Validation of dental implant systems through a review of literature supplied by

system manufacturers
Steven E. Eckert, DDSfl Ann Parein, MD, b Heidi L. Myshin, MD, ~ and Jose
L Padilla, DDS d
Mayo Clinic and Mayo Foundation, Rochester, Minn.

Statement o f problem. The use of endosseous implants to support and retain dental prostheses has
become a routine neatment option in many dental practices. Although physical, mechanical, and chemical
differences exist among implant systems, survival claims are similar.
Purpose of study. This review solicited literature from six implant manufacturers that was thought, by
their standards, to be pertinent to the validation of their implant system.
Methods. The literature was reviewed and categorized.
Conclusion. On the basis of the literature supplied by the manufacturers, only one implant system
demonstrated scientifically valid long-term success. (J Prosthet Dent 1997;77:271-9.)

The prosthodontic community was exposed to the
concept ofosseointegration when the Proceedings of the
Toronto Conference on Osseointegration were published
in I983.113 This conference provided worldwide expo-
sure for the concept ofosseointegration. In the Proceed-
ings, Zarb and Symington ~3described a study performed
at the University of Toronto that replicated the early re-
suits described by Adell. ~° This independent study pro-
vided evidence that long-term success with endosseous
implants to support and retain dental prostheses was not
only possible but a highly predictable process.
In the early 1980s, the use of dental implants was not
a routine part of clinical practice for most dentists. How-
ever, nearly every annual specialty meeting has at least
one lecture on this subject. Many companies market
implants that are said to exhibit a clinical performance
that meets or exceeds the standards set by BrSnemark 2
and others. 1°-~2Different implant systems use different
alloys, implant designs, surface textures, surface coat-
ings, sm'gical techniques, and sterilization procedures~4as;
yet the results presented at meetings are not described
as being adversely affected by these differences.
The American Dental Association (ADA) certification
procedure is designed to evaluate information and en-
sure that all "certified" products have undergone thor-
ough scrutiny by the ADA. 16Because the ADA has given
Presented at the annual session of the Academy of Prosthodontics,
Newport Beach, Calif., ] 996.
~Consultant, Section of Prosthodontics, Mayo Clinic and Mayo Foun-
dation; Assistant Professor of Dentistry, Mayo Medical School.
Section of Prosthodontics.
UVisiting Clinician, Section of Prosthodontics, Mayo Clinic and Mayo
Foundation.
CResidentin Prosthodontics, Mayo Graduate School of Medicine, Sec-
tion of Prosthodontics.
dResident in Periodontics, Mayo Graduate School of Medicine, Sec-
tion of Periodontics.
Nothing in this publication implies that Mayo Foundation endorses
any products mentioned in this manuscript.
provisional or full certification to several manufacturers
of dental implants, it would seem reasonable to assume
that these manufacturers have published data to validate
their systems.
The purpose of this review was to assess the articles
recommended by dental implant manufacturers as a
means of system validation.
METHODS
In 1991, one author contacted six dental implant manu-
facturers and requested references to scientific articles that
could be used to validate the manufacturer's implant sys-
tem (Fig. i). The letter requesting the references specifi-
cally described the anticipated evaluation process. Manu-
facturers (Calcitek Integral, Carlsbad, Calif.; Dentsply
Core Vent, Encino, Calif.; Interpore IMZ, Irvine, Calif.;
Nobelpharma, Westmont, Ill.; Straumann ITI, Cam-
bridge, Mass.) were selected for this review if they had
received provisional or full certification from the ADA or
if they appeared to maintain a significant share of the
North American dental implant market (Steri-Oss, Yorba
Linda, Calif.). After references were obtained from the
manufacturers, the journal articles were read and discussed
in a series of seminars. Consensus regarding the merits of
the material was reached. References that were unavail-
able in our medical library or through interlibrary loan
were not included in the review.
Descriptive categories were designated for scientific
study, animal research, human clinical research, hypoth-
esis, clinical report, comparison study, prospective study,
retrospective study, literature review, and validating study.
Literature reviews were performed, and articles were
placed in as many categories as applicable. Most of these
classifications are self-explanatory.
For the purposes of this literature review, the descriptive
categories were interpreted as liberally as possible. For ex-
ample, D a y ' s 17 description of a scientific study as following
the "IMRAD" format (Introduction, Methods and Mate-

MARCH 1997 THE JOURNAL OF PROSTHETIC DENTISTRY 271

 THE JOURNAL OF PROSTHETIC DENTISTRY ECKERT ET AL

As a member of the Staffofthe Mayo Clinic, I am involved in the review of

literature which is discussed with the prosthodontic residents. In September, 1991
literature pertaining to the research, development, and clinical use of dental implants will
be assessed. An effort is being made to present this data in a comprehensive manner
showing no preference to any implant design or manufacturer.

I am presently contacting the major implant manufacturers to request references

which were instrumental in the development of their implant systems. Please provide a list
of authors and titles which you feel demonstrate the theories, testing methodology, and
clinical success of the _ _ implant. Proprietary information is not being requested.
Selections from these journal articles will be used to provide a reading list for the
prosthodontic residents at the Mayo Graduate School of Medicine. The literature will be
thoroughly scrutinized in a seminar format to evaluate methodology and the end results.
Since your company will be providing the bibliography which relates to the _ system,
an unbiased review of the literature is made possible.

Fig. 1. Text of letter sent in 1991 to implant manufacturers requesting references.

In 1991 I requested from _ _ a list o f references that you believed were

representative of literature that provided scientific vaiidation o f your implant system. This
literature was to be used in the "Implant Seminar" for the Periodontal and Prosthodontie
graduate training programs at the Mayo Graduate School o f Medicine. Following receipt
and review of this literature, I made a second request in 1993 for an update o f this
information.

The results o f the literature review from the 1991 survey were sent to your
company in December 1994 and are included again with this letter. Unfortunately fewer
than 50% o f the implant manufacturers (Nobelpharma, Straumann, Interpore, Calcitek,
Dentsply, and Steri-Oss) responded to my request in 1993. With such a poor response it
did not appear to be fair to all the manufacturers to use material that was not current for
some while others were represented by up to date material. Consequently the most recent
class o f graduate students reviewed the 1991 material once again.

At this point I would like to try again to evaluate scientific literature that _ _
believes to be validating for its implant system. Please provide a list of references that fits
this request. I ask that the list be no longer than fifteen articles (total) since the objective
is to make a qualitative rather than a quantitative assessment. I suggest that you reference
two to four articles on each of the following topics:
• Maxillary implant s u c c e s s
• Mandibular implant s u c c e s s
• Prosthetic rehabilitation of complete edentulism, partial edentulism and single tooth
replacement

Following review o f this material I intend to submit the results of this literature
review for publication. I know that _ _ can provide references that place itself in the
validated category and anticipate reviewing such material. I would appreciate your list by
October 12, 1995.

