title: Two-year outcome with Nobel Direct implants: a retrospective radiographic and microbiologic study in 10 patients.
abstract: BACKGROUND
  The Nobel Direct implant (Nobel Biocare AB, Göteborg, Sweden) was developed to minimize marginal bone resorption and to result in "soft tissue integration" for an optimized aesthetic outcome. However, conflicting results have been presented in the literature. The aim of this present study was to evaluate the clinical and microbiologic outcomes of Nobel Direct implants.
  
  
  METHODS
  Ten partially edentulous subjects without evidence of active periodontitis (mean age 55 years) received 12 Nobel Direct implants. Implants were loaded with single crowns after a healing period of 3 to 6 months. Treatment outcomes were assessed at month 24. Routine clinical assessments, intraoral radiographs, and microbiologic samplings were made. Histologic analysis of one failing implant and chemical spectroscopy around three unused implants was performed. Paired Wilcoxon signed-rank test was used for the evaluation of bone loss; otherwise, descriptive analysis was performed.
  
  
  RESULTS
  Implants were functionally loaded after 3 to 6 months. At 2 years, the mean bone loss of remaining implants was 2.0 mm (SD +/- 1.1 mm; range: 0.0-3.4 mm). Three out of 12 implants with an early mean bone loss >3 mm were lost. The surviving implants showed increasing bone loss between 6 and 24 months (p = .028). Only 3 out of the 12 implants were considered successful and showed bone loss of <1.7 mm after 2 years. High rates of pathogens, including Aggregatibacter actinomycetemcomitans, Fusobacterium spp., Porphyromonas gingivalis, Pseudomonas aeruginosa, and Tanerella forsythia, were found. Chemical spectroscopy revealed, despite the normal signals from Ti, O, and C, also peaks of P, F, S, N, and Ca. A normal histologic image of osseointegration was observed in the apical part of the retrieved implant.
  
  
  CONCLUSIONS
  Radiographic evidence and 25% implant failures are indications of a low success rate. High counts and prevalence of significant pathogens were found at surviving implants. Although extensive bone loss had occurred in the coronal part, the apical portion of the implant showed some bone to implant integration.
authors.affiliation: Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, University of Ghent, Ghent B-9000, Belgium.
authors.forename: Tommie
authors.initials: T
authors.lastname: Van de Velde
authors.forename: Eric
authors.initials: E
authors.lastname: Thevissen
authors.forename: G Rutger
authors.initials: GR
authors.lastname: Persson
authors.forename: Carina
authors.initials: C
authors.lastname: Johansson
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
mesh_terms: D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology*; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D003442:Crowns; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants / Q000009:adverse effects* / Q000382:microbiology*; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D005260:Female; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D015921:Dental Implants