaded and loaded titanium implants with a sandblasted

Cochran DL, Schenk RK, Lussi A, Higginbottom FL, Buser D.

Cylindrical implants with either a TPS or an SLA surface were

Total bone contact (%)

* Reproduced with permission of John Wiley & Sons, Inc.

* R eproduced with permission of John Wiley & Sons, Inc.

* Reproduced with permission of Quintessence Publishing Co Inc., Chicago.

* Reproduced with permission of Quintessence Publishing Co Inc., Chicago.