Trial Outcomes & Findings for Short Implants - An Alternative to Bone Grafting? (NCT NCT01030523)

NCT ID: NCT01030523

Last Updated: 2023-04-06

Results Overview

Any implant that is removed after implant placement will be considered a failure, whatever the reason for removal. Implant survival will be evaluated clinically and radiographically by counting the number of remaining implants. Implant survival rate will be calculated by dividing the number of non-failures by the number of installed implant.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

101 participants

Primary outcome timeframe

5 years after permanent restoration

Results posted on

2023-04-06

Participant Flow

The study was amended to include a 10-year follow-up cohort where all subjects enrolled into the initial 5-year study were invited. In total 77 out of the initial 101 subjects consented and were enrolled into the 10-years extension cohort.

Unit of analysis: Implants

Participant milestones

Participant milestones
Measure
Short Implants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Initial Study (5 Years)
STARTED
50 67
51 70
Initial Study (5 Years)
COMPLETED
44 60
46 64
Initial Study (5 Years)
NOT COMPLETED
6 7
5 6
Follow-up Extension (10 Years)
STARTED
36 48
41 57
Follow-up Extension (10 Years)
COMPLETED
29 39
32 47
Follow-up Extension (10 Years)
NOT COMPLETED
7 9
9 10

Reasons for withdrawal

Reasons for withdrawal
Measure
Short Implants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Initial Study (5 Years)
Death
1
0
Initial Study (5 Years)
Lost to Follow-up
4
5
Initial Study (5 Years)
Implant failure
1
0
Follow-up Extension (10 Years)
Lost to Follow-up
5
4
Follow-up Extension (10 Years)
Withdrawal by Subject
1
3
Follow-up Extension (10 Years)
Adverse Event
1
2

Baseline Characteristics

Short Implants - An Alternative to Bone Grafting?

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Short Implants
n=50 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=51 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Total
n=101 Participants
Total of all reporting groups
Age, Continuous
50.2 years
STANDARD_DEVIATION 12.88 • n=99 Participants
50.5 years
STANDARD_DEVIATION 14.05 • n=107 Participants
50.4 years
STANDARD_DEVIATION 13.40 • n=206 Participants
Sex: Female, Male
Female
29 Participants
n=99 Participants
23 Participants
n=107 Participants
52 Participants
n=206 Participants
Sex: Female, Male
Male
21 Participants
n=99 Participants
28 Participants
n=107 Participants
49 Participants
n=206 Participants

PRIMARY outcome

Timeframe: 5 years after permanent restoration

Population: Outcome measure only applicable for the initial study (5 years) cohort.

Any implant that is removed after implant placement will be considered a failure, whatever the reason for removal. Implant survival will be evaluated clinically and radiographically by counting the number of remaining implants. Implant survival rate will be calculated by dividing the number of non-failures by the number of installed implant.

Outcome measures

Outcome measures
Measure
Short Implants
n=67 Implants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=70 Implants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Implant Survival Rate
66 Implants
70 Implants

SECONDARY outcome

Timeframe: Time of permanent restoration and 5 years after permanent restoration

Population: Initial study (5 years) cohort. At visit 10 (5-year follow-up visit) 44 subjects remained in the short implants group, and 46 subjects remained in the long implants group. 10 subjects within the short implants group had missing or unreadable radiographs and could thus not be included in the analysis. The corresponding number for long implants group was 9 subjects with missing and unreadable radiographs.

Marginal bone level will be determined from radiographs and expressed as the distance from a reference point on the implant to the most coronal bone-to-implant contact on the mesial and distal aspect of the implant. Marginal bone level expressed in millimetres at the 5 year follow-up visit will be compared to values obtained at delivery of permanent restoration. Positive value denotes gain of bone. Negative value denotes loss of bone.

Outcome measures

Outcome measures
Measure
Short Implants
n=44 Implants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=49 Implants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Average Marginal Bone Level (MBL) Change From Permanent Restoration on Implant Level
-0.12 Millimetre
Standard Deviation 0.535
-0.18 Millimetre
Standard Deviation 0.959

SECONDARY outcome

Timeframe: Time of permanent restoration and 10 years after permanent restoration

Population: Follow-up Extension (10 years) cohort. At visit 15 (10-year follow-up visit) 29 subjects remained in the short implants group, and 32 subjects remained in the long implants group. 7 subjects within the short implants group had missing or unreadable radiographs and could thus not be included in the analysis. The corresponding number for long implants group was 9 subjects with missing and unreadable radiographs.

Marginal bone level will be determined from radiographs and expressed as the distance from a reference point on the implant to the most coronal bone-to-implant contact on the mesial and distal aspect of the implant. Marginal bone level expressed in millimetres at the 10 year follow-up visit will be compared to values obtained for the 10-years cohort at delivery of permanent restoration. Positive value denotes gain of bone. Negative value denotes loss of bone.

