Tag Archives: dental implants

A Long-term Retrospective Analysis of Survival Rates of Implants in the Mandible

Balshi TJ, Wolfinger GJ, Stein BE, Balshi SF.

Int J Oral Maxillofac Implants. 2015 Nov-Dec;30(6):1348-54. doi: 10.11607/jomi.3910.



To retrospectively analyze the survival rate of endosseous dental implants placed in the edentulous or partially edentulous mandible over a long-term follow-up period of 10 years or more.


The charts of patients who underwent mandibular implant placement at a private prosthodontics practice and received follow-up care for 10 years or more were included in this study. Implants were examined according to the following study variables: patient sex, patient age, degree of edentulism (fully vs partially edentulous), implant location, time of loading (delayed vs immediate), implant size and type, bone quality, prosthesis type, and the presence of other implants during placement.


The study sample was composed of 2,394 implants placed in 470 patients with 10 to 27 years of follow-up. Of these 2,394 implants, 176 failed, resulting in an overall cumulative survival rate (CSR) of 92.6%. A total of 1,482 implants were placed in edentulous mandibles, and 912 implants were placed in partially edentulous mandibles, with CSRs of 92.6% and 92.7%, respectively. Comparisons of the study variables with respect to CSR were largely nonsignificant. However, there were significant differences in CSRs between anterior vs posterior locations and rough- vs smooth-surfaced implants in addition to some prosthesis types, ages, and bone qualities. The overall CSR of 92.6% in the present study is high and comparable to survival rates observed in previous long-term analyses of mandibular implants. The significant differences observed between implant locations, patient age groups, bone qualities, and prostheses were not suggestive of any remarkable trends.


Patient sex, age, degree of edentulism, implant location, time of loading, implant size and type, bone quality, prosthesis type, and the presence of multiple implants did not result in any significant effect on long-term implant survival. The CSR observed after 10 to 27 years of follow-up in a single private prosthodontic center was high (92.6%) and supports the use of endosseous dental implants as a long-term treatment option for the rehabilitation of the edentulous and partially edentulous mandible.

A Long-term Retrospective Analysis of Survival Rates of Implants in the Mandible in PDF Format

Complete Oral Rehabilitation With Implants Using CAD/CAM Technology, Stereolithography, and Conoscopic Holography

Robert M. Bentz, DMD, and Stephen F. Balshi, MBE

Implant Dentistry, Volume 21 • Number 1.

A 64-year-old totally edentulous female initially presented with ill fitting removable prostheses. A comprehensive treatment plan with dental implants was accepted by the patient. Clinical and laboratory procedures were executed using various computer technologies including computed tomography, rapid prototyping, and optical scanning using conoscopic holography. A review of the patient’s treatment and various modalities used are the focus of this patient report.

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Oral Rehabilitation and Psychosocial Evaluation of a Patient with Bulimia Nervosa Following Teeth in a Day® Immediate Loading Protocol

Thomas J. Balshi, DDS, PhD, FACP; Glenn J. Wolfinger, DMD, FACP; Stephen G. Alfano, DDS, MS, FACP; J. Neil Della Croce, DMD, MS; and Stephen F. Balshi, MBE

Compendium, April 2015, Volume 36, Issue 4 – Published by AEGIS Communications

PURPOSE: The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation.
MATERIALS AND METHODS: A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient’s existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature.
RESULTS: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement. CONCLUSION: In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient’s body image profile was no longer considered to be significantly different from established normative values.

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Management of Soft Tissue Irritation Around Exposed Zygomatic Implant in a Hemimaxillectomy Patient: A Technical Report

Int J Oral Maxillofac Implants. 2014 Dec 5. doi: 10.11607/jomi.3615. [Epub ahead of print]

Balshi TJ, Wolfinger GJ, Balshi SF.

Patients missing portions or all of the maxillary alveolar bone who are restored with zygomatic implants frequently have threads exposed that can be a mucosal irritant. If such irritation is reported, covering the threads with a highly polished titanium sleeve is recommended. The technique of placing said custom sleeve is described. This adjunctive treatment method has eliminated mucosal irritation.

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Zygomatic implants as a rehabilitation approach for a severely deficient maxilla

Al-Thobity AM, Wolfinger GJ, Balshi SF, Flinton RJ, Balshi TJ.

Int J Oral Maxillofac Implants. 2014 Nov-Dec;29(6):e283-9. doi: 10.11607/jomi.3662. Epub 2014 Aug 20.

Abstract: A gunshot injury is one of the main trauma injuries that affect the head and neck region. Severe esthetic, functional, and psychologic deficiencies are consequences of gunshot injuries. The use of implants anchored in the zygomatic bone has been advocated as an approach to the prosthetic rehabilitation of a severely deficient maxilla. This approach provides the patient with an immediate, high-quality, esthetic, and functional complete fixed prosthesis and eliminates the need for bone grafting. In this case report, a patient with a severely deficient maxilla caused by a gunshot injury was rehabilitated by placement of  four zygomatic and two pterygomaxillary implants, which were immediately loaded with a complete fixed all-acrylic resin interim prosthesis. The definitive CM Prosthesis (CM Prosthetics) was constructed using computer-aided design/computer-assisted manufacture (CAD/CAM) technology.

