Mandibular single-implant overdentures: preliminary results of a randomised-control trial on early loading with different implant diameters and attachment systems.

PubMed

Alsabeeha, Nabeel H M; Payne, Alan G T; De Silva, Rohana K; Thomson, W Murray

2011-03-01

To determine surgical and prosthodontic outcomes of mandibular single-implant overdentures, opposing complete maxillary dentures, using a wide diameter implant and large ball attachment system compared with different regular diameter implants with standard attachment systems. Thirty-six edentulous participants (mean age 68 years, SD 9.2) were randomly assigned into three treatment groups (n=12). A single implant was placed in the mandibular midline of participants to support an overdenture using a 6-week loading protocol. The control group received Southern regular implants and standard ball attachments. One group received Southern 8-mm-wide implants and large ball attachments. Another group received Neoss regular implants and Locator attachments. Parametric and non-parametric tests of a statistical software package (SPSS) were used to determine between groups differences in marginal bone loss, implant stability, implant, and prosthodontic success (P<0.05). Implant success after 1 year was 75% for Southern regular implant (control) group; and 100% for the Southern wide and Neoss regular implant groups (P=0.038). Mean marginal bone loss at 1 year was 0.19 mm (SD 0.39) without significant differences observed. Implant stability quotient (ISQ) at baseline was significantly lower for the Southern regular (control) group than the other two groups (P=0.001; P=0.009). At 1 year, no significant difference in implant stability was observed (mean ISQ 74.6, SD 6.1). The change in implant stability from baseline to 1 year was significant for the control group (P=0.025). Prosthodontic success was comparable between the groups but the maintenance (41 events overall, mean 1.2) was greater for the Locator and the standard ball attachments. Mandibular single-implant overdentures are a successful treatment option for older edentulous adults with early loading protocol using implants of different diameters and with different attachment systems. © 2010 John Wiley & Sons A/S.

Reduced bacteria adhesion on octenidine loaded mesoporous silica nanoparticles coating on titanium substrates.

PubMed

Xu, Gaoqiang; Shen, Xinkun; Dai, Liangliang; Ran, Qichun; Ma, Pingping; Cai, Kaiyong

2017-01-01

Bacterial infection is one of the most severe postoperative complications leading to implantation failure. The early bacterial stage (4-6h) was proved to be the "decisive period" for long-term bacteria-related infection. Thus, to endow potential early antibacterial capacity for a titanium (Ti) based implant, an effective antiseptic agent of octenidine dihydrochloride (OCT) was effectively loaded on the mesoporous silica nanoparticles (MSNs)-incorporated titania coating which was fabricated by an electrophoretic-enhanced micro-arc oxidation technique. The surface characteristic of the coatings were characterized by various methods (SEM, AFM, XPS, XRD, etc.), and its corrosion resistance was also examined by the potentiodynamic polarization curves. The composite coating without OCT loading not only displayed good cytocompatibility but also exhibited certain anti-bacterial property. After loading with OCT, its antibacterial efficiency of the titanium substrates with composite coating was greatly enhanced without compromising their cytocompatibility. The study provides an approach for the fabrication of anti-bacterial Ti implant for potential orthopedic application. Copyright © 2016 Elsevier B.V. All rights reserved.

Imunohistological aspects of the tissue around dental implants

NASA Astrophysics Data System (ADS)

Nimigean, Victor; Nimigean, Vanda R.; Sǎlǎvǎstru, Dan I.; Moraru, Simona; BuÅ£incu, Lavinia; Ivaşcu, Roxana V.; Poll, Alexandru

2016-03-01

Objectives: study of soft and hard tissues around implants. Material and methods: For the immunohistochemical and histological study of the implant/soft tissue interface, we examined pieces of peri-implant mucosa harvested from 35 patients. The implant/bone interface was assessed using histologic and histomorphometric examination of hard tissues around unloaded, early loaded or delayed loaded dental implants with pre-established design, with a sandblasted and acid-etched surface, placed both in extraction sockets, or after bone healing following tooth removal. This study was performed on 9 common race dogs. Results: The histological study of the implant/soft tissue interface showed regenerative modifications and moderate chronic subepithelial inflammatory reactions. Immunohistochemical evaluation of the soft tissue biopsies revealed the presence of specific immunocompetent cells and proteins of the matrix metalloproteinase (MMP) expression. Bone-implants contacts were more obvious in the apical half of the implants and at the edges of the threads, than between them. A mature, lamelliform bone containing lacunae with osteocytes and lack of connective tissue were noticed around implants that were late placed and loaded. The new-formed bone was also abundant in the crestal zone, not only in the apical part of the implants. Conclusions: A thorough understanding of the microstructure of dental implant/soft and hard tissue interface will improve the longevity of osseointegrated implants.

A Comparative Finite-Element Analysis of Bone Failure and Load Transfer of Osseointegrated Prostheses Fixations

PubMed Central

Tomaszewski, P. K.; Verdonschot, N.; Bulstra, S. K.

2010-01-01

An alternative solution to conventional stump–socket prosthetic limb attachment is offered by direct skeletal fixation. This study aimed to assess two percutaneous trans-femoral implants, the OPRA system (Integrum AB, Göteborg, Sweden), and the ISP Endo/Exo prosthesis (ESKA Implants AG, Lübeck, Germany) on bone failure and stem–bone interface mechanics both early post-operative (before bony ingrowth) and after full bone ingrowth. Moreover, mechanical consequences of implantation of those implants in terms of changed loading pattern within the bone and potential consequences on long-term bone remodeling were studied using finite-element models that represent the intact femur and implants fitted in amputated femora. Two experimentally measured loads from the normal walking cycle were applied. The analyses revealed that implantation of percutaneous prostheses had considerable effects on stress and strain energy density levels in bone. This was not only caused by the implant itself, but also by changed loading conditions in the amputated leg. The ISP design promoted slightly more physiological strain energy distribution (favoring long-term bone maintenance), but the OPRA design generated lower bone stresses (reducing bone fracture risk). The safety factor against mechanical failure of the two percutaneous designs was relatively low, which could be improved by design optimization of the implants. PMID:20309731

Clinical Management of Implant Prostheses in Patients with Bruxism

PubMed Central

Komiyama, Osamu; Lobbezoo, Frank; De Laat, Antoon; Iida, Takashi; Kitagawa, Tsuyoshi; Murakami, Hiroshi; Kato, Takao; Kawara, Misao

2012-01-01

There is general agreement that excessive stress to the bone-implant interface may result in implant overload and failure. Early failure of the implant due to excessive loading occurs shortly after uncovering the implant. Excess load on a final restoration after successful implant integration can result in physical failure of the implant structure. Many clinicians believe that overload of dental implants is a risk factor for vertical peri-implant bone loss and/or may be detrimental for the suprastructure in implant prostheses. It has been documented that occlusal parafunction, such as, bruxism (tooth grinding and clenching) affects the outcome of implant prostheses, but there is no evidence for a causal relation between the failures and overload of dental implants. In spite of this lack of evidence, often metal restorations are preferred instead of porcelain for patients in whom bruxism is presumed on the basis of tooth wear. The purpose of this paper is to discuss the importance of the occlusal scheme used in implant restorations for implant longevity and to suggest a clinical approach and occlusal materials for implant prostheses in order to prevent complications related to bruxism. PMID:22701484

A Randomized Case-Series Study Comparing the Stability of Implant with Two Different Surfaces Placed in Fresh Extraction Sockets and Immediately Loaded

PubMed Central

Vanden Bogaerde, Leonardo; Sennerby, Lars

2016-01-01

Background. Hydrophilic and moderately rough implant surfaces have been proposed to enhance the osseointegration response. Aim. The aim of this study was to compare early changes of stability for two implants with identical macrodesign but with different surface topographies. Materials and Methods. In 11 patients, a total of 22 implants (11 bimodal (minimally rough, control) and 11 proactive (moderately rough and hydrophilic, test), Neoss Ltd., Harrogate, UK) were immediately placed into fresh extraction sockets and immediately loaded. The peak insertion torque (IT) was measured in Ncm at placement. Resonance Frequency Analysis (RFA) measurements were made at baseline and 2, 4, 6, and 12 weeks after surgery. Results. The two implant types showed similar IT and RFA values at placement (NS). A dip of RFA values after 2 weeks followed by an increase was observed, where the test implant showed a less pronounced decrease and a more rapid recovery than the control implant. The test implants were significantly more stable than the control ones after 12 weeks. Conclusions. The results from the present study indicated that the hydrophilic and rougher test implant was more resistant to immediate loading and showed a significantly higher stability than the smoother control implant after 12 weeks. PMID:27042180

In Vivo Response of Laser Processed Porous Titanium Implants for Load-Bearing Implants.

PubMed

Bandyopadhyay, Amit; Shivaram, Anish; Tarafder, Solaiman; Sahasrabudhe, Himanshu; Banerjee, Dishary; Bose, Susmita

2017-01-01

Applications of porous metallic implants to enhance osseointegration of load-bearing implants are increasing. In this work, porous titanium implants, with 25 vol.% porosity, were manufactured using Laser Engineered Net Shaping (LENS™) to measure the influence of porosity towards bone tissue integration in vivo. Surfaces of the LENS™ processed porous Ti implants were further modified with TiO 2 nanotubes to improve cytocompatibility of these implants. We hypothesized that interconnected porosity created via additive manufacturing will enhance bone tissue integration in vivo. To test our hypothesis, in vivo experiments using a distal femur model of male Sprague-Dawley rats were performed for a period of 4 and 10 weeks. In vivo samples were characterized via micro-computed tomography (CT), histological imaging, scanning electron microscopy, and mechanical push-out tests. Our results indicate that porosity played an important role to establish early stage osseointegration forming strong interfacial bonding between the porous implants and the surrounding tissue, with or without surface modification, compared to dense Ti implants used as a control.

In vivo response of laser processed porous titanium implants for load-bearing implants

PubMed Central

Bandyopadhyay, Amit; Shivaram, Anish; Tarafder, Solaiman; Sahasrabudhe, Himanshu; Banerjee, Dishary; Bose, Susmita

2016-01-01

Applications of porous metallic implants to enhance osseointegration of load-bearing implants are increasing. In this work, porous titanium implants, with 25 volume% porosity, were manufactured using Laser Engineered Net Shaping (LENS™) to measure the influence of porosity towards bone tissue integration in vivo. Surfaces of the LENS™ processed porous Ti implants were further modified with TiO2 nanotubes to improve cytocompatibility of these implants. We hypothesized that interconnected porosity created via additive manufacturing will enhance bone tissue integration in vivo. To test our hypothesis, in vivo experiments using a distal femur model of male Sprague-Dawley rats were performed for a period of 4 and 10 weeks. In vivo samples were characterized via micro-computed tomography (CT), histological imaging, scanning electron microscopy, and mechanical push-out tests. Our results indicate that porosity played an important role to establish early stage osseointegration forming strong interfacial bonding between the porous implants and the surrounding tissue, with or without surface modification, compared to dense Ti implants used as a control. PMID:27307009

A noninterventional study documenting use and success of implants with a new chemically modified titanium surface in daily dental practice.

PubMed

Luongo, Giuseppe; Oteri, Giacomo

2010-01-01

A new chemically modified titanium surface, SLActive, has recently been developed. The results obtained in controlled clinical trials indicate that this implant can be safely used and that it offers predictable results. The goal of this noninterventional study was to verify that the success rates of implants used in daily dental practice are comparable to those reported in controlled clinical trials. This study was a prospective, noninterventional study using implants with a chemically modified surface according to the daily dental practice procedures applied by private practitioners. The choice of the implantation procedure and the loading protocol were the responsibility of the investigator and were chosen according to the patient's needs. Thirty clinical centers actively participated in this study, and 226 patients were treated, of which, 8 patients were lost to follow-up. Because of the noninterventional design of the study, the patients were not selected according to strictly defined inclusion/exclusion criteria. Thus, the study included individuals with risk factors such as smoking (24%), untreated gingivitis or periodontitis (9%), and bruxism (6%). The implants were equally distributed between mandible (46%) and maxilla (54%). A bone augmentation procedure was done in 31% of the cases. Early loading (functional loading between 48 hours and 3 months after implant insertion) was applied most frequently (48%), followed by the conventional loading protocol (3 to 6 months after implant placement, 34%). Immediate restoration and immediate loading were rare (7% and 2%, respectively). Of 276 implants inserted and documented, 5 implants failures were reported, all of which were associated with a sinus floor augmentation procedure. The survival rate was 98.2% at the 1-year follow-up visit. The results showed that implants with a chemically modified surface can be successfully restored with success rates similar to those reported in formal clinical trials under more controlled conditions.

Satisfaction and Clinical Outcomes Among Patients with Immediately Loaded Mandibular Overdentures Supported by One or Two Dental Implants: Results of a 5-Year Prospective Randomized Clinical Trial.

PubMed

Kronstrom, Mats; Davis, Ben; Loney, Robert; Gerrow, Jack; Hollender, Lars

The purpose of this study was to evaluate patient satisfaction and clinical outcomes among subjects with mandibular overdentures supported by one or two immediately placed dental implants 5 years after loading. Thirty-six subjects (16 men and 20 women) received one or two dental implants in the anterior mandible, and all implants were loaded the day of surgery. Subjects were scheduled for follow-up 3-, 6-, and 12 months after implant placement and thereafter annually for 4 more years. Patient satisfaction scores were measured with the Oral Health Impact Profile-EDENT (OHIPEDENT) questionnaire. Seventeen subjects (7 male and 10 female) with a mean age of 59.4 years (range, 44 to 74 years) were available for the 5-year follow-up examination. Nine subjects with 10 failing implants were excluded during the first year and nine subjects were lost to follow-up. No implants failed between the 12- and 60-month follow-up examinations, and the need for denture maintenance was low. Mean peri-implant bone change was 0.92 mm, and the Spearman test failed to show correlation between the insertion torque value and implant stability quotient. Patient satisfaction scores increased significantly when compared with baseline values and continued to be high for both groups, with no significant differences. Ten implants in nine subjects failed early, but no failures were observed after the 12-month examination. No significant differences were found between subjects in the two groups with respect to implant survival rates and peri-implant bone loss, and patient satisfaction scores continued to be high. Although patient satisfaction and implant success were high during the 12- to 60-month period, the results should be interpreted with caution because of the high number of failing implants and patients lost to follow-up. More research is needed to study outcomes of treatment with immediately loaded mandibular implant overdentures.

A comparative study of the effectiveness of early and delayed loading of short tissue-level dental implants with hydrophilic surfaces placed in the posterior section of the mandible-A preliminary study.

PubMed

Makowiecki, Arkadiusz; Botzenhart, Ute; Seeliger, Julia; Heinemann, Friedhelm; Biocev, Peter; Dominiak, Marzena

2017-07-01

The objective of the present study was to compare the primary and secondary stability of tissue-level short dental titanium implants with polished necks and hydrophilic surfaces of two different designs and manufacturers. The first implant system used (SPI ® ELEMENT RC INICELL titanium implants, Thommen Medical AG, Grenchen, Switzerland), allowed functional loading 6 weeks after its placement, whereas the second implant system (RN SLActiv ® tissue-level titanium implants, Straumann GmbH, Fribourg, Germany), was loaded after 15 weeks. The degree of primary and secondary stability was determined using an Osstell ISQ measuring device. Marginal bone loss (MBL) was evaluated radiographically 12 and 24 weeks after implantation and the Wachtel's healing index as well as the patient's satisfaction with the treatment was registered on a VAS scale. The intergroup comparison revealed significant differences in terms of primary stability as well as differences in MBL 3 months after the procedure, but no significant differences could be found after 6 months and for secondary stability. The primary stability was significantly higher for Thommen ® compared to Straumann ® implants. Insertion of short dental implants with a hydrophilic conditioned surface significantly shortens patient treatment time. Copyright © 2017 Elsevier GmbH. All rights reserved.

Carbon nanotubes as VEGF carriers to improve the early vascularization of porcine small intestinal submucosa in abdominal wall defect repair

PubMed Central

Liu, Zhengni; Feng, Xueyi; Wang, Huichun; Ma, Jun; Liu, Wei; Cui, Daxiang; Gu, Yan; Tang, Rui

2014-01-01

Insufficient early vascularization in biological meshes, resulting in limited host tissue incorporation, is thought to be the primary cause for the failure of abdominal wall defect repair after implantation. The sustained release of exogenous angiogenic factors from a biocompatible nanomaterial might be a way to overcome this limitation. In the study reported here, multiwalled carbon nanotubes (MWNT) were functionalized by plasma polymerization to deliver vascular endothelial growth factor165 (VEGF165). The novel VEGF165-controlled released system was incorporated into porcine small intestinal submucosa (PSIS) to construct a composite scaffold. Scaffolds incorporating varying amounts of VEGF165-loaded functionalized MWNT were characterized in vitro. At 5 weight percent MWNT, the scaffolds exhibited optimal properties and were implanted in rats to repair abdominal wall defects. PSIS scaffolds incorporating VEGF165-loaded MWNT (VEGF–MWNT–PSIS) contributed to early vascularization from 2–12 weeks postimplantation and obtained more effective collagen deposition and exhibited improved tensile strength at 24 weeks postimplantation compared to PSIS or PSIS scaffolds, incorporating MWNT without VEGF165 loading (MWNT–PSIS). PMID:24648727

Early Complications of Immediate Loading in Edentulous Full-Arch Restorations: A Retrospective Analysis of 88 Cases.

PubMed

Cercadillo-Ibarguren, Iñaki; Sánchez-Torres, Alba; Figueiredo, Rui; Valmaseda-Castellón, Eduard

To describe the clinical outcomes and complications related to provisional prostheses after full-arch implant-supported rehabilitation by means of an immediate loading protocol. This retrospective cohort study included patients who were consecutively treated with full-arch implant-supported restorations with a minimum of four implants (Replace Select Tapered TiUnite, Nobel Biocare AB) per arch and conical abutments (multi-unit, Nobel Biocare AB) by means of an immediate loading protocol. The surgical procedures were performed between May 2006 and June 2014 by a single oral surgeon. Demographic, surgical, and prosthetic variables were collected, and biologic and mechanical complications were registered. A total of 61 maxillae (57%) and 46 mandibles (43%) were treated in 88 patients (40 men and 48 women) with a mean age of 62.4 years. A total of 558 implants were placed, 295 in postextraction sockets. A total of 331 implants (59.3%) were placed in the maxilla and 227 (40.7%) in the mandible. Within a 9-month period, 18 prostheses (16.8%) fractured (15 maxillary and 3 mandibular); in nine of these patients the opposing dentition was a full-arch, implant-supported restoration, and in the remaining nine patients, it was natural dentition. Six (1.1%) maxillary and three (0.5%) mandibular implants failed. A high implant survival rate is expected in the short term following this immediate loading protocol. Fracture of the provisional prosthesis is a common finding, affecting 17% of patients, and is significantly more prevalent in patients with bruxism and in maxillary prostheses.

Immediate occlusal loading of NanoTite PREVAIL implants: a prospective 1-year clinical and radiographic study.

PubMed

Ostman, Pär-Olov; Wennerberg, Ann; Albrektsson, Tomas

2010-03-01

Recently, a new implant surface texture, featuring application of nanometer-scale calcium phosphate has been shown to enhance early bone fixation and formation in preclinical studies and in human histomorphometric studies, which may be beneficial in immediate loading situations. The purpose of the present prospective clinical study was to, during 1 year, clinically and radiographically evaluate a nanometer scale surface modified implant placed for immediate loading of fixed prostheses in both maxillary and mandibular regions. Thirty-five out of 38 patients who needed implant treatment and met inclusion criteria agreed to participate in the study and were consecutively enrolled. Surgical implant placement requirements consisted of a final torque of a least 25 Ncm prior to final seating and an implant stability quotient above 55. A total of 102 NanoTite PREVAIL (NTP) implants (BIOMET 3i, Palm Beach Gardens, FL, USA) (66 maxillary and 36 mandibular) were placed by one investigator, and the majority of these were placed in posterior regions (65%) and in soft bone (69%). A total of 44 prosthetic constructions were evaluated consisting of 14 single-tooth restorations, 26 fixed partial dentures, and four complete fixed restorations. All provisional constructions were delivered within 1 hour, and the final constructions placed after 4 months. Implants were monitored for clinical and radiographic outcomes at follow-up examinations scheduled for 3, 6, and 12 months. Of the 102 study implants, one implant failed. The simple cumulative survival rate value at 1 year was 99.2%. The average marginal bone resorption was 0.37 mm (SD 0.39) during the first year in function. According to the success criteria of Albrektsson and Zarb, success grade 1 was found with 93% of the implants. Although limited to the short follow-up, immediate loading of NanoTite Prevail implants seems to be a viable option in implant rehabilitation, at least when a good initial fixation is achieved.

Laser-Modified Surface Enhances Osseointegration and Biomechanical Anchorage of Commercially Pure Titanium Implants for Bone-Anchored Hearing Systems

PubMed Central

Omar, Omar; Simonsson, Hanna; Palmquist, Anders; Thomsen, Peter

2016-01-01

Osseointegrated implants inserted in the temporal bone are a vital component of bone-anchored hearing systems (BAHS). Despite low implant failure levels, early loading protocols and simplified procedures necessitate the application of implants which promote bone formation, bone bonding and biomechanical stability. Here, screw-shaped, commercially pure titanium implants were selectively laser ablated within the thread valley using an Nd:YAG laser to produce a microtopography with a superimposed nanotexture and a thickened surface oxide layer. State-of-the-art machined implants served as controls. After eight weeks’ implantation in rabbit tibiae, resonance frequency analysis (RFA) values increased from insertion to retrieval for both implant types, while removal torque (RTQ) measurements showed 153% higher biomechanical anchorage of the laser-modified implants. Comparably high bone area (BA) and bone-implant contact (BIC) were recorded for both implant types but with distinctly different failure patterns following biomechanical testing. Fracture lines appeared within the bone ~30–50 μm from the laser-modified surface, while separation occurred at the bone-implant interface for the machined surface. Strong correlations were found between RTQ and BIC and between RFA at retrieval and BA. In the endosteal threads, where all the bone had formed de novo, the extracellular matrix composition, the mineralised bone area and osteocyte densities were comparable for the two types of implant. Using resin cast etching, osteocyte canaliculi were observed directly approaching the laser-modified implant surface. Transmission electron microscopy showed canaliculi in close proximity to the laser-modified surface, in addition to a highly ordered arrangement of collagen fibrils aligned parallel to the implant surface contour. It is concluded that the physico-chemical surface properties of laser-modified surfaces (thicker oxide, micro- and nanoscale texture) promote bone bonding which may be of benefit in situations where large demands are imposed on biomechanically stable interfaces, such as in early loading and in compromised conditions. PMID:27299883

Meta-Analysis of Correlations Between Marginal Bone Resorption and High Insertion Torque of Dental Implants.

PubMed

Li, Haoyan; Liang, Yongqiang; Zheng, Qiang

2015-01-01

To evaluate correlations between marginal bone resorption and high insertion torque value (> 50 Ncm) of dental implants and to assess the significance of immediate and early/conventional loading of implants under a certain range torque value. Specific inclusion and exclusion criteria were used to retrieve eligible articles from Ovid, PubMed, and EBSCO up to December 2013. Screening of eligible studies, quality assessment, and data extraction were conducted in duplicate. The results were expressed as random/fixed-effects models using weighted mean differences for continuous outcomes with 95% confidence intervals. Initially, 154 articles were selected (11 from Ovid, 112 from PubMed, and 31 from EBSCO). After exclusion of duplicate articles and articles that did not meet the inclusion criteria, six clinical studies were selected. Assessment of P values revealed that correlations between marginal bone resorption and high insertion torque were not statistically significant and that there was no difference between immediately versus early/conventionally loaded implants under a certain range of torque. None of the meta-analyses revealed any statistically significant differences between high insertion torque and conventional insertion torque in terms of effects on marginal bone resorption.

In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening.

PubMed

Dincer Kose, Onur; Karataslı, Burcin; Demircan, Sabit; Kose, Taha Emre; Cene, Erhan; Aya, Serhan Aydın; Erdem, Mehmet Ali; Cankaya, Abdulkadir Burak

2017-01-01

Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload.

In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening

PubMed Central

Demircan, Sabit; Cene, Erhan; Aya, Serhan Aydın; Erdem, Mehmet Ali; Cankaya, Abdulkadir Burak

2017-01-01

Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload. PMID:28473988

Influence of Implant Positions and Occlusal Forces on Peri-Implant Bone Stress in Mandibular Two-Implant Overdentures: A 3-Dimensional Finite Element Analysis.

PubMed

Alvarez-Arenal, Angel; Gonzalez-Gonzalez, Ignacio; deLlanos-Lanchares, Hector; Brizuela-Velasco, Aritza; Dds, Elena Martin-Fernandez; Ellacuria-Echebarria, Joseba

2017-12-01

The aim of this study was to evaluate and compare the bone stress around implants in mandibular 2-implant overdentures depending on the implant location and different loading conditions. Four 3-dimensional finite element models simulating a mandibular 2-implant overdenture and a Locator attachment system were designed. The implants were located at the lateral incisor, canine, second premolar, and crossed-implant levels. A 150 N unilateral and bilateral vertical load of different location was applied, as was 40 N when combined with midline load. Data for von Mises stress were produced numerically, color coded, and compared between the models for peri-implant bone and loading conditions. With unilateral loading, in all 4 models much higher peri-implant bone stress values were recorded on the load side compared with the no-load side, while with bilateral occlusal loading, the stress distribution was similar on both sides. In all models, the posterior unilateral load showed the highest stress, which decreased as the load was applied more mesially. In general, the best biomechanical environment in the peri-implant bone was found in the model with implants at premolar level. In the crossed-implant model, the load side greatly altered the biomechanical environment. Overall, the overdenture with implants at second premolar level should be the chosen design, regardless of where the load is applied. The occlusal loading application site influences the bone stress around the implant. Bilateral occlusal loading distributes the peri-implant bone stress symmetrically, while unilateral loading increases it greatly on the load side, no matter where the implants are located.

Immediate loading of implants in the aesthetic zone: comparison between two placement timings.

PubMed

Carini, Fabrizio; Longoni, Salvatore; Pisapia, Valeria; Francesconi, Manuel; Saggese, Vito; Porcaro, Gianluca

2014-01-01

Implant rehabilitation delivered in accordance with the traditional protocol has proven to be highly predictable and acceptable (1). Nevertheless, the application of immediate loading on post-extraction implants, especially for aesthetic zones, has now considerably increased (2). The aim of this work is to illustrate the immediate loading of implants placed in the aesthetic zone through tapered design fixtures with microgeometry of a high degree of porosity inserted at the same time or 4-8 weeks from dental avulsion (TSA® Advance, Phibo®). A total of 15 implant fixtures of which 8 at an interval of 4-8 weeks from extraction (type 2) and the remaining according to the immediate post-extraction technique (type 1) were positioned. All implants were prosthesized within 24 hours from the placement. Definitive crowns replaced provisional restorations after 20-24 weeks. After 4 and 12 months from implant insertion, the following parameters were assessed: X-ray image, pain, mobility or suppuration, soft tissue condition and aesthetic appearance. Percentage of osseointegration was 93.75%, and 53.5% of the osseointegrated fixtures was type 2. No statistically significant difference between the mean ISQ values for implants of type 1 and 2 both in the post-operative period and after 12 months was evident, indicating that the timing of insertion did not affect the achievement of stability for the implant fixtures tested in our study. Immediate post-extraction implants showed a greater propensity for gingival recession and a peri-implant radiolucency greater than those placed at an interval of 4-8 weeks. The values obtained for the PES/WES and the subjective evaluation of the analyzed sample showed the considerable aesthetic value and the high level of satisfaction guaranteed by the implant technique illustrated. Although well-designed, high quality, randomized clinical trials are still needed as well as the requirement to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome, immediate/early placement and loading of a single TSA® Advance, Phibo® may be considered a valuable and predictable option in terms of implant success as well as hard and soft tissue stability.

Effects of titania nanotubes with or without bovine serum albumin loaded on human gingival fibroblasts

PubMed Central

Liu, Xiangning; Zhou, Xiaosong; Li, Shaobing; Lai, Renfa; Zhou, Zhiying; Zhang, Ye; Zhou, Lei

2014-01-01

Modifying the surface of the transmucosal area is a key research area because this process positively affects the three functions of implants: attachment to soft tissue, inhibiting bacterial biofilm adhesion, and the preservation of the crestal bone. To exploit the potential of titania nanotube arrays (TNTs) with or without using bovine serum albumin (BSA) to modify the surface of a dental implant in contact with the transmucosal area, BSA was loaded into TNTs that were fabricated by anodizing Ti sheets; the physical characteristics of these arrays, including their morphology, chemical composition, surface roughness, contact angle, and surface free energy (SFE), were assessed. The effect of Ti surfaces with TNTs or TNTs-BSA on human gingival fibroblasts (HGFs) was determined by analyzing cell morphology, early adhesion, proliferation, type I collagen (COL-1) gene expression, and the extracellular secretion of COL-1. The results indicate that early HGF adhesion and spreading behavior is positively correlated with surface characteristics, including hydrophilicity, SFE, and surface roughness. Additionally, TNT surfaces not only promoted early HGF adhesion, but also promoted COL-1 secretion. BSA-loaded TNT surfaces promoted early HGF adhesion, while suppressing late proliferation and COL-1 secretion. Therefore, TNT-modified smooth surfaces are expected to be applicable for uses involving the transmucosal area. Further study is required to determine whether BSA-loaded TNT surfaces actually affect closed loop formation of connective tissue because BSA coating actions in vivo are very rapid. PMID:24623977

Effect of healing time on bone-implant contact of orthodontic micro-implants: a histologic study.

PubMed

Ramazanzadeh, Barat Ali; Fatemi, Kazem; Dehghani, Mahboobe; Mohtasham, Nooshin; Jahanbin, Arezoo; Sadeghian, Hamed

2014-01-01

Objectives. This study aimed to evaluate the effect of immediate and delayed loading of orthodontic micro-implants on bone-implant contact. Materials and Methods. Sixty four micro-implants were implanted in dog's jaw bone. The micro-implants were divided into loaded and unloaded (control) groups. The control group had two subgroups: four and eight weeks being implanted. The loaded group had two subgroups of immediate loading and delayed (after four weeks healing) loading. Loaded samples were subjected to 200g load for four weeks. After sacrificing the animals micro-implants and surrounding tissues were observed histologically. Bone-implant contact ratios (BIC) were calculated and different groups' results were compared by three-way ANOVA. Results. Mean survival rate was 96.7% in general. Survival rates were 96.7%, 94.4% and 100% for control, immediate and delayed loaded groups, respectively. BIC values were not significantly different in loaded and control groups, immediate and delayed loading groups, and pressure and tension sides. Mandibular micro-implants had significantly higher BIC than maxillary ones in immediate loading, 4-weeks control, and 8-weeks control groups (P = 0.021, P = 0.009, P = 0.003, resp.). Conclusion Immediate or delayed loading of micro-implants in dog did not cause significant difference in Bone-implant contact which could be concluded that healing time had not significant effect on micro-implant stability.

Effect of Healing Time on Bone-Implant Contact of Orthodontic Micro-Implants: A Histologic Study

PubMed Central

Ramazanzadeh, Barat Ali; Fatemi, Kazem; Dehghani, Mahboobe; Mohtasham, Nooshin; Jahanbin, Arezoo; Sadeghian, Hamed

2014-01-01

Objectives. This study aimed to evaluate the effect of immediate and delayed loading of orthodontic micro-implants on bone-implant contact. Materials and Methods. Sixty four micro-implants were implanted in dog's jaw bone. The micro-implants were divided into loaded and unloaded (control) groups. The control group had two subgroups: four and eight weeks being implanted. The loaded group had two subgroups of immediate loading and delayed (after four weeks healing) loading. Loaded samples were subjected to 200g load for four weeks. After sacrificing the animals micro-implants and surrounding tissues were observed histologically. Bone-implant contact ratios (BIC) were calculated and different groups' results were compared by three-way ANOVA. Results. Mean survival rate was 96.7% in general. Survival rates were 96.7%, 94.4% and 100% for control, immediate and delayed loaded groups, respectively. BIC values were not significantly different in loaded and control groups, immediate and delayed loading groups, and pressure and tension sides. Mandibular micro-implants had significantly higher BIC than maxillary ones in immediate loading, 4-weeks control, and 8-weeks control groups (P = 0.021, P = 0.009, P = 0.003, resp.). Conclusion Immediate or delayed loading of micro-implants in dog did not cause significant difference in Bone-implant contact which could be concluded that healing time had not significant effect on micro-implant stability. PMID:25006463

Radiographic evaluation of marginal bone level around implants with different neck designs after 1 year.

PubMed

Shin, Young-Kyu; Han, Chong-Hyun; Heo, Seong-Joo; Kim, Sunjai; Chun, Heoung-Jae

2006-01-01

To evaluate the influence of macro- and microstructure of the implant surface at the marginal bone level after functional loading. Sixty-eight patients were randomly assigned to 1 of 3 groups. The first group received 35 implants with a machined neck (Ankylos); the second group, 34 implants with a rough-surfaced neck (Stage 1); and the third, 38 implants with a rough-surfaced neck with microthreads (Oneplant). Clinical and radiographic examinations were conducted at baseline (implant loading) and 3, 6, and 12 months postloading. Two-way repeated analysis of variance (ANOVA) was used to test the significance of marginal bone change of each tested group at baseline, 3, 6, and 12 month follow-ups and 1-way ANOVA was also used to compare the bone loss of each time interval within the same implant group (P < .05). At 12 months, significant differences were noted in the amount of alveolar bone loss recorded for the 3 groups (P < .05). The group with the rough-surfaced microthreaded neck had a mean crestal bone loss of 0.18 +/- 0.16 mm; the group with the rough-surfaced neck, 0.76 +/- 0.21 mm; and the group with the machined neck, 1.32 +/- 0.27 mm. In the rough-surfaced group and the rough-surfaced microthreaded group, no statistically significant changes were observed after 3 months, whereas the machined-surface group showed significant bone loss for every interval (P < .05). To minimize marginal bone loss, in addition to the use of a rough surface at the marginal bone level, a macroscopic modification such as the addition of microthreads could be recommended. A rough surface and microthreads at the implant neck not only reduce crestal bone loss but also help with early biomechanical adaptation against loading in comparison to the machined neck design. A rough surface with microthreads at the implant neck was the most effective design to maintain the marginal bone level against functional loading.

