The effects of local factors on the survival of dental implants: A 19 year retrospective study

Sung Hoi Kim; Sunjai Kim; Keun-Woo Lee; Dong-Hoo Han

doi:10.4047/jkap.2010.48.1.28

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Kim, Kim, Lee, and Han: The effects of local factors on the survival of dental implants: A 19 year retrospective study

ORIGINAL ARTICLE

J Korean Acad Prosthodont 2010;48(1):28-40.

Published online: 18 December 2010

DOI: https://doi.org/10.4047/jkap.2010.48.1.28

The effects of local factors on the survival of dental implants: A 19 year retrospective study

Sung Hoi Kim, , Sunjai Kim, DDS, MSD, PhD, Keun-Woo Lee, MSD, DDS, PhD, Dong-Hoo Han, MSD, DDS, PhD^∗

Department of Prosthetic Dentistry, The Graduate School, Yonsei University, Seoul, Korea

∗Corresponding Author: Dong-Hoo Han Department of Prosthodontics, College of Dentistry, Yonsei University, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea +82 2 2228 3163: e-mail, donghoohan@yuhs.ac

Received 1 December 20094 January 2010 Accepted 15 January 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this retrospective study was to provide long-term data about the correlation between multifactorial local factors and the survival of implants.

Material and methods

During 19 years (1991 to 2009), 2796 implants were placed in 879 patients. From dental charts and radiographs, the following data were collected: patient's age at implant placement, gender, implant system, surface, length, diameter, location of implant placement, bone quality, primary stability, type of prosthesis. The correlations between these data and implant survival were analyzed. Statistical analysis was performed using Kaplan-Meier survival analysis, Chi-square test, odds ratio.

Results

1. Among the 2796 implants, 150 implants failed that resulted in a cumulative survival rate of 94.64%. The cumulative survival rate of smooth surface implants (91.76%) was lower than rough surface implants (96.02%). 2. Anatomic location, implant surface, diameter of smooth surface implant, primary stability, type of prosthesis, patient's age and gender were significantly associated with implant survival (P < .05). 3. No significant difference in implant survival was found in relation to the following factors: implant length, bone quality, diameter of rough surface implants and type of rough surface according to implant manufacturer (P < .05).

Conclusions

Local factors such as anatomic location, implant surface, diameter of smooth surface implant, primary stability and type of prosthesis have a significant effect on implant survival. (J Korean Acad Prosthodont 2010;48:28-40)

Keywords: Dental implants, Implant failure, Rough surface implants, Smooth surface implants, Location, Primary stability, Type of prosthesis

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Fig. 1.

The distributions of the placed implants according to patients’ age and gender.

Fig. 2.

Distribution of the placed implants according to implant company and surface.

Fig. 3.

Distribution of the placed implants according to location and implant surface.

Fig. 4.

Distribution of the placed implants according to implant length and surface.

Fig. 5.

Distribution of the placed implants according to implant diameter and surface.

Fig. 6.

Distribution of the placed implants according to type of prosthesis.

Fig. 7.

Kaplan- Meier curves for implant survival, by type of implant surface.

Fig. 8.

Kaplan- Meier curves for implant survival, by type of implant company and surface.

Table I.

The distribution of the placed implants according to location and bone type

	Smooth surface n (%)	Rough surface n (%)	Total n (%)
Location
Ant. Mx.	152 (16.70)	220 (11.66)	372 (13.30)
Post. Mx.	233 (25.60)	638 (33.83)	871 (31.15)
Ant. Mn.	63 (6.92)	80 (4.24)	143 (5.12)
Post. Mx.	462 (50.77)	948 (50.27)	1410 (50.43)
Bone type
Type I	28 (3.08)	45 (2.39)	73 (2.61)
Type II	67 (7.36)	1130 (59.92)	1197 (42.81)
Type III	62 (6.81)	326 (17.29)	388 (13.88)
Type IV	41 (4.51)	47 (2.49)	88 (3.15)
Unknown	712 (78.24)	38 (17.92)	1050 (37.55)
Total	910 (100)	1886 (100)	2796 (100)

Ant.: anterior; Post.: posterior; Mx.: maxilla; Mn.: mandible

Table II.

