Interpretation and Comparison With Other Studies
infection, implant loss, pain
INFECTION
Most investigations concerning the wide-diameter implant are retrospective studies without a control group or small pilots, all with a relatively short-term follow-up (Implant stability as measured by RFA was initially chosen as the primary outcome measure. To date, RFA is still the only objective technique available to measure implant stability. However, as Nelissen et al. (During this study, ISQ values were measured consequently for 10 years. Indeed, the patients who lost their implant during follow-up because of decreased bone quality (e.g., due to radiotherapy to implant site) or infection showed a downward trend in ISQ values. Remarkably, the ISQ values seemed to disperse increasingly over time. This remarkable dispersion appeared particularly in our groups A and C, which matches their higher implant loss rate but makes us question the value of RFA, besides its objectiveness, even more. This study again emphasizes that ISQ changes must be considered not only over the “longer run” but also together with clinical information about the patient. When a patient reports (chronic) pain at the implant site and a periprosthetic infection is plausible, ISQ could be of added value in predicting implant loss. Bearing this in mind, implant loss remains the most evident, and therefore most relevant, outcome measure. This study underlines that implant loss can still occur after years but with shallow risk. This risk is significantly reduced after implantation with a wide-diameter implant. Furthermore, and of clinical importance, implant loss risk did not increase in wide implants loaded 3 weeks after surgery. This result confirms that loading the implant with the sound processor 3 weeks after surgery is safe.Lastly, the question arises whether it is safe to reduce loading times even further. In the light of patient-centered care, it is essential to take the patients' preferences and perspectives regarding postsurgical loading time into account. Caspers et al. (