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses.

PubMed

Borba, Marcelo; Deluiz, Daniel; Lourenço, Eduardo José Veras; Oliveira, Luciano; Tannure, Patrícia Nivoloni

2017-08-21

This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.

In vivo evaluation of an antibacterial coating containing halogenated furanone compound-loaded poly(l-lactic acid) nanoparticles on microarc-oxidized titanium implants.

PubMed

Cheng, Yicheng; Gao, Bo; Liu, Xianghui; Zhao, Xianghui; Sun, Weige; Ren, Huifang; Wu, Jiang

2016-01-01

To prevent peri-implant infection, a new antibacterial coating containing a halogenated furanone compound, (Z-)-4-bromo-5-(bromomethylene)-2(5H)-furanone-loaded poly(l-lactic acid) nanoparticles, has been fabricated. The current study was designed to evaluate the preventive effect of the antibacterial coating under a simulated environment of peri-implant infection in vivo. Microarc-oxidized titanium implants treated with minocycline hydrochloride ointment were used as positive control group, and microarc-oxidized titanium implants without any treatment were used as blank control group. Three kinds of implants were implanted in dogs' mandibles, and the peri-implant infection was simulated by silk ligation and feeding high sugar diet. After 2-month implantation, the results showed that no significant differences were detected between the experimental and positive control groups (P>0.05), but the data of clinical measurements of the blank control group were significantly higher than those of the other two groups (P<0.05), and the bone-implant contact rate and ultimate interfacial strength were significantly lower than those of the other two groups (P<0.05). Scanning electron microscope observation and histological examination showed that more new bone was formed on the surface of the experimental and positive control groups. It can be concluded that the antibacterial coating fabricated on implants has remarkable preventive effect on peri-implant infection at the early stage.

Gene expression of inflammation and bone healing in peri-implant crevicular fluid after placement and loading of dental implants. A kinetic clinical pilot study using quantitative real-time PCR.

PubMed

Slotte, Christer; Lennerås, Maria; Göthberg, Catharina; Suska, Felicia; Zoric, Neven; Thomsen, Peter; Nannmark, Ulf

2012-10-01

Early detection of healing complications after placement of dental implants is a pressing but elusive goal. This paper proposes a non-invasive diagnostic tool for monitoring healing- and peri-implant disease specific genes, complementary to clinical evaluations. Eighteen partially edentulous patients were recruited to this pilot study. Three Brånemark TiUnite® implants/patient (Nobel Biocare) were placed in a one-stage procedure. Abutments with smooth or rough (TiUnite®) surface were placed. The test group (n = 9) received fixed bridges (immediate loading), whereas the control group (n = 9) implants were loaded 3 months after surgery. In addition to clinical measurements, crevicular fluid was collected using paper strips at the implant abutments 2, 14, 28, and 90 days postoperative. mRNA was extracted, purified, and converted to cDNA. Quantitative PCR assays for IL-1β, TNF-α, Osteocalcin (OC), Alkaline Phosphatase (ALP), Cathepsin K, Tartrate Resistant Acid Phosphatase, and 18S ribosomal RNA were designed and validated. Relative gene expression levels were calculated. One implant was lost in the control group and three in the test group. In one test patient, one implant showed lowered stability after 2 to 4 weeks and was unloaded. Later implant stability improved which allowed for loading after 3 to 4 months. TNF-α and ALP most commonly showed correlation with clinical parameters followed by IL-1β and OC. The strongest correlation was found for TNF-α with clinical complications at 2 and 14 days (p = .01/r = -048, and p = .0004/r = -0.56, respectively; test and control groups together). In some cases, gene expression predicted clinical complications (TNF-α, ALP, CK). This study is based on samples from few individuals; still, some genes showed correlation with clinical findings. Further studies are needed to refine and optimize the sampling process, to find the appropriate panel, and to validate gene expression for monitoring implant healing. © 2010 Wiley Periodicals, Inc.

Advances in surfaces and osseointegration in implantology. Biomimetic surfaces

PubMed Central

Albertini, Matteo; Fernandez-Yague, Marc; Lázaro, Pedro; Herrero-Climent, Mariano; Bullon, Pedro; Gil, Francisco-Javier

2015-01-01

The present work is a revision of the processes occurring in osseointegration of titanium dental implants according to different types of surfaces -namely, polished surfaces, rough surfaces obtained from subtraction methods, as well as the new hydroxyapatite biomimetic surfaces obtained from thermochemical processes. Hydroxyapatite’s high plasma-projection temperatures have proven to prevent the formation of crystalline apatite on the titanium dental implant, but lead to the formation of amorphous calcium phosphate (i.e., with no crystal structure) instead. This layer produce some osseointegration yet the calcium phosphate layer will eventually dissolve and leave a gap between the bone and the dental implant, thus leading to osseointegration failure due to bacterial colonization. A new surface -recently obtained by thermochemical processes- produces, by crystallization, a layer of apatite with the same mineral content as human bone that is chemically bonded to the titanium surface. Osseointegration speed was tested by means of minipigs, showing bone formation after 3 to 4 weeks, with the security that a dental implant can be loaded. This surface can be an excellent candidate for immediate or early loading procedures. Key words:Dental implants, implants surfaces, osseointegration, biomimetics surfaces. PMID:25662555

Fabrication and in vitro release behavior of a novel antibacterial coating containing halogenated furanone-loaded poly(L-lactic acid) nanoparticles on microarc-oxidized titanium

PubMed Central

Cheng, Yicheng; Wu, Jiang; Gao, Bo; Zhao, Xianghui; Yao, Junyan; Mei, Shenglin; Zhang, Liang; Ren, Huifang

2012-01-01

Background Dental implants have become increasingly common for the management of missing teeth. However, peri-implant infection remains a problem, is usually difficult to treat, and may lead eventually to dental implant failure. The aim of this study was to fabricate a novel antibacterial coating containing a halogenated furanone compound, ie, (Z-)-4-bromo-5-(bromomethylene)-2(5H)-furanone (BBF)-loaded poly(L-lactic acid) (PLLA) nanoparticles on microarc-oxidized titanium and to evaluate its release behavior in vitro. Methods BBF-loaded PLLA nanoparticles were prepared using the emulsion solvent-evaporation method, and the antibacterial coating was fabricated by cross-linking BBF-loaded PLLA nanoparticles with gelatin on microarc-oxidized titanium. Results The BBF-loaded PLLA nanoparticles had a small particle size (408 ± 14 nm), a low polydispersity index (0.140 ± 0.008), a high encapsulation efficiency (72.44% ± 1.27%), and a fine spherical shape with a smooth surface. The morphology of the fabricated antibacterial coating showed that the BBF-loaded PLLA nanoparticles were well distributed in the pores of the microarc oxidation coating, and were cross-linked with each other and the wall pores by gelatin. The release study indicated that the antibacterial coating could achieve sustained release of BBF for 60 days, with a slight initial burst release during the first 4 hours. Conclusion The novel antibacterial coating fabricated in this study is a potentially promising method for prevention of early peri-implant infection. PMID:23152682

Influence of immediate loading on provisional restoration in dental implant stability

NASA Astrophysics Data System (ADS)

Ikbal, M.; Odang, R. W.; Indrasari, M.; Dewi, R. S.

2017-08-01

The success of dental implant treatment is determined by the primary stability at placement. One factor that could influence this stability is occlusal loading through provisional restoration. Two types of loading protocols are usually used: immediate and delayed loading. However, some controversies remain about the influence of occlusal loading on implant stability. Therefore, the influence of immediate loading on implant stability must be studied. An animal study was conducted by placing nine dental implants in the mandibular jaw of three Macaca fascicularis. Provisional restorations with various occlusal contacts (no, light, and normal contact) were placed on the implant. The implant stability was measured using the Ostell ISQ three times: immediately (baseline) and at the first and second months after implant placement. The implant stability between implants with no and normal occlusal contact as well as light and normal occlusal contact showed significant differences (p < 0.05) at the first and second months after implant placement. However, no significant increase (p > 0.05) in implant stability was seen at the baseline and the first and second months after implant placement for all occlusal contact groups. Immediate loading influenced the implant stability, and provisional restoration of implant without occlusal contact showed the highest implant stability.

Mondani intraoral welding: historical process and main practical applications.

PubMed

Dal Carlo, L; Pasqualini, M E; Mondani, P M; Rossi, F; Moglioni, E; Shulman, M

2017-01-01

The intraoral welder was invented by Dr. Pierluigi Mondani during the early 70’s to weld titanium needle implants to a titanium bar in patient’s mouth and to load them immediately by means of resin prosthesis. The clinical use documented dates back to 1972. Over the years, many practical applications have been added to the initial one, which have expanded the use of this device. In this scientific work, main applications are described. The aim of the work was to trace the historical process of intra-oral welding according to Mondani and describe the main practical applications. Intra-oral welding is a process introduced by dr. Pier Luigi Mondani of Genova (Italy) which allows to firmly conjoin titanium implants of any shape by means of a titanium bar or also directly between them in the mouth during surgery. The immediate stabilization achieved by intraoral welding increases implants success rate, allows immediate loading even in situations of bone atrophy, saves implants that are running into failure, re-evaluates fractured implants, allows to stabilize submerged implants postponing prosthesis management, allows to achieve efficient rehabilitation protocols to deal with difficult cases. The 40-years’ experience with intra-oral welding described in this article, confirms the ease of use and efficiency in providing immediate stabilization of titanium implants of all types.

Machined versus roughened immediately loaded and finally restored single implants inserted flapless: Preliminary 6-month data from a split- mouth randomised controlled trial.

PubMed

Cannizzaro, Gioacchino; Felice, Pietro; Loi, Ignazio; Viola, Paolo; Ferri, Vittorio; Leone, Michele; Lazzarini, Matteo; Trullenque-Eriksson, Anna; Esposito, Marco

To compare the outcome of immediately loaded single implants with a machined or a roughened surface. Fifty patients had two implant sites randomly allocated to receive flaplessplaced single Syra implants (Sweden & Martina), one with a machined and one with a roughened surface (sand-blasted with zirconia powder and acid etched), according to a split-mouth design. To be loaded immediately, implants had to be inserted with a torque superior to 50 Ncm. Implants were restored with definitive crowns in direct occlusal contact within 48 h. Patients were followed for 6 months after loading. Outcome measures were prosthetic and implant failures and complications. Two machined implants and four roughened implants were not loaded immediately. Six months after loading no dropout occurred. One implant loaded late, which had a rough implant surface, failed 20 days after loading (P (McNemar test) = 0.625; difference in proportions = -0.04; 95% CI: -0.15 to 0.07). Three crowns had to be remade on machined implants and four on roughened implants (P (McNemar test) = 1.000; difference in proportions = -0.02; 95% CI: -0.12 to 0.08). Three machined and five roughened implants experienced complications (P (McNemar test) = 0.625; difference in proportions = -0.04; 95% CI: -0.15 to 0.07). There were no statistically significant differences between groups for crown and implant losses as well as complications. Up to 6 months after loading both machined and roughened flapless-placed and immediately loaded single implants provided good and similar results, however, longer follow-ups are needed to evaluate the long-term prognosis of implants with different surfaces.

The effect of implant macro-thread design on implant stability in the early post-operative period: a randomized, controlled pilot study.

PubMed

McCullough, Jeffrey J; Klokkevold, Perry R

2017-10-01

Available literature suggests there is a transient drop in implant stability from approximately week 0 to week 3-4 as a result of peri-implant bone remodeling as it transitions from a primary, mechanical stability to a secondary, biological stability. Research investigating the influence of macro-thread design on this process is scant. The specific aim of this study was to evaluate the role of macro-thread design on implant stability in the early post-operative healing period using resonance frequency analysis (RFA). Seven patients, each missing at least two posterior teeth in the same arch, were included in the study. Three patients qualified for four implants resulting in a total of 10 matched pairs. All sites were healed (>6 months), non-grafted sites with sufficient bone to place implants. Each site in a matched pair was randomly assigned to receive either a control (Megagen EZ Plus Internal; EZ) or test (Megagen AnyRidge; AR) implant. The test implant incorporates a novel thread design with a wide thread depth and increased thread pitch. RFA was used to determine implant stability quotient (ISQ) values for each implant at the time of placement and weekly for the first 8 weeks. Implants consistently achieved a relatively high insertion torque (30-45 N/cm) and high initial ISQ value (79.8 ± 1.49). Baseline ISQ values for test (AR; 79.55 ± 1.61) and control (EZ; 80.05 ± 1.37) implants were similar. A general pattern of stability from baseline through all eight follow-up evaluations was observed for the test implants. A pattern of decreasing ISQ values was observed for the control implants across the early follow-up evaluations up to week four, where the value plateaued. There was a statistically significant main effect due to implant type (P < 0.01) and a statistically significant interaction between implant type and time (P < 0.01), indicating that the test and control implants performed differently at certain time points. Within the limitations of this study, macro-thread design appears to play a role in implant stability in the early post-operative healing period as assessed by RFA. These findings may have important implications related to immediate or early loading protocols. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Immediate loading of subcrestally placed dental implants in anterior and premolar sites.

PubMed

Henningsen, Anders; Smeets, Ralf; Köppen, Kai; Sehner, Susanne; Kornmann, Frank; Gröbe, Alexander; Heiland, Max; Gerlach, Till

2017-11-01

Immediate loading of dental implants has been evolving into an appropriate procedure for the treatment of partially edentulous jaws. The purpose of this study was to evaluate the clinical success and radiological outcome of immediately and delayed loaded dental implants in anterior and premolar sites. In this retrospective study, data of 163 individuals requiring tooth removal with subsequent implant placement in anterior and premolar sites were analyzed. Implants were immediately loaded by provisional acrylic resin bridges or loaded with delay. Implants were followed up annually for up to 9 years including intraoral radiographs. A total of 285 implants in 163 patients were placed. 218 implants were immediately loaded and 67 implants with delay. Fifteen implants failed during the follow-up period resulting in survival rates of 94.5% for immediate loading and 95.5% for delayed loading. After an initial decrease of 0.3 mm in the first 12 months the marginal bone level remained stable. No statistically significant differences were found in marginal bone loss between immediately and delayed loaded implants (P = 0.518, 95% CI). Within the limits of this study, immediate loading of immediately subcrestally placed dental implants in anterior and premolar sites is a reliable treatment option for dental rehabilitation. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Histologic and histomorphometric evaluation of peri-implant bone of immediate or delayed occlusal-loaded non-splinted implants in the posterior mandible--an experimental study in monkeys.

PubMed

Stokholm, Rie; Isidor, Flemming; Nyengaard, Jens R

2014-11-01

The primary aim of this study was to compare the bone reaction around immediate-loaded non-splinted single implants vs. delayed loaded non-splinted single implants placed in healed ridges in the posterior mandible. Six adult Macaca Fascicularis monkeys were used in this study. The first and second premolars and the first molar were extracted in both sides of the mandible. After 3 months of healing, four implants (Replace Select Tapered; Nobel Biocare, Gothenburg, Sweden) with a moderately rough surface (TiUnite, Nobel Biocare) were placed in the edentulous areas of each monkey, two in each side. The implants had a length of 10 mm and a diameter of 3.5 mm. Four groups of varying time and occlusal loading aspects were created: (i) control group: implant placed non-loaded for 3 months; (ii) immediate loaded: implant placed and loaded immediately for 3 months; (iii) immediate loaded: implant placed and loaded immediately for 6 months; and (iv) delayed loaded: implant placed submerged for 3 months and then loaded for 3 months. At the loaded implants, after a second stage surgery, a composite crown was made directly on an abutment mounted on the implant reinsuring simultaneous occlusal contact on the implant crown and the neighboring teeth. After euthanization of the animals, histologic specimens were quantified in the light microscope. All implants were clinically, radiographically, and histologically osseointegrated at the time of euthanization and with only mild signs of inflammation in the peri-implant mucosa. The histologic marginal bone level was located on average 1.14-1.74 mm apical to the margin of the implants in the various groups. The average bone-to-implant contact (BIC) varied between 55% and 65% and the average bone density (i.e., the proportion of mineralized bone tissue from the implant surface and to a distance of 1 mm lateral to the implant) varied between 30.6% and 34.2%. No statistical significant differences between groups were observed in the above-stated histomorphometric parameters. Similar histologic and histomorphometric findings were observed in immediately and delayed loaded non-splinted implants placed in the posterior mandible of macaque monkeys. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Positive effects of cell-free porous PLGA implants and early loading exercise on hyaline cartilage regeneration in rabbits.

PubMed

Chang, Nai-Jen; Lin, Chih-Chan; Shie, Ming-You; Yeh, Ming-Long; Li, Chien-Feng; Liang, Peir-In; Lee, Kuan-Wei; Shen, Pei-Hsun; Chu, Chih-Jou

2015-12-01

The regeneration of hyaline cartilage remains clinically challenging. Here, we evaluated the therapeutic effects of using cell-free porous poly(lactic-co-glycolic acid) (PLGA) graft implants (PGIs) along with early loading exercise to repair a full-thickness osteochondral defect. Rabbits were randomly allocated to a treadmill exercise (TRE) group or a sedentary (SED) group and were prepared as either a PGI model or an empty defect (ED) model. TRE was performed as a short-term loading exercise; SED was physical inactivity in a free cage. The knees were evaluated at 6 and 12 weeks after surgery. At the end of testing, none of the knees developed synovitis, formed osteophytes, or became infected. Macroscopically, the PGI-TRE group regenerated a smooth articular surface, with transparent new hyaline-like tissue soundly integrated with the neighboring cartilage, but the other groups remained distinct at the margins with fibrous or opaque tissues. In a micro-CT analysis, the synthesized bone volume/tissue volume (BV/TV) was significantly higher in the PGI-TRE group, which also had integrating architecture in the regeneration site. The thickness of the trabecular (subchondral) bone was improved in all groups from 6 to 12 weeks. Histologically, remarkable differences in the cartilage regeneration were visible. At week 6, compared with SED groups, the TRE groups manifested modest inflammatory cells with pro-inflammatory cytokines (i.e., TNF-α and IL-6), improved collagen alignment and higher glycosaminoglycan (GAG) content, particularly in the PGI-TRE group. At week 12, the PGI-TRE group had the best regeneration outcomes, showing the formation of hyaline-like cartilage, the development of columnar rounded chondrocytes that expressed enriched levels of collagen type II and GAG, and functionalized trabecular bone with osteocytes. In summary, the combination of implanting cell-free PLGA and performing an early loading exercise can significantly promote the full-thickness osteochondral regeneration in rabbit knee joint models. Promoting effective hyaline cartilage regeneration rather than fibrocartilage scar tissue remains clinically challenging. To address the obstacle, we fabricated a spongy cell-free PLGA scaffold, and designed a reasonable exercise program to generate combined therapeutic effects. First, the implanting scaffold generates an affordable mechanical structure to bear the loading forces and bridge with the host to offer a space in the full-thickness osteochondral regeneration in rabbit knee joint. After implantation, rabbits were performed by an early treadmill exercise 15 min/day, 5 days/week for 2 weeks that directly exerts in situ endogenous growth factor and anti-inflammatory effects in the reparative site. The advanced therapeutic strategy showed that neo-hyaline cartilage formation with enriched collagen type II, higher glycosaminoglycan, integrating subchondral bone formation and modest inflammation. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trial.

PubMed

Felice, Pietro; Pellegrino, Gerardo; Checchi, Luigi; Pistilli, Roberto; Esposito, Marco

2010-12-01

To evaluate whether 7-mm-long implants could be an alternative to longer implants placed in vertically augmented posterior mandibles. Sixty patients with posterior mandibular edentulism with 7-8 mm bone height above the mandibular canal were randomized to either vertical augmentation with anorganic bovine bone blocks and delayed 5-month placement of ≥10 mm implants or to receive 7-mm-long implants. Four months after implant placement, provisional prostheses were delivered, replaced after 4 months, by definitive prostheses. The outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone levels. All patients were followed to 1 year after loading. One patient dropped out from the short implant group. In two augmented mandibles, there was not sufficient bone to place 10-mm-long implants possibly because the blocks had broken apart during insertion. One prosthesis could not be placed when planned in the 7 mm group vs. three prostheses in the augmented group, because of early failure of one implant in each patient. Four complications (wound dehiscence) occurred during graft healing in the augmented group vs. none in the 7 mm group. No complications occurred after implant placement. These differences were not statistically significant. One year after loading, patients of both groups lost an average of 1 mm of peri-implant bone. There no statistically significant differences in bone loss between groups. When residual bone height over the mandibular canal is between 7 and 8 mm, 7 mm short implants might be a preferable choice than vertical augmentation, reducing the chair time, expenses and morbidity. These 1-year preliminary results need to be confirmed by follow-up of at least 5 years. © 2010 John Wiley & Sons A/S.

Platform switching: biomechanical evaluation using three-dimensional finite element analysis.

PubMed

Tabata, Lucas Fernando; Rocha, Eduardo Passos; Barão, Valentim Adelino Ricardo; Assunção, Wirley Goncalves

2011-01-01

The objective of this study was to evaluate, using three-dimensional finite element analysis (3D FEA), the stress distribution in peri-implant bone tissue, implants, and prosthetic components of implant-supported single crowns with the use of the platform-switching concept. Three 3D finite element models were created to replicate an external-hexagonal implant system with peri-implant bone tissue in which three different implant-abutment configurations were represented. In the regular platform (RP) group, a regular 4.1-mm-diameter abutment (UCLA) was connected to regular 4.1-mm-diameter implant. The platform-switching (PS) group was simulated by the connection of a wide implant (5.0 mm diameter) to a regular 4.1-mm-diameter UCLA abutment. In the wide-platform (WP) group, a 5.0-mm-diameter UCLA abutment was connected to a 5.0-mm-diameter implant. An occlusal load of 100 N was applied either axially or obliquely on the models using ANSYS software. Both the increase in implant diameter and the use of platform switching played roles in stress reduction. The PS group presented lower stress values than the RP and WP groups for bone and implant. In the peri-implant area, cortical bone exhibited a higher stress concentration than the trabecular bone in all models and both loading situations. Under oblique loading, higher intensity and greater distribution of stress were observed than under axial loading. Platform switching reduced von Mises (17.5% and 9.3% for axial and oblique loads, respectively), minimum (compressive) (19.4% for axial load and 21.9% for oblique load), and maximum (tensile) principal stress values (46.6% for axial load and 26.7% for oblique load) in the peri-implant bone tissue. Platform switching led to improved biomechanical stress distribution in peri-implant bone tissue. Oblique loads resulted in higher stress concentrations than axial loads for all models. Wide-diameter implants had a large influence in reducing stress values in the implant system.

Bone healing response in cyclically loaded implants: Comparing zero, one, and two loading sessions per day.

PubMed

de Barros E Lima Bueno, Renan; Dias, Ana Paula; Ponce, Katia J; Wazen, Rima; Brunski, John B; Nanci, Antonio

2018-05-31

When bone implants are loaded, they are inevitably subjected to displacement relative to bone. Such micromotion generates stress/strain states at the interface that can cause beneficial or detrimental sequels. The objective of this study is to better understand the mechanobiology of bone healing at the tissue-implant interface during repeated loading. Machined screw shaped Ti implants were placed in rat tibiae in a hole slightly bigger than the implant diameter. Implants were held stable by a specially-designed bone plate that permits controlled loading. Three loading regimens were applied, (a) zero loading, (b) one daily loading session of 60 cycles with an axial force of 1.5 N/cycle for 7 days, and (c) two such daily sessions with the same axial force also for 7 days. Finite element analysis was used to characterize the mechanobiological conditions produced by the loading sessions. After 7 days, the implants with surrounding interfacial tissue were harvested and processed for histological, histomorphometric and DNA microarray analyses. Histomorphometric analyses revealed that the group subjected to repeated loading sessions exhibited a significant decrease in bone-implant contact and increase in bone-implant distance, as compared to unloaded implants and those subjected to only one loading session. Gene expression profiles differed during osseointegration between all groups mainly with respect to inflammatory and unidentified gene categories. The results indicate that increasing the daily cyclic loading of implants induces deleterious changes in the bone healing response, most likely due to the accumulation of tissue damage and associated inflammatory reaction at the bone-implant interface. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

In vivo and in vitro investigations of a nanostructured coating material – a preclinical study

PubMed Central

Adam, Martin; Ganz, Cornelia; Xu, Weiguo; Sarajian, Hamid-Reza; Götz, Werner; Gerber, Thomas

2014-01-01

Immediate loading of dental implants is only possible if a firm bone-implant anchorage at early stages is developed. This implies early and high bone apposition onto the implant surface. A nanostructured coating material based on an osseoinductive bone grafting is investigated in relation to the osseointegration at early stages. The goal is to transmit the structure (silica matrix with embedded hydroxyapatite) and the properties of the bone grafting into a coating material. The bone grafting substitute offers an osseoinductive potential caused by an exchange of the silica matrix in vivo accompanied by vascularization. X-ray diffraction and transmission electron microscopy analysis show that the coating material consists of a high porous silica matrix with embedded nanocrystalline hydroxyapatite with the same morphology as human hydroxyapatite. An in vitro investigation shows the early interaction between coating and human blood. Energy-dispersive X-ray analysis showed that the silica matrix was replaced by an organic matrix within a few minutes. Uncoated and coated titanium implants were inserted into the femora of New Zealand White rabbits. The bone-to-implant contact (BIC) was measured after 2, 4, and 6 weeks. The BIC of the coated implants was increased significantly at 2 and 4 weeks. After 6 weeks, the BIC was decreased to the level of the control group. A histological analysis revealed high bone apposition on the coated implant surface after 2 and 4 weeks. Osteoblastic and osteoclastic activities on the coating material indicated that the coating participates in the bone-remodeling process. The nanostructure of the coating material led to an exchange of the silica matrix by an autologous, organic matrix without delamination of the coating. This is the key issue in understanding initial bone formation on a coated surface. PMID:24627631

Effect of Restorative Configurations and Occlusal Schemes on Strain Levels in Bone Surrounding Implants.

PubMed

Block, Jonathan; Matalon, Shlomo; Tanase, Gabriela; Ormianer, Zeev

2017-08-01

This study investigated strain levels during and after implant insertion, and during and after simulated mastication, in splinted and nonsplinted restorations with different occlusal schemes. Fresh bovine bone resembling type I jawbone was collected. Strain gauges were placed at each implant's neck, one horizontally and one vertically. Strains at and after implant insertion were recorded. The restoration was loaded with cyclic load simulating mastication. Loading and residual strains were recorded for 6 experimental loading types. At and after implant insertion, high horizontal strains were measured. Full splint loading presented higher vertical compared with horizontal strains (P < 0.05). Segmented cross-arch splint showed higher horizontal strains (P < 0.05). Premolar loading guidance presented the most favorable loading and residual strain results (P < 0.05). Splinting implant restorations may reduce strain levels at implant neck area and provide preferable strain distribution during cyclic loading.

An instrumented implant for vertebral body replacement that measures loads in the anterior spinal column.

PubMed

Rohlmann, Antonius; Gabel, Udo; Graichen, Friedmar; Bender, Alwina; Bergmann, Georg

2007-06-01

Realistic loads on a spinal implant are required among others for optimization of implant design and preclinical testing. In addition, such data may help to choose the optimal physiotherapy program for patients with such an implant and to evaluate the efficacy of aids like braces or crutches. Presently, no implant is available that can measure loads in the anterior spinal column during activities of daily life. Therefore, an implant instrumented for in vivo load measurement was developed for vertebral body replacement. The aim of this paper is to describe in detail a telemeterized implant that measures forces and moments acting on it. Six load sensors, a nine-channel telemetry unit and a coil for inductive power supply of the electronic circuits were integrated into a modified vertebral body replacement (Synex). The instrumented part of the implant is hermetically sealed. Patients are videotaped during measurements, and implant loads are displayed on and off line. The average accuracy of load measurement is better than 2% for force and 5% for moment components with reference to the maximum value of 3000 N and 20 Nm, respectively. The measuring implant described here will provide additional information on spinal loads.

Immediate versus conventional loading of implant-supported maxillary overdentures: a finite element stress analysis.

PubMed

Akca, Kivanc; Eser, Atilim; Eckert, Steven; Cavusoglu, Yeliz; Cehreli, Murat Cavit

2013-01-01

To compare biomechanical outcomes of immediately and conventionally loaded bar-retained implant-supported maxillary overdentures using finite element stress analysis. Finite element models were created to replicate the spatial positioning of four 4.1 × 12-mm implants in the completely edentulous maxillae of four cadavers to support bar-retained overdentures with 7-mm distal extension cantilevers. To simulate the bone-implant interface of immediately loaded implants, a contact situation was defined at the interface; conventional loading was simulated by "bonding" the implants to the surrounding bone. The prostheses were loaded with 100 N in the projected molar regions bilaterally, and strain magnitudes were measured at the buccal aspect of bone. The amplitude of axial and lateral strains, the overall strain magnitudes, and the strain magnitudes around anterior and posterior implants in the immediate loading group were comparable to those seen in the conventional loading group, suggesting that the loading regimens created similar stress/strain fields (P > .05). Conventional and immediate loading of maxillary implants supporting bar-retained overdentures resulted in similar bone strains.

Design-Optimization and Material Selection for a Proximal Radius Fracture-Fixation Implant

NASA Astrophysics Data System (ADS)

Grujicic, M.; Xie, X.; Arakere, G.; Grujicic, A.; Wagner, D. W.; Vallejo, A.

2010-11-01

The problem of optimal size, shape, and placement of a proximal radius-fracture fixation-plate is addressed computationally using a combined finite-element/design-optimization procedure. To expand the set of physiological loading conditions experienced by the implant during normal everyday activities of the patient, beyond those typically covered by the pre-clinical implant-evaluation testing procedures, the case of a wheel-chair push exertion is considered. Toward that end, a musculoskeletal multi-body inverse-dynamics analysis is carried out of a human propelling a wheelchair. The results obtained are used as input to a finite-element structural analysis for evaluation of the maximum stress and fatigue life of the parametrically defined implant design. While optimizing the design of the radius-fracture fixation-plate, realistic functional requirements pertaining to the attainment of the required level of the devise safety factor and longevity/lifecycle were considered. It is argued that the type of analyses employed in the present work should be: (a) used to complement the standard experimental pre-clinical implant-evaluation tests (the tests which normally include a limited number of daily-living physiological loading conditions and which rely on single pass/fail outcomes/decisions with respect to a set of lower-bound implant-performance criteria) and (b) integrated early in the implant design and material/manufacturing-route selection process.

Effect of the Coronal Wall Thickness of Dental Implants on the Screw Joint Stability in the Internal Implant-Abutment Connection.

PubMed

Lee, Ji-Hye; Huh, Yoon-Hyuk; Park, Chan-Jin; Cho, Lee-Ra

2016-01-01

To evaluate the effect of implant coronal wall thickness on load-bearing capacity and screw joint stability. Experimental implants were customized after investigation of the thinnest coronal wall thickness of commercially available implant systems with a regular platform diameter. Implants with four coronal wall thicknesses (0.2, 0.3, 0.4, and 0.5 mm) were fabricated. Three sets of tests were performed. The first set was a failure test to evaluate load-bearing capacity and elastic limit. The second and third sets were cyclic and static loading tests. After abutment screw tightening of each implant, vertical cyclic loading of 250 N or static loading from 250 to 800 N was applied. Coronal diameter expansion, axial displacement, and removal torque values of the implants were compared. Repeated measures analysis of variance (ANOVA) was used for statistical analysis (α = .05). Implants with 0.2-mm coronal wall thickness demonstrated significantly low load-bearing capacity and elastic limit (both P < .05). These implants also showed significantly large coronal diameter expansion and axial displacement after screw tightening (both P < .05). Greater vertical load and thinner coronal wall thickness significantly increased coronal diameter expansion of the implant, axial displacement of the abutment, and removal torque loss of the abutment screw (all P < .05). Implant coronal wall thickness of 0.2 mm produces significantly inferior load-bearing capacity and screw joint stability.

The effect of platelet-rich fibrin on implant stability.

PubMed

Öncü, Elif; Alaaddinoğlu, E Emine

2015-01-01

Achieving accelerated implant osseointegration could make immediate or early loading of implants more predictable. Platelet-rich fibrin (PRF) is frequently used to accelerate soft and hard tissue healing. The activated platelets in PRF release growth factors, resulting in cellular proliferation, collagen synthesis, and osteoid production. The aim of this study was to compare the stability of dental implants inserted in a one-stage surgical protocol with or without PRF application. Twenty healthy patients with adequate alveolar bone and two or more adjacent missing teeth extracted at least 6 months previously were included in this study. A minimum of two tapered implants (Ankylos, Dentsply/Friadent) were placed in each patient. After surgical preparation of the implant sockets, PRF that had been prepared preoperatively was placed randomly into one of the sockets (PRF+). The acellular plasma portion of PRF was used to wet the implant placed into the PRF-coated socket. Resonance frequency measurements were made after implant placement and at 1 week and 1 month postoperatively. Mean implant stability quotients (ISQs) of the PRF+ implants was 69.3 ± 10.5, and mean ISQs for the PRF- implants was 64.5 ± 12.2 at the end of the first week. The mean ISQs at 4 weeks postoperatively were 77.1 ± 7.1 for the PRF+ group and 70.5 ± 7.7 for the PRF- group. In this study, PRF application increased implant stability during the early healing period, as evidenced by higher ISQ values. Simple application of this material seems to provide faster osseointegration.

Local delivery of nicotine does not mitigate fibrosis but may lead to angiogenesis.

