Consensus report: Towards optimized treatment outcomes for dental implants

Edited by George A. Zarb and Tomas Albrektsson

The following report describes the proceedings of the

Toronto Symposium, April 24 and 25, 1998, held at the
University of Toronto, Ontario, Canada.
This report seeks to articulate those clear and reproducible determinants which identify successful treatment outcome measures for implants supporting functioning dental prostheses. In an attempt to reach this
objective, each of the four groups was provided with
printed material to use as a starting point or scaffolding
for focused debate. The material comprised the originally proposed Albrektsson et al. (1986) and Smith and
Zarb (1989) Success Criteria, plus the Guckes et al.
(1996) Classification of Treatment Outcomes in
Implant Therapy. The participants were given instructions to massage, edit, replace, etc., any or all of the
original criteria; to consider merits of a set of patientmediated criteria from dentist-mediated ones (although
it was clear that responsible professional behavior had
recognized the twin concerns); and finally to address
the question of the need to identify specific and relevant soft-tissue criteria.
Group A was co-chaired by Drs. Franks and Lloyd
and ably assisted by Dr. Anderson. They concluded that
all future implant research must include patient-based
outcomes that reflect degrees of satisfaction with treatment, quality of life, oral health status, selected morbidities, and economic impact. They also proposed that
criteria derived from patient-based outcome measures
should be recorded in terms relative to expectations
and hopes, so as to permit an estimate of anticipated
benefit and judgment of success. While it was self-evident that the outcome criteria employed to date did
not preclude patient-mediated concerns, it was emphasized that the latter required more rigorous compilation of quantifiable data to ensure informed clinical
decisions.
Groups B, C and D were chaired by Drs. Laskin and
Laney, Drs. McGivney and Fritz, and Drs. Becker and
Weber, respectively. Their approach emphasized the
other side of the coin of therapeutic outcomes, namely
dentist-mediated concerns. This was achieved by build-

ing upon a critical assessment of criteria available to

date. It was also recognized that individual implant success should not be assessed separately from an answer
to the most compelling question of all: did the implant
prescription yield a successful prosthodontic result?
The following conditions for criteria application for
successful outcomes with implant-supported prostheses
are proposed:
(1) Implant therapy is prescribed to resolve prosthodontic problems by permitting diverse prosthodontic
treatments, which in turn impact upon the economics
of the service. Such prostheses should allow for routine
maintenance and should permit planned or unplanned
revisions of the existing design. Treatment outcome
success criteria for implant-supported prostheses
should also be assessed in the context of time dependent considerations for any required retreatment.
(2) Criteria for implant success apply to individual
endosseous implants, and
(a) At the time of testing, the implants have
been under functional loading;
(b) All implants under investigation must be
accounted for;
(c) Since a gold standard for mobility assessment is currently unavailable, the method used
must be specifically described in operative terms;
(d) Radiographs to measure bone loss should
be standard periapical films with specified reference points and angulations.
The success criteria comprise the following determinants:
(1) The resultant implant support does not preclude
the placement of a planned functional and esthetic
prosthesis that is satisfactory to both patient and dentist.
(2) There is no pain, discomfort, altered sensation or
infection attributable to the implants.
(3) Individual unattached implants are immobile
when tested clinically.
(4) The mean vertical bone loss is <0.2 mm annually following the first year of function.

Copyright by the International Journal of Prosthodontics, September/October 1998;11:385-6, 389.

10/1/94525

DECEMBER 1998

THE JOURNAL OF PROSTHETIC DENTISTRY 641