Outcome measures

Outcome measures
Measure
Short Implants
n=28 implants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=23 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Average Marginal Bone Level (MBL) Change From Permanent Restoration on Implant Level
-0.12 Millimetre
Standard Deviation 0.68
-0.24 Millimetre
Standard Deviation 0.82

SECONDARY outcome

Timeframe: 5 years after permanent restoration

Population: Initial study (5 years) cohort. At visit 10 (5-year follow-up visit) 44 subjects remained in the short implants group, and 46 subjects remained in the long implants group. All subjects were included in the Intention-To-Treat population and were included in the analysis of BoP.

Bleeding on Probing will be evaluated at four aspects per implant, i.e. mesially, distally, buccally and palatinally by using a periodontal probe. BoP will be recorded as presence or absence (Yes or No) of bleeding when probing to the bottom of the pocket. The proportion of surfaces that show presence of bleeding will be calculated and presented on a subject level.

Outcome measures

Outcome measures
Measure
Short Implants
n=44 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=46 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Condition of Periimplant Mucosa Measured Through Bleeding on Probing (BoP)
18 Participants
23 Participants

SECONDARY outcome

Timeframe: 10 years after permanent restoration

Population: Follow-up Extension (10 years) cohort. At visit 15 (10-years follow-up visit) 29 subjects remained in the short implants group, and 32 subjects remained in the long implants group. All subjects were included in the ITT population and were included in the analysis of BoP.

Bleeding on Probing will be evaluated at four aspects per implant, i.e. mesially, distally, buccally and palatinally by using a periodontal probe. BoP will be recorded as presence or absence (Yes or No) of bleeding when probing to the bottom of the pocket. The proportion of surfaces that show presence of bleeding will be calculated and presented on a subject level for the 10-years extension cohort.

Outcome measures

Outcome measures
Measure
Short Implants
n=29 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=32 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Condition of Periimplant Mucosa Measured Through Bleeding on Probing (BoP)
16 Participants
23 Participants

SECONDARY outcome

Timeframe: Time of permanent restoration and 5 years after permanent restoration

Population: Initial study (5 years) cohort. At visit 10 (5-year follow-up visit) 44 subjects remained in the short implants group, and 46 subjects remained in the long implants group. One subject in the short implants group did not have baseline PPD and was not included in the PPD analysis.

PPD will be measured as the distance from the mucosal margin to the bottom of the probeable pocket in mm. A mean value will be calculated for each implant as well as for each subject. PPD changes in millimetres at the 5 year follow-up visit will be compared to values obtained at delivery of permanent restoration. Negative value denotes deeper pocket depth.

Outcome measures

Outcome measures
Measure
Short Implants
n=43 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=46 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Condition of Periimplant Mucosa Measure by Average Change in Probing Pocket Depth (PPD) From Permanent Restoration
-0.26 Millimetre
Standard Deviation 0.91
-0.43 Millimetre
Standard Deviation 1.02

SECONDARY outcome

Timeframe: Time of permanent restoration and 10 years after permanent restoration

Population: Follow-up Extension (10 years) cohort. At visit 15 (10-year follow-up visit) 29 subjects remained in the short implants group, and 32 subjects remained in the long implants group. All subjects were included in the ITT population and were included in the analysis of PPD.

PPD will be measured as the distance from the mucosal margin to the bottom of the probeable pocket in mm. A mean value will be calculated for each implant as well as for each subject. PPD changes in millimetres at the 10 year follow-up visit will be compared to values obtained at delivery of permanent restoration. Negative value denotes deeper pocket depth.

Outcome measures

Outcome measures
Measure
Short Implants
n=29 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=32 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Condition of Periimplant Mucosa Measure by Average Change in Probing Pocket Depth (PPD) From Permanent Restoration
-0.4 Millimetre
Standard Deviation 1.2
-0.7 Millimetre
Standard Deviation 1.5

SECONDARY outcome

Timeframe: At baseline (Visit 1 - screening and pre-surgical planning visit) and 5 years after permanent restoration

Population: Initial study (5 years) cohort. At visit 10 (5-year follow-up visit) 44 subjects remained in the short implants group, and 46 subjects remained in the long implants group. All subjects with available OHIP-values from baseline and 5 years after permanent restoration were included in the analysis of overall OHIP-49.

OHIP-49 is describing the consequences of different oral diseases and conditions. It contains 49 items (questions) divided into 7 domains which are; functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. OHIP-49 attempts to measure both the frequency and severity of oral problems on functional and psychosocial well-being. Responses are based on a Likert response, with scale range; 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often, for each of the 49 questions with a higher score being related to a worse outcome. To facilitate assessment of perceived severity of impacts, each statement has a weight derived using the Thurstone's paired comparison technique to reflect the relative importance of each statement. The overall OHIP-49 include all 49 questions with a total minimum score of 0 and a maximum total score of 196, with a higher score being related to a worse outcome.