PubMed

Ng, Kenneth K; Awad, Neven; Brook, Michael A; Holloway, Alison C; Sheardown, Heather

2011-09-01

As with most implanted biomaterials, the wound healing response following implantation of a silicone breast implant leads to the formation of a fibrotic capsule. This can result in capsular contracture, a painful complication that often necessitates the removal of implant. It is well established that nicotine and nicotinic agonists inhibit inflammatory signaling. Based on the link between the inflammatory response and capsule formation, we hypothesized that local delivery of nicotine from the implant may lead to the reduction in inflammation and capsule thickness, which may ultimately reduce the incidence of capsular contracture. Nicotine was loaded into PDMS membranes using a previously established method. The loaded materials were implanted into the submammary pockets between the third and fourth mammary glands of rats. To confirm that the nicotine was acting locally and not systemically, serum cotinine, the primary metabolite of nicotine, was measured by ELISA at 3 days. Thirty days post implantation, the animals were euthanized and the tissue samples were fixed for histological analysis. Blood vessel density was measured immunohistochemically, while the capsule thickness was evaluated microscopically. While the presence of the nicotine metabolite, cotinine, in the serum at the early time points demonstrated that the nicotine was released locally from the devices, there were no significant differences in the capsule thickness between the control and experimental implants. However, the results indicated that there were differences in angiogenesis with the local delivery of nicotine, which may have other implications for the development of biomaterials.

Immediate loading of titanium hexed screw-type implants in the edentulous patient: case report.

PubMed

Calvo, M P; Muller, E; Garg, A K

2000-01-01

Histologic and histomorphometric studies in both animals and humans have shown that more rapid and greater bone-to-implant contact can be achieved with implants that incorporate certain surface characteristics compared with the original machined-surface implants. Such findings are significant because various implant designs may allow the fixtures to sufficiently resist functional loading sooner than originally thought. The case report presented here indicates that immediate loading of hexed titanium screw-type implants in the anterior mandible can lead to successful osseointegration and clinical outcome. The number of implants placed, their distribution, and the type of rigid connection are critical considerations for immediate loading. A bone height that can accommodate dental implants > or = 10 mm long is recommended. Biomechanically, the implants to be immediately loaded must be stable and resistant to macromovement to ensure good osseointegration.

Load-sharing through elastic micro-motion accelerates bone formation and interbody fusion.

PubMed

Ledet, Eric H; Sanders, Glenn P; DiRisio, Darryl J; Glennon, Joseph C

2018-02-13

Achieving a successful spinal fusion requires the proper biological and biomechanical environment. Optimizing load-sharing in the interbody space can enhance bone formation. For anterior cervical discectomy and fusion (ACDF), loading and motion are largely dictated by the stiffness of the plate, which can facilitate a balance between stability and load-sharing. The advantages of load-sharing may be substantial for patients with comorbidities and in multilevel procedures where pseudarthrosis rates are significant. We aimed to evaluate the efficacy of a novel elastically deformable, continuously load-sharing anterior cervical spinal plate for promotion of bone formation and interbody fusion relative to a translationally dynamic plate. An in vivo animal model was used to evaluate the effects of an elastically deformable spinal plate on bone formation and spine fusion. Fourteen goats underwent an ACDF and received either a translationally dynamic or elastically deformable plate. Animals were followed up until 18 weeks and were evaluated by plain x-ray, computed tomography scan, and undecalcified histology to evaluate the rate and quality of bone formation and interbody fusion. Animals treated with the elastically deformable plate demonstrated statistically significantly superior early bone formation relative to the translationally dynamic plate. Trends in the data from 8 to 18 weeks postoperatively suggest that the elastically deformable implant enhanced bony bridging and fusion, but these enhancements were not statistically significant. Load-sharing through elastic micro-motion accelerates bone formation in the challenging goat ACDF model. The elastically deformable implant used in this study may promote early bony bridging and increased rates of fusion, but future studies will be necessary to comprehensively characterize the advantages of load-sharing through micro-motion. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Retrospective Analysis on Survival Rate, Template-Related Complications, and Prevalence of Peri-implantitis of 694 Anodized Implants Placed Using Computer-Guided Surgery: Results Between 1 and 10 Years of Follow-Up.

PubMed

Tallarico, Marco; Meloni, Silvio Mario

To report survival rate, early surgical template-related complications, and prevalence of peri-implantitis of dental implants placed in private practices using computer-guided, template-assisted surgery and followed between 1 and 10 years. The present retrospective multicenter study evaluated data collected from fully or partially edentulous patients, with anodized-surface implants placed using computer-guided, template-assisted surgery between January 2006 and December 2015. The outcome measures were implant cumulative survival rate (CSR), early surgical complications involving the surgical template, and prevalence of peri-implantitis. A total of 694 implants were placed in 141 patients. Ten patients (7.1%) with 48 implants (6.9%) dropped out during the study period. One hundred seventeen patients, who received 121 surgical and prosthetic procedures, were treated according to a double-scan protocol, while the remaining 24 patients were treated by using the integrated treatment workflow. Most of the implants were immediately loaded (528 implants, 76.1%; 112 patients, 79.4%). Overall, 107 complete full-arch restorations (supported by four to eight implants each) were delivered in 103 patients (73%) with 595 implants (85.7%), while 13 single and 30 partial restorations (two to five implants each) were delivered in 38 patients (27%) with 99 implants (14.3%). Patients were followed for up to 10 years (mean: 58.2 months, range: 12 to 120 months). Implant- and patient-level CSR (Kaplan-Meier estimation) at the 10-year follow-up was 97.4% (95% CI: 1.0309 to 0.9161) and 92.1% (95% CI: 1.1575 to 0.6836), respectively. All failed implants were lost before definitive prosthesis delivery (early failure). Ten (7.1%) minor template-related complications were experienced and resolved chairside. Over the entire follow-up period, four patients (2.8%) with 12 implants (1.7%) showed signs of peri-implantitis at the 1- (four implants), 2- (four implants), and 4-year (four implants) visits. High long-term survival rates and low complications and prevalence of peri-implantitis were observed for a large cohort of anodized-surface implants placed in private practices. Further studies are needed to confirm these preliminary results.

Assessment of Various Risk Factors for Success of Delayed and Immediate Loaded Dental Implants: A Retrospective Analysis.

PubMed

Prasant, M C; Thukral, Rishi; Kumar, Sachin; Sadrani, Sannishth M; Baxi, Harsh; Shah, Aditi

2016-10-01

Ever since its introduction in 1977, a minimum of few months of period is required for osseointegration to take place after dental implant surgery. With the passage of time and advancements in the fields of dental implant, this healing period is getting smaller and smaller. Immediate loading of dental implants is becoming a very popular procedure in the recent time. Hence, we retrospectively analyzed the various risk factors for the failure of delayed and immediate loaded dental implants. In the present study, retrospective analysis of all the patients was done who underwent dental implant surgeries either by immediate loading procedure or by delayed loading procedures. All the patients were divided broadly into two groups with one group containing patients in which delayed loaded dental implants were placed while other consisted of patients in whom immediate loaded dental implants were placed. All the patients in whom follow-up records were missing and who had past medical history of any systemic diseases were excluded from the present study. Evaluation of associated possible risk factors was done by classifying the predictable factors as primary and secondary factors. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Kaplan-Meier survival analyses and chi-square test were used for assessment of level of significance. In delayed and immediate group of dental implants, mean age of the patients was 54.2 and 54.8 years respectively. Statistically significant results were obtained while comparing the clinical parameters of the dental implants in both the groups while demographic parameters showed nonsignificant correlation. Significant higher risk of dental implant failure is associated with immediate loaded dental implants. Tobacco smoking, shorter implant size, and other risk factors play a significant role in predicting the success and failure of dental implants. Delayed loaded dental implant placement should be preferred as they are associated with decreased risk of implant failure.

Implant Mandibular Overdentures Retained by Immediately Loaded Implants: A 1-Year Randomized Trial Comparing the Clinical and Radiographic Outcomes Between Mini Dental Implants and Standard-Sized Implants.

PubMed

Zygogiannis, Kostas; Aartman, Irene Ha; Parsa, Azin; Tahmaseb, Ali; Wismeijer, Daniel

The aim of this 1-year randomized trial was to evaluate and compare the clinical and radiographic performance of four immediately loaded mini dental implants (MDIs) and two immediately loaded standard-sized tissue-level (STL) implants, placed in the interforaminal region of the mandible and used to retain mandibular overdentures (IODs) in completely edentulous patients. A total of 50 completely edentulous patients wearing conventional maxillary dentures and complaining about insufficient retention of their mandibular dentures were divided into two groups; 25 patients received four MDIs and 25 patients received two STL implants. The marginal bone loss (MBL) at the mesial and distal sides of each implant was assessed by means of standardized intraoral radiographs after a period of 1 year. Implant success and survival rates were also calculated. Immediate loading was possible for all patients in the first group. In the second group, an immediate loading protocol could not be applied for 10 patients. These patients were treated with a delayed loading protocol. A mean MBL of 0.42 ± 0.56 mm for the MDIs and 0.54 ± 0.49 mm for the immediately loaded STL implants was recorded at the end of the evaluation period. There was no statistically significant difference between the MDIs and the immediately loaded STL implants. Two MDIs failed, resulting in a survival rate of 98%. The success rate was 91%. For the immediately loaded conventional implants, the survival rate was 100% and the success rate 96.7% after 1 year of function. However, in 10 patients, the immediate loading protocol could not be followed. Considering the limitations of this short-term clinical study, immediate loading of four unsplinted MDIs or two splinted STL implants to retain mandibular overdentures seems to be a feasible treatment option. The marginal bone level changes around the MDIs were well within the clinically acceptable range.

Influence of implant number on the biomechanical behaviour of mandibular implant-retained/supported overdentures: a three-dimensional finite element analysis.

PubMed

Liu, Jingyin; Pan, Shaoxia; Dong, Jing; Mo, Zhongjun; Fan, Yubo; Feng, Hailan

2013-03-01

The aim of this study was to evaluate strain distribution in peri-implant bone, stress in the abutments and denture stability of mandibular overdentures anchored by different numbers of implants under different loading conditions, through three-dimensional finite element analysis (3D FEA). Four 3D finite element models of mandibular overdentures were established, using between one and four Straumann implants with Locator attachments. Three types of load were applied to the overdenture in each model: 100N vertical and inclined loads on the left first molar and a 100N vertical load on the lower incisors. The biomechanical behaviours of peri-implant bone, implants, abutments and overdentures were recorded. Under vertical load on the lower incisors, the single-implant overdenture rotated over the implant from side to side, and no obvious increase of strain was found in peri-implant bone. Under the same loading conditions, the two-implant-retained overdenture showed more apparent rotation around the fulcrum line passing through the two implants, and the maximum equivalent stress in the abutments was higher than in the other models. In the three-implant-supported overdenture, no strain concentration was found in cortical bone around the middle implant under three loading conditions. Single-implant-retained mandibular overdentures do not show damaging strain concentration in the bone around the only implant and may be a cost-effective treatment option for edentulous patients. A third implant can be placed between the original two when patients rehabilitated by two-implant overdentures report constant and obvious denture rotation around the fulcrum line. Copyright © 2012 Elsevier Ltd. All rights reserved.

Load fatigue performance of four implant-abutment interface designs: effect of torque level and implant system.

PubMed

Quek, H C; Tan, Keson B; Nicholls, Jack I

2008-01-01

Biomechanical load-fatigue performance data on single-tooth implant systems with different implant-abutment interface designs is lacking in the literature. This study evaluated the load fatigue performance of 4 implant-abutment interface designs (Brånemark-CeraOne; 3i Osseotite-STA abutment; Replace Select-Easy abutment; and Lifecore Stage-1-COC abutment system). The number of load cycles to fatigue failure of 4 implant-abutment designs was tested with a custom rotational load fatigue machine. The effect of increasing and decreasing the tightening torque by 20% respectively on the load fatigue performance was also investigated. Three different tightening torque levels (recommended torque, -20% recommended torque, +20% recommended torque) were applied to the 4 implant systems. There were 12 test groups with 5 samples in each group. The rotational load fatigue machine subjected specimens to a sinusoidally applied 35 Ncm bending moment at a test frequency of 14 Hz. The number of cycles to failure was recorded. A cutoff of 5 x 10(6) cycles was applied as an upper limit. There were 2 implant failures and 1 abutment screw failure in the Brånemark group. Five abutment screw failures and 4 implant failures was recorded for the 3i system. The Replace Select system had 1 implant failure. Five cone screw failures were noted for the Lifecore system. Analysis of variance revealed no statistically significant difference in load cycles to failure for the 4 different implant-abutment systems torqued at recommended torque level. A statistically significant difference was found between the -20% torque group and the +20% torque group (P < .05) for the 3i system. Load fatigue performance and failure location is system specific and related to the design characteristics of the implant-abutment combination. It appeared that if the implant-abutment interface was maintained, load fatigue failure would occur at the weakest point of the implant. It is important to use the torque level recommended by the manufacturer.

Effects of lateral cortical anchorage on the primary stability of implants subjected to controlled loads: an in vitro study.

PubMed

Xiao, Jian-rui; Li, Yong-Qi; Guan, Su-Min; Kong, Liang; Liu, Baolin; Li, Dehua

2012-03-01

Our aim was to evaluate the effects of lateral cortical anchorage on the primary stability of implants subjected to immediate loading. Implants were placed into bovine bones with monocortical anchorage (implant placed through the cortical bone of the crest) and bicortical anchorage (the crest cortical bone plus one cortical bone on the lateral side). Loads of 25N and 50N were applied to the implants in different cycles. The implant stability quotient (ISQ) was measured before and after the cyclic loadings. Under 25N load there was no difference in ISQ between 1800 cyclic loading and preloading, but the values decreased significantly after 3600 cyclic loading in both groups (p<0.05). Under a 50N load the ISQ value after 1800 and 3600 cyclic loading decreased in the monocortical group (p<0.05), but there was no difference between 1800 cyclic loading and preloading in the bicortical group, and the ISQ in the bicortical group was higher than in the monocortical group after 1800 cyclic loading (p<0.05). Our results suggest that the stability of implants with bicortical anchorage decreased more slowly under higher loads. Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Stability and Marginal Bone Level Changes of SLActive Titanium-Zirconium Implants Placed with Flapless Surgery: A Prospective Pilot Study.

PubMed

Altinci, Pinar; Can, Gulsen; Gunes, Onur; Ozturk, Caner; Eren, Hakan

2016-12-01

Immediately-loaded, narrow-diameter implants can be a less invasive alternative for the implant-supported fixed rehabilitation of narrow, posterior crests. To determine the stability and marginal bone level (MBL) changes of narrow-diameter, titanium-zirconium (TiZr) implants placed with flapless surgery and loaded immediately in the posterior region. Thirty-eight TiZr implants (3.3 mm diameter, 10 mm length, Roxolid, Straumann AG) were placed in the posterior crests of 14 patients with computer-guided flapless surgery as a support of 3-unit posterior bridges. Eighteen implants were loaded immediately, and 20 implants were loaded conventionally. The implant stability quotients were determined at the 1, 2, 4, and 8. weeks of healing before conventional loading, and at the 3, 6, and 12. months after loading by resonance frequency analysis. The MBL changes were measured by digital radiography. The surgical protocols were accomplished without any biological complications. There was no significant difference in the stability changes of TiZr implants between the loading groups (p > .05). The MBL changes were -0.18 ± 0.27 mm and -0.24 ± 0.27 mm at the 12. month of immediate and conventional loading, respectively, which was not statistically significant (p > .05). The stability and MBL changes of TiZr implants supporting posterior 3-unit bridges were clinically acceptable at the first year of loading. © 2016 Wiley Periodicals, Inc.

Adhesive strength of total knee endoprostheses to bone cement - analysis of metallic and ceramic femoral components under worst-case conditions.

PubMed

Bergschmidt, Philipp; Dammer, Rebecca; Zietz, Carmen; Finze, Susanne; Mittelmeier, Wolfram; Bader, Rainer

2016-06-01

Evaluation of the adhesive strength of femoral components to the bone cement is a relevant parameter for predicting implant safety. In the present experimental study, three types of cemented femoral components (metallic, ceramic and silica/silane-layered ceramic) of the bicondylar Multigen Plus knee system, implanted on composite femora were analysed. A pull-off test with the femoral components was performed after different load and several cementing conditions (four groups and n=3 components of each metallic, ceramic and silica/silane-layered ceramic in each group). Pull-off forces were comparable for the metallic and the silica/silane-layered ceramic femoral components (mean 4769 N and 4298 N) under standard test condition, whereas uncoated ceramic femoral components showed reduced pull-off forces (mean 2322 N). Loading under worst-case conditions led to decreased adhesive strength by loosening of the interface implant and bone cement using uncoated metallic and ceramic femoral components, respectively. Silica/silane-coated ceramic components were stably fixed even under worst-case conditions. Loading under high flexion angles can induce interfacial tensile stress, which could promote early implant loosening. In conclusion, a silica/silane-coating layer on the femoral component increased their adhesive strength to bone cement. Thicker cement mantles (>2 mm) reduce adhesive strength of the femoral component and can increase the risk of cement break-off.

Numerical investigation of bone remodelling around immediately loaded dental implants using sika deer (Cervus nippon) antlers as implant bed.

PubMed

He, Yun; Hasan, Istabrak; Keilig, Ludger; Fischer, Dominik; Ziegler, Luisa; Abboud, Marcus; Wahl, Gerhard; Bourauel, Christoph

2018-03-01

This study combines finite element method and animal studies, aiming to investigate tissue remodelling processes around dental implants inserted into sika deer antler and to develop an alternative animal consuming model for studying bone remodelling around implants. Implants were inserted in the antlers and loaded immediately via a self-developed loading device. After 3, 4, 5 and 6 weeks, implants and surrounding tissue were taken out. Specimens were scanned by μCT scanner and finite element models were generated. Immediate loading and osseointegration conditions were simulated at the implant-tissue interface. A vertical force of 10 N was applied on the implant. During the healing time, density and Young's modulus of antler tissue around the implant increased significantly. For each time point, the values of displacement, stresses and strains in the osseointegration model were lower than those of the immediate loading model. As the healing time increased, the displacement of implants was reduced. The 3-week immediate loading model (9878 ± 1965 μstrain) illustrated the highest strains in the antler tissue. Antler tissue showed similar biomechanical properties as human bone in investigating the bone remodelling around implants, therefore the use of sika deer antler model is a promising alternative in implant biomechanical studies.

Biomechanical optimization of implant diameter and length for immediate loading: a nonlinear finite element analysis.

PubMed

Kong, Liang; Gu, Zexu; Li, Tao; Wu, Junjie; Hu, Kaijin; Liu, Yanpu; Zhou, Hongzhi; Liu, Baolin

2009-01-01

A nonlinear finite element method was applied to examine the effects of implant diameter and length on the maximum von Mises stresses in the jaw, and to evaluate the maximum displacement of the implant-abutment complex in immediate-loading models. The implant diameter (D) ranged from 3.0 to 5.0 mm and implant length (L) ranged from 6.0 to 16.0 mm. The results showed that the maximum von Mises stress in cortical bone was decreased by 65.8% under a buccolingual load with an increase in D. In cancellous bone, it was decreased by 71.5% under an axial load with an increase in L. The maximum displacement in the implant-abutment complex decreased by 64.8% under a buccolingual load with an increase in D. The implant was found to be more sensitive to L than to D under axial loads, while D played a more important role in enhancing its stability under buccolingual loads. When D exceeded 4.0 mm and L exceeded 11.0 mm, both minimum stress and displacement were obtained. Therefore, these dimensions were the optimal biomechanical selections for immediate-loading implants in type B/2 bone.

Assessment of reliability of CAD-CAM tooth-colored implant custom abutments.

PubMed

Guilherme, Nuno Marques; Chung, Kwok-Hung; Flinn, Brian D; Zheng, Cheng; Raigrodski, Ariel J

2016-08-01

Information is lacking about the fatigue resistance of computer-aided design and computer-aided manufacturing (CAD-CAM) tooth-colored implant custom abutment materials. The purpose of this in vitro study was to investigate the reliability of different types of CAD-CAM tooth-colored implant custom abutments. Zirconia (Lava Plus), lithium disilicate (IPS e.max CAD), and resin-based composite (Lava Ultimate) abutments were fabricated using CAD-CAM technology and bonded to machined titanium-6 aluminum-4 vanadium (Ti-6Al-4V) alloy inserts for conical connection implants (NobelReplace Conical Connection RP 4.3×10 mm; Nobel Biocare). Three groups (n=19) were assessed: group ZR, CAD-CAM zirconia/Ti-6Al-4V bonded abutments; group RC, CAD-CAM resin-based composite/Ti-6Al-4V bonded abutments; and group LD, CAD-CAM lithium disilicate/Ti-6Al-4V bonded abutments. Fifty-seven implant abutments were secured to implants and embedded in autopolymerizing acrylic resin according to ISO standard 14801. Static failure load (n=5) and fatigue failure load (n=14) were tested. Weibull cumulative damage analysis was used to calculate step-stress reliability at 150-N and 200-N loads with 2-sided 90% confidence limits. Representative fractured specimens were examined using stereomicroscopy and scanning electron microscopy to observe fracture patterns. Weibull plots revealed β values of 2.59 for group ZR, 0.30 for group RC, and 0.58 for group LD, indicating a wear-out or cumulative fatigue pattern for group ZR and load as the failure accelerating factor for groups RC and LD. Fractographic observation disclosed that failures initiated in the interproximal area where the lingual tensile stresses meet the compressive facial stresses for the early failure specimens. Plastic deformation of titanium inserts with fracture was observed for zirconia abutments in fatigue resistance testing. Significantly higher reliability was found in group ZR, and no significant differences in reliability were determined between groups RC and LD. Differences were found in the failure characteristics of group ZR between static and fatigue loading. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Effects of Food Texture on Three-Dimensional Loads on Implants During Mastication Based on In Vivo Measurements.

PubMed

Yoda, Nobuhiro; Ogawa, Toru; Gunji, Yoshinori; Vanegas, Juan R; Kawata, Tetsuo; Sasaki, Keiichi

2016-08-01

The mechanisms by which the loads exerted on implants that support prostheses are modulated during mastication remain unclear. The purpose of this study was to evaluate the effects of food texture on 3-dimensional loads measured at a single implant using a piezoelectric transducer. Two subjects participated in this study. The transducer and the experimental superstructure, which had been adjusted to the subject's occlusal scheme, were attached to the implant with a titanium screw. The foods tested were chewing gum and peanuts. The mean maximum load on the implant in each chewing cycle was significantly higher during peanut chewing than during gum chewing. The direction of maximum load was significantly more widely dispersed during peanut chewing than during gum chewing. The range of changes in load direction during the force-increasing phase of each chewing cycle was significantly wider during peanut chewing than during gum chewing. The load on the implant was affected by food texture in both subjects. This measurement method can be useful to investigate the mechanisms of load modulation on implants during mastication.

Tilted Implants for Full-Arch Rehabilitations in Completely Edentulous Maxilla: A Retrospective Study

PubMed Central

Cavalli, Nicolò; Barbaro, Bruno; Spasari, Davide; Azzola, Francesco; Ciatti, Alberto; Francetti, Luca

2012-01-01

Purpose. The aims of this study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants in the edentulous maxilla and to evaluate the incidence of biological and prosthetic complications. Materials and Methods. Thirty-four patients (18 women and 16 men) were included in the study. Each patient received a maxillary full-arch fixed bridge supported by two axial implants and two distal tilted implants. A total of 136 implants were inserted. Loading was applied within 48 hours of surgery and definitive restorations were placed 4 to 6 months later. Patients were scheduled for followup at 6, 12, 18, and 24 months and annually up to 5 years. At each followup plaque level and bleeding scores were assessed and every complication was recorded. Results. The overall follow-up range was 12 to 73 months (mean 38.8 months). No implant failures were recorded to date, leading to a cumulative implant survival rate of 100%. Biological complications were recorded such as alveolar mucositis (11.8% patients), peri-implantitis (5.9% patients), and temporomandibular joint pain (5.9% patients). The most common prosthetic complications were the fracture or detachment of one or multiple acrylic teeth in both the temporary (20.6% patients) and definitive (17.7% patients) prosthesis and the minor acrylic fractures in the temporary (14.7% patients) and definitive (2.9% patients) prosthesis. Hygienic complications occurred in 38.2% patients. No patients' dissatisfactions were recorded. Conclusions. The high cumulative implant survival rate indicates that this technique could be considered a viable treatment option. An effective recall program is important to early intercept and correct prosthetic and biologic complications in order to avoid implant and prosthetic failures. PMID:23133453

Intramedullary nailing in opening wedge high tibial osteotomy-in vitro test for validation of a method of fixation.

PubMed

Burchard, Rene; Katerla, Denise; Hammer, Marina; Pahlkötter, Anke; Soost, Christian; Dietrich, Gerhard; Ohrndorf, Arne; Richter, Wolfgang; Lengsfeld, Markus; Christ, Hans-Jürgen; Graw, Jan Adriaan; Fritzen, Claus-Peter

2018-02-01

Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant. Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test. Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions. The results suggest that intramedullary nailing might be used as an alternative concept in HTO.

A Radiographic Comparison of Progressive and Conventional Loading on Crestal Bone Loss and Density in Single Dental Implants: A Randomized Controlled Trial Study

PubMed Central

Ghoveizi, Rahab; Alikhasi, Marzieh; Siadat, Mohammad-Reza; Siadat, Hakimeh; Sorouri, Majid

2013-01-01

Objective: Crestal bone loss is a biological complication in implant dentistry. The aim of this study was to compare the effect of progressive and conventional loading on crestal bone height and bone density around single osseointegrated implants in the posterior maxilla by a longitudinal radiographic assessment technique. Materials and Methods: Twenty micro thread implants were placed in 10 patients (two implants per patient). One of the two implants in each patient was assigned to progressive and the other to conventional loading groups. Eight weeks after surgery, conventional implants were restored with a metal ceramic crown and the progressive group underwent a progressive loading protocol. The progressive loading group took different temporary acrylic crowns at 2, 4 and 6 months. After eight months, acrylic crowns were replaced with a metal ceramic crown. Computer radiography of both progressive and conventional implants was taken at 2, 4, 6, and 12 months. Image analysis was performed to measure the height of crestal bone loss and bone density. Results: The mean values of crestal bone loss at month 12 were 0.11 (0.19) mm for progressively and 0.36 (0.36) mm for conventionally loaded implants, with a statistically significant difference (P < 0.05) using Wilcoxon sign rank. Progressively loaded group showed a trend for higher bone density gain compared to the conventionally loaded group, but when tested with repeated measure ANOVA, the differences were not statistically significant (P > 0.05). Conclusion: The progressive group showed less crestal bone loss in single osseointegrated implant than the conventional group. Bone density around progressively loaded implants showed increase in crestal, middle and apical areas. PMID:23724215

Immediate loading with fixed full-arch prostheses in the maxilla: Review of the literature

PubMed Central

Peñarrocha-Oltra, David; Covani, Ugo; Peñarrocha-Diago, Miguel

2014-01-01

Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full-arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extraction implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic procedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the conclusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures. Key words:Immediate loading, full-arch, dental implants, loading protocols. PMID:24880445

Implant-bone interface stress distribution in immediately loaded implants of different diameters: a three-dimensional finite element analysis.

PubMed

Ding, Xi; Zhu, Xing-Hao; Liao, Sheng-Hui; Zhang, Xiu-Hua; Chen, Hong

2009-07-01

To establish a 3D finite element model of a mandible with dental implants for immediate loading and to analyze stress distribution in bone around implants of different diameters. Three mandible models, embedded with thread implants (ITI, Straumann, Switzerland) with diameters of 3.3, 4.1, and 4.8 mm, respectively, were developed using CT scanning and self-developed Universal Surgical Integration System software. The von Mises stress and strain of the implant-bone interface were calculated with the ANSYS software when implants were loaded with 150 N vertical or buccolingual forces. When the implants were loaded with vertical force, the von Mises stress concentrated on the mesial and distal surfaces of cortical bone around the neck of implants, with peak values of 25.0, 17.6 and 11.6 MPa for 3.3, 4.1, and 4.8 mm diameters, respectively, while the maximum strains (5854, 4903, 4344 muepsilon) were located on the buccal cancellous bone around the implant bottom and threads of implants. The stress and strain were significantly lower (p < 0.05) with the increased diameter of implant. When the implants were loaded with buccolingual force, the peak von Mises stress values occurred on the buccal surface of cortical bone around the implant neck, with values of 131.1, 78.7, and 68.1 MPa for 3.3, 4.1, and 4.8 mm diameters, respectively, while the maximum strains occurred on the buccal surface of cancellous bone adjacent to the implant neck, with peak values of 14,218, 12,706, and 11,504 microm, respectively. The stress of the 4.1-mm diameter implants was significantly lower (p < 0.05) than those of 3.3-mm diameter implants, but not statistically different from that of the 4.8 mm implant. With an increase of implant diameter, stress and strain on the implant-bone interfaces significantly decreased, especially when the diameter increased from 3.3 to 4.1 mm. It appears that dental implants of 10 mm in length for immediate loading should be at least 4.1 mm in diameter, and uniaxial loading to dental implants should be avoided or minimized.

Three-Dimensional Nonlinear Finite Element Analysis and Microcomputed Tomography Evaluation of Microgap Formation in a Dental Implant Under Oblique Loading.

PubMed

Jörn, Daniela; Kohorst, Philipp; Besdo, Silke; Borchers, Lothar; Stiesch, Meike

2016-01-01

Since bacterial leakage along the implant-abutment interface may be responsible for peri-implant infections, a realistic estimation of the interface gap width during function is important for risk assessment. The purpose of this study was to compare two methods for investigating microgap formation in a loaded dental implant, namely, microcomputed tomography (micro-CT) and three-dimensional (3D) nonlinear finite element analysis (FEA); additionally, stresses to be expected during loading were also evaluated by FEA. An implant-abutment complex was inspected for microgaps between the abutment and implant in a micro-CT scanner under an oblique load of 200 N. A numerical model of the situation was constructed; boundary conditions and external load were defined according to the experiment. The model was refined stepwise until its load-displacement behavior corresponded sufficiently to data from previous load experiments. FEA of the final, validated model was used to determine microgap widths. These were compared with the widths as measured in micro-CT inspection. Finally, stress distributions were evaluated in selected regions. No microgaps wider than 13 μm could be detected by micro-CT for the loaded implant. FEA revealed gap widths up to 10 μm between the implant and abutment at the side of load application. Furthermore, FEA predicted plastic deformation in a limited area at the implant collar. FEA proved to be an adequate method for studying microgap formation in dental implant-abutment complexes. FEA is not limited in gap width resolution as are radiologic techniques and can also provide insight into stress distributions within the loaded complex.

Two Bilateral Zygomatic Implants Placed and Immediately Loaded: A Retrospective Chart Review with Up-to-54-Month Follow-up.

PubMed

Neugarten, Jay; Tuminelli, Frank J; Walter, Leora

To report on the outcome of placement of two bilateral zygomatic implants with an immediately loaded prosthesis. A retrospective chart review was conducted of all patients treated with zygomatic implants between August 1, 2011 and June 6, 2016. All patients had at least two zygomatic implants placed bilaterally and immediately loaded with a provisional prosthesis the same day of implant placement. The implants were Nobel Biocare TiUnite or machined surface with lengths of 30 to 52.5 mm. All patients were treated by a team consisting of one surgeon, a restorative dentist or prosthodontist, an anesthesiologist, and a laboratory technician. Implant success was defined as successful integration of the implant; prosthetic success was defined as retention of the prosthesis under normal function. One hundred five zygomatic implants were placed and immediately loaded in 28 patients over a period of 1 to 60 months. Ages ranged from 46 to 81 years, with 26 female and 2 male patients. All the implants were placed by one surgeon. The immediate load on the day of implant placement was completed by either one of 2 prosthodontists or 11 restorative dentists. Implant success was 96% (101/105). All four failed implants were in one patient and were TiUnite surface coated. This study demonstrated that two zygomatic implants bilaterally placed and immediately loaded with a full-arch splinted prosthesis will provide a predictable outcome.

Advanced immediate functional loading: requirements for long-term success in modern implant dentistry.

PubMed

Romanos, Georgios E

2014-01-01

There are benefits to be derived from the use of advanced surgical protocols in conjunction with immediate functional loading using various dental implant designs and implant-abutment connections. Clinical protocols with simultaneous bone grafting, immediate implant placement, and/or sinus augmentations when a shortened treatment period is needed are included in this report, with the aim of providing understanding of the main protocol characteristics and prerequisites for long-term success in implant dentistry. This article presents three clinical cases that illustrate possibilities for advanced immediate loading using different implant designs. It demonstrates treatment of severe bone defects and the facilitation of placing implants in regenerated bone that can be immediately loaded.

Accelerated and enhanced bone formation on novel simvastatin-loaded porous titanium oxide surfaces.

PubMed

Nyan, Myat; Hao, Jia; Miyahara, Takayuki; Noritake, Kanako; Rodriguez, Reena; Kasugai, Shohei

2014-10-01

With increasing application of dental implants in poor-quality bones, the need for implant surfaces ensuring accelerated osseointegration and enhanced peri-implant bone regeneration is increased. A study was performed to evaluate the osseointegration and bone formation on novel simvastatin-loaded porous titanium oxide surface. Titanium screws were treated by micro-arc oxidation to form porous oxide surface and 25 or 50 μg of simvastatin was loaded. The nontreated control, micro-arc oxidized, and simvastatin-loaded titanium screws were surgically implanted into the proximal tibia of 16-week-old male Wistar rats (n = 36). Peri-implant bone volume, bone-implant contact, and mineral apposition rates were measured at 2 and 4 weeks. Data were analyzed by one-way analysis of variance followed by Tukey's post hoc test. New bone was formed directly on the implant surface in the bone marrow cavity in simvastatin-loaded groups since 2 weeks. Bone-implant contact values were significantly higher in simvastatin-loaded groups than control and micro-arc oxidized groups at both time points (p < .05). Peri-implant bone volume and mineral apposition rate of simvastatin-loaded groups were significantly higher than control and micro-arc oxidized groups at 2 weeks (p < .05). These data suggested that simvastatin-loaded porous titanium oxide surface provides faster osseointegration and peri-implant bone formation and it would be potentially applicable in poor-quality bones. © 2013 Wiley Periodicals, Inc.