Fig. 2. Text of letter sent in 1995 to implant manufacturers requesting references.

rials, Results, Analysis, Discussion) was used as a guide for
the reviewers instead of a strict model. The reviewers agreed
that an article must meet specific criteria to achieve the
description of a "scientific study" for this review. An article
must systematically review patient data reported in the ar-
ticle. All treated patients had to be included in the reported
data or their exclusion explained in the article. Data about
implant success or implant survival had to be gathered and
analyzed in some way. Although these criteria for a "scien-
tific study" are loose, they were thought to be the mini-
mum needed to "simulate" science.
Articles in the "hypothesis" category discussed ideas
about design, materials, or approaches instead of report-
ing the results of a study. An article that discussed un-
tested ideas was considered a "hypothesis" article.
A "validating" article established a scientific basis for
the implant design in question. To validate the specific
implant design, the article had to be described by the
reviewers as "scientific." Articles were designated as pro-
spective or retrospective studies if they fulfilled the crite-
ria described for a "scientific study" and could validate
the design in question. Conversely, unproved or untested

272 VOLUME 77 NUMBER3

ECKERT ET AL
1991 U t e r a t u r e Review
cal ~n IMZ ~T~ ~ob
Fig. 3. Number of validating articles and number of articles in
which research was performed in human studies. Validating
articles were defined as articles that demonstrated data col-
lection and meticulous follow-up in humans. Articles supplied
by Calcitek (Cal), Dentsply (Den), lnterpore (IMZ), Straumann
(ITI), Nobelpharma (Nob), and Steri-Oss (S-O).
hypotheses, clinical reports, literature reviews, and pro-
spective or retrospective studies that lacked data collec-
tion and analysis were not considered validating studies.
After reviewing all the submitted articles independently,
the authors discussed them and determined the dassifica-
tion. When disagreements arose about the relative merits of
an article, the article was voted on to determine the appro-
priate categorization. The review process was more likely to
be liberal in its classification process. After all articles were
discussed thoroughly and categorized, a summary letter was
written and sent to the implant manufacturers.
The entire review process was repeated in the sum-
mer o f 1995. The 1995 letter that requested material
from the manufacturers was more specific regarding the
literature that was to be reviewed (Fig. 2). Included with
the request for additional material was the list o f articles
submitted and reviewed in 1991 along with the results
o f the previous review. Since it is quality o f material that
is needed to validate an implant system instead o f quan-
tity o f articles, a limited number o f submissions was sug-
gested. Because four years had elapsed, it was expected
that the definition o f a "scientific article" could be more
specific than the one used in 1991 and that the defini-
tion would be expanded to include success criteria for
the individual implants. It was agreed that reports o f
implant retention, without success criteria, would be
considered as "survivors" and that the "strength" o f vali-
dation by using survival studies alone would not pro-
vide the same level o f validation as reports that used
success criteria. Because some o f the participants involved
in the 1991 review had graduated, all articles solicited
for this review article (1991 and 1995) were read and
discussed by the authors. All articles were placed in ap-
propriate descriptive categories by the authors.
RESULTS
All six manufacturers responded to the request for ref-
erences in 1991; however, two o f them, Dentsply and
Steri-Oss, declined to participate in the 1995 review.
MARCH 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
~995 LRetatm'e Review
12-
o o
S~O
2;
CalcRe~ IMZ tTt '~0~p~am'~
Fig. 4. Number of articles submitted by manufacturers, num-
ber of validating articles, and number of articles that pro-
vided "strong" validation. Strong validation was provided if
article provided evidence of research that demonstrated
objective success criteria, data analysis, and documentation
of at least 5 years of clinical performance. IMZ, Interpore;
[TI, Straumann.
Calcitek Integral
Calcitek Integral submitted 10 articles for review in
1991. ~8-27M1 o f these articles were available for review.
M t h o u g h five o f the articles 19-2~,2a'25were considered
"scientific," all o f the research was p e r f o r m e d in ani-
mal models (Fig. 3). The animal studies were similar
in design and were t h o u g h t to demonstrate testing bias
because commercially available implants were compared
with alternative designs that physically resembled other
implant designs but had differences that may have been
responsible for p o o r clinical performance. The differ-
ences in the customized implants were not discussed
as possible complicating factors to implant survival. The
other five articles consisted o f clinical reports and com-
pilations o f clinical reports. The one human clinical
research article 18had p o o r data analysis and lacked suc-
cess criteria, for which reason the reviewers did not
recognize this article as a research article. Consequently,
validation o f this implant system was provided in ani-
mal models, but the need for controlled human clini-
cal studies was noted.
In 1995, the manufacturer submitted 15 articles, but
f o u r o f t h e m h a d b e e n i n c l u d e d in t h e 1 9 9 1
list. 18J9aa,24,2s-38 The articles indicated increased atten-
tion to human studies. All o f the articles were available
for review. The articles categorized as "scientific stud-
ies" did not provide criteria for implant success, which
resulted in a lower level o f validation. ~*,a2,33,a7,38These
studies were concerned primarily with implant survival
(Fig. 4). They did not distinguish between survival with
and survival without intervention to treat bone loss or
soft tissue complications. Validation o f the system was
d e m o n s t r a t e d in 33% o f the articles; however, the
strength o f this validation was less than expected, de-
273
 THE JOURNAL OF PROSTHETIC DENTISTRY
spite the large number of implants discussed, because
success criteria were not used. Improvement in strength
of validation may be anticipated if success criteria are
established in future research.
Dentsply Core Vent
Dentsply Core Vent provided 19 references, but four
were not in English and no translation was available.23.a9-s2
Although some of the articles demonstrated scientific merit,
none of the studies evaluated Dentsply or Core Vent im-
plants. No testing of the Dentsply Core Vent implant
system was described, and the theoretical basis of the
system was n o t described. Many of the articles recom-
mended by Dentsply as providing validation of their
implant system did provide validation of other systems
or of the concept of osseointegration, but there was no
