YIJOM-2869; No of Pages 9 Please cite this article in press as: Goiato MC, et al. Longevity of dental implants in type IV bone: a systematic review, Int J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.ijom.2014.02.016 Systematic Review Paper Dental Implants Longevity of dental implants in type IV bone: a systematic review M. C. Goiato, D. M. dos Santos, J. F. Jr. Santiago, A. Moreno, E. P. Pellizzer: Longevity of dental implants in type IV bone: a systematic review. Int. J. Oral Maxillofac. Surg. 2014; xxx: xxx–xxx. # 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. M. C. Goiato, D. M. dos Santos, J. F. Jr. Santiago, A. Moreno, E. P. Pellizzer Department of Dental Materials and Prosthodontics, Aracatuba Dental School, UNESP – Universidade Estadual Paulista, Aracatuba, Sa ˜o Paulo, Brazil Abstract. Bone quality and quantity are important factors with regard to the survival rate of dental implants. The aim of this study was to conduct a systematic review of dental implants inserted in low-density bone and to determine the survival rate of dental implants with surface treatments over time. A systematic review of the literature was undertaken by two independent individuals; the Medline/PubMed database was searched for the period July 1975 to March 2013. Relevant reports on bone quality and osseointegration of dental implants were selected. The search retrieved 1018 references, and after inclusion and exclusion criteria were applied, 19 studies were selected for review. A total of 3937 patients, who had received a total of 12,465 dental implants, were analyzed. The survival rates of dental implants according to the bone density were: type I, 97.6%; type II, 96.2%; type III, 96.5%; and type IV, 88.8%. The survival rate of treated surface implants inserted in low- density bone was higher (97.1%) than that of machined surface implants (91.6%). Surface-treated dental implants inserted in low-density bone have a high survival rate and may be indicated for oral rehabilitation. However, more randomized studies are required to better evaluate this issue. Keywords: dental implants; alveolar bone; im- plant-supported dental prosthesis; randomized controlled trial. Accepted for publication 25 February 2014 Currently, the predictability of oral reha- bilitations using dental implants is high. 1,2 Dental implants have been used for over- dentures, fixed partial and total dentures, and maxillofacial prostheses, as well as immediate dental loading. 3,4 However, with regard to the rehabilitation of low density bone, great diversity exists among dental implants from different companies, with different surface treatments and con- nections. 3,5 The dental implant survival rate may be related to the quality and quantity of bone in the dental arch. There are various clas- sifications for the quality and quantity of bone reported in the literature, including the bone type (I–IV) 6 and density (heavy or soft), 7 as well as type V bone. 8 Lekholm and Zarb 6 established a precursor classi- fication for organizing bone tissue into four categories with different degrees of density. This classification allowed the quality of bone tissue to be related to the stability of an implant. Furthermore, it is possible to develop instruments and surgical techniques appropriate for each specific situation. In the previous decade, Bahat 8 proposed a subdivision of the clas- sification of type IV bone, referring to bone type V in situations with a complete absence of cortical tissue (upper and lower). Moreover, there is a classification that considers the bone as dense (high- density), normal (moderate-density), or soft (low-density). 7,9 One of the main methods used to determine the density of bone tissue is based on the perception of the clinician at the time of preparation of the surgical bed. 7 Int. J. Oral Maxillofac. Surg. 2014; xxx: xxx–xxx http://dx.doi.org/10.1016/j.ijom.2014.02.016, available online at http://www.sciencedirect.com 0901-5027/000001+09 $36.00/0 # 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.