Assessment of Embedded Conjugated Polymer Sensor Arrays for Potential Load Transmission Measurement in Orthopaedic Implants

PubMed Central

Micolini, Carolina; Holness, Frederick Benjamin; Johnson, James A.

2017-01-01

Load transfer through orthopaedic joint implants is poorly understood. The longer-term outcomes of these implants are just starting to be studied, making it imperative to monitor contact loads across the entire joint implant interface to elucidate the force transmission and distribution mechanisms exhibited by these implants in service. This study proposes and demonstrates the design, implementation, and characterization of a 3D-printed smart polymer sensor array using conductive polyaniline (PANI) structures embedded within a polymeric parent phase. The piezoresistive characteristics of PANI were investigated to characterize the sensing behaviour inherent to these embedded pressure sensor arrays, including the experimental determination of the stable response of PANI to continuous loading, stability throughout the course of loading and unloading cycles, and finally sensor repeatability and linearity in response to incremental loading cycles. This specially developed multi-material additive manufacturing process for PANI is shown be an attractive approach for the fabrication of implant components having embedded smart-polymer sensors, which could ultimately be employed for the measurement and analysis of joint loads in orthopaedic implants for in vitro testing. PMID:29186079

Experimental investigation of commercial small diameter dental implants in porcine mandibular segments.

PubMed

Hasan, Istabrak; Heinemann, Friedhelm; Schwegmann, Monika; Keilig, Ludger; Stark, Helmut; Bourauel, Christoph

2017-02-01

Small diameter (mini) dental implants have become more popular in recent years as alternatives to classical implant treatment in clinical cases with critical bony situations. However, an in-depth scientific analysis of the mechanical and biomechanical effects of small diameter implants has not yet been published. The aim of the present study was to investigate experimentally different commercial mini implants by measuring their displacements under immediate loading. Twelve commercially available mini implants were measured. Implants were inserted into porcine mandibular segments and loaded by means of a predefined displacement of 0.5 mm of the loading system. The implants were loaded at an angle of 30° to the implant long axis using the self-developed biomechanical hexapod measurement system. Implant displacements were registered. The experimental results were compared to the numerical ones from a previous study. Measured implant displacements were within the range of 39-194 μm. A large variation in the displacements was obtained among the different implant systems due to the different designs and thread profiles. Comparing experimental and numerical results, the displacements that were obtained numerically were within the range of 79-347 μm. The different commercial mini implants showed acceptable primary stability and could be loaded immediately after their insertion.

Properties of axially loaded implant-abutment assemblies using digital holographic interferometry analysis.

PubMed

Brozović, Juraj; Demoli, Nazif; Farkaš, Nina; Sušić, Mato; Alar, Zeljko; Gabrić Pandurić, Dragana

2014-03-01

The aim of this study was to (i) obtain the force-related interferometric patterns of loaded dental implant-abutment assemblies differing in diameter and brand using digital holographic interferometry (DHI) and (ii) determine the influence of implant diameter on the extent of load-induced implant deformation by quantifying and comparing the obtained interferometric data. Experiments included five implant brands (Ankylos, Astra Tech, blueSKY, MIS and Straumann), each represented by a narrow and a wide diameter implant connected to a corresponding abutment. A quasi-Fourier setup with a 25mW helium-neon laser was used for interferometric measurements in the cervical 5mm of the implants. Holograms were recorded in two conditions per measurement: a 10N preloaded and a measuring-force loaded assembly, resulting with an interferogram. This procedure was repeated throughout the whole process of incremental axial loading, from 20N to 120N. Each measurement series was repeated three times for each assembly, with complete dismantling of the implant-loading device in between. Additional software analyses calculated deformation data. Deformations were presented as mean values±standard deviations. Statistical analysis was performed using linear mixed effects modeling in R's lme4 package. Implants exhibited linear deformation patterns. The wide diameter group had lower mean deformation values than the narrow diameter group. The diameter significantly affected the deformation throughout loading sessions. This study gained in vitro implant performance data, compared the deformations in implant bodies and numerically stated the biomechanical benefits of wider diameter implants. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema.

PubMed

Cicinelli, Maria Vittoria; Cavalleri, Michele; Querques, Lea; Rabiolo, Alessandro; Bandello, Francesco; Querques, Giuseppe

2017-12-01

To analyse the effects of intravitreal dexamethasone implant in patients suffering from diabetic macular oedema (DME) on the basis of their visual and functional response to antivascular endothelial growth factor (VEGF) loading dose, in order to early shift to corticosteroids in poorly responding patients. Retrospective monocentric study. Data of patients with diabetes shifted to 0.7 mg dexamethasone implant after three injections of ranibizumab (RNB) and followed-up to 12 months were reviewed. Main outcome was the evaluation of short-term changes after dexamethasone implant injection, stratifying patients on the basis of best-corrected visual acuity (BCVA) and central macular thickness (CMT) after RNB loading dose. Secondary outcome was to investigate clinical gain maintenance at long-term follow-up. Overall, 45 eyes of 45 patients (23 males, 51.1%), mean age 69.7±9 years, were included in the analysis. After 3 injections of RNB, 30 eyes (66.7%) had a poor visual response (-4.3±10.7 letters), while 15 eyes (33.3%) disclosed good visual outcome (+13.9±9.2 letters). Patients with poor visual response were associated with limited morphological improvement (p=0.04). After 1 month from dexamethasone, only poor responders showed relevant increase in BCVA (p=0.006) and reduction in CMT (p=0.002), in comparison to good visual response patients, featuring only minor clinical effects (p=0.3). The same trend was maintained up to 12 months, after a mean of 1.9±1.1 dexamethasone administrations. Visual and anatomical responses after RNB loading dose are significant predictors of both early term and long-term visual acuity improvement after switching to corticosteroids in patients with DME unresponsive to anti-VEGF. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Random spectrum loading of dental implants: An alternative approach to functional performance assessment.

PubMed

Shemtov-Yona, K; Rittel, D

2016-09-01

The fatigue performance of dental implants is usually assessed on the basis of cyclic S/N curves. This neither provides information on the anticipated service performance of the implant, nor does it allow for detailed comparisons between implants unless a thorough statistical analysis is performed, of the kind not currently required by certification standards. The notion of endurance limit is deemed to be of limited applicability, given unavoidable stress concentrations and random load excursions, that all characterize dental implants and their service conditions. We propose a completely different approach, based on random spectrum loading, as long used in aeronautical design. The implant is randomly loaded by a sequence of loads encompassing all load levels it would endure during its service life. This approach provides a quantitative and comparable estimate of its performance in terms of lifetime, based on the very fact that the implant will fracture sooner or later, instead of defining a fatigue endurance limit of limited practical application. Five commercial monolithic Ti-6Al-4V implants were tested under cyclic, and another 5 under spectrum loading conditions, at room temperature and dry air. The failure modes and fracture planes were identical for all implants. The approach is discussed, including its potential applications, for systematic, straightforward and reliable comparisons of various implant designs and environments, without the need for cumbersome statistical analyses. It is believed that spectrum loading can be considered for the generation of new standardization procedures and design applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Influence of controlled immediate loading and implant design on peri-implant bone formation.

PubMed

Vandamme, Katleen; Naert, Ignace; Geris, Liesbet; Vander Sloten, Jozef; Puers, Robert; Duyck, Joke

2007-02-01

Tissue formation at the implant interface is known to be sensitive to mechanical stimuli. The aim of the study was to compare the bone formation around immediately loaded versus unloaded implants in two different implant macro-designs. A repeated sampling bone chamber with a central implant was installed in the tibia of 10 rabbits. Highly controlled loading experiments were designed for a cylindrical (CL) and screw-shaped (SL) implant, while the unloaded screw-shaped (SU) implant served as a control. An F-statistic model with alpha=5% determined statistical significance. A significantly higher bone area fraction was observed for SL compared with SU (p<0.0001). The mineralized bone fraction was the highest for SL and significantly different from SU (p<0.0001). The chance that osteoid- and bone-to-implant contact occurred was the highest for SL and significantly different from SU (p<0.0001), but not from CL. When bone-to-implant contact was observed, a loading (SL versus SU: p=0.0049) as well as an implant geometry effect (SL versus CL: p=0.01) was found, in favour of the SL condition. Well-controlled immediate implant loading accelerates tissue mineralization at the interface. Adequate bone stimulation via mechanical coupling may account for the larger bone response around the screw-type implant compared with the cylindrical implant.

Zirconia-implant-supported all-ceramic crowns withstand long-term load: a pilot investigation.

PubMed

Kohal, Ralf-J; Klaus, Gerold; Strub, Jörg R

2006-10-01

The purpose of this pilot investigation was to test whether zirconia implants restored with different all-ceramic crowns would fulfill the biomechanical requirements for clinical use. Therefore, all-ceramic Empress-1 and Procera crowns were cemented on zirconia implants and exposed to the artificial mouth. Afterwards, the fracture strength of the all-ceramic implant-crown systems was evaluated. Conventional titanium implants restored with porcelain-fused-to-metal (PFM) crowns served as controls. Sixteen titanium implants with 16 PFM crowns and 32 zirconia implants with 16 Empress-1 crowns and 16 Procera crowns each--i.e., three implant-crown groups--were used in this investigation. The titanium implants were fabricated using the ReImplant system and the zirconia implants using the Celay system. The upper left central incisor served as a model for the fabrication of the implants and the crowns. Eight samples of each group were submitted to a long-term load test in the artificial mouth (1.2 million chewing cycles). Subsequently, a fracture strength test was performed with seven of the eight crowns. The remaining eight samples of each group were not submitted to the long-term load in the artificial mouth but were fracture-tested immediately. One loaded and one unloaded sample of each group were evaluated regarding the marginal fit of the crowns. All test samples survived the exposure to the artificial mouth. Three Empress-1 crowns showed cracks in the area of the loading steatite ball. The values for the fracture load in the titanium implant-PFM crown group without artificial loading ranged between 420 and 610 N (mean: 531.4 N), between 460 and 570 N (mean: 512.9 N) in the Empress-1 crown group, and in the Procera crown group the values were between 475 and 700 N (mean: 575.7 N) when not loaded artificially. The results when the specimens were loaded artificially with 1.2 million cycles were as follows: the titanium implant-PFM crowns fractured between 440 and 950 N (mean: 668.6 N), the Empress-1 crowns between 290 and 550 N (mean: 410.7 N), and the Procera crowns between 450 and 725 N (mean: 555.5 N). No statistically significant differences could be found among the groups without artificial load. The fracture values for the PFM and the Procera crowns after artificial loading were statistically significantly higher than that for the loaded Empress-1 crowns. There was no significant difference between the PFM crown group and the Procera group. Within the limits of this pilot investigation, it seems that zirconia implants restored with the Procera crowns possibly fulfill the biomechanical requirements for anterior teeth. However, further investigations with larger sample sizes have to confirm these preliminary results. As three Empress-1 crowns showed crack development in the loading area of the steatite balls in the artificial mouth, their clinical use on zirconia implants has to be questioned.

Time Course of Peri-Implant Bone Regeneration around Loaded and Unloaded Implants in a Rat Model

PubMed Central

Jariwala, Shailly H.; Wee, Hwabok; Roush, Evan P.; Whitcomb, Tiffany L.; Murter, Christopher; Kozlansky, Gery; Lakhtakia, Akhlesh; Kunselman, Allen R.; Donahue, Henry J.; Armstrong, April D.; Lewis, Gregory S.

2018-01-01

The time-course of cancellous bone regeneration surrounding mechanically loaded implants affects implant fixation, and is relevant to determining optimal rehabilitation protocols following orthopaedic surgeries. We investigated the influence of controlled mechanical loading of titanium-coated polyether-ether ketone (PEEK) implants on osseointegration using time-lapsed, non-invasive, in vivo micro-computed tomography (micro-CT) scans. Implants were inserted into proximal tibial metaphyses of both limbs of eight female Sprague-Dawley rats. External cyclic loading (60 μm or 100 μm displacement, 1 Hz, 60 seconds) was applied every other day for 14 days to one implant in each rat, while implants in contralateral limbs served as the unloaded controls. Hind limbs were imaged with high-resolution micro-CT (12.5 μm voxel size) at 2, 5, 9, and 12 days post-surgery. Trabecular changes over time were detected by 3D image registration allowing for measurements of bone-formation rate (BFR) and bone-resorption rate (BRR). At day 9, mean %BV/TV for loaded and unloaded limbs were 35.5 ± 10.0 % and 37.2 ± 10.0 %, respectively, and demonstrated significant increases in bone volume compared to day 2. BRR increased significantly after day 9. No significant differences between bone volumes, BFR, and BRR were detected due to implant loading. Although not reaching significance (p = 0.16), an average 119 % increase in pull-out strength was measured in the loaded implants. PMID:27381807

Misfit of Three Different Implant-Abutment Connections Before and After Cyclic Load Application: An In Vitro Study.

PubMed

Gehrke, Sergio Alexandre; Delgado-Ruiz, Rafael Arcesio; Prados Frutos, Juan Carlos; Prados-Privado, María; Dedavid, Berenice Anina; Granero Marín, Jose Manuel; Calvo Guirado, José Luiz

This study aimed to evaluate the misfit of three different implant-abutment connections before and after cycling load. One hundred twenty dental implants and correspondent prefabricated titanium abutments were used. Three different implant-abutment connections were evaluated: Morse taper (MT group), external hexagon (EH group), and internal hexagon (IH group). Forty implants and 40 abutments were used per group. The parameters for the mechanical evaluation were set as: 360,000 cycles, load of 150 N, and frequency of 4 Hz. Samples were sectioned in their longitudinal and transversal axes, and the misfit of the implant-abutment connection was evaluated by scanning electron microscopy analysis. One-way analyses of variance, Tukey post hoc analyses (α = .05), and t test (P < .05) were used to determine differences between groups. At the longitudinal direction, all the groups showed the presence of microgaps before cycling load; after cycling load, microgaps were reduced in all groups (P > .05). Transversally, only the MT group showed full fitting after cycling load compared with the other groups (EH and IH) (P < .0001). The application of cycling load produces an accommodation of the implant-abutment connection in internal, external, and Morse taper connections. In the longitudinal direction, the accommodation decreases and/or eliminates the gap observed initially (before load). In the horizontal direction, Morse cone implant-abutment connections experience a complete accommodation with the elimination of the gap.

Clinical and Radiographic Assessment of Three-Implant-Supported Fixed-Prosthesis Rehabilitation of the Edentulous Mandible: Immediate Versus Delayed Loading.

PubMed

Primo, Bruno Tochetto; Mezzari, Leonardo Marcos; da Fontoura Frasca, Luís Carlos; Linderman, Raquel; Rivaldo, Elken Gomes

To evaluate and compare the clinical and radiographic outcomes of mandibular rehabilitation with fixed prostheses on three implants with immediate versus delayed loading. The sample comprised 21 patients who underwent treatment with immediate loading and 23 who received delayed loading. All had worn their prostheses for at least 18 months. Radiographic evaluation of bone loss was carried out in Adobe Photoshop CS5 by a single calibrated examiner using digitized panoramic radiographs. Clinical examination of the technical conditions of the prosthetic device assessed the condition of the acrylic resin base, dental occlusion, metal framework, presence of cover screws, screw fixation of the prosthesis and abutments, length of cantilever (effort) and resistance arms, presence of plaque on prosthetic abutments, and hygiene of the prosthesis. One implant failed in each group, resulting in a 95.23% treatment success rate with immediate loading and 95.65% with delayed loading (no statistically significant between-group difference). In the immediate-loading group, the mean bone loss was 1.96 ± 0.73 mm around central implants and 1.64 ± 0.84 mm at distal implants. In the delayed-loading group, the mean bone loss was 1.85 ± 0.67 mm around central implants and 1.70 ± 0.77 mm at distal implants. According to Student t test, there was no significant within-group difference in bone loss and no difference between the immediate-loading and delayed-loading groups. The only prosthesis-related complications that differed significantly between groups were "condition of the acrylic base," "occlusion," and "presence of right cover screw." There was no statistically significant association of lever arm ratio with peri-implant bone loss or bone loss on the mesial surfaces compared to the distal surfaces of the distal implants. The three-implant-supported fixed prosthesis protocol tested in this study proved to be a viable therapeutic strategy for mandibular edentulous patients with maxillary complete dentures, regardless of whether loading was immediate or delayed, with no difference in peri-implant bone loss.

Biological and immunotoxicity evaluation of antimicrobial peptide-loaded coatings using a layer-by-layer process on titanium

PubMed Central

Shi, Jue; Liu, Yu; Wang, Ying; Zhang, Jing; Zhao, Shifang; Yang, Guoli

2015-01-01

The prevention and control of peri-implantitis is a challenge in dental implant surgery. Dental implants with sustained antimicrobial coating are an ideal way of preventing peri-implantitis. This study reports development of a non- immunotoxicity multilayered coating on a titanium surface that had sustained antimicrobial activity and limited early biofilm formation. In this study, the broad spectrum AMP, Tet213, was linked to collagen IV through sulfo-SMPB and has been renamed as AMPCol. The multilayer AMPCol coatings were assembled on smooth titanium surfaces using a LBL technique. Using XPS, AFM, contact angle analysis, and QCM, layer-by-layer accumulation of coating thickness was measured and increased surface wetting compared to controls was confirmed. Non-cytotoxicity to HaCaT and low erythrocyte hemolysis by the AMPCol coatings was observed. In vivo immunotoxicity assays showed IP administration of AMPCol did not effect serum immunoglobulin levels. This coating with controlled release of AMP decreased the growth of both a Gram-positive aerobe (Staphylococcus aureus) and a Gram-negative anaerobe (Porphyromonas gingivalis) up to one month. Early S. aureus biofilm formation was inhibited by the coating. The excellent long-term sustained antimicrobial activity of this multilayer coating is a potential method for preventing peri-implantitis through coated on the neck of implants before surgery. PMID:26548760

Dynamic fatigue performance of implant-abutment assemblies with different tightening torque values.

PubMed

Xia, Dandan; Lin, Hong; Yuan, Shenpo; Bai, Wei; Zheng, Gang

2014-01-01

Implant-abutment assemblies are usually subject to long-term cyclic loading. To evaluate the dynamic fatigue performance of implant-abutment assemblies with different tightening torque values, thirty implant-abutment assemblies (Zimmer Dental, Carlsbad, CA, USA) were randomly assigned to three tightening groups (24 Ncm; 30 Ncm; 36 Ncm), each consisted of 10 implants. Five specimens from each group were unscrewed, and their reverse torque values recorded. The remaining specimens were subjected to a load between 30 N~300 N at a loading frequency of 15 Hz for 5 × 10(6) cycles. After fatigue tests, residual reverse torque values were recorded if available. In the 24 Ncm tightening group, all the implants fractured at the first outer thread of the implant after fatigue loading, with fatigue crack propagation at the fractured surface showed by SEM observation. For the 30 Ncm and 36 Ncm tightening groups, a statistical significant difference (p<0.05) between the unloaded and loaded groups was revealed. Compared with the unloaded specimens, the specimens went through fatigue loading had decreased reverse torque values. It was demonstrated that insufficient torque will lead to poor fatigue performance of dental implant-abutment assemblies and abutment screws should be tightened to the torque recommended by the manufacturer. It was also concluded that fatigue loading would lead to preload loss.

Instant loading with intraoral welding technique and PRAMA implants: a new prosthetic approach.

PubMed

Celletti, R; Fanali, S; Laici, C U; Santori, C; Pignatelli, P; Sinjari, B

2017-01-01

When splinting multiple implants passive fit of the framework should be achieved to avoid excessive force distribution on the implants. Recently, a protocol was suggested for immediate loading of multiple implants by welding a titanium bar to implant abutments directly in the oral cavity so as to create a customized, precise and passive metal-reinforced provisional restoration. The intraoral welding technique subsequently proves to be a successful option in the full-arch immediate restorations of the mandible and maxilla. The aim of this article is to present a case report in which a new prosthetic approach, using trans-mucosal implants, is described. Dental implants are instantly loaded with a provisional prosthesis supported by an intraoral welded titanium framework to obtain a precise passive fit of the immediate loaded prosthesis.

Impact of Intentional Overload on Joint Stability of Internal Implant-Abutment Connection System with Different Diameter.

PubMed

Lee, Ji-Hye; Lee, Won; Huh, Yoon-Hyuk; Park, Chan-Jin; Cho, Lee-Ra

2017-09-05

To evaluate the axial displacement of the implant-abutment assembly of different implant diameter after static and cyclic loading of overload condition. An internal conical connection system with three diameters (Ø 4.0, 4.5, and 5.0) applying identical abutment dimension and the same abutment screw was evaluated. Axial displacement of abutment and reverse torque loss of abutment screw were evaluated under static and cyclic loading conditions. Static loading test groups were subjected to vertical static loading of 250, 400, 500, 600, 700, and 800 N consecutively. Cyclic loading test groups were subjected to 500 N cyclic loading to evaluate the effect of excessive masticatory loading. After abutment screw tightening for 30 Ncm, axial displacement was measured upon 1, 3, 10, and 1,000,000 cyclic loadings of 500 N. Repeated-measure ANOVA and 2-way ANOVA were used for statistical analysis (α = 0.05). The increasing magnitude of vertical load and thinner wall thickness of implant increased axial displacement of abutment and reverse torque loss of abutment screw (p < 0.05). Implants in the Ø 5.0 diameter group demonstrated significantly low axial displacement, and reverse torque loss after static loading than Ø 4.0 and Ø 4.5 diameter groups (p < 0.05). In the cyclic loading test, all diameter groups of implant showed significant axial displacement after 1 cycle of loading of 500 N (p < 0.05). There was no significant axial displacement after 3, 10, or 1,000,000 cycles of loading (p = 0.603). Implants with Ø 5.0 diameter demonstrated significantly low axial displacement and reverse torque loss after the cyclic and static loading of overload condition. © 2017 by the American College of Prosthodontists.

Evaluation of implants coated with rhBMP-2 using two different coating strategies: a critical-size supraalveolar peri-implant defect study in dogs.

PubMed

Lee, Jaebum; Decker, John F; Polimeni, Giuseppe; Cortella, Carlo Alberto; Rohrer, Michael D; Wozney, John M; Hall, Jan; Susin, Cristiano; Wikesjö, Ulf M E

2010-06-01

Implants coated with recombinant human bone morphogenetic protein-2 (rhBMP-2) induce relevant bone formation but also resident bone remodelling. To compare the effect of implants fully or partially coated with rhBMP-2 on new bone formation and resident bone remodelling. Twelve, male, adult, Hound Labrador mongrel dogs were used. Critical-size, supraalveolar, peri-implant defects received titanium porous oxide surface implants coated in their most coronal aspect with rhBMP-2 (coronal-load/six animals) or by immersion of the entire implant in an rhBMP-2 solution (soak-load/six animals) for a total of 30 mug rhBMP-2/implant. All implants were air-dried. The animals were euthanized at 8 weeks for histometric evaluation. Clinical healing was uneventful. Supraalveolar bone formation was not significantly affected by the rhBMP-2 application protocol. New bone height and area averaged (+/- SE) 3.4 +/- 0.2 versus 3.5 +/- 0.4 mm and 2.6 +/- 0.4 versus 2.5 +/- 0.7 mm(2) for coronal-load and soak-load implants, respectively (p>0.05). The corresponding bone density and bone-implant contact (BIC) recordings averaged 38.0 +/- 3.8%versus 34.4 +/- 5.6% and 25.0 +/- 3.8%versus 31.2 +/- 3.3% (p>0.05). In contrast, resident bone remodelling was significantly influenced by the rhBMP-2 application protocol. Bone density outside the implants threads averaged 74.7 +/- 3.8% and 50.8 +/- 4.1% for coronal-load and soak-load implants, respectively (p<0.05); bone density within the thread area averaged 51.8 +/- 1.2% and 37.8 +/- 2.9%, and BIC 70.1 +/- 6.7% and 43.3 +/- 3.9% (p<0.05). Local application of rhBMP-2 appears to be a viable technology to support local bone formation and osseointegration. Coronal-load implants obviate resident bone remodelling without compromising new bone formation.

The Failure Envelope Concept Applied To The Bone-Dental Implant System.

PubMed

Korabi, R; Shemtov-Yona, K; Dorogoy, A; Rittel, D

2017-05-17

Dental implants interact with the jawbone through their common interface. While the implant is an inert structure, the jawbone is a living one that reacts to mechanical stimuli. Setting aside mechanical failure considerations of the implant, the bone is the main component to be addressed. With most failure criteria being expressed in terms of stress or strain values, their fulfillment can mean structural flow or fracture. However, in addition to those effects, the bony structure is likely to react biologically to the applied loads by dissolution or remodeling, so that additional (strain-based) criteria must be taken into account. While the literature abounds in studies of particular loading configurations, e.g. angle and value of the applied load to the implant, a general study of the admissible implant loads is still missing. This paper introduces the concept of failure envelopes for the dental implant-jawbone system, thereby defining admissible combinations of vertical and lateral loads for various failure criteria of the jawbone. Those envelopes are compared in terms of conservatism, thereby providing a systematic comparison of the various failure criteria and their determination of the admissible loads.

Hydroxyapatite-coated double network hydrogel directly bondable to the bone: Biological and biomechanical evaluations of the bonding property in an osteochondral defect.

PubMed

Wada, Susumu; Kitamura, Nobuto; Nonoyama, Takayuki; Kiyama, Ryuji; Kurokawa, Takayuki; Gong, Jian Ping; Yasuda, Kazunori

2016-10-15

We have developed a novel hydroxyapatite (HAp)-coated double-network (DN) hydrogel (HAp/DN gel). The purpose of this study was to determine details of the cell and tissue responses around the implanted HAp/DN gel and to determine how quickly and strongly the HAp/DN gel bonds to the bone in a rabbit osteochondral defect model. Immature osteoid tissue was formed in the space between the HAp/DN gel and the bone at 2weeks, and the osteoid tissue was mineralized at 4weeks. The push-out load of the HAp/DN gel averaged 37.54N and 42.15N at 4 and 12weeks, respectively, while the push-out load of the DN gel averaged less than 5N. The bonding area of the HAp/DN gel to the bone was above 80% by 4weeks, and above 90% at 12weeks. This study demonstrated that the HAp/DN gel enhanced osseointegration at an early stage after implantation. The presence of nanoscale structures in addition to osseointegration of HAp promoted osteoblast adhesion onto the surface of the HAp/DN gel. The HAp/DN gel has the potential to improve the implant-tissue interface in next-generation orthopaedic implants such as artificial cartilage. Recent studies have reported the development of various hydrogels that are sufficiently tough for application as soft supporting tissues. However, fixation of hydrogels on bone surfaces with appropriate strength is a great challenge. We have developed a novel, tough hydrogel hybridizing hydroxyapatite (HAp/DN gel), which is directly bondable to the bone. The present study demonstrated that the HAp/DN gel enhanced osseointegration in the early stage after implantation. The presence of nanoscale structures in addition to the osseointegration ability of hydroxyapatite promoted osteoblast adhesion onto the surface of the HAp/DN gel. The HAp/DN gel has the potential to improve the implant-tissue interface in next-generation orthopaedic implants such as artificial cartilage. Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Fatigue lifetime prediction of a reduced-diameter dental implant system: Numerical and experimental study.

PubMed

Duan, Yuanyuan; Gonzalez, Jorge A; Kulkarni, Pratim A; Nagy, William W; Griggs, Jason A

2018-06-16

To validate the fatigue lifetime of a reduced-diameter dental implant system predicted by three-dimensional finite element analysis (FEA) by testing physical implant specimens using an accelerated lifetime testing (ALT) strategy with the apparatus specified by ISO 14801. A commercially-available reduced-diameter titanium dental implant system (Straumann Standard Plus NN) was digitized using a micro-CT scanner. Axial slices were processed using an interactive medical image processing software (Mimics) to create 3D models. FEA analysis was performed in ABAQUS, and fatigue lifetime was predicted using fe-safe ® software. The same implant specimens (n=15) were tested at a frequency of 2Hz on load frames using apparatus specified by ISO 14801 and ALT. Multiple step-stress load profiles with various aggressiveness were used to improve testing efficiency. Fatigue lifetime statistics of physical specimens were estimated in a reliability analysis software (ALTA PRO). Fractured specimens were examined using SEM with fractographic technique to determine the failure mode. FEA predicted lifetime was within the 95% confidence interval of lifetime estimated by experimental results, which suggested that FEA prediction was accurate for this implant system. The highest probability of failure was located at the root of the implant body screw thread adjacent to the simulated bone level, which also agreed with the failure origin in physical specimens. Fatigue lifetime predictions based on finite element modeling could yield similar results in lieu of physical testing, allowing the use of virtual testing in the early stages of future research projects on implant fatigue. Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

No influence of simultaneous bone-substitute application on the success of immediately loaded dental implants: a retrospective cohort study.

PubMed

Kopp, Sigmar; Behrend, Detlef; Kundt, Günther; Ottl, Peter; Frerich, Bernhard; Warkentin, Mareike

2013-06-01

To examine the influence of bone-substitute application during implantation on the success of immediately placed and loaded dental implants. A total of 147 consecutive patients (age, 16.5-80.4 years) were provided with 696 immediately loaded implants. The mean follow-up time was 34.1 months. Of these implants, 50.4% (n=351) were immediately placed into extraction sockets. A total of 119 implants were added by simultaneous bone-substitute application (NanoBone, Artoss GmbH, Rostock Germany), whereas the other implants were placed in healed bone. Univariate and multivariate analysis was performed using IBM SPSS V.20. The overall implant success rate was 96.1%. Implants with simultaneous bone replacement had a hazard ratio of 0.877 (p=0.837); 95% CI, 0.253-3.04). Factors found to be statistically significant modifiers of success on multivariate analysis (p<0.05) included type of superstructure (p<0.001), implant-abutment connection (p<0.001), membrane use (p=0.010), and jaw (p=0.026). None of the other factors investigated were significant modifiers. The present study demonstrates high success rates for immediately loaded implants and their superstructures independent of the simultaneous application of bone substitute. The declared aim of socket preservation, the prevention avoiding bone loss, is achieved in the immediate implant placement scenario under immediate-loading conditions.

Immediate prosthesis over implants retained using abutments with flexible screws: A preliminary study.

PubMed

Peñarrocha-Oltra, David; Serra-Pastor, Blanca; Balaguer-Martí, José-Carlos; Peñarrocha-Diago, Miguel; Agustín-Panadero, Rubén

2017-12-01

Immediate loading protocols for the rehabilitation of edentulous or partially edentulous patients have become very popular, due to the conveniences they afford in comparison with conventional loading techniques. A preliminary study was carried out with 8 patients subjected to dental implant treatment with an immediate loading protocol involving a novel system of abutments with flexible screws. Implant survival was analyzed, together with marginal bone loss and patient and dentist satisfaction. A total of 35 implants were subjected to immediate loading using the abutments with flexible screws. The mean patient and dentist satisfaction score was 9.1 and 8.5, respectively. After 12 months the dental implant survival rate was 95.8%, with a mean marginal bone loss of 0.51 ± 0.12 mm. The novel system of abutments with flexible screws offers a good alternative to conventional immediate loading, since it allows rapid and simple manufacture of a reliable passive fit, fixed interim prosthesis after surgery. Key words: Dental implants, Flexafit®, Immediate loading, Immediate prosthesis.

Immediate Functional Loading of One-Piece Zirconia Implants in a Full-Arch Maxillary Restoration: A Five-Year Case Report.

PubMed

Peter, Burghard

Immediate loading has proven to be a predictable modality for restorations with titanium dental implants. An increasing number of articles indicate that zirconia implants might osseointegrate to a similar extent in this context. This 5-year case report describes an outpatient maxillary restoration with eight immediately loaded zirconia implants. Implantation followed extensive bone augmentation. At the 5-year follow-up, all implants were still well osseointegrated clinically and radiologically. No major bone loss or peri-implantitis had occurred in spite of temporary insufficient patient compliance. More research and studies are needed to confirm these results.

Immediate occlusal loading of double acid-etched surface titanium implants in 41 consecutive full-arch cases in the mandible and maxilla: 6- to 74-month results.

PubMed

Ibañez, Juan C; Tahhan, Marcelo J; Zamar, Juan A; Menendez, Alicia B; Juaneda, Agustina M; Zamar, Nicolas J; Monqaut, Jose L

2005-11-01

The high success rate of dental implants has changed the quality of life for many patients. Immediate loading finds its application in some clinical cases and certainly adds another modality of treatment for the implant patient. Starting with a few implants immediately loaded with a bar overdenture in the mandible, the concept of immediate loading evolved to loading multiple implants in both the maxilla and mandible. In this investigation, 41 consecutive patients who needed full-arch restorations were treated with 343 double acid-etched surface implants between May 1998 and March 2004. The sample included smokers and bruxers. Twenty-three mandibular and 26 maxillary cases were treated, loading the implants within 48 hours, by using resin provisional prostheses, metal-reinforced provisional prostheses, or definitive prostheses (metal-acrylic or metal-ceramic). All implants were followed for 12 to 74 months. Follow-up consisted of clinical as well as radiographic examination. Furthermore, resonance frequency analysis was done in most of the implants during the last 2 years. The success rate obtained was 99.42% (only two mandibular implants that are still surviving were considered failures). The bone level was measured every year. The average radiographic bone level change was 0.56 mm at 12, 0.76 mm at 24, 0.84 mm at 36, 0.82 mm at 48, 0.83 mm at 60, and 0.94 mm at 72 months. A high success rate can be achieved when double acid-etched surface implants are immediately loaded with fixed full-arch restorations in the maxilla and mandible.

Immediate Loading of Tapered Implants Placed in Postextraction Sockets and Healed Sites.