mention of the Dentsply or Core Vent system. Because
the literature did not evaluate the system, it was impos-
sible to validate the system on the basis of the articles
supplied by the manufacturer (Fig. 3).
In response to the 1995 request for literature, the
manufacturer said that the company was sponsoring a
major research endeavor and that the results would not
be available until 1998.* Thus, it was not possible for
us to validate this implant system.
Interpore IMZ implant system
Interpore provided 23 references in response to the
1991 request, but four were unavailable in English trans-
lation. 21,s3-71These articles included evidence of human
and animal research and a comprehensive review of the
hypotheses associated with the unique design of the I M Z
implant system. Prospective animal studies and several
retrospective human studies were included among the
submitted articles. It was difficult to determine the sci-
entific value of the human studies because the descrip-
tion of data collection methods was often vague. Quali-
fied validation of the I M Z system, based on survival rates
that were lower than those of the other implant systems,
was provided by this material. 21,33,6°,6s,67
Retrospective reviews were the primary means of vali-
dation for the 1995 review, s4,6s,72-s8A large number of
patients and implants were described in four stud-
ies, 72,s°,sl,s3but the method of gathering data and an ex-
planation about the patients lost to follow-up were poorly
explained or not provided. Specific success criteria gen-
erally were not described in these studies, which made
the validity of the studies less profound than it may have
been had criteria been established. The exception was
the study by Spiekermann et al.r2 in which success crite-
ria were described. One of the mentioned criteria, less
than 4 m m of mesial or distal bone loss, was less strin-
gent than that recommended by Albrektsson et al. s9 and
Smith and Zarb. 9° Application of the more stringent
*Patrick DR. Personalcommunication, Encino,Calif., November 1995.
274
ECKERT ET AL
success criteria described in these latter two articles would
not allow the article of Spiekermann et al. 72 to be used
for validation purposes. Scientific validation of this im-
plant system, based on the articles supplied by the manu-
facturer, 72,s°,sl,s3 was found, but this validation lacked
strength because of the failure to describe specific crite-
ria for success and the vague process used for patient
follow-up (Fig. 4).
Nobelpharma system
In response to the 1991 request, Nobelpharma pro-
vided a large volume of textbook material 9>1°5 and a list
of journal articles. 89,1°6-n2 Because our literature review
was designed to assess material that had the potential to
qualify as "scientific literature," the material presented in
the implant textbooks could not be considered37,n3 Al-
though the number of articles was relatively small, 1°s-n2
their quality was sufficient to provide validation for the
Nobelpharma implant system (Fig. 3). These articles de-
scribed several clinical applications performed in various
treatment centers. The data in these studies were prima-
rily from long-term retrospective mulficenter studies.
In 1995, the manufacturer recommended 15 articles
that described all types of treatment approaches, n4-I27
The quality of research documentation was excellent,
with prospective multicenter studies demonstrating clini-
cal performance with strict success criteria (Fig. 4). Vali-
dation of this implant system was achieved through re-
view of references supplied by Nobelpharma. nS-nT,u9
~2aa2s-127 The early research, that is the references
supplied in 1991, provided the scientific basis for future
research in osseointegration, and the later references
reported research that set standards for the industry.
Straumann ITI system
The Straumann ITI implant system was introduced to
the North American market after several years of clinical
use in Europe. In response to the 1991 request for litera-
ture, the manufacturer provided 12 references. ~28-~39The
articles included prospective and retrospective material
and descriptions of the development of the implant sys-
tem. Most studies presented short-term results that rep-
resented excellent clinical success. On the basis of this
information, the ITI implant system demonstrated strong
validation (Fig. 3). 128,13°,132,134,13sa39
The response of the manufacturer to the request for
references in 1995 was similar to that provided in 1991
a n d i n c l u d e d six articles r e c o m m e n d e d in
1991.128'132"134'136'137'I4°-143 These repeat studies were
considered "validating" in both 1991 and 1995. For the
1995 review, the reviewers expected to find reports of 5-
and 7-year studies. This was not the case. The longest
term study reported in the articles was a 3-year prospec-
tive research project. Success criteria were not provided
by any of the articles, 12~,134,1as,143which caused the review-
ers to question the previously strong validation (Fig. 4).
VOLUME 77 NUMBER3
ECKERT ET AL
Steri-Oss implant system
The manufacturer provided 14 references for the 1991
review.~44-1s7 None of the articles represented scientific
studies. One human study156 was included, but it pre-
sented only preliminary material and no data analysis.
The material supplied by the manufacturer failed to vali-
date the implant system. The articles were descriptive of
the implant system but lacked success criteria, data col-
lection, or actual scrutiny of the system.
In response to the request for references in 1995, the
manufacturer eventually declined to participate in the
review.*
DISCUSSION
This literature review was initiated to provide an aca-
demic base to assist in understanding the multiple im-
plant systems and to ensure the scientific validity of popu-
lar implant systems. The review was conducted in an
academic setting as a cooperative effort between two
graduate training programs, periodontology and pros-
thodontics, and with the assistance of a research associ-
ate. Every effort was made to prevent reviewer bias af-
fecting literature selection or interpretation. References
were gathered through requests made to the implant
manufacturers so they would have the opportunity to
portray their respective implant system in the most fa-
vorable way. The manufacturers were advised of the pur-
pose of the review and were informed of the results of
the 1991 review before additional references were re-
quested in 1995.
Many dental practitioners have the impression that
the field of dental implants, especially as related to
osseointegration, has been researched intensively. Con-
trolled scientific studies in animal and human models
are commonly assumed to be the basis for implant den-
tistry. These impressions provided the stimulus for the
current review. Despite such perceptions, this review
failed to demonstrate a strong research base for implant
dentistry.
The 1991 review provided a moderately strong base
of animal research from one manufacturer (Calcitek) but
had little human data to support the animal studies.