The distribution of the placed implants according to implant diameter and length

	Smooth surface n (%)	Rough surface n (%)	Total n (%)
Length (mm)
< 10	86 (9.45)	185 (9.81)	271 (9.69)
10 - 15	787 (86.48)	1679 (89.02)	2466 (88.20)
> 15	37 (4.07)	22 (1.17)	59 (2.11)
Diameter (mm)
< 3.75	17 (1.87)	95 (5.04)	112 (4.00)
3.75 - 4.5	709 (77.91)	943 (50.00)	1652 (59.09)
> 4.5	184 (20.22)	848 (44.96)	1032 (36.91)
Total	910 (100)	1886 (100)	2796 (100)

Table III.

The distribution of the placed implants according to primary stability

	Smooth surface n (%)	Rough surface n (%)	Total n (%)
Excellent	36 (3.96)	668 (35.42)	704 (25.18)
Good	44 (4.84)	467 (24.76)	511 (18.28)
Fair	11 (1.21)	182 (9.65)	193 (6.90)
Poor	15 (1.65)	23 (1.22)	38 (1.36)
Unknown	804 (88.35)	546 (28.95)	1350 (48.28)
Total	910 (100)	1886 (100)	2796 (100)

Table IV.

The distribution of the placed implants according to type of prosthesis

	Smooth surface n (%)	Rough surface n (%)	Total n (%)
Single crown	105 (11.99)	364 (19.85)	469 (17.31)
FPD	677 (77.28)	1289 (70.28)	1966 (72.55)
Overdenture	87 (9.93)	170 (9.27)	257 (9.48)
Telescopic denture	7 (0.80)	11 (0.60)	18 (0.66)
Total	876 (100)	1834 (100)	2710 (100)

Table V.

Timing of implant failure according to implant surface

	Smooth surface (% row) (% column)	Rough surface (% row (% column)	w) Total (% row) (% column)
Early failure	34 (39.53)	52 (60.47)	86 (100)
	(45.33)	(69.33)	(57.33)
Late failure	41 (64.06)	23 (35.94)	64 (100)
	(54.67)	(30.67%)	(42.67)
Total	75 (50)	75 (50)	150
	(100)	(100)

Table VI.

Survival rate according to patient related factor (age, gender)

	Placed implant (n)	Failed Implant (n)	CSR (%)	P - value	Odds ratio	95% CI
Total	2796	150	94.64
Age
< 40	532	12	97.74	0.001	1.00	1.00^a,b
40 - 59	1373	78	94.32		2.6	1.41, 4.83^a
60 - 79	855	59	93.10		3.21	1.71, 6.03^b
> 79	36	1	97.22		1.24	0.16, 9.80
Gender
Male	1431	91	93.64	0.0188	1.00	1.00^c
Female	1365	59	95.68		0.67	0.48, 0.93^c

CSR: cumulative survival rate Groups with same superscripts are significantly different at P < .05.

Table VII.

Survival rate according to implant surface and company

Placed implant (n)	Failed	CSR (%)	P- value	Odds ratio	95% CI
Implant (n)
Total 2796	150	94.64
Surface
Smooth 910	75	91.76	0.0039	1.00	1.00^a
Rough 1886	75	96.02		0.46	0.33, 0.64^a
Company, surface
Brarnemark^® 910 machined	75	91.76	<.0001	1.00	1.00^b,c
Brarnemark^® 246 Ti-Unite	7	97.15		0.33	0.15, 0.72^b
ITI^®, SLA 864	23	97.33		0.30	0.19, 0.49
ITI^®, TPS 24	1	95.83		0.48	0.06, 3.63
Replace^® 28 Ti-Unite	2	92.86		0.86	0.20, 3.68
Replace^® 24 acid etched	3	87.50		1.59	0.46, 5.46
Silhouette^® 693 RBM	37	94.66		0.63	0.42, 0.94
Etc. 6	2	66.67		5.57	1.00, 30.8^c

Groups with same superscripts are significantly different at P < .05.

Table VIII.