PubMed

Han, Chang-Hun; Mangano, Francesco; Mortellaro, Carmen; Park, Kwang-Bum

2016-07-01

The aim of the present study was to compare the survival, stability, and complications of immediately loaded implants placed in postextraction sockets and healed sites. Over a 2-year period, all patients presenting with partial or complete edentulism of the maxilla and/or mandible (healed site group, at least 4 months of healing after tooth extraction) or in need of replacement of nonrecoverable failing teeth (postextraction group) were considered for inclusion in this study. Tapered implants featuring a nanostructured calcium-incorporated surface were placed and loaded immediately. The prosthetic restorations comprised single crowns, fixed partial dentures, and fixed full arches. Primary outcomes were implant survival, stability, and complications. Implant stability was assessed at placement and at each follow-up evaluation (1 week, 3 months, and 1 year after placement): implants with an insertion torque (IT) <45 N·cm and/or with an implant stability quotient (ISQ) <70 were considered failed for immediate loading. A statistical analysis was performed. Thirty implants were placed in postextraction sockets of 17 patients, and 32 implants were placed in healed sites of 22 patients. There were no statistically significant differences in ISQ values between the 2 groups, at each assessment. In total, 60 implants (96.8%) had an IT ≥45 and an ISQ ≥70 at placement and at each follow-up control: all these implants were successfully loaded. Only 2 implants (1 in a postextraction socket and 1 in a healed site, 3.2%) could not achieve an IT ≥45 N·cm and/or an ISQ ≥70 at placement or over time: accordingly, these were considered failed for stability, as they could not be subjected to immediate loading. One of these 2 implants, in a healed site of a posterior maxilla, had to be removed, yielding an overall 1-year implant survival rate of 98.4%. No complications were reported. No significant differences were reported between the 2 groups with respect to implant failures and complications. Immediately loaded implants placed in postextraction sockets and healed sites had similar high survival and stability, with no reported complications. Further long-term studies on larger samples of patients are needed to confirm these results.

Evaluation of implants coated with recombinant human bone morphogenetic protein-2 and vacuum-dried using the critical-size supraalveolar peri-implant defect model in dogs.

PubMed

Decker, John F; Lee, Jaebum; Cortella, Carlo Alberto; Polimeni, Giuseppe; Rohrer, Michael D; Wozney, John M; Hall, Jan; Susin, Cristiano; Wikesjö, Ulf M E

2010-12-01

Endosseous implants coated with recombinant human bone morphogenetic protein-2 (rhBMP-2) in a laboratory bench setting and air-dried induce relevant bone formation but also resident bone remodeling. Thus, the objective of this study is to evaluate the effect of implants fully or partially coated with rhBMP-2 and vacuum-dried using an industrial process on local bone formation and resident bone remodeling. Twelve male adult Hound Labrador mongrel dogs were used. Critical-size, supraalveolar, peri-implant defects received titanium porous oxide surface implants coated in their most coronal aspect with rhBMP-2 (coronal-load, six animals), or by immersion of the entire implant in a rhBMP-2 solution (soak-load, six animals) for a total of 30 μg rhBMP-2 per implant. All implants were vacuum-dried. The animals were sacrificed at 8 weeks for histometric evaluation. Clinical healing was unremarkable. Bone formation was not significantly affected by the rhBMP-2 application protocol. New bone height and area averaged (± SE) 3.2 ± 0.5 versus 3.6 ± 0.3 mm, and 2.3 ± 0.5 versus 2.6 ± 0.8 mm(2) for coronal-load and soak-load implants, respectively (P >0.05). The corresponding bone density and bone-implant contact registrations averaged 46.7% ± 5.8% versus 31.6% ± 4.4%, and 28% ± 5.6% versus 36.9% ± 3.4% (P >0.05). In contrast, resident bone remodeling was significantly influenced by the rhBMP-2 application protocol. Peri-implant bone density averaged 72.2% ± 2.1% for coronal-load versus 60.6% ± 4.7% for soak-load implants (P <0.05); the corresponding bone-implant contact averaged 70.7% ± 6.1% versus 47.2% ± 6.0% (P <0.05). Local application of rhBMP-2 and vacuum-drying using industrial process seems to be a viable technology to manufacture implants that support local bone formation and osseointegration. Coronal-load implants obviate resident bone remodeling without compromising local bone formation.

In-vivo orthopedic implant diagnostic device for sensing load, wear, and infection

DOEpatents

Evans, III, Boyd McCutchen; Thundat, Thomas G.; Komistek, Richard D.; Dennis, Douglas A.; Mahfouz, Mohamed

2006-08-29

A device for providing in vivo diagnostics of loads, wear, and infection in orthopedic implants having at least one load sensor associated with the implant, at least one temperature sensor associated with the implant, at least one vibration sensor associated with the implant, and at least one signal processing device operatively coupled with the sensors. The signal processing device is operable to receive the output signal from the sensors and transmit a signal corresponding with the output signal.

Proximal tibial strain in medial unicompartmental knee replacements: A biomechanical study of implant design.

PubMed

Scott, C E H; Eaton, M J; Nutton, R W; Wade, F A; Pankaj, P; Evans, S L

2013-10-01

As many as 25% to 40% of unicompartmental knee replacement (UKR) revisions are performed for pain, a possible cause of which is proximal tibial strain. The aim of this study was to examine the effect of UKR implant design and material on cortical and cancellous proximal tibial strain in a synthetic bone model. Composite Sawbone tibiae were implanted with cemented UKR components of different designs, either all-polyethylene or metal-backed. The tibiae were subsequently loaded in 500 N increments to 2500 N, unloading between increments. Cortical surface strain was measured using a digital image correlation technique. Cancellous damage was measured using acoustic emission, an engineering technique that detects sonic waves ('hits') produced when damage occurs in material. Anteromedial cortical surface strain showed significant differences between implants at 1500 N and 2500 N in the proximal 10 mm only (p < 0.001), with relative strain shielding in metal-backed implants. Acoustic emission showed significant differences in cancellous bone damage between implants at all loads (p = 0.001). All-polyethylene implants displayed 16.6 times the total number of cumulative acoustic emission hits as controls. All-polyethylene implants also displayed more hits than controls at all loads (p < 0.001), more than metal-backed implants at loads ≥ 1500 N (p < 0.001), and greater acoustic emission activity on unloading than controls (p = 0.01), reflecting a lack of implant stiffness. All-polyethylene implants were associated with a significant increase in damage at the microscopic level compared with metal-backed implants, even at low loads. All-polyethylene implants should be used with caution in patients who are likely to impose large loads across their knee joint.

Design and biomechanical evaluation of a cementable endosteal blade implant.

PubMed

Pugh, J; Weiss, C; Weiss, F; Malkin, D

1976-07-01

A cementable endosteal blade implant has been developed and evaluated. Inherent in the design are the following factors: minimization of stress concentrators, ease of implantation, and high resistance to loosening. Other potential advantages of this design as compared with conventional endosteal blade implants include reduced hazards of postoperative infection and reduced likelihood of metallic corrosion. Six conventional endosteal implants and six cementable implants were installed in steer mandibles using standard dental surgical techniques and Simplex-brand methyl methacrylate bone cement. They were loaded in uniaxial compresstion at a loading rate of 0.0122 in./min. the stiffness (S), deformation at 900-lb load (D900), proportional limil (PL), and load at 0.04 in. deformation (L0.04) were calculated for each test. The cementable design showed a twofold increase in stiffness, only 17% of the deformation at 900lb, more than twice the proportional limit, and at least twice the load at 0.04 in. deformation when compared with similar values for the conventional endosteal implants. This study reveals that, in addition to being unstable in bone, conventional endosteal implants are also unstable when used with acrylic bone cement. The new design should eliminate most of the problems associated with endosteal blade implantation.

Biomechanical changes of the lumbar segment after total disc replacement : charite(r), prodisc(r) and maverick(r) using finite element model study.

PubMed

Kim, Ki-Tack; Lee, Sang-Hun; Suk, Kyung-Soo; Lee, Jung-Hee; Jeong, Bi-O

2010-06-01

The purpose of this study was to analyze the biomechanical effects of three different constrained types of an artificial disc on the implanted and adjacent segments in the lumbar spine using a finite element model (FEM). The created intact model was validated by comparing the flexion-extension response without pre-load with the corresponding results obtained from the published experimental studies. The validated intact lumbar model was tested after implantation of three artificial discs at L4-5. Each implanted model was subjected to a combination of 400 N follower load and 5 Nm of flexion/extension moments. ABAQUS version 6.5 (ABAQUS Inc., Providence, RI, USA) and FEMAP version 8.20 (Electronic Data Systems Corp., Plano, TX, USA) were used for meshing and analysis of geometry of the intact and implanted models. Under the flexion load, the intersegmental rotation angles of all the implanted models were similar to that of the intact model, but under the extension load, the values were greater than that of the intact model. The facet contact loads of three implanted models were greater than the loads observed with the intact model. Under the flexion load, three types of the implanted model at the L4-5 level showed the intersegmental rotation angle similar to the one measured with the intact model. Under the extension load, all of the artificial disc implanted models demonstrated an increased extension rotational angle at the operated level (L4-5), resulting in an increase under the facet contact load when compared with the adjacent segments. The increased facet load may lead to facet degeneration.

Effect of implant number and distribution on load transfer in implant-supported partial fixed dental prostheses for the anterior maxilla: A photoelastic stress analysis study.

PubMed

Lee, Jae-In; Lee, Yoon; Kim, Yu-Lee; Cho, Hye-Won

2016-02-01

The 4-, 3- or even 2-implant-supported partial fixed dental prosthesis (PFDP) designs have been used to rehabilitate the anterior edentulous maxilla. The purpose of this in vitro study was to compare the stress distribution in the supporting tissues surrounding implants placed in the anterior maxilla with 5 PFDP designs. A photoelastic model of the human maxilla with an anterior edentulous region was made with photoelastic resin (PL-2; Vishay Micro-Measurements), and 6 straight implants (OsseoSpeed; Astra Tech AB) were placed in the 6 anterior tooth positions. The 5 design concepts based on implant location were as follows: model 6I: 6 implants; model 2C2CI: 4 implants (2 canines and 2 central incisors); model 2C2LI: 4 implants (2 canines and 2 lateral incisors); model 2C1CI: 3 implants (2 canines and 1 central incisor); and model 2C: 2 canines. A load of 127.4 N was applied on the cingulum of 3 teeth at a 30-degree angle to the long axis of the implant. Stresses that developed in the supporting structure were recorded photographically. The 6-implant-supported PFDP exhibited the most even and lowest distribution of stresses in all loading conditions. When the canine was loaded, the 2- or 3-implant-supported PFDP showed higher stresses around the implant at the canine position than did the 4- or 6-implant-supported PFDP. When the central incisor or lateral incisor was loaded, the two 4-implant-supported PFDPs exhibited similar levels of stresses around the implants and showed lower stresses than did the 2- or 3-implant-supported PFDP. Implant number and distribution influenced stress distribution around the implants in the anterior maxilla. With a decrease in implant number, the stresses around the implants increased. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Fatigue induced changes in conical implant-abutment connections.

PubMed

Blum, Kai; Wiest, Wolfram; Fella, Christian; Balles, Andreas; Dittmann, Jonas; Rack, Alexander; Maier, Dominik; Thomann, Ralf; Spies, Benedikt Christopher; Kohal, Ralf Joachim; Zabler, Simon; Nelson, Katja

2015-11-01

Based on the current lack of data and understanding of the wear behavior of dental two-piece implants, this study aims for evaluating the microgap formation and wear pattern of different implants in the course of cyclic loading. Several implant systems with different conical implant-abutment interfaces were purchased. The implants were first evaluated using synchrotron X-ray high-resolution radiography (SRX) and scanning electron microscopy (SEM). The implant-abutment assemblies were then subjected to cyclic loading at 98N and their microgap was evaluated after 100,000, 200,000 and 1 million cycles using SRX, synchrotron micro-tomography (μCT). Wear mechanisms of the implant-abutment connection (IAC) after 200,000 cycles and 1 million cycles were further characterized using SEM. All implants exhibit a microgap between the implant and abutment prior to loading. The gap size increased with cyclic loading with its changes being significantly higher within the first 200,000 cycles. Wear was seen in all implants regardless of their interface design. The wear pattern comprised adhesive wear and fretting. Wear behavior changed when a different mounting medium was used (brass vs. polymer). A micromotion of the abutment during cyclic loading can induce wear and wear particles in conical dental implant systems. This feature accompanied with the formation of a microgap at the IAC is highly relevant for the longevity of the implants. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Effect of cyclic load on vertical misfit of prefabricated and cast implant single abutment

PubMed Central

DE JESUS TAVAREZ, Rudys Rodolfo; BONACHELA, Wellington Cardoso; XIBLE, Anuar Antônio

2011-01-01

Objective The purpose of this in vitro study was to evaluate misfit alterations at the implant/abutment interface of external and internal connection implant systems when subjected to cyclic loading. Material and Methods Standard metal crowns were fabricated for 5 groups (n=10) of implant/abutment assemblies: Group 1, external hexagon implant and UCLA cast-on premachined abutment; Group 2, internal hexagon implant and premachined abutment; Group 3, internal octagon implant and prefabricated abutment; Group 4, external hexagon implant and UCLA cast-on premachined abutment; and Group 5, external hexagon implant and Ceraone abutment. For groups 1, 2, 3 and 5, the crowns were cemented on the abutments and in group 4 crowns were screwed directly on the implant. The specimens were subjected to 500,000 cycles at 19.1 Hz of frequency and non-axial load of 133 N in a MTS 810 machine. The vertical misfit (μm) at the implant/abutment interface was evaluated before (B) and after (A) application of the cyclic loading. Data were analyzed statistically by using two-away ANOVA and Tukey’s post-hoc test (p<0.05). Results Before loading values showed no difference among groups 2 (4.33±3.13), 3 (4.79±3.43) and 5 (3.86±4.60); between groups 1 (12.88±6.43) and 4 (9.67±3.08), and among groups 2, 3 and 4. However, groups 1 and 4 were significantly different from groups 2, 3 and 5. After loading values of groups 1 (17.28±8.77) and 4 (17.78±10.99) were significantly different from those of groups 2 (4.83±4.50), 3 (8.07±4.31) and 5 (3.81±4.84). There was a significant increase in misfit values of groups 1, 3 and 4 after cyclic loading, but not for groups 2 and 5. Conclusion The cyclic loading and type of implant/abutment connection may develop a role on the vertical misfit at the implant/abutment interface. PMID:21437464

Stress Distribution Around Single Short Dental Implants: A Finite Element Study.

PubMed

Vidya Bhat, S; Premkumar, Priyanka; Kamalakanth Shenoy, K

2014-12-01

Bone height restrictions are more common in the posterior regions of the mandible, because of either bone resorption resulting from tooth loss or even anatomic limitations, such as the position of the inferior alveolar nerve. In situations where adequate bone height is not available in the posterior mandible region, smaller lengths of implants may have to be used but it has been reported that the use of long implants (length ≥10 mm) is a positive factor in osseointegration and authors have reported failures with short implants. Hence knowledge about the stress generated on the bone with different lengths of implants needs scientific evaluation. The purpose of this study was to compare and evaluate the influence of different lengths of implants on stress upon bone in mandibular posterior area. A 3 D finite element model was made of the posterior mandible using the details from a CT scan, using computer software (ANSYS 12). Four simulated implants with lengths 6 mm, 8 mm, 10 mm and 13 mm were placed in the centre of the bone. A static vertical force of 250 N and a static horizontal force of 100 N were applied. The stress generated in the cortical and cancellous bone around the implant were recorded and evaluated with the help of ANSYS. In this study, Von Mises stress on a 6 mm implant under a static vertical load of 250 N appeared to be almost in the same range of 8 and 10 mm implant which were more as compared to 13 mm implant. Von Mises stress on a 6mm implant under a static horizontal load of 100 N appeared to be less when compared to 8, 10 and 13 mm implants. From the results obtained it may be inferred that under static horizontal loading conditions, shorter implants receive lesser load and thus may tend to transfer more stresses to the surrounding bone. While under static vertical loading the shorter implants bear more loads and comparatively transmit lesser load to the surrounding bone.

Immediate and early function of Brånemark System implants placed in the esthetic zone: a 1-year prospective clinical multicenter study.

PubMed

Maló, Paulo; Friberg, Bertil; Polizzi, Giovanni; Gualini, Federico; Vighagen, Torbjörn; Rangert, Bo

2003-01-01

Immediate/early implant function means great benefits for patients and therapists because treatment time and cost can be substantially reduced. This concept has become an accepted alternative for complete arch fixed restorations in the mandible, and clinical documentation is emerging for other indications. The purpose of this prospective clinical multicenter study was to evaluate the outcome of implants placed in incisor, canine, and premolar regions in maxillas or mandibles. Implants were loaded with provisional crowns and bridges on the same day or within a few days and were followed up for 1 year during function. Four centers treated 76 patients each in need of an implant-retained prosthesis in the anterior and premolar regions in the maxilla or mandible. A total of 116 titanium implants with machined surfaces (Brånemark System , Nobel Biocare AB, Gothenburg, Sweden) were placed: 74 in maxillas and 42 in mandibles. Eighty-seven prostheses were made, of which 63 were single crowns and 24 were bridges (supported by 53 splinted implants). Twenty-two implants in 14 patients were placed in fresh extraction sites. The goal with the preparation and insertion technique was to achieve good primary implant stability and a minimum implant insertion torque of 30 Ncm before the implant was completely seated. The occlusion was adjusted to eliminate direct contact with the provisional prostheses. After 6 months, the patients received their permanent prostheses. Sixty-seven patients were followed for 1 year. Five implants were lost in five patients, three in the maxilla and two in the mandible. Four of the lost implants were single-tooth replacements and one was splinted. The cumulative survival rate (CSR) was 95.7% for all implants after 1 year and 93.7% and 98.1% for single-tooth and splinted implants, respectively. There were no implant losses in the extraction sites. The CSR of 96% at 1 year indicates that immediate function of Brånemark System implants placed in incisor to premolar regions in both jaws is a viable concept. More failures occurred with single-tooth replacements (6.3%) than with splinted implants (1.9%).

Sinking and fit of abutment of locking taper implant system

PubMed Central

Moon, Seung-Jin; Kim, Hee-Jung; Son, Mee-Kyoung

2009-01-01

STATEMENT OF PROBLEM Unlike screw-retention type, fixture-abutment retention in Locking taper connection depends on frictional force so it has possibility of abutment to sink. PURPOSE In this study, Bicon® Implant System, one of the conical internal connection implant system, was used with applying loading force to the abutments connected to the fixture. Then the amount of sinking was measured. MATERIAL AND METHODS 10 Bicon® implant fixtures were used. First, the abutment was connected to the fixture with finger force. Then it was tapped with a mallet for 3 times and loads of 20 kg corresponding to masticatory force using loading application instrument were applied successively. The abutment state, slightly connected to the fixture without pressure was considered as a reference length, and every new abutment length was measured after each load's step was added. The amount of abutment sinking (mm) was gained by subtracting the length of abutment-fixture under each loading condition from reference length. RESULTS It was evident, that the amount of abutment sinking in Bicon® Implant System increased as loads were added. When loads of 20 kg were applied more than 5 - 7 times, sinking stopped at 0.45 ± 0.09 mm. CONCLUSION Even though locking taper connection type implant shows good adaption to occlusal force, it has potential for abutment sinking as loads are given. When locking taper connection type implant is used, satisfactory loads are recommended for precise abutment location. PMID:21165262

Pain and discomfort following immediate and delayed loading by overdentures in the single mandibular implant study (SMIS).

PubMed

Mundt, T; Passia, N; Att, W; Heydecke, G; Freitag-Wolf, S; Luthardt, R G; Kappel, S; Konstantinidis, I K; Stiesch, M; Wolfart, S; Kern, M

2017-03-01

This randomized clinical trial compares immediate and delayed loading of single implants to support mandibular overdentures. The aim of this preliminary analysis is to test the hypothesis whether patients with immediate loading will experience less pain and discomfort through the intervention than patients with delayed loading. Edentulous patients in nine German dental schools received a midline implant with a length of 11 mm. Implants with a minimum insertion torque of 30 Ncm and an implant stability quotient of ≥60 were randomly allocated to group A for immediate loading using ball attachments or to group B for delayed loading after 3 months. Patients completed questionnaires with 100-mm visual analogue scales about the items pain, pain during chewing, swelling, bleeding, and perception of the intervention at the day of surgery and 1, 2, 3, and 7 days, thereafter. Groups were compared by Wilcoxon-Mann-Whitney tests (P ≤ 0.05). The questionnaires of 81 patients in group A and 74 patients in group B were completed. The medians for pain and discomfort were moderate (<30). Participants of group A felt significantly more pain from the first day and more swelling from the third day after implantation than participants of group B. The individual perception of interventions showed no significant differences between groups. Immediate loading evoked more postoperative pain and swelling than the two stages of delayed loading. Immediate loading of a single mandibular midline implant supporting overdentures should be carefully considered.

The relationship between substrate morphology and biological performances of nano-silver-loaded dopamine coatings on titanium surfaces

PubMed Central

Zhang, Weibo; Wang, Shuang; Ge, Shaohua; Ji, Ping

2018-01-01

Biomedical device-associated infection (BAI) and lack of osseointegration are the main causes of implant failure. Therefore, it is imperative for implants not only to depress microbial activity and biofilm colonization but also to prompt osteoblast functions and osseointegration. As part of the coating development for implants, the interest of in vitro studies on the interaction between implant substrate morphology and the coating's biological performances is growing. In this study, by harnessing the adhesion and reactivity of bioinspired polydopamine, nano-silver was successfully anchored onto micro/nanoporous as well as smooth titanium surfaces to analyse the effect of substrate morphology on biological performances of the coatings. Compared with the smooth surface, a small size of nano-silver and high silver content was found on the micro/nanoporous surface. More mineralization happened on the coating on the micro/nanoporous structure than on the smooth surface, which led to a more rapid decrease of silver release from the micro/nanoporous surface. Antimicrobial tests indicated that both surfaces with resulting coating inhibit microbial colonization on them and growth around them, indicating that the coating eliminates the shortcoming of the porous structure which render the implant extremely susceptible to BAI. Besides, the multiple osteoblast responses of nano-silver-loaded dopamine coatings on both surfaces, i.e. attachment, proliferation and differentiation, have deteriorated, however the mineralized surfaces of these coatings stimulated osteoblast proliferation and differentiation, especially for the micro/nanoporous surface. Therefore, nano-silver-loaded dopamine coatings on micro/nanoporous substratum may not only reduce the risk of infection but also facilitate mineralization during the early post-operative period and then promote osseointegration owing to the good osteoblast-biocompatibility of the mineralized surface. These results clearly highlight the influence of the substrate morphology on the biological performances of implant coating. PMID:29765680

Comparison of load distribution for implant overdenture attachments.

PubMed

Porter, Joseph A; Petropoulos, Vicki C; Brunski, John B

2002-01-01

The aim of this study was to compare the force and moment distributions that develop on different implant overdenture attachments when vertical compressive forces are applied to an implant-retained overdenture. The following attachments were examined: Nobel Biocare bar and clip (NBC), Nobel Biocare standard ball (NSB), Nobel Biocare 2.25-mm-diameter ball (NB2), Zest Anchor Advanced Generation (ZAAG), Sterngold ERA white (SEW), Sterngold ERA orange (SEO), Compliant Keeper System with titanium shims (CK-Ti), Compliant Keeper System with black nitrile 2SR90 sleeve rings (CK-70), and Compliant Keeper System with clear silicone 2SR90 sleeve rings (CK-90). The attachments were tested using custom strain-gauged abutments and 2 Brånemark System implants placed in a test model. Each attachment type had one part embedded in a denture-like housing and the other part (the abutment) screwed into the implants. Compressive static loads of 100 N were applied (1) bilaterally, over the distal midline (DM); (2) unilaterally, over the right implant (RI); (3) unilaterally, over the left implant (LI); and (4) between implants in the mid-anterior region (MA). Both the force and bending moment on each implant were recorded for each loading location and attachment type. Results were analyzed using 2-way analysis of variance and the Duncan multiple-range test. Both loading location and attachment type were statistically significant factors (P < .05). In general, the force and moment on an implant were greater when the load was applied directly over the implant or at MA. While not significant at every loading location, the largest implant forces tended to occur with ZAAG attachments; the smallest were found with the SEW, the SEO, the NSB, the CK-70, and the CK-90. Typically, higher moments existed for NBC and ZAAG, while lower moments existed for SEW, SEO, NSB, CK-90, and CK-70. For different loading locations, significant differences were found among the different overdenture attachment systems.

Micro finite element analysis of dental implants under different loading conditions.

PubMed

Marcián, Petr; Wolff, Jan; Horáčková, Ladislava; Kaiser, Jozef; Zikmund, Tomáš; Borák, Libor

2018-05-01

Osseointegration is paramount for the longevity of dental implants and is significantly influenced by biomechanical stimuli. The aim of the present study was to assess the micro-strain and displacement induced by loaded dental implants at different stages of osseointegration using finite element analysis (FEA). Computational models of two mandible segments with different trabecular densities were constructed using microCT data. Three different implant loading directions and two osseointegration stages were considered in the stress-strain analysis of the bone-implant assembly. The bony segments were analyzed using two approaches. The first approach was based on Mechanostat strain intervals and the second approach was based on tensile/compression yield strains. The results of this study revealed that bone surrounding dental implants is critically strained in cases when only a partial osseointegration is present and when an implant is loaded by buccolingual forces. In such cases, implants also encounter high stresses. Displacements of partially-osseointegrated implant are significantly larger than those of fully-osseointegrated implants. It can be concluded that the partial osseointegration is a potential risk in terms of implant longevity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Osseous adaptation to continuous loading of rigid endosseous implants

NASA Technical Reports Server (NTRS)

Roberts, W. E.; Smith, R. K.; Mozsary, P. G.; Zilberman, Y.; Smith, R. S.

1984-01-01

The effect of loading on etched Ti implants in the femurs of young (3 mo) and adult (6 mo) rabbits is investigated experimentally. The results are presented in photographs, fluorescence and polarization micrographs, radiographs, and drawings and discussed. Implantation is followed by formation of coarse woven bone within 3 d and mature lamellar bone by 6 wks, with nonspecific subperiosteal bony hypertrophy in the young rabbits only. Spring loading at 100 g produces spontaneous spiral-type fractures when applied immediately, but the implants remain rigid when loads are applied after 6-12 wks of healing. The mechanisms of bone formation involved are examined, and the potential of endosseous implants as anchors in orthodontics or dentofacial-orthopedics is confirmed.

A glass fiber-reinforced composite - bioactive glass cranioplasty implant: A case study of an early development stage implant removed due to a late infection.

PubMed

Posti, Jussi P; Piitulainen, Jaakko M; Hupa, Leena; Fagerlund, Susanne; Frantzén, Janek; Aitasalo, Kalle M J; Vuorinen, Ville; Serlo, Willy; Syrjänen, Stina; Vallittu, Pekka K

2015-03-01

This case study describes the properties of an early development stage bioactive glass containing fiber-reinforced composite calvarial implant with histology that has been in function for two years and three months. The patient is a 33-year old woman with a history of substance abuse, who sustained a severe traumatic brain injury later unsuccessfully treated with an autologous bone flap and a custom-made porous polyethylene implant. She was thereafter treated with developmental stage glass fiber-reinforced composite - bioactive glass implant. After two years and three months, the implant was removed due to an implant site infection. The implant was analyzed histologically, mechanically, and in terms of chemistry and dissolution of bioactive glass. Mechanical integrity of the load bearing fiber-reinforced composite part of the implant was not affected by the in vivo period. Bioactive glass particles demonstrated surface layers of hydroxyapatite like mineral and dissolution, and related increase of pH was considerably less after two and three months period than that for fresh bioactive glass. There was a difference in the histology of the tissues inside the implant areas near to the margin of the implant that absorbed blood during implant installation surgery, showed fibrous tissue with blood vessels, osteoblasts, collagenous fibers with osteoid formation, and tiny clusters of more mature hard tissue. In the center of the implant, where there was less absorbed blood, only fibrous tissue was observed. This finding is in line with the combined positron emission tomography - computed tomography examination with (18F)-fluoride marker, which demonstrated activity of the mineralizing bone by osteoblasts especially at the area near to the margin of the implant 10 months after implantation. Based on these promising reactions found in the bioactive glass containing fiber-reinforced composite implant that has been implanted for two years and three months, calvarial reconstruction with the presented material appears to be a feasible method. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of Cyclic Loading on Micromotion at the Implant-Abutment Interface.

PubMed

Karl, Matthias; Taylor, Thomas D

2016-01-01

Cyclic loading may cause settling of abutments mounted on dental implants, potentially affecting screw joint stability and implant-abutment micromotion. It was the goal of this in vitro study to compare micromotion of implant-abutment assemblies before and after masticatory simulation. Six groups of abutments (n = 5) for a specific tissue-level implant system with an internal octagon were subject to micromotion measurements. The implant-abutment assemblies were loaded in a universal testing machine, and an apparatus and extensometers were used to record displacement. This was done twice, in the condition in which they were received from the abutment manufacturer and after simulated loading (100,000 cycles; 100 N). Statistical analysis was based on analysis of variance, two-sample t tests (Welch tests), and Pearson product moment correlation (α = .05). The mean values for micromotion ranged from 33.15 to 63.41 μm and from 30.03 to 42.40 μm before and after load cycling. The general trend toward reduced micromotion following load cycling was statistically significant only for CAD/CAM zirconia abutments (P = .036) and for one type of clone abutment (P = .012), with no significant correlation between values measured before and after cyclic loading (Pearson product moment correlation; P = .104). While significant differences in micromotion were found prior to load cycling, no significant difference among any of the abutment types tested could be observed afterward (P > .05 in all cases). A quantifiable settling effect at the implant-abutment interface seems to result from cyclic loading, leading to a decrease in micromotion. This effect seems to be more pronounced in low-quality abutments. For the implant system tested in this study, retightening of abutment screws is recommended after an initial period of clinical use.

Multiscale Analyses of the Bone-implant Interface

PubMed Central

Cha, J.Y.; Pereira, M.D.; Smith, A.A.; Houschyar, K.S.; Yin, X.; Mouraret, S.; Brunski, J.B.

2015-01-01

Implants placed with high insertion torque (IT) typically exhibit primary stability, which enables early loading. Whether high IT has a negative impact on peri-implant bone health, however, remains to be determined. The purpose of this study was to ascertain how peri-implant bone responds to strains and stresses created when implants are placed with low and high IT. Titanium micro-implants were inserted into murine femurs with low and high IT using torque values that were scaled to approximate those used to place clinically sized implants. Torque created in peri-implant tissues a distribution and magnitude of strains, which were calculated through finite element modeling. Stiffness tests quantified primary and secondary implant stability. At multiple time points, molecular, cellular, and histomorphometric analyses were performed to quantitatively determine the effect of high and low strains on apoptosis, mineralization, resorption, and collagen matrix deposition in peri-implant bone. Preparation of an osteotomy results in a narrow zone of dead and dying osteocytes in peri-implant bone that is not significantly enlarged in response to implants placed with low IT. Placing implants with high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Using high IT to place an implant creates high interfacial stress and strain that are associated with damage to peri-implant bone and therefore should be avoided to best preserve the viability of this tissue. PMID:25628271

Is early weight bearing resumption beneficial after total hip replacement?

PubMed

Merle, J; Rougier, P; Belaid, D; Cantalloube, S; Lamotte, D

2009-04-01

Current rehabilitation protocols of patients following total hip replacement recommend weight bearing on the operated extremity as early as possible. This strategy is likely to induce specific consequences on postural balance control; this study seeks to highlight these reactions to early loading. Eight men and six women, ranging in age from 57 to 85 years, volunteered enrolling this study on their arrival at our rehabilitation center. This study assessed their postural behavior using a system composed of two separate force platforms under two loading situations; in the course of these tests they were required to minimize their body sway as much as possible by keeping their eyes open. In the natural uncontrolled situation, the subjects adopted a comfortable body weight distribution. In the imposed (IMP) situation, they had to load their operated extremity more than in regular natural conditions in order to distribute their body weight more evenly. Three successive 32-s trials (sampled at 64 Hz) with intermediate recovery periods of equivalent duration were performed allowing period of rest between each trial. The balance strategies were evaluated through a frequency analysis of the resultant and plantar centers of pressure (CP(Res)) of each foot and of the estimated trajectories of the vertical projection of the center of gravity (CG), and from the difference CP(Res)-CG. No difference was found for the plantar CP trajectories in the situation where body weight is spontaneously distributed, whereas loading the implanted extremity induced increased CP(Res), CG, and CP(Res)-CG trajectory amplitudes along the mediolateral axis. No effect was observed along the anteroposterior axis. Finally, when comparing the two limbs for each testing condition, the statistical analysis demonstrated greater displacements along the ML axis for the trajectories measured under the healthy leg than under the implanted extremity. Loading the operated extremity early in the rehabilitation process leads to less stability (an increase in the CG movements) and to increased energy expenditure (an increase in the CP(Res)-CG movements). These postural behavior alterations can be explained by various factors including a loss of muscle strength, residual apprehension due to the disuse of this limb, and persistent pain, all of which are increased by limb loading. These features should be taken into consideration when elaborating the rehabilitation protocol for these patients.

Optimally oriented grooves on dental implants improve bone quality around implants under repetitive mechanical loading.