References supplied by other manufacturers included
weak supporting reports (IMZ), assorted nonscientific
case studies (Steri-Oss), or reports that were not perti-
nent to the manufacturer's device (Dentsply). Only two
manufacturers (Nobelpharma, Straumann ITI) provided
references that demonstrated substantial validation of
their implant systems. Nobelpharma recommended a list
of articles in recognized peer-reviewed journals that de-
scribed the clinical performance of the Nobelpharma
implant system in various clinical applications. The great-
est criticism of the Nobelpharma references was that they
*Kennard D. Personal communication,Yorba Linda, Calif., October
1995.
MARCH 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
emphasized retrospective instead of prospective studies.
In defense of this system, the reports showed long-term
performance instead of short-term studies. In distinc-
tion, Straumann ITI provided primarily prospective stud-
ies that followed implants for relatively short periods of
time. Research from Straumann ITI was performed by a
relatively small group of investigators in what appeared
to be a controlled environment. The validation was rela-
tively strong but the reviewers were left with questions
about implant survival when other practitioners provided
services. Also, the readers wondered about survival for
longer rime periods.
The request for literature in 1995 elicited a mixture
of responses. Two companies (Dentsply and Steri-Oss)
declined to supply references, and communication with
representatives of each of these companies indicated that
they were unable to identify peer-reviewed articles that
would fulfill the requirements for system validation as
requested.
References to human clinical research were supplied
by Calcitek and Interpore, and the results reported in
these articles demonstrated a high implant survival ini-
tially. However, evaluation of these articles demonstrated
a continuous decline in implant survival rates.lS,3a.as,72,8~
Success criteria were not discussed in the articles of ei-
ther of these reference lists, except for the article by
O'Roark, al in which the author described success as "sur-
vival" and stated that "any implant removed or one that
would be removed by any reasonable and experienced
implantologist is a failure," and the one by Spiekermann
et al.,72 in which new, less rigorous success criteria were
established.
The articles recommended by Straumann ITI failed to
demonstrate strict success criteria. Essentially, these ar-
ticles demanded pain-free, immobile, restorable implants
but did not suggest criteria for bone maintenance. Longer
follow-up, in comparison with the studies recommended
in 1991, was not provided in any of the articles recom-
mended in 1995. Most of the articles were theoretical
descriptions of newer treatment approaches or reviews of
more sophisticated testing methods. Although the articles
recommended in 1991 provided validation of the
Straumann ITI implant system, the articles recommended
in 1995 did not enhance the original validation.
Nobelpharma provided references to articles with strict
success criteria and rigid adherence to research proto-
cols. Prospective studies for the clinical application of
this implant system in complete and partial edentulism
for the maxilla and mandible were provided. This re-
view differed from the 1991 material in that the earlier
articles were primarily retrospective. The articles dis-
cussed theory and clinical practice.
Therefore, validation from the references provided in
1995 must be described at the moderate level for three
manufacturers (Calcitek, Interpore, Straumann) and at
the strong level for one manufacturer (Nobelpharma).
275
THE JOURNAL OF PROSTHETIC DENTISTRY
The meaning o f this literature-based validation is un-
clear. F r o m an academic standpoint, it is absolutely ap-
propriate to demand evidence before changes in therapy,
techniques, designs, or materials are initiated. Clinical
trials should be conducted to ensure safety and effec-
tiveness o f new or different implant materials, surface
configurations, surgical techniques, and surface coatings.
At this time, many o f these trials are being conducted at
research facilities, but the results are not yet available. It
must be recognized that the clinical practitioner may
not be willing to wait for results o f studies that may take
years to complete. Because anecdotal information pre-
sented at meetings and in the dental literature suggests
that there is evidence o f adequate clinical performance
from many implant systems, the practitioner is placed in
a quandary. Unfortunately, testing m e t h o d o l o g y is not
available for anecdotal reports. The question remains
one o f whether the profession should demand research
or simply move forward without it.
After reviewing this extensive list o f references over a
4-year period, the authors were left with several ques-
tions and few answers. It was clear from the review that
some implant systems are prone to high initial survival
rates, which are followed by longer periods o f declining
survival. This response was seen in references for the
Interpore r2,81 and Calcitek I8,33,3simplant systems. This is
in contrast to the higher rate of implant nonintegration,
evaluated at implant uncovering, with the Nobelpharma
system 1~9a= that is followed by a lower incidence o f late
implant loss. It appears that implant survival curves for
all the reporting implant systems intersect in the 3- to
7-year period, with the Nobelpharma implant system
maintaining a favorable survival slope with increasing
years o f implant service. This analysis is complicated by
the difference in categorization o f implants as "success-
ful" or "surviving." A "surviving implant" in one study
may be a failed implant in another study because differ-
ent success criteria were used. The reviewers questioned
the value o f describing similar osseointegration perfor-
mance when the failure pattern o f the different systems
is not the same.
Most o f the articles reviewed failed to describe the
criteria by which implant success was established. Most
o f the articles discussed implant survival without con-
sidering that an implant may be retained in bone with-
out exhibiting signs compatible with health. Implants
that exhibit progressive bone loss, demonstrate soft tis-
sue complications, or require multiple surgical interven-
tions to retain the implants in the bone are not as suc-
cessful as an implant that, after being inserted, provides
no biologic complications. This is true even t h o u g h the
implant may technically be described as "surviving."
Implants must be restorable in a manner that achieves
the prosthetic goals o f function, comfort, and esthetics.
Implants that are retained in the bone but cannot be
restored successfully must also be considered in a differ-
276
ECKERT ET AL
ent way from those that can be restored. Because suc-
cess criteria were not described in many o f the articles,
it is impossible to directly compar e the articles.
It seems appropriate to consider the Nobelpharma
implant system, whose validity has been demonstrated