Survival rate according to implant surface and location

	Placed implant (n)	Failed Implant (n)	CSR (%)	P- value	Odds ratio	95% CI
Total	2796	150	94.64
Ant. Mx.	372	24	93.55	<.0001	1.00	1.00^a
Post. Mx.	871	77	91.16		1.41	0.87, 2.26^b,c
Ant. Mn.	143	1	99.30		0.10	0.01, 0.76^a,b
Post. Mn.	1410	48	96.60		0.51	0.31, 0.85^c
Smooth surface	910	75	91.76
Ant. Mx.	153	11	92.81	0.0042	1.00	1.00
Post. Mx.	218	31	85.78		2.14	1.04, 4.40^d,e
Ant. Mn.	64	1	98.44		0.20	0.03, 1.62^d
Post. Mn.	475	32	93.26		0.93	0.46, 1.90^e
Rough surface	1886	75	96.02
Ant. Mx.	219	13	94.06	< .0001	1.00	1.00^f
Post. Mx.	653	46	92.96		1.20	0.63, 2.27^g
Ant. Mn.	79	0	100.00		0.94	0.91, 0.97
Post. Mn.	935	16	98.29		0.28	0.13, 0.58^f.g

Ant., anterior; Post., posterior; Mx, maxilla; Mn., mandible. Groups with same superscripts are significantly different at P < .05.

Table IX.

Survival rate according to implant surface and length

	Placed implant (n)	Failed Implant (n)	CSR (%)	P- value	Odds ratio	95% CI
Total	2796	150	94.64
< 10	271	19	92.99	0.2447	1.00	1.00
10 - 15	2466	125	94.93		0.71	0.43, 1.17
> 15	59	6	89.83		1.50	0.57, 3.93
Smooth surface	910	75	91.76
< 10	83	7	91.57	0.8494	1.00	1.00
10 - 15	781	63	91.93		0.95	0.42, 2.15
> 15	46	5	89.13		1.30	0.40, 4.44
Rough surface	1886	75	96.02
< 10	188	12	93.62	0.1984	1.00	1.00
10 - 15	1685	62	96.32		0.56	0.30, 1.06
> 15	13	1	92.31		1.22	0.15, 10.20

There are no significant differences between the implant length and the survival rate. Therefore, the odds ratio is not available.

Table X.

Survival rate according to implant surface and diameter

	Placed implant (n)	Failed Implant (n)	CSR (%)	P- value	Odds ratio	95% CI
Total	2796	150	94.64
< 3.75	112	1	99.11	0.041	1.00	1.00
3.75 - 4.5	1652	86	94.79		6.10	0.84, 44.18
> 4.5	1032	63	93.90		7.22	0.99, 52.54
Smooth surface	910	75	91.76
< 3.75	14	0	100.00	0.0079	1.00	1.00^a
3.75 - 4.5	737	52	92.94		1.08	1.05, 1.10^a
> 4.5	159	23	85.53		1.17	1.10, 1.25
Rough surface	1886	75	96.02
< 3.75	98	1	98.98	0.2011	1.00	1.00
3.75 - 4.5	915	34	96.28		3.74	0.51, 27.65
> 4.5	873	40	95.42		4.66	0.63,34.26

Groups with same superscripts are significantly different at P < .05.

Table XI.

Survival rate according to implant surface and bone quality

	Placed implant (n)	Failed Implant (n)	CSR (%)	P - value	Odds ratio	95% CI
Total	2796	150	94.64
Type I	73	2	97.26	0.144	1.00	1.00
Type II	1197	52	95.66		1.61	0.38, 6.75
Type III	388	25	93.56		2.44	0.57, 10.55
Type IV	88	9	89.77		4.04	0.85, 19.35
Unknown	1050	62	94.64	-	-	-
Smooth s.	910	75	91.76
Type I	28	1	96.43	0.4744	1.00	1.00
Type II	67	5	92.54		2.18	0.24, 19.54
Type III	62	8	87.10		4	0.48, 33.64
Type IV	41	5	87.80		3.75	0.41, 33.99
Unknown	712	56	92.13	-	-	-
Rough s.	1886	75	96.02
Type I	45	1	97.78	0.4181	1.00	1.00
Type II	1130	47	95.84		1.91	0.26, 14.16
Type III	326	17	94.79		2.42	0.31, 18.64
Type IV	47	4	91.49		4.093	0.44, 38.11
Unknown	338	6	98.23	-	-	-

There are no significant differences between the bone quality and the survival rate. Therefore, the odds ratio is not available. Smooth s., smooth surface; Rough s., rough surface.

Table XII.