PubMed

Kuroshima, Shinichiro; Nakano, Takayoshi; Ishimoto, Takuya; Sasaki, Muneteru; Inoue, Maaya; Yasutake, Munenori; Sawase, Takashi

2017-01-15

The aim was to investigate the effect of groove designs on bone quality under controlled-repetitive load conditions for optimizing dental implant design. Anodized Ti-6Al-4V alloy implants with -60° and +60° grooves around the neck were placed in the proximal tibial metaphysis of rabbits. The application of a repetitive mechanical load was initiated via the implants (50N, 3Hz, 1800 cycles, 2days/week) at 12weeks after surgery for 8weeks. Bone quality, defined as osteocyte density and degree of biological apatite (BAp) c-axis/collagen fibers, was then evaluated. Groove designs did not affect bone quality without mechanical loading; however, repetitive mechanical loading significantly increased bone-to-implant contact, bone mass, and bone mineral density (BMD). In +60° grooves, the BAp c-axis/collagen fibers preferentially aligned along the groove direction with mechanical loading. Moreover, osteocyte density was significantly higher both inside and in the adjacent region of the +60° grooves, but not -60° grooves. These results suggest that the +60° grooves successfully transmitted the load to the bone tissues surrounding implants through the grooves. An optimally oriented groove structure on the implant surface was shown to be a promising way for achieving bone tissue with appropriate bone quality. This is the first report to propose the optimal design of grooves on the necks of dental implants for improving bone quality parameters as well as BMD. The findings suggest that not only BMD, but also bone quality, could be a useful clinical parameter in implant dentistry. Although the paradigm of bone quality has shifted from density-based assessments to structural evaluations of bone, clarifying bone quality based on structural bone evaluations remains challenging in implant dentistry. In this study, we firstly demonstrated that the optimal design of dental implant necks improved bone quality defined as osteocytes and the preferential alignment degree of biological apatite c-axis/collagen fibers using light microscopy, polarized light microscopy, and a microbeam X-ray diffractometer system, after application of controlled mechanical load. Our new findings suggest that bone quality around dental implants could become a new clinical parameter as well as bone mineral density in order to completely account for bone strength in implant dentistry. Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

The effect of implant number and position on the stress behavior of mandibular implant retained overdentures: A three-dimensional finite element analysis.

PubMed

Topkaya, Tolga; Solmaz, Murat Yavuz

2015-07-16

The present study evaluated the effects of ball anchor abutment attached to implants with a 4.30 mm diameter and 11 mm insert length on stress distribution in a patient without any remaining teeth in the lower jaw. In the study, the stress analysis was performed for five different configurations (2 with 4 implant-supported and 3 with 2 implant-supported) and three different loading types using ANSYS Workbench software. The stresses measured in the 4 implant-supported models were lower compared to the stresses measured in the 2 implant-supported models. The stresses on the implants intensified on the cervical region of the implants. When the effects of the loading sites on the stress were examined, the loading on the first molar tooth produced the highest stresses on the implants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Immediately loaded mini dental implants as overdenture retainers: 1-Year cohort study of implant stability and peri-implant marginal bone level.

PubMed

Šćepanović, Miodrag; Todorović, Aleksandar; Marković, Aleksa; Patrnogić, Vesna; Miličić, Biljana; Moufti, Adel M; Mišić, Tijana

2015-05-01

This 1-year cohort study investigated stability and peri-implant marginal bone level of immediately loaded mini dental implants used to retain overdentures. Each of 30 edentulous patients received 4 mini dental implants (1.8 mm × 13 mm) in the interforaminal mandibular region. The implants were immediately loaded with pre-made overdentures. Outcome measures included implant stability and bone resorption. Implant stability was measured using the Periotest Classic(®) device immediately after placement and on the 3rd and 6th weeks and the 4th, 6th and 12th months postoperatively. The peri-implant marginal bone level (PIBL) was evaluated at the implant's mesial and distal sides from the polished platform to the marginal crest. Radiographs were taken using a tailored film holder to reproducibly position the X-ray tube at the 6th week, 4th and 12th months postoperatively. The primary stability (Periotest value, PTV) measured -0.27 ± 3.41 on a scale of -8 to + 50 (lower PTV reflects higher stability). The secondary stability decreased significantly until week 6 (mean PTV = 7.61 ± 7.05) then increased significantly reaching (PTV = 6.17 ± 6.15) at 12 months. The mean PIBL measured -0.40 mm after 1 year of functional loading, with no statistically significant differences at the various follow-ups (p = 0.218). Mini dental implants placed into the interforaminal region could achieve a favorable primary stability for immediate loading. The follow-up Periotest values fluctuated, apparently reflecting the dynamics of bone remodeling, with the implants remaining clinically stable (98.3%) after 1 year of function. The 1-year bone resorption around immediately loaded MDIs is within the clinically acceptable range for standard implants. Copyright © 2014 Elsevier GmbH. All rights reserved.

Immediate prosthesis over implants retained using abutments with flexible screws: A preliminary study

PubMed Central

Peñarrocha-Oltra, David; Serra-Pastor, Blanca; Balaguer-Martí, José-Carlos; Agustín-Panadero, Rubén

2017-01-01

Background Immediate loading protocols for the rehabilitation of edentulous or partially edentulous patients have become very popular, due to the conveniences they afford in comparison with conventional loading techniques. Material and Methods A preliminary study was carried out with 8 patients subjected to dental implant treatment with an immediate loading protocol involving a novel system of abutments with flexible screws. Implant survival was analyzed, together with marginal bone loss and patient and dentist satisfaction. Results A total of 35 implants were subjected to immediate loading using the abutments with flexible screws. The mean patient and dentist satisfaction score was 9.1 and 8.5, respectively. After 12 months the dental implant survival rate was 95.8%, with a mean marginal bone loss of 0.51 ± 0.12 mm. Conclusions The novel system of abutments with flexible screws offers a good alternative to conventional immediate loading, since it allows rapid and simple manufacture of a reliable passive fit, fixed interim prosthesis after surgery. Key words:Dental implants, Flexafit®, Immediate loading, Immediate prosthesis. PMID:29410752

A Paradigm for the Development and Evaluation of Novel Implant Topologies for Bone Fixation: In Vivo Evaluation

PubMed Central

Long, Jason P.; Hollister, Scott J.; Goldstein, Steven A.

2012-01-01

While contemporary prosthetic devices restore some function to individuals who have lost a limb, there are efforts to develop bio-integrated prostheses to improve functionality. A critical step in advancing this technology will be to securely attach the device to remnant bone. To investigate mechanisms for establishing robust implant fixation in bone while undergoing loading, we previously used a topology optimization scheme to develop optimized orthopaedic implants and then fabricated selected designs from titanium (Ti)-alloy with selective laser sintering (SLS) technology. In the present study, we examined how implant architecture and mechanical stimulation influence osseointegration within an in vivo environment. To do this, we evaluated three implant designs (two optimized and one non-optimized) using a unique in vivo model that applied cyclic, tension/ compression loads to the implants. Eighteen (six per implant design) adult male canines had implants surgically placed in their proximal, tibial metaphyses. Experimental duration was 12 weeks; daily loading (peak load of ±22N for 1000 cycles) was applied to one of each animal’s bilateral implants for the latter six weeks. Following harvest, osseointegration was assessed by non-destructive mechanical testing, micro-computed tomography (microCT) and back-scatter scanning electron microscopy (SEM). Data revealed that implant loading enhanced osseointegration by significantly increasing construct stiffness, peri-implant trabecular morphology, and percentages of interface connectivity and bone ingrowth. While this experiment did not demonstrate a clear advantage associated with the optimized implant designs, osseointegration was found to be significantly influenced by aspects of implant architecture. PMID:22951278

A paradigm for the development and evaluation of novel implant topologies for bone fixation: in vivo evaluation.

PubMed

Long, Jason P; Hollister, Scott J; Goldstein, Steven A

2012-10-11

While contemporary prosthetic devices restore some function to individuals who have lost a limb, there are efforts to develop bio-integrated prostheses to improve functionality. A critical step in advancing this technology will be to securely attach the device to remnant bone. To investigate mechanisms for establishing robust implant fixation in bone while undergoing loading, we previously used a topology optimization scheme to develop optimized orthopedic implants and then fabricated selected designs from titanium (Ti)-alloy with selective laser sintering (SLS) technology. In the present study, we examined how implant architecture and mechanical stimulation influence osseointegration within an in vivo environment. To do this, we evaluated three implant designs (two optimized and one non-optimized) using a unique in vivo model that applied cyclic, tension/compression loads to the implants. Eighteen (six per implant design) adult male canines had implants surgically placed in their proximal, tibial metaphyses. Experimental duration was 12 weeks; daily loading (peak load of ±22 N for 1000 cycles) was applied to one of each animal's bilateral implants for the latter six weeks. Following harvest, osseointegration was assessed by non-destructive mechanical testing, micro-computed tomography (microCT) and back-scatter scanning electron microscopy (SEM). Data revealed that implant loading enhanced osseointegration by significantly increasing construct stiffness, peri-implant trabecular morphology, and percentages of interface connectivity and bone ingrowth. While this experiment did not demonstrate a clear advantage associated with the optimized implant designs, osseointegration was found to be significantly influenced by aspects of implant architecture. Copyright © 2012 Elsevier Ltd. All rights reserved.

Clinical evaluation of immediate loading of electroeroded screw-retained titanium fixed prostheses supported by tilted implant: a multicenter retrospective study.

PubMed

Acocella, Alessandro; Ercoli, Carlo; Geminiani, Alessandro; Feng, Changyong; Billi, Mauro; Acocella, Gabriele; Giannini, Domenico; Sacco, Roberto

2012-05-01

Immediate occlusal loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable treatment protocol. However, there is limited long-term data available in the literature, when an electroeroded definitive cast-titanium fixed prosthesis is used for this treatment protocol. The aim of this study was to evaluate the clinical effectiveness of dental implants (Astra Tech Dental, Mölndal, Sweden) in the edentulous mandible immediately loaded with an electroeroded cast-titanium screw-retained fixed prosthesis. Forty-five patients received five implants each in the interforaminal area. All the implants were inserted with torque up to 40 Ncm and the distal implants were distally tilted approximately 20 to 30 degrees to minimize the length of posterior cantilevers. Implants were loaded within 48 hours of placement with an acrylic resin-titanium screw-retained prosthesis fabricated by electroerosion. Two of the 225 inserted implants failed after 3 and 16 months of healing, respectively, with a cumulative survival rate of 99.1% and a prosthetic survival rate of 97.8%. Immediate loading of tilted dental implants inserted in the edentulous mandible with a screw-retained titanium definitive prosthesis fabricated with electrical discharge machining provide reliable and predictable results. © 2011 Wiley Periodicals, Inc.

Influence of artificial aging on the load-bearing capability of straight or angulated zirconia abutments in implant/tooth-supported fixed partial dentures.

PubMed

Nothdurft, Frank P; Doppler, Klaus E; Erdelt, Kurt J; Knauber, Andreas W; Pospiech, Peter R

2010-01-01

The aim of the study was to evaluate the influence of artificial aging on the fracture behavior of straight and angulated zirconia implant abutments used in ZirDesign (Astra Tech) implant/tooth-supported fixed partial dentures (FPDs) in the maxilla. Four different test groups (n = 8) representing anterior implant/tooth-supported FPDs were prepared. Groups 1 and 2 simulated a clinical situation with an ideal implant position (maxillary left central incisor) from a prosthetic point of view, which allowed for the use of a straight, prefabricated zirconia abutment. Groups 3 and 4 simulated a situation with a compromised implant position that required an angulated (20-degree) abutment. OsseoSpeed implants (4.5 3 13 mm, Astra Tech) as well as metal tooth analogs (maxillary right lateral incisor) with simulated periodontal mobility were mounted in polymethyl methacrylate. The FPDs (chromium-cobalt alloy) were cemented with glass ionomer. Groups 2 and 4 were thermomechanically loaded and subjected to static loading until failure. Statistical analysis of force data at the fracture site was performed using nonparametric tests. All samples survived thermomechanical loading. Artificial aging did not lead to a significant decrease in load-bearing capacity in either the straight abutments or the angulated abutments. The restorations that used angulated abutments exhibited higher fracture loads than the restorations with straight abutments (group 1: 209.13 ± 39.11 N; group 2: 233.63 ± 30.68 N; group 3: 324.62 ± 108.07 N; group 4: 361.75 ± 73.82 N). This difference in load-bearing performance was statistically significant, both with and without artificial aging. All abutment fractures occurred below the implant shoulder. Compensation for angulated implant positions with an angulated zirconia abutment is possible without reducing the load-bearing capacity of implant/tooth-supported anterior FPDs.

Maxillary sinus floor augmentation using a nano-crystalline hydroxyapatite silica gel: case series and 3-month preliminary histological results.

PubMed

Canullo, Luigi; Dellavia, Claudia; Heinemann, Friedhelm

2012-03-20

The aim of this case series is to histologically examine a new hydroxyapatite in sinus lift procedure after 3 months. Ten 2-stage sinus lifts were performed in 10 healthy patients having initial bone height of 1-2mm and bone width of 5mm, asking for a fixed implant-supported rehabilitation. After graft material augmentation, a rough-surfaced mini-implant was inserted to maintain stability of the sinus widow. A bioptical core containing a mini-implant was retrieved 3 months after maxillary sinus augmentation with NanoBone(®) and processed for undecalcified histology. From the histomorphometric analysis, NanoBone(®) residuals accounted for the 38.26% ± 8.07% of the bioptical volume, marrow spaces for the 29.23% ± 5.18% and bone for the 32.51% ± 4.96% (new bone: 20.64% ± 2.96%, native bone: 11.87% ± 3.27%). Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systems surrounded the residual NanoBone(®) particles. The measured bone-to-implant contact amounted to 26.02% ± 5.46%. No connective tissue was observed at the implant boundary surface. In conclusion, the tested material showed good histological outcomes also 3 months after surgery. In such critical conditions, the use of a rough-surfaced mini-implant showed BIC values supposed to be effective also in case of functional loading. Although longer follow-up and a wider patient size are needed, these preliminary results encourage further research on this biomaterial for implant load also under early stage and critical conditions. Copyright © 2011 Elsevier GmbH. All rights reserved.

Short Implants Versus Standard Implants: Midterm Outcomes of a Clinical Study.

PubMed

Benlidayi, M Emre; Ucar, Yurdanur; Tatli, Ufuk; Ekren, Orhun; Evlice, Burcu; Kisa, Halil Ibrahim; Baksi, Uygar

2018-02-01

The aim of this study was to evaluate the midterm survival rate, marginal bone resorption (MBR), and stability of short implants and to compare the results with standard length implants. A total of 38 patients were included. In total, 147 implants (Nucleoss Implants, Izmir, Turkey) were placed (86 short implants and 61 standard implants). Cement-retained metal-ceramic prostheses were fabricated. MBR was evaluated on periapical radiographs taken at implant placement, at the time of crown insertion and annually thereafter. The stability of the implants was evaluated by resonance frequency analysis. The 3- and 5-year cumulative survival rates for standard implants was 98.4% and for short implants was 96.5% (P = 0.644). The MBR of the short implants was significantly lower than that of the standard implants after 1, 2, and 3 years of loading (P < 0.05). No significant differences were found between 2 groups after 6 and 12 months of loading in terms of implant stability (implant stability quotient values) (P > 0.05). Within the limits of this study, it is concluded that short implants achieved similar results as standard implants after 3 to 5 years of loading.

Loading capacity of zirconia implant supported hybrid ceramic crowns.

PubMed

Rohr, Nadja; Coldea, Andrea; Zitzmann, Nicola U; Fischer, Jens

2015-12-01

Recently a polymer infiltrated hybrid ceramic was developed, which is characterized by a low elastic modulus and therefore may be considered as potential material for implant supported single crowns. The purpose of the study was to evaluate the loading capacity of hybrid ceramic single crowns on one-piece zirconia implants with respect to the cement type. Fracture load tests were performed on standardized molar crowns milled from hybrid ceramic or feldspar ceramic, cemented to zirconia implants with either machined or etched intaglio surface using four different resin composite cements. Flexure strength, elastic modulus, indirect tensile strength and compressive strength of the cements were measured. Statistical analysis was performed using two-way ANOVA (p=0.05). The hybrid ceramic exhibited statistically significant higher fracture load values than the feldspar ceramic. Fracture load values and compressive strength values of the respective cements were correlated. Highest fracture load values were achieved with an adhesive cement (1253±148N). Etching of the intaglio surface did not improve the fracture load. Loading capacity of hybrid ceramic single crowns on one-piece zirconia implants is superior to that of feldspar ceramic. To achieve maximal loading capacity for permanent cementation of full-ceramic restorations on zirconia implants, self-adhesive or adhesive cements with a high compressive strength should be used. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

2D FEA of evaluation of micromovements and stresses at bone-implant interface in immediately loaded tapered implants in the posterior maxilla.

PubMed

Desai, Shrikar R; Singh, Rika; Karthikeyan, I

2013-09-01

The aim of the study is to evaluate the influence implant length on stress distribution at bone implant interface in single immediately loaded implants when placed in D4 bone quality. A 2-dimensional finite element models were developed to simulate two types of implant designs, standard 3.75 mm-diameter tapered body implants of 6 and 10 mm lengths. The implants were placed in D4 bone quality with a cortical bone thickness of 0.5 mm. The implant design incorporated microthreads at the crestal part and the rest of the implant body incorporated Acme threads. The Acme thread form has a 29° thread angle with a thread height half of the pitch; the apex and valley are flat. A 100 N of force was applied vertically and in the oblique direction (at an angle of 45°) to the long axis of the implants. The respective material properties were assigned. Micro-movements and stresses at the bone implant interface were evaluated. The results of total deformation (micro-movement) and Von mises stress were found to be lower for tapered long implant (10 mm) than short implant (6 mm) while using both vertical as well as oblique loading. Short implants can be successfully placed in poor bone quality under immediate loading protocol. The novel approach of the combination of microthreads at the crestal portion and acme threads for body portion of implant fixture gave promising results.

Three-Dimensional Finite Element Analysis of Varying Diameter and Connection Type in Implants with High Crown-Implant Ratio.

PubMed

Moraes, Sandra Lúcia Dantas de; Verri, Fellippo Ramos; Santiago, Joel Ferreira; Almeida, Daniel Augusto de Faria; Lemos, Cleidiel Aparecido Araujo; Gomes, Jéssica Marcela de Luna; Pellizzer, Eduardo Piza

2018-01-01

The aim of this study was to evaluate the effect of varying the diameter, connection type and loading on stress distribution in the cortical bone for implants with a high crown-implant ratio. Six 3D models were simulated with the InVesalius, Rhinoceros 3D 4.0 and SolidWorks 2011 software programs. Models were composed of bone from the posterior mandibular region; they included an implant of 8.5 mm length, diameter Ø 3.75 mm or Ø 5.00 mm and connection types such as external hexagon (EH), internal hexagon (IH) and Morse taper (MT). Models were processed using the Femap 11.2 and NeiNastran 11.0 programs and by using an axial force of 200 N and oblique force of 100 N. Results were recorded in terms of the maximum principal stress. Oblique loading showed high stress in the cortical bone compared to that shown by axial loading. The results showed that implants with a wide diameter showed more favorable stress distribution in the cortical bone region than regular diameter, regardless of the connection type. Morse taper implants showed better stress distribution compared to other connection types, especially in the oblique loading. Thus, oblique loading showed higher stress concentration in cortical bone tissue when compared with axial loading. Wide diameter implant was favorable for improved stress distribution in the cortical bone region, while Morse taper implants showed lower stress concentration than other connections.

Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

PubMed

Berberi, Antoine N; Tehini, Georges E; Noujeim, Ziad F; Khairallah, Alexandre A; Abousehlib, Moustafa N; Salameh, Ziad A

2014-10-01

Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p < 0.002) compared to the traditional two-stage technique. Whereas mesial surfaces remained stable for the 5-year observation period, significant marginal bone loss was observed on distal surfaces of implants after cementation of interim prostheses (p < 0.007) and after 12 months (p < 0.034). Within the limitations of this study, immediate loading of implants placed into fresh extraction sockets reduced marginal bone loss and did not compromise the success rate of the restorations. © 2014 by the American College of Prosthodontists.

Microleakage at the Different Implant Abutment Interface: A Systematic Review

PubMed Central

Chowdhary, Ramesh; Kumari, Shail

2017-01-01

Introduction Presence of gap at the implant-abutment interface, leads to microleakage and accumulation of bacteria which can affect the success of dental implants. Aim To evaluate the sealing capability of different implant connections against microleakage. Materials and Methods In January 2017 an electronic search of literature was performed, in Medline, EBSCO host and Pubmed data base. The search was focused on ability of different implant connections in preventing microleakage. The related titles and abstracts available in English were screened, and the articles that fulfilled the inclusion criteria were selected for full text reading. Results In this systematic review, literature search initially resulted in 78 articles among which 30 articles only fulfilled the criteria for inclusion and were finally included in the review. Almost all the studies showed that there was some amount of microleakage at abutment implant interface. Microleakage was very less in Morse taper implants in comparison to other implant connections. Majority of studies showed less microleakage in static loading conditions and microleakage increases in dynamic loading conditions. Conclusion In this systematic review maximum studies showed that there was some amount of microleakage at abutment implant interface. External hexagon implants failed completely to prevent microleakage in both static and dynamic loading conditions of implants. Internal hexagon implants mainly internal conical (Morse taper) implants are very promising in case of static loading and also showed less microleakage in dynamic loading conditions. Torque recommended by manufacturer should be followed strictly to get a better seal at abutment implant interface. Zirconia abutments are more to microleakage than Titanium abutments and there use should be discouraged. Zirconia abutments should be only restricted to cases where there was very high demand of aesthetics. PMID:28764310

Tilted orthodontic micro implants: a photoelastic stress analysis.

PubMed

Çehreli, Seçil; Özçırpıcı, Ayça Arman; Yılmaz, Alev

2013-10-01

The aim of this study was to examine peri-implant stresses around orthodontic micro implants upon torque-tightening and static load application by quasi-three-dimensional photoelastic stress analysis. Self-tapping orthodontic micro implants were progressively inserted into photoelastic models at 30, 45, 70, and 90 degrees and insertion torques were measured. Stress patterns (isochromatic fringe orders) were recorded by the quasi-three-dimensional photoelastic method using a circular polariscope after insertion and 250 g static force application. Torque-tightening of implants generated peri-implant stresses. Upon insertion, 90 degree placed implants displayed the lowest and homogeneous stress distribution followed by 30, 70, and 45 degree tilted implants. Static loading did not dramatically alter stress fields around the implants tested. The highest alteration in stress distribution was observed for the 90 degree placed implant, while 70 degree tilted implant had the lowest stresses among tilted implants. Torque-tightening of orthodontic micro implants creates a stress field that is not dramatically altered after application of static lateral moderate orthodontic loads, particularly at the cervical region of tilted implants.

A 5-year comparison of marginal bone level following immediate loading of single-tooth implants placed in healed alveolar ridges and extraction sockets in the maxilla.

PubMed

Berberi, Antoine N; Sabbagh, Joseph M; Aboushelib, Moustafa N; Noujeim, Ziad F; Salameh, Ziad A

2014-01-01

The aim of present investigation was to evaluate marginal bone level after 5-year follow-up of implants placed in healed ridges and fresh extraction sockets in maxilla with immediate loading protocol. Thirty-six patients in need of a single-tooth replacement in the anterior maxilla received 42 Astra Tech implants (Astra Tech Implant system™, Dentsply Implants, Mölndal, Sweden). Implants were placed either in healed ridges (group I) or immediately into fresh extraction sockets (group II). Implants were restored and placed into functional loading immediately by using a prefabricated abutment. Marginal bone level relative to the implant reference point was recorded at implant placement, crown cementation, 12, 36, and 60 months following loading using intra-oral radiographs. Measurements were made on the mesial and distal sides of each implant. Overall, two implants were lost from the group II, before final crown cementation: they were excluded from the study. The mean change in marginal bone loss (MBL) after implant placement was 0.26 ± 0.161 mm for 1 year, and 0.26 ± 0.171 mm for 3 years, and 0.21 ± 0.185 mm for 5 years in extraction sockets and was 0.26 ± 0.176 mm for 1 year and 0.21 ± 0.175 mm for 3 years, and 0.19 ± 0.172 mm for 5 years in healed ridges group. Significant reduction of marginal bone was more pronounced in implants inserted in healed ridges (P < 0.041) compared to fresh surgical extraction sockets (P < 0.540). Significant MBL was observed on the mesial side of the implant after cementation of the provisional (P < 0.007) and after 12 months (P < 0.034) compared to the distal side which remained stable for 3 and 5 years observation period. Within the limitations of this study, responses of local bone to immediately loaded implants placed either in extraction sockets or healed ridges were similar. Functional loading technique by using prefabricated abutment placed during the surgery time seems to maintain marginal bone around implant in both healed and fresh extraction sites.

Comparison of removal torques between laser-etched and modified sandblasted acid-etched Ti implant surfaces in rabbit tibias

PubMed Central

Al Awamleh, Abdel Ghani Ibrahim

2018-01-01

PURPOSE The purpose of this study was to analyze the effects of two different implant surface treatments on initial bone connection by comparing the Removal Torque Values (RTQs) at 7 and 10 days after chemically modified, sandblasted, large-grit and acid-etched (modSLA), and Laser-etched (LE) Ti implant placements. MATERIALS AND METHODS Twenty modSLA and 20 LE implants were installed on the left and right tibias of 20 adult rabbits. RTQs were measured after 7 and 10 days in 10 rabbits each. Scanning electron microscope (SEM) photographs of the two implants were observed by using Quanta FEG 650 from the FEI company (Hillsboro, OR, USA). Analyses of surface elements and components were conducted using energy dispersive spectroscopy (EDS, Horiba, Kyoto, Japan). RESULTS The mean RTQs were 12.29 ± 0.830 and 12.19 ± 0.713 Ncm after 7 days (P=.928) and 16.47 ± 1.324 and 16.17 ± 1.165 Ncm after 10 days (P=.867) for LE and modSLA, respectively, indicating no significant inter-group differences. Pore sizes in the LE were 40 µm and consisted of numerous small pores, whereas pore sizes in the modSLA were 5 µm. In the EDS analysis, Ti, O, and C were the only three elements found in the LE surfaces. Na, Ca, Cl, and K were also observed in modSLA, in addition to Ti, O, and C. CONCLUSION The implants showed no significant difference in biomechanical bond strength to bone in early-stage osseointegration. LE implant can be considered an excellent surface treatment method in addition to the modSLA implant and can be applied to the early loading of the prosthesis clinically. PMID:29503717

Influence of parafunctional loading and prosthetic connection on stress distribution: a 3D finite element analysis.

PubMed

Torcato, Leonardo Bueno; Pellizzer, Eduardo Piza; Verri, Fellippo Ramos; Falcón-Antenucci, Rosse Mary; Santiago Júnior, Joel Ferreira; de Faria Almeida, Daniel Augusto

2015-11-01

Clinicians should consider parafunctional occlusal load when planning treatment. Prosthetic connections can reduce the stress distribution on an implant-supported prosthesis. The purpose of this 3-dimensional finite element study was to assess the influence of parafunctional loading and prosthetic connections on stress distribution. Computer-aided design software was used to construct 3 models. Each model was composed of a bone and an implant (external hexagon, internal hexagon, or Morse taper) with a crown. Finite element analysis software was used to generate the finite element mesh and establish the loading and boundary conditions. A normal force (200-N axial load and 100-N oblique load) and parafunctional force (1000-N axial and 500-N oblique load) were applied. Results were visualized as the maximum principal stress. Three-way analysis of variance and Tukey test were performed, and the percentage of contribution of each variable to the stress concentration was calculated from sum-of squares-analysis. Stress was concentrated around the implant at the cortical bone, and models with the external hexagonal implant showed the highest stresses (P<.001). Oblique loads produced high tensile stress concentrations on the site opposite the load direction. Internal connection implants presented the most favorable biomechanical situation, whereas the least favorable situation was the biomechanical behavior of external connection implants. Parafunctional loading increased the magnitude of stress by 3 to 4 times. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Removal torque evaluation of three different abutment screws for single implant restorations after mechanical cyclic loading.

PubMed

Paepoemsin, T; Reichart, P A; Chaijareenont, P; Strietzel, F P; Khongkhunthian, P

2016-01-01

The aim of this study was to evaluate the removal torque of three different abutment screws and pull out strength of implant-abutment connection for single implant restorations after mechanical cyclic loading. The study was performed in accordance with ISO 14801:2007. Three implant groups (n=15) were used: group A, PW Plus® with flat head screw; group B, PW Plus® with tapered screw; and group C, Conelog® with flat head screw. All groups had the same implant-abutment connection feature: cone with mandatory index. All screws were tightened with manufacturer's recommended torque. Ten specimens in each group underwent cyclic loading (1×106 cycles, 10 Hz, and 250 N). Then, all specimens were un-tightened, measured for the removal torque, and underwent a tensile test. The force that dislodged abutment from implant fixture was recorded. The data were analysed using independent sample t-test, ANOVA and Tukey HSD test. Before cyclic loading, removal torque in groups A, B and C were significantly different (B> A> C, P<.05). After cyclic loading, removal torque in all groups decreased significantly (P<.05). Group C revealed significantly less removal torque than groups A and B (P<.005). Tensile force in all groups significantly increased after cyclic loading (P<.05), group A had significantly less tensile force than groups B and C (P<.005). Removal torque reduced significantly after cyclic loading. Before cyclic loading, tapered screws maintained more preload than did flat head screws. After cyclic loading, tapered and flat head screws maintained even amounts of preload. The tensile force that dislodged abutment from implant fixture increased immensely after cyclic loading.

Removal torque evaluation of three different abutment screws for single implant restorations after mechanical cyclic loading

PubMed Central

PAEPOEMSIN, T.; REICHART, P. A.; CHAIJAREENONT, P.; STRIETZEL, F. P.; KHONGKHUNTHIAN, P.

2016-01-01

SUMMARY Purpose The aim of this study was to evaluate the removal torque of three different abutment screws and pull out strength of implant-abutment connection for single implant restorations after mechanical cyclic loading. Methods The study was performed in accordance with ISO 14801:2007. Three implant groups (n=15) were used: group A, PW Plus® with flat head screw; group B, PW Plus® with tapered screw; and group C, Conelog® with flat head screw. All groups had the same implant-abutment connection feature: cone with mandatory index. All screws were tightened with manufacturer’s recommended torque. Ten specimens in each group underwent cyclic loading (1×106 cycles, 10 Hz, and 250 N). Then, all specimens were un-tightened, measured for the removal torque, and underwent a tensile test. The force that dislodged abutment from implant fixture was recorded. The data were analysed using independent sample t-test, ANOVA and Tukey HSD test. Results Before cyclic loading, removal torque in groups A, B and C were significantly different (B> A> C, P<.05). After cyclic loading, removal torque in all groups decreased significantly (P<.05). Group C revealed significantly less removal torque than groups A and B (P<.005). Tensile force in all groups significantly increased after cyclic loading (P<.05), group A had significantly less tensile force than groups B and C (P<.005). Conclusions Removal torque reduced significantly after cyclic loading. Before cyclic loading, tapered screws maintained more preload than did flat head screws. After cyclic loading, tapered and flat head screws maintained even amounts of preload. The tensile force that dislodged abutment from implant fixture increased immensely after cyclic loading. PMID:28042450

A New Experimental Design for Bacterial Microleakage Investigation at the Implant-Abutment Interface: An In Vitro Study.

PubMed

Zipprich, Holger; Miatke, Sven; Hmaidouch, Rim; Lauer, Hans-Christoph

2016-01-01

This study aimed to test bacterial microleakage at the implant-abutment interface (IAI) before and after dynamic loading using a new chewing simulation. Fourteen implant systems (n = 5 samples of each) were divided into two groups: (1) systems with conical implant-abutment connections (IACs), and (2) systems with flat IACs. For collecting samples without abutment disconnection, channels (Ø = 0.3 mm) were drilled into implants perpendicularly to their axes, and stainless-steel cannulas were adhesively glued inside these channels to allow a sterilized rinsing solution to enter the implant interior and to exit with potential contaminants for testing. Implants were embedded in epoxy resin matrices, which were supported by titanium cylinders with lateral openings for inward and outward cannulas. Abutments were tightened and then provided with vertically adjustable, threaded titanium balls, which were cemented using composite cement. Specimens were immersed in a bacterial liquid and after a contact time of 15 minutes, the implant interior was rinsed prior to chewing simulation (0 N ≘ static seal testing). Specimens were exposed to a Frankfurt chewing simulator. Two hundred twenty force cycles per power level (110 in ± X-axis) were applied to simulate a daily masticatory load of 660 chewing cycles (equivalent to 1,200,000 cycles/5 years). The applied load was gradually increased from 0 N to a maximum load of 200 N in 25-N increments. The implant interior was rinsed to obtain samples before each new power level. All samples were tested using fluorescence microscopy; invading microorganisms could be counted and evaluated. No bacterial contamination was detected under static loading conditions in both groups. After loading, bacterial contamination was detected in one sample from one specimen in group 1 and in two samples from two specimens in group 2. Controlled dynamic loading applied in this study simulated a clinical situation and enabled time-dependent analysis regarding the bacterial seal of different implant systems. Conical IACs offer a better bacterial seal compared with flat IACs, which showed increased microleakage after dynamic loading. IAC design plays a crucial role in terms of bacterial colonization. Taking samples of the implant interior without abutment disconnection eliminates an error source.

Single dental implant retained mandibular complete dentures – influence of the loading protocol: study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Over the years, there has been a strong consensus in dentistry that at least two implants are required to retain a complete mandibular denture. It has been shown in several clinical trials that one single median implant can retain a mandibular overdenture sufficiently well for up to 5 years without implant failures, when delayed loading was used. However, other trials have reported conflicting results with in part considerable failure rates when immediate loading was applied. Therefore it is the purpose of the current randomized clinical trial to test the hypothesis that immediate loading of a single mandibular midline implant with an overdenture will result in a comparable clinical outcome as using the standard protocol of delayed loading. Methods/design This prospective nine-center randomized controlled clinical trial is still ongoing. The final patient will complete the trial in 2016. In total, 180 edentulous patients between 60 and 89 years with sufficient complete dentures will receive one median implant in the edentulous mandible, which will retain the existing complete denture using a ball attachment. Loading of the median implant is either immediately after implant placement (experimental group) or delayed by 3 months of submerged healing at second-stage surgery (control group). Follow-up of patients will be performed for 24 months after implant loading. The primary outcome measure is non-inferiority of implant success rate of the experimental group compared to the control group. The secondary outcome measures encompass clinical, technical and subjective variables. The study was funded by the Deutsche Forschungsgemeinschaft (German research foundation, KE 477/8-1). Discussion This multi-center clinical trial will give information on the ability of a single median implant to retain a complete mandibular denture when immediately loaded. If viable, this treatment option will strongly improve everyday dental practice. Trial registration The trial has been registered at Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS-ID: DRKS00003730 since 23 August 2012. (http://www.germanctr.de). PMID:24884848

Settling of abutments into implants and changes in removal torque in five different implant-abutment connections. Part 1: Cyclic loading.

