Together with leading clinicians worldwide, Straumann has studied the clinical performance of SLActive® implants under the most challenging medical conditions and treatment protocols to demonstrate the outstanding healing capacity of the SLActive® surface.
As new insights emerge and new data becomes available, discover how you can benefit from the high performance SLActive® surface to support your patients’ healing capabilities.
Immediate loading allows the patient to benefit from the restoration straightaway after implant placement.
However, this demanding protocol carries a higher risk of implant failure.
Ever increasing patient expectations continue to drive demand for faster and more efficient treatment protocols. Immediate loading allows the clinician to place an implant and prosthetic restoration on the same day, so that the patient can benefit from the restoration straightaway. However, this demanding protocol carries a higher risk of failure due to premature loading of a healing implant.
One of the most challenging patient groups for implant treatment includes patients who have undergone a combination of tumor surgery, chemotherapy and radiotherapy. The bone quality in these patients is severely compromised.
Irradiation leads to decreased bone vascularity4,5, impaired osteoblastic activity6 and reduced bone vitality7,8, which severely compromise bone quality in these patients. The fragile mucosa and the risk of osteoradionecrosis present further challenges.
However, from a quality-of-life perspective, this patient group stands to benefit the most from implant- supported prosthetic rehabilitation.
- 102 implants, 20 patients
- Post-surgery, radiotherapy and chemotherapy for oral carcinoma
** Adjusted, excluding the patients deceased due to cancer mortality.
- Patients with diabetes have reduced wound healing capacity,15,16 which puts implants at risk
- Worldwide, 1 in 6 adults 60 years of age and older has diabetes.17
Worldwide, 1 in 11 adults has diabetes, while among adults 60 years of age and older, the prevalence is twice as high.17
Over the past 30 years, the number of people with diabetes in the US has quadrupled and, according to the US Center for Disease Control (CDC), the figure could increase to as many as one in every three adults by 205018. In an estimated 50% of people with type 2 diabetes, the disease remains undiagnosed.17
Given the ever rising prevalence of type 2 diabetes, how can clinicians address this risk particularly in older patients?
GROWING CLINICAL EVIDENCE OF highly predictable PERFORMANCE OF SLActive® IN DIABETIC PATIENTS:
A new clinical study19 that compared SLActive® performance in patients with and without diabetes showed uncompromised performance of SLActive® implants:
- 100 % implant success rate in the diabetic group
- Bone changes similar to those in healthy individuals
- Despite the observed lower levels of bone quality all implants in this study showed good primary stability.
- Roxolid SLActive® surface stimulates an early anti-inflammatory cell response20
- SLActive® is associated with an increased anti-inflammatory macrophage response in the early healing phase in both healthy and diabetic animals. This may be an important mechanism to improve osseous healing under compromised systemic conditions.21
REFERENCES
1 Straumann SLActive implants compared to Straumann SLA implants. Lang NP, Salvi GE, Huynh-Ba G, Ivanovski S, Donos N, Bosshardt DD. Early osseointegration to hydrophilic and hydrophobic implant surfaces in humans. Clin Oral Implants Res. 2011 Apr;22(4):349-56. doi: 10.1111/j.1600-0501.2011.02172.x.
2 Nicolau P, Guerra F, Reis R, Krafft T, Benz K , Jackowski J 10-year results from a randomized controlled multicenter study with immediately and early loaded SLActive implants in posterior jaws. Presented at 25th Annual Scientific Meeting of the European Association of Osseointegration – 29 Sep – 1 Oct 2016, Paris.
3 Patients treated with dental implants after surgery and radio-chemotherapy of oral cancer. Heberer S, Kilic S, Hossamo J, Raguse J-D, Nelson K. Rehabilitation of irradiated patients with modified and conventional sandblasted, acid-etched implants: preliminary results of a split-mouth study. Clin. Oral Impl. Res. 22, 2011; 546–551.
4 Yerit, K., Posch, M., Seemann, M., Hainich, S., Dortbudak, O., Turhani, D., Ozyuvaci, H., Watzinger, R. and Ewers, R. (2006) Implant Survival in Mandibles of Irradiated Oral Cancer Patients. Clinical Oral Implants Research, 17, 337-344. http://dx.doi.org/10.1111/j.1600-0501.2005.01160.x
5 Verdonck, H.W.D., Meijer, G.J., Laurin, T., Nieman, F.H.M., Stoll, C., Riediger, D., Stoelinga, P.J.W. and de Baat, C. (2007) Assessment of Vascularity in Irradiated and Non-Irradiated Maxillary and Mandibular Alveolar Minipig Bone Using Laser Doppler Flowmetry. International Journal of Oral Maxillofacial Implants, 22, 774-778.