Outcome measures

Outcome measures
Measure
Short Implants
n=33 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=35 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Change in Overall Oral Health Impact Profile (OHIP-49)
-12 score on a scale
Standard Deviation 26.3
-16.9 score on a scale
Standard Deviation 23.9

SECONDARY outcome

Timeframe: At baseline (Visit 1 - screening and pre-surgical planning visit) and 10 years after permanent restoration

Population: Follow-up Extension (10 years) cohort. At visit 15 (10-year follow-up visit) 29 subjects remained in the short implants group, and 32 subjects remained in the long implants group. All subjects with available OHIP-values from baseline and 10 years after permanent restoration were included in the analysis of overall OHIP-49.

OHIP-49 is describing the consequences of different oral diseases and conditions. It contains 49 items (questions) divided into 7 domains which are; functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. OHIP-49 attempts to measure both the frequency and severity of oral problems on functional and psychosocial well-being. Responses are based on a Likert response, with scale range; 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often, for each of the 49 questions with a higher score being related to a worse outcome. To facilitate assessment of perceived severity of impacts, each statement has a weight derived using the Thurstone's paired comparison technique to reflect the relative importance of each statement. The overall OHIP-49 include all 49 questions with a total minimum score of 0 and a maximum total score of 196, with a higher score being related to a worse outcome.

Outcome measures

Outcome measures
Measure
Short Implants
n=15 Participants
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants in Combination With Bone Grafting
n=16 Participants
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with bone grafting
Change in Overall Oral Health Impact Profile (OHIP-49)
-2.2 score on scale
Standard Deviation 19.1
-9.8 score on scale
Standard Deviation 16.3

Adverse Events

Short Implants - All Subjects, Including the 10-years Extension Cohort

Serious events: 6 serious events
Other events: 23 other events
Deaths: 1 deaths

Long Implants + Grafting - All Subjects, Including the 10-years Extension Cohort

Serious events: 7 serious events
Other events: 27 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Short Implants - All Subjects, Including the 10-years Extension Cohort
n=50 participants at risk
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants + Grafting - All Subjects, Including the 10-years Extension Cohort
n=51 participants at risk
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with grafing
Renal and urinary disorders
Kidney stone
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Cardiac disorders
Aorta stent
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Surgical and medical procedures
Knee replacement surgery
2.0%
1/50 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
0.00%
0/51 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Injury, poisoning and procedural complications
Car accident, back injury
2.0%
1/50 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
0.00%
0/51 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Cardiac disorders
Chest pain during dental surgery procedure
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Benign medular tumour
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Breast cancer
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Blood and lymphatic system disorders
Blood cancer
2.0%
1/50 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Musculoskeletal and connective tissue disorders
Fracture left shoulder
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Vascular disorders
Hematoma upper leg (hospitalization)
0.00%
0/50 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
2.0%
1/51 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Cardiac disorders
Heart valve replacement
2.0%
1/50 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
0.00%
0/51 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Pancreas cancer
2.0%
1/50 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
0.00%
0/51 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Musculoskeletal and connective tissue disorders
Leg fracture
2.0%
1/50 • Number of events 1 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
0.00%
0/51 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.

Other adverse events

Other adverse events
Measure
Short Implants - All Subjects, Including the 10-years Extension Cohort
n=50 participants at risk
ASTRA TECH Implant System, OsseoSpeed™ 4.0 S (length: 6 mm)
Long Implants + Grafting - All Subjects, Including the 10-years Extension Cohort
n=51 participants at risk
ASTRA TECH Implants System, OsseoSpeed™ implants (lengths: 11, 13, 15 mm) in combination with grafing
Product Issues
Abutment related event
24.0%
12/50 • Number of events 17 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
19.6%
10/51 • Number of events 11 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Investigations
Swollen after oral surgery
6.0%
3/50 • Number of events 3 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
15.7%
8/51 • Number of events 8 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Product Issues
Crown related event
16.0%
8/50 • Number of events 11 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
17.6%
9/51 • Number of events 9 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
Cardiac disorders
Hypertension
4.0%
2/50 • Number of events 2 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.
5.9%
3/51 • Number of events 3 • From enrollment up to study termination, i.e. up to 5 years post permanent restoration for subjects not consenting to the study prolongation, and up to 10 years post permanent restoration for the 10-years extension cohort.

Additional Information

Manager of Global Clinical Research

Dentsply Sirona Implants

Phone: +46313763500

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place