PubMed

Kim, Ki-Seong; Han, Jung-Suk; Lim, Young-Jun

2014-01-01

The aim of this study was to evaluate and compare the settling of abutments into implants and the removal torque values (RTVs) before and after cyclic loading. Five different implant-abutment connections were tested: Ext = external butt joint + two-piece abutment; Int-H2 = internal hexagon + two-piece abutment; Int-H1 = internal hexagon + one-piece abutment; Int-O2 = internal octagon + two-piece abutment; and Int-O1 = internal octagon + one-piece abutment. Ten abutments from each group were secured to their corresponding implants (total n = 50). All samples were tested in a universal testing machine with a vertical load of 250 N for 100,000 cycles of 14 Hz. The amount of settling of the abutment into the implant was calculated from the change in the total length of the implant-abutment sample before and after loading, as measured with an electronic digital micrometer. The RTV after cyclic loading was compared to the initial RTV with a digital torque gauge. Statistical analysis was performed at a 5% significance level. A multiple-comparison test showed specific significant differences in settling values in each group after 250 N cyclic loading (Int-H1, Ext < Int-H2 < Int-O2 < Int-O1). There were statistically significant decreases in RTVs after loading compared to the initial RTVs in the Int-H2 and Int-O2 groups. No statistically significant differences were found in the Ext, Int-H1, and Int-O1 groups. The results of this study demonstrated that the settling amount and RTV (loss of preload) after cyclic loading were specific to the abutment type and related to the design characteristics of the implant-abutment connection.

Survival of dental implants in patients with Down syndrome: A case series.

PubMed

Limeres Posse, Jacobo; López Jiménez, Julian; Ruiz Villandiego, José C; Cutando Soriano, Antonio; Fernández Feijoo, Javier; Linazasoro Elorza, Maialen; Diniz Freitas, Márcio; Diz Dios, Pedro

2016-12-01

The need for tooth replacement in individuals with Down syndrome (DS) is explained by the high prevalence of dental agenesis and by the premature loss of teeth through severe periodontal disease. Dental implants may be the dental procedure of choice in some of these patients. The purpose of this clinical study was to analyze dental implant survival in a series of patients with DS. This was a multicenter, retrospective, observational study. Information on patients was gathered using a standardized questionnaire designed specifically for this study, including personal details, oral health status, information on the surgical and prosthetic phases, and follow-up visits. The questionnaire was sent to centers registered with the research network of the Spanish Society of Special Needs Dentistry (SEOENE). Patients with DS aged 18 years or older were included in the study if they had at least 1 dental implant and the corresponding prosthesis and had been followed up for at least a year. The study population was formed of 25 adult patients (13 men and 12 women) aged between 19 and 60 years. The interventions were performed by 5 different dental surgeons, usually under general anesthesia or deep sedation (n=17 patients). A total of 73 implants were inserted, 30 in the maxilla and 43 in the mandible, most commonly in the anterior region (n=51). The mean time to loading the implants was 4.1 ±1.3 months after surgery (range, 1 to 7 months). All patients completed prosthetic rehabilitation; the most frequent design used was the single fixed prosthesis (n=13 patients). A total of 17 (23.2%) implants failed in 8 (32%) patients; the majority (n=14 implants) failed in the postsurgical period before implant loading. The distribution by patients was 1 implant failure in 6 patients, 3 failures in 1 patient, and 8 failures in 1 patient. Dental implant survival is lower in individuals with DS than in the general population. The reasons for early implant failure in these patients have still not been clearly identified. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Immediate loading of mandibular overdentures supported by one-piece, direct metal laser sintering mini-implants: a short-term prospective clinical study.

PubMed

Mangano, Francesco G; Caprioglio, Alberto; Levrini, Luca; Farronato, Davide; Zecca, Piero A; Mangano, Carlo

2015-02-01

Only a few studies have dealt with immediately loaded, unsplinted mini-implants supporting ball attachment-retained mandibular overdentures (ODs). The aim of this study is to evaluate treatment outcomes of ball attachment-retained mandibular ODs supported by one-piece, unsplinted, immediately loaded, direct metal laser sintering (DMLS) mini-implants. Over a 4-year period (2009 to 2012), all patients referred to the Dental Clinic, University of Varese, and to a private practice for treatment with mandibular ODs were considered for inclusion in this study. Each patient received three or four DMLS mini-implants. Immediately after implant placement, a mandibular OD was connected to the implants. At each annual follow-up session, clinical and radiographic parameters were assessed, including the following outcome measures: 1) implant failures; 2) peri-implant marginal bone loss; and 3) complications. Statistical analysis was conducted using a life-table analysis. A total of 231 one-piece DMLS mini-implants were inserted in 62 patients. After 4 years of loading, six implants failed, giving an overall cumulative survival rate of 96.9%. The mean distance between the implant shoulder and the first visible bone-to-implant contact was 0.38 ± 0.25 and 0.62 ± 0.20 mm at the 1- and 4-year follow-up examinations, respectively. An incidence of 6.0% of biologic complications was reported; prosthetic complications were more frequent (12.9%). Within the limits of this study, it can be concluded that the immediate loading of one-piece, unsplinted, DMLS titanium mini-implants by means of ball attachment-supported mandibular ODs is a successful treatment procedure. Long-term follow-up studies are needed to confirm these results.

Influence of occlusal loading on peri-implant clinical parameters. A pilot study

PubMed Central

Pellicer-Chover, Hilario; Viña-Almunia, José; Romero-Millán, Javier; Peñarrocha-Oltra, David; Peñarrocha-Diago, María

2014-01-01

Objectives: To investigate the relation between occlusal loading and peri-implant clinical parameters (probing depth, bleeding on probing, gingival retraction, width of keratinized mucosa, and crevicular fluid volume) in patients with implant-supported complete fixed prostheses in both arches. Material and Methods: This clinical study took place at the University of Valencia (Spain) dental clinic. It included patients attending the clinic for regular check-ups during at least 12 months after rehabilitation of both arches with implant-supported complete fixed ceramo-metallic prostheses. One study implant and one control implant were established for each patient using the T-Scan®III computerized system (Tesco, South Boston, USA). The maxillary implant closest to the point of maximum occlusal loading was taken as the study implant and the farthest (with least loading) as the control. Occlusal forces were registered with the T-Scan® III and then occlusal adjustment was performed to distribute occlusal forces correctly. Peri-implant clinical parameters were analyzed in both implants before and two and twelve months after occlusal adjustment. Results: Before occlusal adjustment, study group implants presented a higher mean volume of crevicular fluid (51.3±7.4 UP) than the control group (25.8±5.5 UP), with statistically significant difference. Two months after occlusal adjustment, there were no significant differences between groups (24.6±3.8 UP and 26±4.5 UP respectively) (p=0.977). After twelve months, no significant differences were found between groups (24.4±11.1 UP and 22.5±8.9 UP respectively) (p=0.323). For the other clinical parameters, no significant differences were identified between study and control implants at any of the study times (p>0.05). Conclusions: Study group implants receiving higher occlusal loading presented significantly higher volumes of crevicular fluid than control implants. Crevicular fluid volumes were similar in both groups two and twelve months after occlusal adjustment. Key words:Occlusal loading, crevicular fluid, peri-implant clinical parameters, T-Scan®. PMID:24316708

Stress and strain distribution in three different mini dental implant designs using in implant retained overdenture: a finite element analysis study.

PubMed

Aunmeungtong, W; Khongkhunthian, P; Rungsiyakull, P

2016-01-01

Finite Element Analysis (FEA) has been used for prediction of stress and strain between dental implant components and bone in the implant design process. Purpose of this study was to characterize and analyze stress and strain distribution occurring in bone and implants and to compare stress and strain of three different implant designs. Three different mini dental implant designs were included in this study: 1. a mini dental implant with an internal implant-abutment connection (MDIi); 2. a mini dental implant with an external implant-abutment connection (MDIe); 3. a single piece mini dental implant (MDIs). All implant designs were scanned using micro-CT scans. The imaging details of the implants were used to simulate models for FEA. An artificial bone volume of 9×9 mm in size was constructed and each implant was placed separately at the center of each bone model. All bone-implant models were simulatively loaded under an axial compressive force of 100 N and a 45-degree force of 100 N loading at the top of the implants using computer software to evaluate stress and strain distribution. There was no difference in stress or strain between the three implant designs. The stress and strain occurring in all three mini dental implant designs were mainly localized at the cortical bone around the bone-implant interface. Oblique 45° loading caused increased deformation, magnitude and distribution of stress and strain in all implant models. Within the limits of this study, the average stress and strain in bone and implant models with MDIi were similar to those with MDIe and MDIs. The oblique 45° load played an important role in dramatically increased average stress and strain in all bone-implant models. Mini dental implants with external or internal connections have similar stress distribution to single piece mini dental implants. In clinical situations, the three types of mini dental implant should exhibit the same behavior to chewing force.

Esthetic Outcomes of Immediately Loaded Locking Taper Implants in the Anterior Maxilla: A Case Series Study.

PubMed

Lombardo, Giorgio; Corrocher, Giovanni; Pighi, Jacopo; Mascellaro, Anna; Marincola, Mauro; Nocini, Per Francesco

2016-06-01

The purpose of this study was to evaluate the esthetic outcome of single-tooth locking taper connection implants placed in the anterior maxilla following a postextractive nonfunctional loading protocol. This preliminary clinical study involving 16 patients evaluated the results of 21 implants placed in areas with high esthetic value. For each implant the pink esthetic score, white esthetic score, cumulative survival rate, and health status of peri-implant tissues were evaluated. The cumulative survival rate was 100% 2 years after prosthetic loading, and the mean total pink esthetic score/white esthetic score was 16.9 ± 1.14 on a maximum value of 20. There was excellent plaque control in all patients, and inflammation indices were within the norm. Within the limits of this study, this immediate nonfunctional loading protocol seems to be a successful procedure esthetically and for the maintenance of peri-implant soft tissues.

Titanium versus zirconia implants supporting maxillary overdentures: three-dimensional finite element analysis.

PubMed

Osman, Reham B; Elkhadem, Amr H; Ma, Sunyoung; Swain, Michael V

2013-01-01

The purpose of this study was to compare the stress and strain occurring in peri-implant bone and implants used to support maxillary overdentures. Three-dimensional finite element analysis (3D FEA) was used to compare one-piece zirconia and titanium implants. Two types of implants were simulated using a 3D FEA model: one-piece zirconia and titanium implants (diameter, 3.8 × 11.5 mm) with 2.25-mm diameter ball abutments. In each simulation four implants were placed bilaterally in the canine/premolar region of an edentulous maxillary model. Static loads were applied axially and 20 degrees buccolingually on the buccal slope of the lingual cusps of posterior teeth of the first quadrant. Von Mises stresses and equivalent strains generated in peri-implant bone and first principal stresses in the implants were calculated. Comparable stress and strain values were shown in the peri-implant bone for both types of implants. The maximum equivalent strain produced in the peri-implant region was mostly within the range for bone augmentation. Under oblique loading, maximum von Mises stresses and equivalent strain were more evident at the neck of the most distal implant on the loaded side. Under axial load, the stress and strain were transferred to the peri-implant bone around the apex of the implant. Maximum tensile stresses that developed for either material were well below their fracture strength. The highest stresses were mainly located at the distobuccal region of the neck for the two implant materials under both loading conditions. From a biomechanical point of view, ceramic implants made from yttrium-stabilized tetragonal polycrystalline zirconia may be a potential alternative to conventional titanium implants for the support of overdentures. This is particularly relevant for a select group of patients with a proven allergy to titanium. Prospective clinical studies are still required to confirm these in vitro results. Different simulations presenting various cortical bone thicknesses and implant designs are required to provide a better understanding of the biomechanics of zirconia implants.

Does implant coating with antibacterial-loaded hydrogel reduce bacterial colonization and biofilm formation in vitro?

PubMed

Drago, Lorenzo; Boot, Willemijn; Dimas, Kostantinos; Malizos, Kostantinos; Hänsch, Gertrud M; Stuyck, Jos; Gawlitta, Debby; Romanò, Carlo L

2014-11-01

Implant-related infections represent one of the most severe complications in orthopaedics. A fast-resorbable, antibacterial-loaded hydrogel may reduce or prevent bacterial colonization and biofilm formation of implanted biomaterials. We asked: (1) Is a fast-resorbable hydrogel able to deliver antibacterial compounds in vitro? (2) Can a hydrogel (alone or antibacterial-loaded) coating on implants reduce bacterial colonization? And (3) is intraoperative coating feasible and resistant to press-fit implant insertion? We tested the ability of Disposable Antibacterial Coating (DAC) hydrogel (Novagenit Srl, Mezzolombardo, Italy) to deliver antibacterial agents using spectrophotometry and a microbiologic assay. Antibacterial and antibiofilm activity were determined by broth microdilution and a crystal violet assay, respectively. Coating resistance to press-fit insertion was tested in rabbit tibias and human femurs. Complete release of all tested antibacterial compounds was observed in less than 96 hours. Bactericidal and antibiofilm effect of DAC hydrogel in combination with various antibacterials was shown in vitro. Approximately 80% of the hydrogel coating was retrieved on the implant after press-fit insertion. Implant coating with an antibacterial-loaded hydrogel reduces bacterial colonization and biofilm formation in vitro. A fast-resorbable, antibacterial-loaded hydrogel coating may help prevent implant-related infections in orthopaedics. However, further validation in animal models and properly controlled human studies is required.

Displacement of dental implants in trabecular bone under a static lateral load in fresh bovine bone.

PubMed

Engelke, Wilfried; Müller, Alois; Decco, Oscar A; Rau, María J; Cura, Andrea C; Ruscio, Mara L; Knösel, Michael

2013-04-01

The study aims to provide objective data for the displacement of titanium screw implants in trabecular bone specimens. One hundred Semados implants (Bego, Bremen, Germany) were inserted in bovine type IV bone specimens. All implants had a diameter of 3.75 mm; 50 implants had a length of 8.5 mm and 50 implants had a length of 15 mm. Insertion torque was determined at intervals of 10, 20, and 30 Ncm. Implants were loaded horizontally with 10, 20, and 30 N for 2 seconds. An indicator strip was attached to the implant abutment to allow direct observation of implant movement relative to the bone surface. Horizontal displacement was assessed with an accuracy of measurement of 10 µm. Seven implants got lost by visible loosening. Degree of displacement was subject to evaluation with all others. Those implants showed a mean displacement of 59 µm for 10 N (n = 100), 173 µm for 20 N (n = 99), and 211 µm for 30 N (n = 93). The mean displacement of 15-mm implants (16, 37, 51 µm) was significantly lower compared with 8.5-mm implants (103, 311, 396 µm) corresponding to 10, 20, and 30 N as lateral loads. Displacement of screw implants in trabecular bone can be detected and visualized using commercially available endoscopes with a high magnification. A lateral load of 20 N indicates a mean displacement of over 100 µm and therefore results in a critical displacement. © 2011 Wiley Periodicals, Inc.

Micromotion-induced strain fields influence early stages of repair at bone-implant interfaces

PubMed Central

Wazen, Rima M.; Currey, Jennifer A.; Guo, Hongqiang; Brunski, John B.; Helms, Jill A.; Nanci, Antonio

2013-01-01

Implant loading can create micromotion at the bone-implant interface. The interfacial strain associated with implant micromotion could contribute to regulating the tissue healing response. Excessive micromotion can lead to fibrous encapsulation and implant loosening. Our objective was to characterize the influence of interfacial strain on bone regeneration around implants in mouse tibiae. A micromotion system was used to create strain under conditions of (1) no initial contact between implant and bone, and (2) a direct bone-implant contact. Pin- and screw-shaped implants were subjected to displacements of 150 μm or 300 μm, 60 cycles/day, for 7 days. Pin-shaped implants placed in 5 animals were subjected to 3 sessions of 150 μm displacement per day, with 60 cycles per session. Control implants in both types of interfaces were stabilized throughout the healing period. Experimental strain analyses, microtomography, image-based displacement mapping, and finite element simulations were used to characterize interfacial strain fields. Calcified tissue sections were prepared and stained with Goldner to evaluate tissue reaction in higher and lower strain regions. In stable implants, bone formation occurred consistently around the implants. In implants subjected to micromotion, bone regeneration was disrupted in areas of high strain concentrations (e.g. > 30%), whereas lower strain values were permissive of bone formation. Increasing implant displacement or number of cycles per day also changed the strain distribution and disturbed bone healing. These results indicate that not only implant micromotion but also the associated interfacial strain field contributes to regulating the interfacial mechanobiology at healing bone-implant interfaces. PMID:23337705

Success and High Predictability of Intraorally Welded Titanium Bar in the Immediate Loading Implants

PubMed Central

Fogli, Vaniel; Camerini, Michele; Carinci, Francesco

2014-01-01

The implants failure may be caused by micromotion and stress exerted on implants during the phase of bone healing. This concept is especially true in case of implants placed in atrophic ridges. So the primary stabilization and fixation of implants are an important goal that can also allow immediate loading and oral rehabilitation on the same day of surgery. This goal may be achieved thanks to the technique of welding titanium bars on implant abutments. In fact, the procedure can be performed directly in the mouth eliminating possibility of errors or distortions due to impression. This paper describes a case report and the most recent data about long-term success and high predictability of intraorally welded titanium bar in immediate loading implants. PMID:24963419

2D FEA of evaluation of micromovements and stresses at bone-implant interface in immediately loaded tapered implants in the posterior maxilla

PubMed Central

Desai, Shrikar R.; Singh, Rika; Karthikeyan, I.

2013-01-01

Aim: The aim of the study is to evaluate the influence implant length on stress distribution at bone implant interface in single immediately loaded implants when placed in D4 bone quality. Materials and Methods: A 2-dimensional finite element models were developed to simulate two types of implant designs, standard 3.75 mm–diameter tapered body implants of 6 and 10 mm lengths. The implants were placed in D4 bone quality with a cortical bone thickness of 0.5 mm. The implant design incorporated microthreads at the crestal part and the rest of the implant body incorporated Acme threads. The Acme thread form has a 29° thread angle with a thread height half of the pitch; the apex and valley are flat. A 100 N of force was applied vertically and in the oblique direction (at an angle of 45°) to the long axis of the implants. The respective material properties were assigned. Micro-movements and stresses at the bone implant interface were evaluated. Results: The results of total deformation (micro-movement) and Von mises stress were found to be lower for tapered long implant (10 mm) than short implant (6 mm) while using both vertical as well as oblique loading. Conclusion: Short implants can be successfully placed in poor bone quality under immediate loading protocol. The novel approach of the combination of microthreads at the crestal portion and acme threads for body portion of implant fixture gave promising results. PMID:24174759

Maxillary "All-On-Four" treatment using zygomatic implants. A mechanical analysis.

PubMed

de Moraes, P H; Olate, S; Nóbilo, M de Arruda; Asprino, L; de Moraes, M; Barbosa, J de Albergaría

2016-04-01

Zygomatic implants may be used for dental rehabilitation in atrophic maxillae. The aim of this study was to establish experimentally the areas of stress distribution using 2 kinds of "All-On-Four" maxillary procedures. The best position to insert the implants was selected using polyurethane craniomaxillary models and surgical guides were made. Group 1 was designed with two posterior zygomatic implants and two conventional anterior implants, and group 2 with two posterior zygomatic implants and two anterior zygomatic implants. A titanium bar was built to link the 4 implants in both groups. Photoelastic replicas of these models were made and the implants were inserted using the surgical guides. An Instrom 4411 testing machine was used to perform a unilateral compressive loading at the level of the right first molar until 2mm of displacement was obtained. Group 1 showed a high strain concentration in the right lateral orbital region at the level of the apex of the zygomatic implant. Less strain was noticed at the apical levels of the conventional implants in the anterior sector and of the contralateral zygomatic implant. Group 2 showed high strains in the lateral inferior orbital area. The load was low in the alveolar bone sector. Zygomatic bone and paranasal structures are loaded at high levels when zygomatic implants are used to stabilize a full maxillary prosthodontic rehabilitation on 4 implants. The use of 4 zygomatic implants loads the alveolar bone to a lower extent and seems better suited from a mechanical point of view than the use of 2 zygomatic implants. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Experimental and numeric stress analysis of titanium and zirconia one-piece dental implants.

PubMed

Mobilio, Nicola; Stefanoni, Filippo; Contiero, Paolo; Mollica, Francesco; Catapano, Santo

2013-01-01

To compare the stress in bone around zirconia and titanium implants under loading. A one-piece zirconia implant and a replica of the same implant made of commercially pure titanium were embedded in two self-curing acrylic resin blocks. To measure strain, a strain gauge was applied on the surface of the two samples. Loads of 50, 100, and 150 N, with orientations of 30, 45, and 60 degrees with respect to the implant axis were applied on the implant. Strain under all loading conditions on both samples was measured. Three-dimensional virtual replicas of both the implants were reproduced using the finite element method and inserted into a virtual acrylic resin block. All the materials were considered isotropic, linear, and elastic. The same geometry and loading conditions of the experimental setup were used to realize two new models, with the implants embedded within a virtual bone block. Very close values of strain in the two implants embedded in acrylic resin were obtained both experimentally and numerically. The stress states generated by the implants embedded in virtual bone were also very similar, even if the two implants moved differently. Moreover, the stress levels were higher on cortical bone than on trabecular bone. The stress levels in bone, generated by the two implants, appeared to be very similar. From a mechanical point of view, zirconia is a feasible substitute for titanium.

Effects of mechanical repetitive load on bone quality around implants in rat maxillae

PubMed Central

Uto, Yusuke; Nakano, Takayoshi; Ishimoto, Takuya; Inaba, Nao; Uchida, Yusuke; Sawase, Takashi

2017-01-01

Greater understanding and acceptance of the new concept “bone quality”, which was proposed by the National Institutes of Health and is based on bone cells and collagen fibers, are required. The novel protein Semaphorin3A (Sema3A) is associated with osteoprotection by regulating bone cells. The aims of this study were to investigate the effects of mechanical loads on Sema3A production and bone quality based on bone cells and collagen fibers around implants in rat maxillae. Grade IV-titanium threaded implants were placed at 4 weeks post-extraction in maxillary first molars. Implants received mechanical loads (10 N, 3 Hz for 1800 cycles, 2 days/week) for 5 weeks from 3 weeks post-implant placement to minimize the effects of wound healing processes by implant placement. Bone structures, bone mineral density (BMD), Sema3A production and bone quality based on bone cells and collagen fibers were analyzed using microcomputed tomography, histomorphometry, immunohistomorphometry, polarized light microscopy and birefringence measurement system inside of the first and second thread (designated as thread A and B, respectively), as mechanical stresses are concentrated and differently distributed on the first two threads from the implant neck. Mechanical load significantly increased BMD, but not bone volume around implants. Inside thread B, but not thread A, mechanical load significantly accelerated Sema3A production with increased number of osteoblasts and osteocytes, and enhanced production of both type I and III collagen. Moreover, mechanical load also significantly induced preferential alignment of collagen fibers in the lower flank of thread B. These data demonstrate that mechanical load has different effects on Sema3A production and bone quality based on bone cells and collagen fibers between the inside threads of A and B. Mechanical load-induced Sema3A production may be differentially regulated by the type of bone structure or distinct stress distribution, resulting in control of bone quality around implants in jaw bones. PMID:29244883

Effects of mechanical repetitive load on bone quality around implants in rat maxillae.

PubMed

Uto, Yusuke; Kuroshima, Shinichiro; Nakano, Takayoshi; Ishimoto, Takuya; Inaba, Nao; Uchida, Yusuke; Sawase, Takashi

2017-01-01

Greater understanding and acceptance of the new concept "bone quality", which was proposed by the National Institutes of Health and is based on bone cells and collagen fibers, are required. The novel protein Semaphorin3A (Sema3A) is associated with osteoprotection by regulating bone cells. The aims of this study were to investigate the effects of mechanical loads on Sema3A production and bone quality based on bone cells and collagen fibers around implants in rat maxillae. Grade IV-titanium threaded implants were placed at 4 weeks post-extraction in maxillary first molars. Implants received mechanical loads (10 N, 3 Hz for 1800 cycles, 2 days/week) for 5 weeks from 3 weeks post-implant placement to minimize the effects of wound healing processes by implant placement. Bone structures, bone mineral density (BMD), Sema3A production and bone quality based on bone cells and collagen fibers were analyzed using microcomputed tomography, histomorphometry, immunohistomorphometry, polarized light microscopy and birefringence measurement system inside of the first and second thread (designated as thread A and B, respectively), as mechanical stresses are concentrated and differently distributed on the first two threads from the implant neck. Mechanical load significantly increased BMD, but not bone volume around implants. Inside thread B, but not thread A, mechanical load significantly accelerated Sema3A production with increased number of osteoblasts and osteocytes, and enhanced production of both type I and III collagen. Moreover, mechanical load also significantly induced preferential alignment of collagen fibers in the lower flank of thread B. These data demonstrate that mechanical load has different effects on Sema3A production and bone quality based on bone cells and collagen fibers between the inside threads of A and B. Mechanical load-induced Sema3A production may be differentially regulated by the type of bone structure or distinct stress distribution, resulting in control of bone quality around implants in jaw bones.

Pre-load on oral implants after screw tightening fixed full prostheses: an in vivo study.

PubMed

Duyck, J; Van Oosterwyck, H; Vander Sloten, J; De Cooman, M; Puers, R; Naert, I

2001-03-01

The fit of implant supported fixed prostheses is said to be of clinical concern because of the rigid fixation of an oral implant in its surrounding bone. The influence of the torque sequence of the set screws during fixation of implant supported fixed full prostheses on the final pre-load was investigated in vitro. No significant effect of the torque sequence of the set screws on the final pre-load was observed. The main objective of this study was to quantify and qualify the pre-load in vivo on implants supporting a fixed full prosthesis. This was performed when the prostheses were supported by all five or six implants and was repeated when the prostheses were supported by only four and three implants. A total of 13 patients with a fixed full implant supported prosthesis were selected. The existing abutments were changed for strain gauged abutments. After tightening the set screws with a torque of 10 N cm, the pre-load conditions were registered. The average (SEM) axial forces and bending moments in case of five or six, four and three supporting implants were 323 N (43 N), 346 N (59 N), 307 N (60 N) 21 N cm (3 N cm) and 21 N cm (2 N cm), 23 N cm (5 N cm), respectively. In addition, the pre-load was registered after fixation of a machined gold cylinder, as delivered by the manufacturer, on each of the supporting implants, representing the 'optimal fit' situation. The corresponding average (SEM) axial forces and bending moments in case of five or six, four and three supporting implants were 426 N (36 N), 405 N (40 N), 413 N (46 N) and 8 N cm (1 N cm), 8 N cm (1 N cm), 8 N cm (1 N cm), respectively. The induced axial forces after tightening the prostheses were significantly lower then after tightening the gold cylinder in case of five or six supporting implants (P < 0.02). The induced bending moments after tightening the prostheses were statistically significantly higher (P < 0.0001) then after tightening the gold cylinder in all test conditions (five or six, four or three supporting implants). This study underlines the static load present after screw tightening implant supported fixed full prostheses.

The dynamic natures of implant loading.

PubMed

Wang, Rui-Feng; Kang, Byungsik; Lang, Lisa A; Razzoog, Michael E

2009-06-01

A fundamental problem in fully understanding the dynamic nature of implant loading is the confusion that exists regarding the torque load delivered to the implant complex, the initial force transformation/stress/strain developed within the system during the implant complex assembly, and how the clamping forces at the interfaces and the preload stress impact the implant prior to any external loading. The purpose of this study was to create an accurately dimensioned finite element model with spiral threads and threaded bores included in the implant complex, positioned in a bone model, and to determine the magnitude and distribution of the force transformation/stress/strain patterns developed in the modeled implant system and bone and, thus, provide the foundational data for the study of the dynamic loading of dental implants prior to any external loading. An implant (Brånemark Mark III), abutment (CeraOne), abutment screw (Unigrip), and the bone surrounding the implant were modeled using HyperMesh software. The threaded interfaces between screw/implant and implant/bone were designed as a spiral thread helix assigned with specific coefficient of friction values. Assembly simulation using ABAQUS and LS-DYNA was accomplished by applying a 32-Ncm horizontal torque load on the abutment screw (Step 1), then decreasing the torque load to 0 Ncm to simulate the wrench removal (Step 2). The postscript data were collected and reviewed by HyperMesh. A regression analysis was used to depict the relationships between the torque load and the mechanical parameters. During the 32-Ncm tightening sequence, the abutment screw elongated 13.3 mum. The tightening torque generated a 554-N clamping force at the abutment/implant interface and a 522-N preload. The von Mises stress values were 248 MPa in the abutment at the abutment-implant interface, 765 MPa at the top of the screw shaft, 694 MPa at the bottom of the screw shaft, 1365 MPa in the top screw thread, and 21 MPa in the bone at the top of the implant-bone interface. This study also identified various characteristic isosurface stress patterns. The maximum stress magnitude to complete the von Mises stress joint pattern in the present model was 107 MPa during screw tightening, and was reduced to 104 MPa with removal of the wrench. Various specific stress patterns were identified within all elements of the implant complex during the assembly simulation. During the torque moment application, the abutment screw was elongated, and every 1.0-mum elongation of the screw was equivalent to a 47.9-N increase of the preload in the implant complex. The ideal index to determine the preload amount was the contact force at the interface between the screw threads and the threaded screw bore. The isosurface mode identified various characteristic stress patterns developed within the implant complex at the various interfaces during the assembly simulation. These patterns are the (1) spiral and ying-yang pattern of the XY stress, (2) spring, cap, clamping, and preload pattern of the ZZ stress, and (3) bone holding and joint pattern of the von Mises stress.

Cadaveric study validating in vitro monitoring techniques to measure the failure mechanism of glenoid implants against clinical CT.

PubMed

Junaid, Sarah; Gregory, Thomas; Fetherston, Shirley; Emery, Roger; Amis, Andrew A; Hansen, Ulrich

2018-03-23

Definite glenoid implant loosening is identifiable on radiographs, however, identifying early loosening still eludes clinicians. Methods to monitor glenoid loosening in vitro have not been validated to clinical imaging. This study investigates the correlation between in vitro measures and CT images. Ten cadaveric scapulae were implanted with a pegged glenoid implant and fatigue tested to failure. Each scapulae were cyclically loaded superiorly and CT scanned every 20,000 cycles until failure to monitor progressive radiolucent lines. Superior and inferior rim displacements were also measured. A finite element (FE) model of one scapula was used to analyze the interfacial stresses at the implant/cement and cement/bone interfaces. All ten implants failed inferiorly at the implant-cement interface, two also failed at the cement-bone interface inferiorly, and three showed superior failure. Failure occurred at of 80,966 ± 53,729 (mean ± SD) cycles. CT scans confirmed failure of the fixation, and in most cases, was observed either before or with visual failure. Significant correlations were found between inferior rim displacement, vertical head displacement and failure of the glenoid implant. The FE model showed peak tensile stresses inferiorly and high compressive stresses superiorly, corroborating experimental findings. In vitro monitoring methods correlated to failure progression in clinical CT images possibly indicating its capacity to detect loosening earlier for earlier clinical intervention if needed. Its use in detecting failure non-destructively for implant development and testing is also valuable. The study highlights failure at the implant-cement interface and early signs of failure are identifiable in CT images. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 9999:XX-XX, 2018. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.

Influence of the height of the external hexagon and surface treatment on fatigue life of commercially pure titanium dental implants.

PubMed

Gil, Francisco Javier; Aparicio, Conrado; Manero, Jose M; Padros, Alejandro

2009-01-01

This study evaluated the effect of external hexagon height and commonly applied surface treatments on the fatigue life of titanium dental implants. Electropolished commercially pure titanium dental implants (seven implants per group) with three different external hexagon heights (0.6, 1.2, and 1.8 mm) and implants with the highest external hexagon height (1.8 mm) and different surface treatments (electropolishing, grit blasting with aluminium oxide, and acid etching with sulfuric acid) were tested to evaluate their mechanical fatigue life. To do so, 10-Hz triangular flexural load cycles were applied at 37 degrees C in artificial saliva, and the number of load cycles until implant fracture was determined. Tolerances of the hexagon/abutment fit and implant surface roughness were analyzed by scanning electron microscopy and light interferometry. Transmission electron microscopy and electron diffraction analyses of titanium hydrides were performed. First, the fatigue life of implants with the highest hexagon (8,683 +/- 978 load cycles) was more than double that of the implants with the shortest hexagons (3,654 +/- 789 load cycles) (P < .02). Second, the grit-blasted implants had the longest fatigue life of the tested materials (21,393 +/- 2,356 load cycles), which was significantly greater than that of the other surfaces (P < .001). The compressive surface residual stresses induced when blasting titanium are responsible for this superior mechanical response. Third, precipitation of titanium hydrides in grain boundaries of titanium caused by hydrogen adsorption from the acid solution deteriorates the fatigue life of acid-etched titanium dental implants. These implants had the shortest fatigue life (P < .05). The fatigue life of threaded root-form dental implants varies with the height of the external hexagon and/or the surface treatment of the implant. An external hexagon height of 1.8 mm and/or a blasting treatment appear to significantly increase fatigue life of dental implants.

Fracture toughness of titanium-cement interfaces: effects of fibers and loading angles.