through a series o f retrospective and prospective clinical
studies, as the reference standard against which all other
systems must be compared. By using this implant sys-
tem as a therapeutic control, prospective randomized
clinical trials may be designed to determine scientifically
whether there is a difference among implant systems.
The time has come to abandon the c o m m o n practice o f
designing tests that serve no function other than to prove
the pretesting bias. Implant dentistry has the opportu-
nity to elevate the science o f dentistry, but it can do this
only through scientifically valid means. After valid data
are available, dental practitioners will have the opportu-
nity to make informed choices to improve the quality o f
patient care.
CONCLUSIONS
Articles recommended by implant manufacturers were
reviewed in an effort to validate implant systems. The
following conclusions were reached.
1. Scientific validation o f the Nobelpharma implant
system was provided through a series o f prospective and
retrospective studies that used specific success criteria in
multiple clinical applications.
2. Validation o f the Calcitek, IMZ, and ITI implant
systems was provided through quasi-scientific documen-
tation. The recommended articles often did not describe
success criteria, provide statistical analysis, or differenti-
ate among implant designs.
3. Analysis o f implant survival alone is inadequate to
demonstrate the validity o f a specific implant system.
Implant health, bone response, soft tissue health, failure
pattern, time o f failure, and ease o f restoration must be
considered in discussing implant success.
4. Scientific documentation o f implant "success" ei-
ther is not readily available for review or the implant
manufacturers are not able to supply references for such
documentation.
5. Success criteria that are acceptable to the implant
industry should be developed to assist the dental practi-
tioner in malting informed choices about selecting an
implant system.
6. Randomized clinical trials using validated implant
systems as controls should be performed to determine
the presence or absence of differences among implant sys-
tems.
REFERENCES
1. Zarb GA. Introduction to osseointegration in clinical dentistry. ] Prosthet
Dent 1983;49:824.
2. Br~,nemark PI. Osseointegration and its experimental background. ] Prosthet
Dent 1983;50:399-410.
3. Zarb GA. The edentulous milieu. J Prosthet Dent 1983;49:825-31.
VOLUME 77 NUMBER3
ECKERT ET AL
4. Kasemo B. Biocompatibility of titanium implants: surface science aspects.
J Prosthet Dent 1983;49:832-7.
5. Skalak R. Biomechanica[ considerations in osseointegrated prostheses. J
Prosthet Dent 1983;49:843-8.
6. Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced
bone tissue injury: a vital-microscopic study in the rabbit. J Prosthet Dent
1983;50:101-7.
7. Hansson HA, Albrektsson T, Br~nemark PI. Structural aspects of the inter-
face between tissue and titanium implants. J Prosthet Dent 1983;50:108-
13.
8. Bergman B. Evaluation of the results of treatment with osseointegrated
implants by the Swedish National Board of Health and Welfare. J Prosthet
Dent 1983;50:114-5.
9. Lekholm U. Clinical procedures for treatment with osseointegrated dental
implants. J Prosthet Dent 1983;50:116-20.
10. Adell R. Clinical results of osseointegrated implants supporting fixed pros-
theses in edentulous jaws. J Prosthet Dent 1983;50:251-4.
11. Albrektsson T. Direct bone anchorage of dental implants. J Prosthet Dent
1983;50:255-61.
12. Lundqvist S, Carlsson GE. Maxillary fixed prostheses on osseointegrated
dental implants. J Prosthet Dent 1983;50:262-70.
13. Zarb GA, Symington JM. Osseointegrated dental implants: preliminary
report on a replication study. I Prosthet Dent 1983;50:271-6.
14. AIbrektsson T, Zarb GA. Current interpretations of the osseointegrated
response: clinical significance. Int J Prosthodont 1993;6:95-105.
15. Smith DC. Dental implants: materials and design considerations. Int J
Prosthodont 1993;6:106-17.
16. EckertSE. Food and Drug Administration requirements for dental implants.
# Prosthet Dent 1995;74:162-8.
17. Day RA. How to write and publish a scientific paper. 3rd ed. Phoenix, AZ:
Oryx Press, 198:1-10.
18. Kent JN, Block MS, Finger IM, Guerra L, Larsen H, Misiek DJ. Biointegrated
hydroxylapatite-coated dental implants: 5-year clinical observations. J Am
Dent Assoc 1990;121:138-44.
19. Block MS, Kent JN, Einger IM. Use of the integral implant for overdenture
stabilization, lntJ Oral Maxillofac Implants 1990;5:140-7.
20. Block MS, Finger IM, Fontenot MG, Kent JN. Loaded hydroxylapatite~coated
and grit-blasted titanium implants in dogs. Int J Oral Maxillofac Implants
1989;4:219-25.
21. Gammage DD, Bowman AE, Meffert RM, Cassingham RJ, Davenport WA.
Histologic and scanning electron micrographic comparison of the osseous
interface in loaded IMZ and integral implants. Int J Periodont Rest Dent
1990;10:124-35.
22. Golec TS. implants. What and when. CDAJ 1987;15:49-54.
23. Cook SD, Kay JF, Thomas KA, Jarcho M. Interface mechanics and histol-
ogy of titanium and hydroxyapatite-coated titanium for dental implant
applications, lnt J Oral Maxillofac Implants 1987;2:15-22.
24. Block MS, Kent JN, Kay JF. Evaluation of hydroxylapatite-coated titanium
dental implants in dogs. J Oral Maxillofac Surg 1987;45:601-7.
25. Meffert RM, Block MS, Kent JN. What is osseointegration? Int J Periodont
Rest Dent 1987;7:%21.
26. /ensen RL, Jensen JH, Krauser JT, Schulte JK. Hydroxylapatite coated den-
ta[ implants. Northwest Dent 1989;68:14-25.
27. Golec TS. Three-year clinical review of HA coated titanium cylinder im-
plants. J Oral Implanto[ 1988;14:437-54.
28. Yukna RA. Clinical comparison of hydroxyapatite-coated titanium dental
implants placed in fresh extraction sockets and healed sites, l Periodontol
1991 ;62:468-72.
29. Holloway JA, McGlumphy EA. Soft tissue contouring for aesthetic single-
tooth implant restorations. Pract Periodontics Aesthet Dent 1993;5:41-
8.
30. McGlumphy EA, Papazoglou E, Riley RL. The combination implant crown: a
cement- and screw-retained restoration. Compendium 1992;13:34, 36, 38.
31. O'Roark WL. Improving implant survival rates by using a new method of
at risk analysis. Int J Oral Implantol 1991 ;8:31-57.
32. Bell FA, Cavazos EJ Jr, Jones AA, Stewart KL. Four-year experience with
the placement, restoration, and maintenance of dental implants by dental
students. Int J Oral Maxillofac Implants 1994;9:725-31.
33. Block MS, Kent JN. Long-term follow-up on hydroxylapatite-coated cylin-
drical dental implants: a comparison between developmental and recent
periods. J Oral Maxillofac Surg 1994;52:937-43.
34. Golec TS, Krauser JT, Long-term retrospective studies on hydroxyapatite
coated endosteal and subperiosteal implants. Dent C[in North Am
1992;36:39-65.
35. Stultz ER, Lofland R, Sendax VI, Hornbuckle C. A mu[ticenter 5-year retro-
MARCH 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
spective survival analysis of 6,200 integral implants. Compendium
1993;14:478, 480, 482.
36. Chiche GJ, Pinault A. Prosthetic restoration of the Integral implant with