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A Retrospective Analysis of 800 Brånemark System Implants Following the All-on-Four™ Protocol

Thomas J. Balshi, DDS, PhD, FACP, Glenn J. Wolfinger, DMD, FACP,  Robert W. Slauch, BS, & Stephen F. Balshi, MBE

J Prosthodont. The American College of Prosthodontists J Prosthodont. 23 (2014) 83–88.

Purpose: The purpose of this study was to retrospectively evaluate implant survival rates in patients treated with the All-on-Four™ protocol according to edentulous jaws, gender, and implant orientation (tilted vs. axial). Materials and Methods: All Brånemark System implants placed in patients following the All-on-Four™ protocol in a single private practice were separated into multiple classifications (maxilla vs. mandible; male vs. female; tilted vs. axial) by retrospective patient chart review. Inclusion criteria consisted of any Brånemark System implant placed with the All-on-Four™  protocol from the clinical inception (May 2005) until December 2011. Life tables were constructed to determine cumulative implant survival rates (CSR). The arches, genders, and implant orientations were statistically compared with ANOVA.

Results: One hundred fifty-two patients, comprising 200 arches (800 implants) from May 2005 until December 2011, were included in the study. Overall implant CSR was 97.3% (778 of 800). Two hundred eighty-nine of 300 maxillary implants and 489 of 500 mandibular implants survived, for CSRs of 96.3% and 97.8%, respectively. In male patients, 251 of 256 implants (98.1%) remain in function while 527 of 544 implants (96.9%) in female patients survived. Regarding implant orientation, 389 of 400 tilted implants and 389 of 400 axial implants osseointegrated, for identical CSRs of 97.3%. All comparisons were found to be statistically insignificant. The prosthesis survival rate was 99.0%.

Conclusions: The results from this study suggest that edentulous jaws, gender, and implant orientation are not significant parameters when formulating an All-on-Four™ treatment plan. The high CSRs for each variable analyzed demonstrate the All-on- Four™ treatment as a viable alternative to more extensive protocols for rehabilitating the edentulous maxilla or mandible.

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Treatment of a severely atrophic maxilla using an immediately loaded, implant-supported fixed prosthesis without the use of bone grafts: A clinical report

Jeffrey S. Sherry, Thomas J. Balshi, Lawrence O. Sims, Stephen F. Balshi

JPD, Volume 103, Issue 3, Pages 133-194 (March 2010) Pages 133-138.

This report describes a clinical approach to using the zygomatic and pterygomaxillary bones to provide additional anchorage for longer implants to support an immediately functional maxillary screw-retained provisional fixed prosthesis. The purpose is to report the problems of patients who have experienced the most severe form of maxillary alveolar resorption and to demonstrate a specific protocol which provides immediately loaded implants without bone grafting.

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A Retrospective Analysis of 110 Zygomatic Implants in a Single-Stage Immediate Loading Protocol

Int J Oral Maxillofac Implants.Vol 24, No. 2, 335-341, 2009.

Balshi SF, Wolfinger GJ, Balshi TJ
Institute for Facial Esthetics, Prosthodontics Intermedica, Fort Washington, Pennsylvania, USA.

This clinical study using a specific technique was carried out to determine the clinical effectiveness of zygomatic implants under an immediate loading protocol. All patients treated between May 2000 and October 2006 who received zygomatic implants were included in this retrospective analysis. All patients were treated using the same surgical and restorative protocol. The following data were recorded: gender, age, type of implant, number of implants placed, dimensions of implants, and implant and prosthesis survival. Fifty-six consecutive patients (29 women, 27 men; mean age of 60.58 years [range, 38.78 to 84.01]) were treated. All were in need of oral reconstruction and had maxillary atrophy that warranted zygomatic implant placement. One hundred ten zygomatic implants were placed in these 56 patients. Four of the 110 zygomatic implants failed, resulting in a cumulative survival rate of 96.37% with follow-up data no less than 9 months and in excess of 5 years. All four failures were turned-surface zygomatic implants. There have been no failures to date with the titanium anodized-surface zygomatic implants. The prosthesis survival rate was 100.0%. In this retrospective analysis of 56 patients receiving 110 zygomatic implants, the survival rate of zygomatic implants was in excess of 96% over a period of 9 months to 5 years. This technique resulted in a stable and predictable prosthetic reconstruction.

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Case of the Month: No Bone Solution™ Computer Guided Implant Surgery Protocol for Prosthodontic Rehabilitation of the Severely Atrophic Maxilla

Thomas J. Balshi, DDS, PhD, FACP, Glenn J. Wolfinger, DMD, FACP, John J. Thaler, James R. Bowers, Stephen F. Balshi

The Journal of Implant and Advanced Clinical Dentistry, Volume 1, No. 2, April 2009.

Background: Prosthodontic rehabilitation of the severely atrophic maxilla presents significant challenges to the restoring dental team. Inadequate bone quantity often necessitates time dependent augmentation procedures that considerably delay delivery of the final dental prostheses. This case report demonstrates a newly developed specialized  computer guided dental implant surgery protocol for prosthetic rehabilitation of the severely atrophic maxilla: the No Bone Solution.™

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