Survival rate according to implant surface and primary stability

	Placed implant (n)	Failed Implant (n)	CSR (%)	P- value	Odds ratio	95% CI
Total	2796	150	94.64
Excellent	704	27	96.16	< .0001	1.00	1.00^a,b,c
Good	511	20	96.09		1.02	0.57, 1.84^d,e
Fair	193	20	89.64		2.90	1.59, 5.29^b,d,f
Poor	38	11	71.05		10.22	4.59, 22.73^c,e,f
Unknown	1350	72	94.67	-	-	-
Smooth s.	910	75	91.76
Excellent	36	2	94.44	0.0187	1.00	1.00
Good	44	3	93.18		1.24	0.20, 7.88^g
Fair	11	1	90.91		1.70	0.14, 20.75
Poor	15	5	66.67		8.50	1.43, 50.66^g
Unknown	804	64	92.04	-	-	-
Rough s.	1886	75	96.02
Excellent	668	25	96.26	<.0001	1.00	1.00^h,i
Good	467	17	96.36		0.97	0.52, 1.82^j,k
Fair	182	19	89.56		3.00	1.61, 5.5^h,j
Poor	23	6	73.91		9.08	3.30, 24.99^i,k
Unknown	546	8	98.53	-	-	-

Smooth s.: smooth surface; Rough s.: rough surface Groups with same superscripts are significantly different at P < .05.

Table XIII.

Survival rate according to implant surface and type of prosthesis

	Placed implant (n)	Failed Implant (n)	CSR (%)	P- value	Odds ratio	95% CI
Total	2796	150	94.64
SC	469	13	97.23	< .0001	1.00	1.00^a
FPD	1966	30	98.47		0.62	0.32, 1.18^b
OD	257	13	94.94		2.03	0.94, 4.39^c
TD	18	8	55.56		31.57	10.98, 90.75^a,b,c
Smooth s.	910	75	91.76
SC	105	6	94.28	< .0001	1.00	1.00^d
FPD	677	22	96.75		0.55	0.22, 1.40^e
OD	87	8	90.80		1.67	0.56, 5.01^f
TD	7	5	28.57		49.5	8.18, 299.46^d,e,f
Rough s.	1886	75	96.02
SC	364	7	98.08	<.0001	1.00	1.00^g
FPD	1289	8	99.38		0.48	0.19, 1.22^h
OD	170	5	97.06		1.88	0.62, 5.67ⁱ
TD	11	3	72.73		19.13	4.17, 87.72^g,h,i

Groups with same superscripts are significantly different at P < .05. SC, implant supported single crown; OD, overdenture; FPD, implant supported fixed partial denture; TD, telescopic denture; Smooth s., smooth surface; Rough s., rough surface.

Table XIV.

Survival rate according to implant surface and type of overdenture

	Placed implant (n)	Failed Implant (n)	CSR t (%)	P- value	Odds ratio	95% CI
Total	257	13	94.94
SO	192	2	98.96	0.0024	1.00	1.00^a
RO	65	11	83.08		5.1930	1.63, 16.50^a
Smooth surface	e 87	8	90.8
SO	47	2	95.74	0.0156	1.00	1.00^b
RO	40	6	85.00		3.9706	0.75, 20.91^b
Rough surface	170	5	97.06
SO	145	0	100.00	0.0598	1.00	1.00
RO	25	5	80.00	0.0598	4.0580	0.64, 25.62

Groups with same superscripts are significantly different at P < .05. SO: implant supported overdenture; RO: implant retained overdenture

Table XV.

Survival rate according to type of prosthesis, implant surface and location

Type of Prosthesis	Implant surface	Location
		Maxilla			Mandible
		Placed (n)	Failed (n)	CSR (%)	Placed (n)	Failed (n)	CSR (%)
Single crown	Machined Rough	61 170	2 5	96.72 97.06	44 194	4 2	90.91 98.97
FPD	Machined Rough	227 534	9 6	96.04 98.88	450 755	13 2	97.11 99.74
Supported	Machined	31	2	93.55	16	0	100
overdenture	Rough	97	3	96.91	48	0	100
Retained	Machined	29	6	79.31	11	0	100
overdenture	Rough	20	2	90.00	5	0	100
Telescopic	Machined	5	5	0	2	0	100
denture	Rough	11	3	72.73	0	0	-

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