6 Hu, W.W., Ward, B.B., Wang, Z. and Krebsbach, P.H. (2010) Bone Regeneration in Defects Compromised by Radiotherapy. Journal of Dental Research, 89, 77-81. http://dx.doi.org/10.1177/0022034509352151
7 Wang, R., Pillai, K. and Jones, P.K. (1998) Dosimetric Measurements of Scatter Radiation from Dental Implants in Stimulated Head and Neck Radiotherapy. International Journal of Oral Maxillofacial Implants, 13, 197-203.
8 Grotz, K.A., Al-Nawas, B., Piepkorn, B., Reichert, T.E., Duschner, H. and Wagner, W.(1999) Micromorphological Findings in Jaw Bone after Radiotherapy. Mund-, Kiefer- und Gesichtschirurgie, 3, 140-145.
9 Chambrone L, Mandia J, Shibli JA, Romito GA, Abrahao M. Dental Implants Installed in Irradiated Jaws: A Systematic Review. Journal of Dental Research. 2013;92(12 Suppl):119S-130S. doi:10.1177/0022034513504947.
10 Shugaa-Addin B, Al-Shamiri H-M, Al-Maweri S, Tarakji B. The effect of radiotherapy on survival of dental implants in head and neck cancer patients. Journal of Clinical and Experimental Dentistry. 2016;8(2):e194-e200. doi:10.4317/jced.52346.
11 Nooh N. Dental implant survival in irradiated oral cancer patients: a systematic review of the literature. Int J Oral Maxillofac Implants. 2013 Sep-Oct;28(5):1233-42. doi: 10.11607/jomi.3045.
12 Dholam KP, Gurav SV. Dental implants in irradiated jaws: A literature review. J Can Res Ther [serial online] 2012 [cited 2016 Aug 17];8:85-93. Available from: http://www.cancerjournal.net/text.asp?2012/8/6/85/92220
13 C. NACK, J.-D. RAGUSE, A. STRICKER , K. NELSON & S. NAHLES. Rehabilitation of irradiated patients with chemically modified and conventional SLA implants: five-year follow-up. Journal of Oral Rehabilitation 2015 42; 57—64
14 Nelson, K., Stricker, A., Raguse, J.-D. and Nahles, S. (2016), Rehabilitation of irradiated patients with chemically modified and conventional SLA implants: a clinical clarification. J Oral Rehabil, 43: 871–872. doi:10.1111/joor.12434
15 Devlin H, Garland H, Sloan P. Healing of tooth extraction sockets in experimental diabetes mellitus. J. of Oral Maxillofac. Surg. 1996; 54:1087-1091.
16 Wang F1, Song YL, Li DH, Li CX, Wang Y, Zhang N, Wang BG. Type 2 diabetes mellitus impairs bone healing of dental implants in GK rats. Diabetes Res Clin Pract. 2010; 88:e7-9.
17 IDF Diabetes Atlas, 7th Edition, 2015 http://www.diabetesatlas.org/
18 US Centers for Disease Control and Prevention. Diabetes 2014 report card. Available from: www.cdc.gov/diabetes/library/reports/congress.html. Accessed September 2015.
19 Machuca G., Cabrera J.J. “A prospective, case-control clinical study of titanium-zirconium allow implants with hydrophilic surface in patients with Type 2 diabetes mellitus” Manuscript submitted.
20 Hotchkiss KM, Ayad NB, Hyzy SL, Boyan BD, Olivares-Navarrete R. Dental implant surface chemistry and energy alter macrophage activation in vitro. Clin. Oral Impl. Res. 00, 2016, 1–10. doi: 10.1111/clr.12814
21 Lee R, Hamlet SM, Ivanovski S. The influence of titanium surface characteristics on macrophage phenotype polarization during osseous healing in type I diabetic rats: A pilot study. Clin Oral Impl Res (accepted 4/8/2016).
22 Straumann (2016). SLActive supports enhanced bone formation in a minipig surgical GBR model with coronal circumferential defects. Unpublished data