fixed partial dentures. Quintessence Dent Technol 1992;15:89-103.
37. Block MS, Kent JN. Cylindrical HA-coated implants--B-year observations.
Compendium 1993;Suppl 15:$526-32.
38. Lozada JL, James RA, Boskovic M. HA-coated implants: warranted or not?
Compendium 1993;(Suppl 15):$539-43.
39. Adell R, Eriksson B, Lekholm U, BrAnemark PI, Jemt T. Long-term follow-up
study of osseointegrated implants in the treatment of totally edentu[ous
jaws. Int J Oral Maxillofac Implants 1990;5:347-59.
40. SonesAD. Complications with osseointegrated implants. J Prosthet Dent
1989;62:581-5.
41. Mito RS, Lewis S, Beumer J III, Perri J, Moy PK. The UCLA implant study: a
three-year review of the Br~nemark implant system success rate. J Calif
Dental Assoc 1989;17:12-7.
42. Jaffin RA, Berman CL. The excessive loss of Br~nemark fixtures in type IV
bone: a 5-year analysis. J Periodontol 1991 ;62:2-4.
43. Jemt T, Lekholm U, Grondahl K. 3-Year followup study of early single im-
plant restorations ad modum Br~nemark. Int ] Periodontics Restorative
Dent 1990; 10:340-9.
44. Ohme[I L, Hirsch J, Ericsson I, Br~nemark P-l. Single-tooth rehabilitation
using osseointegration. A modified surgical and prosthodontic approach.
Quintessence Int 1988;19:871-6.
45. Schroeder A, van der Zypen E, Stich H, Sutter F. The reactions of bone,
connective tissue, and epithelium to endosteal implants with titanium-
sprayed surfaces. J Maxillofac Surg 1981 ;9:15-25.
46. Breine U, Br&nemark PI. Reconstruction of alveolar jaw bone. An experi-
mental and clinical study of immediate and preformed autologous bone
grafts in combination with osseointegrated implants. Scand J Piast Reconstr
Surg 1980;14:23-48.
47. Adell R, Lekho[m U, Rockier B, Br~.nemark PI. A 15-year study of
osseointegrated implants in the treatment of the edentu[ous jaw. Int J Oral
5urg 1981;10:387-416.
48. Dobbs HS, Robertson JL. Alloys for orthopaedic implant use. Eng Med
1982;11:175-82.
49. Laney WR. Selecting endentulous patients for tissue-integrated prosthe-
ses. Int J Oral Maxillofac Implants 1986;1:12%38.
50. Brunski JB. Biomaterials and biomechanics in dental implant design. Int J
Oral Maxil[ofac Implants 1988;3:85-97.
51. Langer 8, Sullivan DY. Osseointegration: its impact on the interrelation-
ship of periodontics and restorative dentistry. Part 1. lntJ Perio Rest Dent
1989;9:84-105.
52. Schnitman PA, Rubenstein JE, Whorle PS, DaSilva JD, Koch GG. Implants
for partial edentulism. J Dent Educ 1988;52:725-36.
53. Kraut RA, Dootson J, McCul[en A. Biomechanica[ analysis of
osseointegration of IMZ implants in goat mandibles and maxillae. Int J
Oral Maxillofac Implants 1991 ;6:187-94.
54. Sager RD, Thies RM. Implant-retained precision two-stage single-tooth re-
placement. J Oral Implantol 1991 ;17:166-71.
55. Jensen J, Simonsen EK, Sindet-Pedersen S. Reconstruction of the severely
resorbed maxilla with bone grafting and osseointegrated implants: a pre-
liminary report. J Oral Maxillofac Surg 1990;48:27-32.
56. Chapman RJ, Kirsch A. Variations in occlusal forces with a resilient inter-
nal implant shock absorber. Int J Oral Maxil[ofac implants 1990;5:369-
74.
57. Kent JN, Block MS. Simultaneous maxillary sinus floor bone grafting and
placement of hydroxylapatite-coated implants. J Oral Maxillofac Surg
1989;47:238-42.
58. Mentag PJ, Kosinski T. Hydroxyapatite-augmented sites as receptors for
replacement implants. J Oral Implanto11989;t5:114-23.
59. Kay HB. Osseointegration--beyond tooth replacement: the intramobile
cylinder (IMZ) as a stabilizing abutment in periodontal-prosthesis. [nt J
Perio Res Dent 1989;9:395-416.
60. Kirsch A, Ackermann KL. The IMZ osteointegrated implant system. Dent
C[in North Am 1989;33:733-91.
61. McGlumphy EA, Toplek PA, Robinson DM, Mendel DA. Fatigue resistance
of implant screws housed in rigid or resilient elements [abstract]. Am Assoc
Dent Res 1989; .
62. Parham PLJr, Cobb CM, French AA, Love JW, Drisko CL, Killoy WJ. Effects
of an air-powder abrasive system on plasma-sprayed titanium implant sur-
faces: an in vitro evaluation. J Oral Imp[antol 1989;15:78-86.
63. Gross HN, Holmes RE. Surgical retrieval and histologic evaluation of an
endosteal implant: a case report with clinical, radiographic and microscopic
observations. J Oral Implantol 1989;15:104-13.
277
THE JOURNAL OF PROSTHETIC DENTISTRY
64. McGlumphy EA, Campagni WV, Peterson LJ. A comparison of the stress
transfer characteristics of a dental implant with a rigid or a resilient inter-
nal element. J Prosthet Dent 1989;62:586-93.
65. Setz J, Kramer A, Benzing U, Weber H. Complete dentures fixed on den-
ta[ imp]ants: chewing patterns and implant stress. Int J Oral Maxillofac
Implants 1989;4:107-11.
66. Chapman RJ. Osseointegrated implants: five systems. The IMZ implant. J
Can Dent Assoc 1989;55:474-5.
67. Boyne PJ. Host response to intraosseous implants placed in HA grafted
mandibles. Mater Res Soc Syrup Proc 1989;110:219-27.
68. Babbush CA, Kirsch A, Mentag PJ, Hill B. Intramobile cylinder (IMZ) two-
stage osteointegrated implant system with the intramobile element (IME):
part I. Its rationale and procedure for use. Int J Oral Maxillofac Implants
1987;2:203-16.
69. Kirsch A, Mentag PJ. The IMZ endosseous two phase implant system: a
complete oral rehabilitation treatment concept. J Oral Implantol
1986;12:576-89.
70. Kirsch A. Plasma-sprayed titaniumq.M.Z, implant. J Oral Implantol
1986;12:494-7.
71. Kirsch A. The two-phase implantation method using IMZ intramobile cyl-
inder implants. J Oral Implantol 1983;11:197-210.
72. Spiekermann H, Jansen VK, Richter EJ. A 10-year follow-up study of IMZ
and TPS implants in the edentulous mandible using bar-retained
overdentures. Int J Oral Maxillofac Imp]ants 1995;10:231-43.
73. Gracis SE, Nichol[s JI, Chalupnik JD, Yuodelis RA. Shock-absorbing behav-
ior of five restorative materials used on implants. Int J Prosthodont
1991 ;4:282-91.
74. Sager RD, Theis RM. Dental implants placed in a patient with multiple
myeloma: report of case. J Am Dent Assoc 1990;121:699-701.
75. Ettinger RL, Spivey JD, Han DH, Koorbusch GF. Measurement of the inter-
face between bone and immediate endosseous implants: a pilot study in
dogs. Int J Oral Maxillofac Implants 1993;8:420-7.
76. Fugazzotto PA, Hempton TJ. Guided tissue regeneration in oral recon-
struction: surgical and restorative applications. J Am Dent Assoc
1993;124:82-5.
77. Cavicchia F, Bravi F. Free-standing vs tooth-connected implant-supported
fixed partial restorations: a comparative retrospective clinical study of the
prosthetic results. Int J Oral Maxi[Iofac Implants 1994;9:711-8.
78. Last KS, Smith S, Pender N. Monitoring of IMZ titanium endosseous den-
tal implants by glycosaminoglycan analysis of peri-implant sulcus fluid. Int
J Oral Maxi[Iofac Implants 1995;10:58-66.
79. Fugazzotto PA. Maxillary sinus grafting with and without simu]taneous
implant placement: technical considerations and case reports. Int J Peri-
odontics Restorative Dent 1994;14:544-51.
80. Fugazzotto PA, Wheeler SL, Lindsay JA. Success and failure rates of cylin-
der implants in type IV bone. J Periodonto[ 1993;64:1085-7.
81. Fugazzotto PA, Gu[bransen HJ, Wheeler SL, Lindsay JA. The use of IMZ
osseointegrated implants in partially and completely edentulous patients:
success and failure rates of 2,023 implant cylinders up to 60+ months in
function. IntJ Ora ! Maxillofac Implants 1993;8:617-21.
82. Benzing UR, Gall H, Weber H. Biomechanical aspects of two different
implant-prosthetic concepts for edentulous maxillae. Int J Oral Maxillofac
Implants 1995;I 0:188-98.
83. Babbush CA, Shimura M. Five-year statistical and clinical observations with
the IMZ two-stage osteointegrated implant system. Int J Oral Maxillofac
Implants 1993;8:245-53.
84. Kramer A, Weber H, Benzing U. Implant and prosthetic treatment of the
edentulous maxilla using a bar-supported prosthesis. Int J Oral Maxillofac
Implants 1992;7:251-5.
85. Wright PS, Watson RM, Heath MR. The effects of prefabricated bar de-
sign on the success of overdentures stabilized by implants. Int J Oral
Maxillofac Implants. 1995;I 0:79-87.
86. Shernoff AF, Edmonds PP, Ward RD, Matthews BL. Osseointegrated im-
plants with an intramobile element in the treatment of edentulous jaws.
Compend Contin Educ Dent 1991 ;I 2:394-402.
87. Kay HB. Free-standing versus implant-tooth-interconnected restorations:
understanding the prosthodontic perspective. Int J Periodontics Restor-
ative Dent 1993;13:47-69.
88. Fugazzotto PA. Bone regeneration over a poorly positioned imp]ant to cor-
rect an esthetic deformity: a case report. J Periodontol 1993;64:1088-91.
89. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term effi-
cacy of currently used dental implants: a review and proposed criteria of
success. IntJ Oral Maxi[lofac Implants 1986;1:11-25.
90. Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous
implants. J Prosthet Dent 1989;62:567-72.
278
ECKERT ET AL
91. Br~nemark P-I. Introduction to osseointegration. In: Br~.nemark P-l, Zarb
GA, Albrektsson T, editors. Tissue-integrated prostheses: osseointegration
in clinical dentistry. Chicago: Quintessence Pub[ Co, 1985:11-76.
92. Zarb GA, Albrektsson T. Nature of implant attachments. In: 8r~nemark P-
I, Zarb GA, Albrektsson T, editors. Tissue-integrated prostheses:
osseointegration in clinical dentistry. Chicago: Quintessence Publ
Co, I 985:89-98.
93. Kasemo B, Lausmaa J. Metal selection and surface characteristics. In:
Br~nemark P-l, Zarb GA, Albrektsson T, editors. Tissue-integrated prosthe-
ses: osseointegration in clinical dentistry. Chicago: Quintessence Pub[
Co, I 985:99-I 16.
94. Skalak R. Aspects of biomechanical considerations. In: Br~nemark P-I,Zarb
GA, Albrektsson T, editors. Tissue-integrated prostheses: osseointegration
in clinical dentistry. Chicago: Quintessence Publ Co, I 985:117-28.
95. Albrektsson T. Bone tissue response. In: Br~nemark P-l, Zarb GA,
Albrektsson T, editors. Tissue-integrated prostheses: osseointegration in
clinical dentistry. Chicago: Quintessence Publ Co, I 985:129-43.
96. Carlsson GE, Haraldson T. Functional response. In: Br~nemark P-l, Zarb
GA, Albrektsson T, editors. Tissue-integrated prostheses: osseointegration
in clinical dentistry. Chicago: Quintessence Publ Co, I 985:155-63.
97. Blomberg S. Psychological response. In: Br~nemark P-l, Zarb GA,
Albrektsson T, editors. Tissue-integrated prostheses: osseointegration in
clinical dentistry. Chicago: Quintessence Pub] Co, I 985:165-74.
98. Adel[ R. Long-term treatment results. In: Br~nemark P-l, Zarb GA,
Albrektsson T, editors. Tissue-integrated prostheses: osseointegration in
clinical dentistry. Chicago: Quintessence Pub[ Co, I 985:175-86.
99. Strid K-G. Radiographic results. In: Br~nemark P-l, Zarb GA, Albrektsson T,
editors. Tissue-integrated prostheses: osseointegration in clinical dentistry.
Chicago: Quintessence Publ Co,1985:187-98.
100. Lekholm U, Ade[] R, Br/memark P-[. Complications. In: Br~nemark P-I,Zarb
GA, A[brektsson T, editors. Tissue-integrated prostheses: osseointegration
in clinical dentistry. Chicago: Quintessence Publ Co, I 985:233-40.
101. Thomsen P. Titanium and the inflammatory response. In: A]brektsson T,
Zarb GA, editors. The Br~nemark osseointegrated implant. Chicago: Quin-
tessence Publ Co, 1989:25-35.
102. Carmichael AP, Apse P, Zarb GA, McCulloch AG. Biological, microbio-
logical, and clinical apsects of the peri-implant mucosa. In: Albrektsson T,
Zarb GA, editors. The Br~nemark osseointegrated implant. Chicago: Quin-
tessence Publ Co, 1989:39-78.
103. Zarb GA. Impact of osseointegration on preprosthetic surgery. In:
A[brektsson "I-,Zarb GA, editors. The BrSnemark osseointegrated implant.
Chicago: Quintessence Publ Co, 1989:91-I 02.
104. Komiyama Y. Clinical and research experiences with osseointegrated im-
plants in Japan. In: Albrektsson T, Zarb GA, editors. The Br/memark
osseointegrated implant. Chicago: Quintessence Publ Co, 1989:197-214.
105. Albrektsson T, Zarb GA. Clinical results of a 24-team multicenter study of
the Br/memark implant. In: A]brektsson T, Zarb GA, editors. The Br/memark
osseointegrated implant. Chicago: Quintessence Publ Co, 1989:229-32.
106. Albrektsson T, Sennerby L. State of the art in oral implants. J Clin Periodonto[
1991 ;I 8:474-81.
107. A[brektsson T, Sennerby L. Direct bone anchorage of oral implants: Clini-
cal and experimental considerations of the concept of osseointegration.
Int J Prosthodont 1990;3:30-41.
108. Albrektsson T, Dahl E, Enbom L, et al. Osseointegrated oral implants. A
Swedish mu[ticenter study of 8139 consecutively inserted Nobelpharma
implants. J Periodontol 1988;59:287-96.
109. A[brektsson T. A multicenter report on osseointegrated oral implants. J
Prosthet Dent 1988;60:75-84.
110. Lekholm U, Adell R, Lindhe J, et ah Marginal tissue reactions at
osseointegrated titanium fixtures. (II) A cross-sectional retrospective study.
Int J Oral Maxillofac Surg 1986;I 5:53-61.
11 I. van Steenberghe D. A retrospective mu[ticenter evaluation of the survival
rate of osseointegrated fixtures supporting fixed partial prostheses in the
treatment of partial edentulism. J Prosthet Dent 1989;61:217-23.
112. Parel SM, Tjellstrom A. The United States and Swedish experience with
osseointegration and facial prostheses. Int J Oral Maxillofac Implants
1991 ;6:75-9
113. Levine RL Ethics and regulation of clinical research. 2nd ed. Baltimore,
MD: Urban & Schwarzenberg, 1986:1-I 5; 37-51; 413-24.
114. Andersson B, ()dinah P, Buss A, J6rn~us L. Mechanical testing of super-
structures on the CeraOne abutment in the Br~nemark system. IntJ Oral
Maxillofac Implants 1994;9:665-72.
115. Schrnitt A, Zarb GA. The longitudinal clinical effectiveness of
osseointegrated dental implants for single-tooth replacement. Int J
Prosthodont 1993;6:197-202.
VOLUME 77 NUMBER3
ECKERT ET AL
116. Laney WR, Jemt T, Harris D, et al. Osseointegrated implants for single-
tooth replacement: progress report from a multicenter prospective study
after 3 years. Int J Oral Maxillofac Implants 1994;9:49-54.
117. Naert I, Quirynen M, van Steenberghe D, Darius P. A six-yearprosthodontic
study of 509 consecutively inserted implants for the treatment of partial
edentulism. J Prosthet Dent 1992;67:236-45.
118. Gunne J, Jemt T, Linden B. Implant treatment in partially edentulous pa-
tients: a report on prostheses after 3 years. Int J Prosthodont 1994;7:143-
8.
119. Lekholm U, van Steenberghe D, Herrmann I, et al. Osseointegrated im-
plants in the treatment of partially edentulous jaws: a prospective 5-year
multicenter study. IntJ Oral Maxillofac Implants 1994;9:627-35.
120. Naert I, Quirynen M, van Steenberghe D, Darius P. A study of 589 con~
secutive implants supporting complete fixed prostheses. Part Ih prosthetic
aspects. J Prosthet Dent 1992;68:949-56.
121.Zarb GA, Schmitt A. The longitudinal clinical effectiveness of
osseointegrated dental imp[ants: The Toronto Study. Part lh the prosthetic
results. J Prosthet Dent 1990;64:53-61.
122. Adell R, Eriksson B, Lekholm U, Br~nemark PI, Jemt T. Long-term follow-up
study of osseointegrated implants in the treatment of totally edentulous
iaws. Int J Oral Maxil[ofac Implants 1990;5:347~59.
123. Adell R, Lekholm U, Grondahl K, Br~nemark PI, Lindstrom J, Jacobsson M.
Reconstruction of severely resorbed edentulous maxillae using
osseointegrated fixtures in immediate autogenous bone grafts. Int J Oral
Maxillofac Implants 1990;5:233-46.
124. Lundqvist S, Haraldson T. Oral function in patients wearing fixed prosthe-
sis on osseointegrated implants in the maxilla: 3-year follow-up study. Scand
J Dent Res 1992;100:279-83.
125. Jemt T, Lekholm U. Implant treatment in edentulous maxillae: a 5-year
follow-up report on patients with different degrees of jaw resorption, lnt J
Oral Maxillofac Implants 1995;10:303-11.
126. Zarb GA, Schmitt A. The longitudinal clinical effectiveness of
osseointegrated dental implants: The Toronto study. Part h surgical re-
sults. J Prosthet Dent 1990;63:451-7.
127. Quirynen M, Naert I, van Steenberghe D, Nys L. A study of 589 consecu-
tive implants supporting complete fixed prostheses. Part h periodontal
aspects. J Prosthet Dent 1992;68:655-63.
128. Buser D, Schenk RK, Steinemann S, Fiorellini JP, Fox CH, 5tich H. Influ~
ence of surface characteristics on bone integration of titanium implants. A
histomorphometric study in miniature pigs. J Biomed Mater Res
1991 ;25:889-902.
129. ten Bruggenkate CM, Sutter F, Oosterbeek HS, Schroeder A. Indications
for angled implants. J Prosthet Dent 1992;67:85-93.
130.8user D, Weber HP, Bragger U, Balsiger C. Tissue integration of one-stage
ITI implants: 3-year results of a longitudinal study with Hollow-Cylinder
and Hollow-Screw implants. Int J Oral Maxillofac Implants 1991 ;6:405~12.
131. Listgarten MA, Lang NP, Schroeder HE, Schroeder A. Periodontal tissues
and their counterparts around endosseous implants. Clin Oral Implant Res
1991;2:1-19.
132. Buser D, Weber HP, Donath K, Fiore]lini JP, Paquette DW, williams RC.
Soft tissue reactions to non-submerged unloaded titanium implants in
beagle dogs, J Periodontol 1992;63:225~35.
133. Listgarten MA, 8user D, Steinemann SG, Donath K, Lang NP, Weber HP.
Light and transmission electron microscopy of the intact interfaces be-
tween non-submerged titanium-coated epoxy resin implants and bone or
gingiva. J Dent Res 1992;71:364-71.
134. Buser D, Weber HP, Lang NP. Tissue integration of non-submerged im-
plants. 1-Year results of a prospective study with 100 ITI hollow-cylinder
and hollow-screw implants. Clin Oral Implants Res 1990;1:33-40.
135. Buser D, Weber HP, Bragger U. The treatment of partially edentulous
patients with ITI hollow~screw implants: presurgical evaluation and surgi-
cal procedures~ [nt J Oral Maxillofac Implants 1990;5:165-75.
136. Sutter F, Schroeder A, Buser DA. The new concept of ITI hollow-cylinder
MARCH 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
and hollow-screw implants: Part I. Engineering and design. [nt ] Oral
Maxillofac Implants 1988;3:161-72.
137. Buser DA, Schroeder A, Sutter F, Lang NP. The new concept of ITI hollow-
cylinder and hollow~screw implants: Part 2. Clinical aspects, indications,
and early clinical results. Int J Oral Maxillofac Implants 1988;3:173-81.
138. Buser D, Warrer K, Karring T, Stich H. Titanium implants with a true peri-
odontal ligament: an alternative to osseointegrated implants? [nt J Oral
Maxi[Iofac Implants 1990;5:113~6.
139. Gotfredsen K, Hjorting-Hansen E, Budtz-Jorgensen E. Clinical and radio-
graphic evaluation of submerged and nonsubmerged implants in mon-
keys. Int J Prosthodont 1990;3:463-9.
140. gutter F, Weber HP, Sorensen J, Belser U. The new restorative concept of
the ITI dental implant system: design and engineering. Int j Perio Rest
Dent 1993;13:40%31.
141.Cochran DL, Douglas HB. Augmentation of osseous tissue around
nonsubmerged endosseous dental implants. Int J Perio Rest Dent
1993;13:507-19.
142. Weber HP, Fiore![ini JP. The biology and morphology of the implant~tissue
interface. Alpha Omegan 1992;85:61-4.
143. Weber HP, Buser D, Fiorellini JP, Williams RC. Radiographic evaluation of
crestal bone levels adjacent to nonsubmerged titanium implants. Clin Oral
Implants Res 1992;3:181-8.
144. Byland JH. Use of a reduction coping to restore nonparallel root form
abutments. A clinical report. J Prosthet Dent 1991 ;65:466-8.
145. Homoly P, Misch C. Case study: the implant supported fixed-detachable
denture bridge: the Steri-Oss PME abutment. Implant Quarterly 1991 ;win-
ter/spring: 1-4.
146. Buchs AU, Lee JG. Implants restored with traditional crown and bridge in
an edentulous maxilla. Implant Digest 1990-1991 ;winter:4-5.
147. Implant system. Clinical Research Associates Newsletter 1990; 14:1-2.
148. Implant update, cylinders & screws. Clinical ResearchAssociates Newslet-
ter 1991 ;! 5:1-4.
149. Rosenlicht J. Special surgical considerations in implant dentistry. Implant
Soc 1990;1:2-4.
150. Kwan JY, Meffert RM. Macroscopic, microscopic and spectrometric com-
parison of hydroxylapatite-coated dental implants. The implant Report
1990;2:38-44.
151. Hahn JA. The blade implant. J Am Dent Assoc 1990;121:394, 396, 400.
152. English CE, Adrian ED. A V.C.L. resin block coping implant transfer tech~
nique. Practical Perio Aesthet Dent 1990;2:43-7.
153. Cal[an DP. Use of human freeze-dried demineralized bone prior to im-
plantation. Part I. Practical Perio Aesthet Dent 1990;2:14-8.
154. Ca[lan DP. Use of human freeze-dried skin allograft material in dental im-
plant treatment. Part [I. Practical Perio Aesthet Dent 1990;2:43-6.
155. English CE. Use of the Steri-Oss PME abutment with a bar-retained
overdenture. Trends Tech Contemp Dent Lab 1990;7:75-80.
156. Hahn JA. A preliminary clinical evaluation of the Steri-Oss implant system.
Int J Oral Implant 1990;7:31-6.
157. Whittaker JM, James RA, Lozada J, Cordova C, GaRey DJ. Histological
response and clinical evaluation of heterograft and allograft materials in
the elevation of the maxillary sinus for the preparation of endosteal dental
implant sites. Simultaneous sinus elevation and root form implantation: an
eight-month autopsy report, j Oral Imp[anto[ 1989;15:141-4,
Reprint requests to:
DR. STEVENE. ECKERT
MAYOCLINIC
200 FIRSTSTREETSW
ROCHESTER,MN 55905
Copyright © 1997 by The Editorial Council of The Journal of Prosthetic Den-
tistrX
0022-3913/97/$5.00 + 0. 10/1/79250
279