PubMed

Khandaker, Morshed; Utsaha, Khatri Chhetri; Morris, Tracy

2014-01-01

Ideal implant-cement or implant-bone interfaces are required for implant fixation and the filling of tissue defects created by disease. Micron- to nanosize osseointegrated features, such as surface roughness, fibers, porosity, and particles, have been fused with implants for improving the osseointegration of an implant with the host tissue in orthopedics and dentistry. The effects of fibers and loading angles on the interface fracture toughness of implant-cement specimens with and without fibers at the interface are not yet known. Such studies are important for the design of a long-lasting implant for orthopedic applications. The goal of this study was to improve the fracture toughness of an implant-cement interface by deposition of micron- to nanosize fibers on an implant surface. There were two objectives in the study: 1) to evaluate the influence of fibers on the fracture toughness of implant-cement interfaces with and without fibers at the interfaces, and 2) to evaluate the influence of loading angles on implant-cement interfaces with and without fibers at the interfaces. This study used titanium as the implant, poly(methyl methacrylate) (PMMA) as cement, and polycaprolactone (PCL) as fiber materials. An electrospinning unit was fabricated for the deposition of PCL unidirectional fibers on titanium (Ti) plates. The Evex tensile test stage was used to determine the interface fracture toughness (KC) of Ti-PMMA with and without PCL fibers at 0°, 45°, and 90° loading angles, referred to in this article as tension, mixed, and shear tests. The study did not find any significant interaction between fiber and loading angles (P>0.05), although there was a significant difference in the KC means of Ti-PMMA samples for the loading angles (P<0.05). The study also found a significant difference in the KC means of Ti-PMMA samples with and without fibers (P<0.05). The results showed that the addition of the micron- to nanosize PCL fibers on Ti improved the quality of the Ti-PMMA union. The results of the study are essential for fatigue testing and finite-element analysis of implant-cement interfaces to evaluate the performance of orthopedic and orthodontic implants.

Parafunctional loading and occlusal device on stress distribution around implants: A 3D finite element analysis.

PubMed

Borges Radaelli, Manuel Tomás; Idogava, Henrique Takashi; Spazzin, Aloisio Oro; Noritomi, Pedro Yoshito; Boscato, Noéli

2018-04-30

An occlusal device is frequently recommended for patients with bruxism to protect implant-supported restorations and prevent marginal bone loss. Scientific evidence to support this treatment is lacking. The purpose of this 3-dimensional (3D) finite element study was to evaluate the influence of an acrylic resin occlusal device, implant length, and insertion depth on stress distribution with functional and parafunctional loadings. Computer-aided design software was used to construct 8 models. The models were composed of a mandibular bone section including the second premolar and first and second molars. Insertion depths (bone level and 2 mm subcrestal) were simulated at the first molar. Three natural antagonist maxillary teeth and the placement or not of an occlusal device were simulated. Functional (200-N axial and 10-N oblique) and parafunctional (1000-N axial and 25-N oblique) forces were applied. Finite element analysis (FEA) was used to determine the maximum principal stress for the cortical and trabecular bone and von Mises for implant and prosthetic abutment. Stress concentration was observed at the abutment-implant and the implant-bone interfaces. Occlusal device placement changed the pattern of stress distribution and reduced stress levels from parafunctional loading in all structures, except in the trabecular bone. Implants with subcrestal insertion depths had reduced stress at the implant-abutment interface and cortical bone around the implant abutment, while the stress increased in the bone in contact with the implant. Parafunctional loading increased the stress levels in all structures when compared with functional loading. An occlusal device resulted in the lowest stress levels at the abutment and implant and the most favorable stress distribution between the cortical and trabecular bone. Under parafunctional loading, an occlusal device was more effective in reducing stress distribution for longer implants inserted at bone level. Subcrestally, implant insertion yielded the most favorable biomechanical conditions at the abutment-implant interface and at the coronal surface of the cortical bone, mainly when there was no occlusal device. Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Numerical study of effect of elastomeric stress absorbers on stress reduction in bone-dental implant interface.

PubMed

Mehdi, Ghalem; Belarbi, Abderrahmane; Mansouri, Bensmaine; Azari, Zitouni

2015-01-01

This paper focused on optimal stress distribution in the mandibular bone surrounding a dental implant and is devoted to the development of a modified Osteoplant® implant type in order to minimize stress concentration in the bone-implant interface. This study investigated 0.4 mm thick layers of two elastomeric stress barriers incorporated into the dental implant using 3-D finite element analysis. Overall, this proposed implant provoked lower load transfer in bone-implant interface due to the effect of the elastomers as stress absorbers. The stress level in the bone was reduced between 28% and 42% for three load cases: 75 N, 60 N and 27 N in corono-apical, linguo-buccal and disto-mesial direction, respectively. The proposed model provided an acceptable solution for load transfer reduction to the mandible. This investigation also permitted to choose how to incorporate two elastomers into the Osteoplant® implant system.

Enhanced antitumor efficacy of poly(D,L-lactide-co-glycolide)-based methotrexate-loaded implants on sarcoma 180 tumor-bearing mice

PubMed Central

Gao, Li; Xia, Lunyang; Zhang, Ruhui; Duan, Dandan; Liu, Xiuxiu; Xu, Jianjian; Luo, Lan

2017-01-01

Purpose Methotrexate is widely used in chemotherapy for a variety of malignancies. However, severe toxicity, poor pharmacokinetics, and narrow safety margin of methotrexate limit its clinical application. The aim of this study was to develop sustained-release methotrexate-loaded implants and evaluate antitumor activity of the implants after intratumoral implantation. Materials and methods We prepared the implants containing methotrexate, poly(D,L-lactide-co-glycolide), and polyethylene glycol 4000 with the melt-molding technique. The implants were characterized with regards to drug content, morphology, in vitro, and in vivo release profiles. Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) were carried out to investigate the physicochemical properties of the implants. Furthermore, the antitumor activity of the implants was tested in a sarcoma 180 mouse model. Results The implants were prepared as solid rods. Scanning electron microscopy images showed a smooth surface of the implant, suggesting that methotrexate was homogeneously dispersed in the polymeric matrix. The results of DSC and FTIR indicated that no significant interaction between methotrexate and the polymer was observed in the implants. Both in vitro and in vivo release profiles of the implants were characterized by burst release followed by sustained release of methotrexate. Intratumoral implantation of methotrexate-loaded implants could efficiently delay tumor growth. Moreover, an increase in the dose of implants led to a higher tumor suppression rate without additional systemic toxicity. Conclusion These results demonstrate that methotrexate-loaded implants had significant antitumor efficacy in a sarcoma 180 mouse model without dose-limiting side effects, and suggest that the implants could be potentially applied as an intratumoral delivery system to treat cancer. PMID:29118572

Impact of constrained dual-screw anchorage on holding strength and the resistance to cyclic loading in anterior spinal deformity surgery: a comparative biomechanical study.

PubMed

Koller, Heiko; Fierlbeck, Johann; Auffarth, Alexander; Niederberger, Alfred; Stephan, Daniel; Hitzl, Wolfgang; Augat, Peter; Zenner, Juliane; Blocher, Martina; Blocher, Martina; Resch, Herbert; Mayer, Michael

2014-03-15

Biomechanical in vitro laboratory study. To compare the biomechanical performance of 3 fixation concepts used for anterior instrumented scoliosis correction and fusion (AISF). AISF is an ideal estimate for selective fusion in adolescent idiopathic scoliosis. Correction is mediated using rods and screws anchored in the vertebral bodies. Application of large correction forces can promote early weakening of the implant-vertebra interfaces, with potential postoperative loss of correction, implant dislodgment, and nonunion. Therefore, improvement of screw-rod anchorage characteristics with AISF is valuable. A total of 111 thoracolumbar vertebrae harvested from 7 human spines completed a testing protocol. Age of specimens was 62.9 ± 8.2 years. Vertebrae were potted in polymethylmethacrylate and instrumented using 3 different devices with identical screw length and unicortical fixation: single constrained screw fixation (SC fixation), nonconstrained dual-screw fixation (DNS fixation), and constrained dual-screw fixation (DC fixation) resembling a novel implant type. Mechanical testing of each implant-vertebra unit using cyclic loading and pullout tests were performed after stress tests were applied mimicking surgical maneuvers during AISF. Test order was as follows: (1) preload test 1 simulating screw-rod locking and cantilever forces; (2) preload test 2 simulating compression/distraction maneuver; (3) cyclic loading tests with implant-vertebra unit subjected to stepwise increased cyclic loading (maximum: 200 N) protocol with 1000 cycles at 2 Hz, tests were aborted if displacement greater than 2 mm occurred before reaching 1000 cycles; and (4) coaxial pullout tests at a pullout rate of 5 mm/min. With each test, the mode of failure, that is, shear versus fracture, was noted as well as the ultimate load to failure (N), number of implant-vertebra units surpassing 1000 cycles, and number of cycles and related loads applied. Thirty-three percent of vertebrae surpassed 1000 cycles, 38% in the SC group, 19% in the DNS group, and 43% in the DC group. The difference between the DC group and the DNS group yielded significance (P = 0.04). For vertebrae not surpassing 1000 cycles, the number of cycles at implant displacement greater than 2 mm in the SC group was 648.7 ± 280.2 cycles, in the DNS group was 478.8 ± 219.0 cycles, and in the DC group was 699.5 ± 150.6 cycles. Differences between the SC group and the DNS group were significant (P = 0.008) as between the DC group and the DNS group (P = 0.0009). Load to failure in the SC group was 444.3 ± 302 N, in the DNS group was 527.7 ± 273 N, and in the DC group was 664.4 ± 371.5 N. The DC group outperformed the other constructs. The difference between the SC group and the DNS group failed significance (P = 0.25), whereas there was a significant difference between the SC group and the DC group (P = 0.003). The DC group showed a strong trend toward increased load to failure compared with the DNS group but without significance (P = 0.067). Surpassing 1000 cycles had a significant impact on the maximum load to failure in the SC group (P = 0.0001) and in the DNS group (P = 0.01) but not in the DC group (P = 0.2), which had the highest number of vertebrae surpassing 1000 cycles. Constrained dual-screw fixation characteristics in modern AISF implants can improve resistance to cyclic loading and pullout forces. DC constructs bear the potential to reduce the mechanical shortcomings of AISF.

Numerical verification of two-component dental implant in the context of fatigue life for various load cases.

PubMed

Szajek, Krzysztof; Wierszycki, Marcin

2016-01-01

Dental implant designing is a complex process which considers many limitations both biological and mechanical in nature. In earlier studies, a complete procedure for improvement of two-component dental implant was proposed. However, the optimization tasks carried out required assumption on representative load case, which raised doubts on optimality for the other load cases. This paper deals with verification of the optimal design in context of fatigue life and its main goal is to answer the question if the assumed load scenario (solely horizontal occlusal load) leads to the design which is also "safe" for oblique occlussal loads regardless the angle from an implant axis. The verification is carried out with series of finite element analyses for wide spectrum of physiologically justified loads. The design of experiment methodology with full factorial technique is utilized. All computations are done in Abaqus suite. The maximal Mises stress and normalized effective stress amplitude for various load cases are discussed and compared with the assumed "safe" limit (equivalent of fatigue life for 5e6 cycles). The obtained results proof that coronial-appical load component should be taken into consideration in the two component dental implant when fatigue life is optimized. However, its influence in the analyzed case is small and does not change the fact that the fatigue life improvement is observed for all components within whole range of analyzed loads.

Effect of macro-design of immediately loaded implants on micromotion and stress distribution in surrounding bone using finite element analysis.

PubMed

Fazel, Akbar; Aalai, Shima; Rismanchian, Mansour

2009-08-01

Macro-design influences the initial stability of implant and reduces micromotions. The aim of this study was to determine and compare micromotions and stress distribution in the bone around immediately loaded Maestro and Xive implants using finite element analysis. In this experimental study, accurate, clear photos were prepared of Xive and Maestro implants 12 and 13 mm long and 4 and 3.8 mm in diameter, respectively, using a Nikon Digital Camera with a resolution 5.24-megapixels with 8x Optical Zoom and 4x Digital Zoom. After accurate measurements, 3-D models of the implants inside the lower mandible (D2) were processed in Solidworks Version 2003 environment and transferred into Ansys for finite element analysis. After loading of 500 N angled at 70 degrees from the horizontal plane, the micromotion of the implant and Von Misses stresses around the bone were measured. The measured micromotion in Maestro implant was 148 mum and that in Xive was 284 mum. Stress distribution in the bone surrounding Maestro implant was better than Xive, but maximum stress surrounding Xive implants (30 MPa) was lower than Maestro (33 MPa). Based on the results obtained in the present study, maximum micromotion in maestro was less than that in Xive implants. This finding can guarantee the application of maestro implants for immediate loading.

A 5-year comparison of marginal bone level following immediate loading of single-tooth implants placed in healed alveolar ridges and extraction sockets in the maxilla

PubMed Central

Berberi, Antoine N.; Sabbagh, Joseph M.; Aboushelib, Moustafa N.; Noujeim, Ziad F.; Salameh, Ziad A.

2014-01-01

Purpose: The aim of present investigation was to evaluate marginal bone level after 5-year follow-up of implants placed in healed ridges and fresh extraction sockets in maxilla with immediate loading protocol. Materials and Methods: Thirty-six patients in need of a single-tooth replacement in the anterior maxilla received 42 Astra Tech implants (Astra Tech Implant system™, Dentsply Implants, Mölndal, Sweden). Implants were placed either in healed ridges (group I) or immediately into fresh extraction sockets (group II). Implants were restored and placed into functional loading immediately by using a prefabricated abutment. Marginal bone level relative to the implant reference point was recorded at implant placement, crown cementation, 12, 36, and 60 months following loading using intra-oral radiographs. Measurements were made on the mesial and distal sides of each implant. Results: Overall, two implants were lost from the group II, before final crown cementation: they were excluded from the study. The mean change in marginal bone loss (MBL) after implant placement was 0.26 ± 0.161 mm for 1 year, and 0.26 ± 0.171 mm for 3 years, and 0.21 ± 0.185 mm for 5 years in extraction sockets and was 0.26 ± 0.176 mm for 1 year and 0.21 ± 0.175 mm for 3 years, and 0.19 ± 0.172 mm for 5 years in healed ridges group. Significant reduction of marginal bone was more pronounced in implants inserted in healed ridges (P < 0.041) compared to fresh surgical extraction sockets (P < 0.540). Significant MBL was observed on the mesial side of the implant after cementation of the provisional (P < 0.007) and after 12 months (P < 0.034) compared to the distal side which remained stable for 3 and 5 years observation period. Conclusions: Within the limitations of this study, responses of local bone to immediately loaded implants placed either in extraction sockets or healed ridges were similar. Functional loading technique by using prefabricated abutment placed during the surgery time seems to maintain marginal bone around implant in both healed and fresh extraction sites. PMID:24550840

Vertical ridge augmentation with autogenous bone grafts 3 years after loading: resorbable barriers versus titanium-reinforced barriers. A randomized controlled clinical trial.

PubMed

Merli, Mauro; Lombardini, Francesco; Esposito, Marco

2010-01-01

To compare the efficacy of two different techniques for vertical bone regeneration at implant placement with particulated autogenous bone at 3 years after loading: resorbable collagen barriers supported by osteosynthesis plates and nonresorbable titanium-reinforced expanded polytetrafluoroethylene barriers. Twenty-two partially edentulous patients requiring vertical bone augmentation were randomly allocated to two treatment groups, each composed of 11 patients. Prosthetic and implant failures, complications, the amount of vertically regenerated bone, and peri-implant marginal bone levels were recorded by independent and blinded assessors. The implant site requiring the most vertical bone regeneration was selected in each patient for bone level assessment. The follow-up time ranged from provisional loading to 3 years after loading. Analysis of covariance and paired t tests were conducted to compare means at the .05 level of significance. No patient dropped out or was excluded at the 3-year follow-up. No prosthetic failures and no implant failures or complications occurred after loading. There was no statistically significant difference in bone loss between the two groups at either 1 year or 3 years. Both groups had gradually lost a statistically significant amount of peri-implant bone at 1 and 3 years (P < .05). After 3 years, patients treated with resorbable barriers had lost a mean of 0.55 mm of bone; patients who had received nonresorbable barriers showed a mean of 0.53 mm of bone loss. Up to 3 years after implant loading, no failures or complications occurred and peri-implant marginal bone loss was minimal. Vertically regenerated bone can be successfully maintained after functional loading.

Evaluation of stress distribution of implant-retained mandibular overdenture with different vertical restorative spaces: A finite element analysis

PubMed Central

Ebadian, Behnaz; Farzin, Mahmoud; Talebi, Saeid; Khodaeian, Niloufar

2012-01-01

Background: Available restorative space and bar height is an important factor in stress distribution of implant-supported overdentures. The purpose of this study was to evaluate the effect of different vertical restorative spaces and different bar heights on the stress distribution around implants by 3D finite element analysis. Materials and Methods: 3D finite element models were developed from mandibular overdentures with two implants in the interforaminal region. In these models, four different bar heights from gingival crest (0.5, 1, 1.5, 2 mm) with 15 mm occlusal plane height and three different occlusal plane heights from gingival crest (9, 12, 15 mm) with 2 mm bar height were analyzed. A vertical unilateral and a bilateral load of 150 N were applied to the central occlusal fossa of the first molar and the stress of bone around implant was analyzed by finite element analysis. Results: By increasing vertical restorative space, the maximum stress values around implants were found to be decreased in unilateral loading models but slightly increased in bilateral loading cases. By increasing bar height from gingival crest, the maximum stress values around implants were found to be increased in unilateral loading models but slightly decreased in bilateral loading cases. In unilateral loading models, maximum stress was found in a model with 9 mm occlusal plane height and 1.5 mm bar height (6.254 MPa), but in bilateral loading cases, maximum stress was found in a model with 15 mm occlusal plane height and 0.5 mm bar height (3.482 MPa). Conclusion: The reduction of bar height and increase in the thickness of acrylic resin base in implant-supported overdentures are biomechanically favorable and may result in less stress in periimplant bone. PMID:23559952

In vivo evaluation of teicoplanin- and calcium sulfate-loaded PMMA bone cement in preventing implant-related osteomyelitis in rats.

PubMed

Tuzuner, T; Sencan, I; Ozdemir, D; Alper, M; Duman, S; Yavuz, T; Yildirim, M

2006-12-01

The objective of this study was to evaluate the efficacy of teicoplanin- and calcium sulphate-loaded polymethylmethacrylate (PMMA) bone cements in preventing experimental implant-related osteomyelitis in rats. Four groups of antibiotic-loaded rods were prepared and were implanted into the lateral condylus of the rat femur after inoculation of Staphylococcus aureus. The effectiveness of these were assessed microbiologically, radiographically, and histopathologically. Radiographic evaluation revealed a significant reduction of periostal reaction and osteolysis in rats that received calcium sulphate- and teicoplanin-loaded rods. Histopathological evaluation confirmed these results. Acute infection and bone necrosis were found to be significantly lower in rats that had received calcium sulphate- and teicoplanin-loaded rods. The addition of calcium sulfate to teicoplanin-loaded PMMA bone cement appeared satisfactory as an antibiotic-carrying system for prophylaxis of experimental implant-related osteomyelitis, but further investigations are needed to reach definitive statements for clinical applications.

Radiographic and clinical outcomes of implants placed in ridge preserved sites: a 12-month post-loading follow-up.

PubMed

Patel, K; Mardas, N; Donos, N

2013-06-01

The aim of this clinical study was to evaluate the interproximal radiographic bone levels and the survival/success rate of dental implants placed in alveolar ridges previously preserved with a synthetic bone substitute or a bovine xenograft. Alveolar ridge preservation was performed in 27 patients who were randomly assigned in two groups. In the test group (n = 14), the extraction socket was treated with a synthetic bone graft Straumann Bone Ceramic; SBC and a collagen barrier, whereas in the control group (n = 13) a deproteinized bovine bone mineral (DBBM) and the same collagen barrier were used. After 8 months of healing, titanium dental implants with a hydrophilic surface were placed in the preserved ridges. During surgery, 9/13 implants in the SBC group and 8/12 implants in the DBBM group presented with either dehiscence or fenestration defects and required additional bone augmentation. The implants were loaded at 4 months following placement and were followed up for 1 year post-loading. Interproximal radiographic bone levels were evaluated in standardized periapical radiographs at loading and 1 year post-loading. Probing pocket depth, gingival recession and bleeding upon probing were recorded at implants and neighbouring teeth. The success rate of the implants was evaluated according to criteria set by Albrektsson et al. (1986). The survival rate of the implants in both groups was 100% at 1-year post-loading. No statistically significant differences in any of the clinical and radiographic measurements were detected between the two groups (P < 0.05). The success rate of the implants was 84.6% (11/13) in the SBC group and 83.3% (10/12) in the DBBM group. Equivalent success and survival rates (as well as similar radiographic changes) of dental implants placed in alveolar ridges previously preserved with SBC or DBBM should be anticipated. © 2012 John Wiley & Sons A/S.

Influence of fine threads and platform-switching on crestal bone stress around implant-a three-dimensional finite element analysis.

PubMed

Khurana, Pardeep; Sharma, Arun; Sodhi, Kiranmeet Kaur

2013-12-01

The aims of this study were to investigate the effect of implant fine threads on crestal bone stress compared to a standard smooth implant collar and to analyze how different abutment diameters influenced the crestal bone stress level. Three-dimensional finite element imaging was used to create a cross-sectional model in SolidWorks 2007 software of an implant (5-mm platform and 10 mm in length) placed in the premolar region of the mandible. The implant model was created to resemble a commercially available fine thread implant. Abutments of different diameters (5.0 mm: standard, 4.5 mm, 4.0 mm, and 3.5 mm) were loaded with a force of 100 N at 90° vertical and 40° oblique angles. Finite element analysis was done in COSMOSWorks software, which was used to analyze the stress patterns in bone, especially in the crestal region. Upon loading, the fine thread implant model had greater stress at the crestal bone adjacent to the implant than the smooth neck implant in both vertical and oblique loading. When the abutment diameter decreased progressively from 5.0 mm to 4.5 mm to 4 mm and to 3.5 mm the thread model showed a reduction of stress at the crestal bone level from 23.2 MPa to 15.02 MPa for fine thread and from 22.7 to 13.5 MPa for smooth collar implant group after vertical loading and from 43.7 MPa to 33.1 MPa in fine thread model and from 36.9 to 20.5 MPa in smooth collar implant model after oblique loading. Fine threads increase crestal stress upon loading. Reduced abutment diameter that is platform switching resulted in less stress translated to the crestal bone in the fine thread and smooth neck.

Biomechanical investigation of thread designs and interface conditions of zirconia and titanium dental implants with bone: three-dimensional numeric analysis.

PubMed

Fuh, Lih-Jyh; Hsu, Jui-Ting; Huang, Heng-Li; Chen, Michael Y C; Shen, Yen-Wen

2013-01-01

Bone stress and interfacial sliding at the bone-implant interface (BII) were analyzed in zirconia and titanium implants with various thread designs and interface conditions (bonded BII and contact BIIs with different frictional coefficients) for both conventional and immediately loaded treatments. A total of 18 finite element models comprising two implant materials (zirconia and titanium), three thread designs (different shapes and pitches), and three interface conditions (bonded and contact BIIs) were analyzed to assess the effects on bone stresses and on sliding at the BII. The material properties of the bone model were anisotropic, and a lateral force of 130 N was applied as the loading condition. In the immediately loaded implant, the stress was highly concentrated at one site of the peri-implant bone. The peak bone stress was more than 20% lower in zirconia implants than in titanium implants for a bonded BII and 14% to 20% lower for a contact BII. The bone stresses did not differ significantly between implants with V-shaped threads and square threads. However, sliding at the BII was more than 25% lower with square-thread implants than with V-shaped-thread implants for titanium implants and 36% lower for zirconia implants. Reducing the thread size and pitch in cortical bone (via two V-shaped threads with different pitches) decreased the bone stress by 13%. Increasing the frictional coefficient reduced sliding at the BII in both zirconia and titanium implants. As an implant material, zirconia can reduce the bone stress in the crestal cortical region. Bone stress and sliding at the BII are heavily dependent on the thread design and the frictional coefficient at the BII of immediately loaded implants.

Comparing the influence of crestal cortical bone and sinus floor cortical bone in posterior maxilla bi-cortical dental implantation: a three-dimensional finite element analysis.

PubMed

Yan, Xu; Zhang, Xinwen; Chi, Weichao; Ai, Hongjun; Wu, Lin

2015-05-01

This study aimed to compare the influence of alveolar ridge cortical bone and sinus floor cortical bone in sinus areabi-cortical dental implantation by means of 3D finite element analysis. Three-dimensional finite element (FE) models in a posterior maxillary region with sinus membrane and the same height of alveolar ridge of 10 mm were generated according to the anatomical data of the sinus area. They were either with fixed thickness of crestal cortical bone and variable thickness of sinus floor cortical bone or vice versa. Ten models were assumed to be under immediate loading or conventional loading. The standard implant model based on the Nobel Biocare implant system was created via computer-aided design software. All materials were assumed to be isotropic and linearly elastic. An inclined force of 129 N was applied. Von Mises stress mainly concentrated on the surface of crestal cortical bone around the implant neck. For all the models, both the axial and buccolingual resonance frequencies of conventional loading were higher than those of immediate loading; however, the difference is less than 5%. The results showed that bi-cortical implant in sinus area increased the stability of the implant, especially for immediately loading implantation. The thickness of both crestal cortical bone and sinus floor cortical bone influenced implant micromotion and stress distribution; however, crestal cortical bone may be more important than sinus floor cortical bone.

Immediate functional loading of single implants: a multicenter study with 4 years of follow-up

PubMed Central

Raes, Filiep; Eccellente, Tammaro; Lenzi, Carolina; Ortolani, Michele; Luongo, Giuseppe; Mangano, Carlo; Mangano, Francesco

2018-01-01

Background. In the current scientific literature there are only few studies on the immediate functional loading of single implants. The aim of the present present study was to evaluate the 4-year survival rate, complication rate and peri-implant marginal bone loss (PIMBL) of immediately loaded single implants inserted in healed ridges and fresh post-extraction sites. Methods. Six centers were involved in this prospective study. The surgical and prosthetic protocol was defined in detail, before the start of recruiting patients. Recruitment of patients and performance of surgeries took place between February 2012 and February 2013. Criteria for inclusion were single-tooth gaps in healed ridges and fresh post-extraction sockets. All the fixtures (Anyridge®, Megagen Corporation, Gyeongbuk, South Korea) were functionally loaded immediately after insertion and followed for a period of 4 years. Outcome measures were implant survival, complications and PIMBL. Results. Forty-six patients (18‒73 years of age) were selected. In total, 57 fixtures were placed (10 in fresh post-extraction sockets). After 4 years of functional loading, only one fixture was lost; therefore, high survival rates (97.6% patient-based; 98.1% implant-based) were reported. In addition, a limited incidence of biologic (4.8% patient-based; 3.8% implant-based) and prosthetic (9.7% patient-based; 7.6% implant-based) complications was reported. The overall 4-year PIMBL amounted to 0.38±0.21 mm (healed ridges: 0.4±0.21 mm; fresh post-extraction sockets: 0.33±0.20 mm). Conclusion. Loading single implants immediately seems to be a highly successful treatment modality. However, long-term data are needed to confirm these positive outcomes. PMID:29732018

Critical review of immediate implant loading.

PubMed

Gapski, Ricardo; Wang, Hom-Lay; Mascarenhas, Paulo; Lang, Niklaus P

2003-10-01

Implant dentistry has become successful with the discovery of the biological properties of titanium. In the original protocol, studies have advocated a 2-stage surgical protocol for load-free and submerged healing to ensure predictable osseointegration. However, the discomfort, inconvenience, and anxiety associated with waiting period remains a challenge to both patients and clinicians. Hence, loading implant right after placement was attempted and has gained popularity among clinicians. Issues/questions related to this approach remain unanswered. Therefore, it is the purpose of this review article to (1). review and analyze critically the current available literature in the field of immediate implant loading and (2). discuss, based on scientific evidence, factors that may influence this treatment modality. Literature published over the past 20 years was selected and reviewed. Findings from these studies were discussed and summarized in the tables. The advantages and disadvantages associated with immediate implant loading were analyzed. Factors that may influence the success of immediate implant loading, including patient selection, type of bone quality, required implant length, micro- and macrostructure of the implant, surgical skill, need for achieving primary stability/control of occlusal force, and prosthesis guidelines, were thoroughly reviewed and discussed. Various studies have demonstrated the feasibility and predictability of this technique. However, most of these articles are based on retrospective data or uncontrolled cases. Randomized, prospective, parallel-armed longitudinal human trials are primarily based on short-term results and long-term follow-ups are still scarce in this field. Nonetheless, from available literature, it may be concluded that anatomic locations, implant designs, and restricted prosthetic guidelines are key to ensure successful outcomes. Future studies, preferably randomized, prospective longitudinal studies, are certainly needed before this approach can be widely used.

Load-Bearing Capacity and Retention of Newly Developed Micro-Locking Implant Prosthetic System: An In Vitro Pilot Study.

PubMed

Choi, Jae-Won; Choi, Kyung-Hee; Chae, Hee-Jin; Chae, Sung-Ki; Bae, Eun-Bin; Lee, Jin-Ju; Lee, So-Hyoun; Jeong, Chang-Mo; Huh, Jung-Bo

2018-04-06

The aim of this study was to introduce the newly developed micro-locking implant prosthetic system and to evaluate the resulting its characteristics. To evaluate load-bearing capacity, 25 implants were divided into five groups: external-hexagon connection (EH), internal-octagon connection (IO), internal-hexagon connection (IH), one-body implant (OB), micro-locking implant system (ML). The maximum compressive load was measured using a universal testing machine (UTM) according to the ISO 14801. Retention was evaluated in two experiments: (1) a tensile test of the structure modifications of the components (attachment and implant) and (2) a tensile test after cyclic loading (total 5,000,000 cycles, 100 N, 2 Hz). The load-bearing capacity of the ML group was not significantly different from the other groups ( p > 0.05). The number of balls in the attachment and the presence of a hexagonal receptacle did not show a significant correlation with retention ( p > 0.05), but the shape of the retentive groove in the implant post had a statistically significant effect on retention ( p < 0.05). On the other hand, the retention loss was observed during the initial 1,000,000 cycles, but an overall constant retention was maintained afterward. Various preclinical studies on this novel micro-locking implant prosthetic system should continue so that it can be applied in clinical practice.

Load-Bearing Capacity and Retention of Newly Developed Micro-Locking Implant Prosthetic System: An In Vitro Pilot Study

PubMed Central

Choi, Kyung-Hee; Chae, Hee-Jin; Chae, Sung-Ki; Bae, Eun-Bin; Lee, Jin-Ju; Lee, So-Hyoun; Jeong, Chang-Mo; Huh, Jung-Bo

2018-01-01

The aim of this study was to introduce the newly developed micro-locking implant prosthetic system and to evaluate the resulting its characteristics. To evaluate load-bearing capacity, 25 implants were divided into five groups: external-hexagon connection (EH), internal-octagon connection (IO), internal-hexagon connection (IH), one-body implant (OB), micro-locking implant system (ML). The maximum compressive load was measured using a universal testing machine (UTM) according to the ISO 14801. Retention was evaluated in two experiments: (1) a tensile test of the structure modifications of the components (attachment and implant) and (2) a tensile test after cyclic loading (total 5,000,000 cycles, 100 N, 2 Hz). The load-bearing capacity of the ML group was not significantly different from the other groups (p > 0.05). The number of balls in the attachment and the presence of a hexagonal receptacle did not show a significant correlation with retention (p > 0.05), but the shape of the retentive groove in the implant post had a statistically significant effect on retention (p < 0.05). On the other hand, the retention loss was observed during the initial 1,000,000 cycles, but an overall constant retention was maintained afterward. Various preclinical studies on this novel micro-locking implant prosthetic system should continue so that it can be applied in clinical practice. PMID:29642407

Long-Term Retrospective Clinical and Radiographic Follow-up of 205 Brånemark System Mk III TiUnite Implants Submitted to Either Immediate or Delayed Loading.

PubMed

Imburgia, Mario; Del Fabbro, Massimo

2015-10-01

Studies are needed to evaluate long-term performance of immediately loaded implants with moderately rough surface. This retrospective study evaluated long-term survival and periimplant soft and hard tissue conditions in patients treated with TiUnite implants. Forty-one consecutive patients (mean age, 52.6 years) received 205 Brånemark System Mk III TiUnite implants (145 maxillary, 60 mandibular). The indication was single tooth (n = 7 implants), partial (n = 94), or full arches (n = 104). One hundred thirteen implants were immediately loaded. Cumulative survival rate (CSR) of implants was assessed. Long-term marginal bone remodeling, probing pocket depth (PPD), and periimplant mucosa conditions were assessed. Follow-up averaged 8.8 years (range, 6.6-10.6 years). Eight implants in 5 patients failed. CSR was 96.1% (implant basis) and 87.8% (patient basis) up to 10 years. At the longest follow-up, bone loss averaged 0.43 ± 1.15 mm (n = 173), PPD averaged 3.64 ± 0.74 mm, and periimplant mucosa was healthy in 74.6% of cases. Furthermore, 50.3% and 35.5% of implants scored negative for plaque and bleeding, respectively. No significant difference in CSR and hard and soft tissue conditions was found in the long term between immediately and delayed loaded implants. Implants with TiUnite surface demonstrated excellent long-term survival, marginal bone response, and soft tissue conditions, despite a nonoptimal level of oral hygiene.

Influence of abutment screw preload on stress distribution in marginal bone.

PubMed

Khraisat, Ameen

2012-01-01

Changes in an implant assembly after abutment connection might possibly cause deformation in the implant/abutment joint and even in the marginal bone. The aim of this study was to evaluate the influence of abutment screw preload through the implant collar on marginal bone stress without external load application. Models of three implant parts made of titanium (implant, abutment, and abutment screw) and cortical bone were built and positioned with computer-aided design software. Meshing and generation of boundary conditions, loads, and interactions were performed. Each part was meshed independently. The sole load applied to the model was a torque of 32 Ncm on the abutment screw about its axis of rotation. The implant collar was deformed axially after the screw was tightened (3 μm). This deformation resulted in 60 MPa of stress in the marginal bone. Moreover, pressure on the marginal bone in a radial direction was observed. It can be concluded that, without any external load application, abutment screw preload exerts stresses on the implant collar and the marginal bone. These findings should help guide the development of new implant/abutment joint designs that exert less stress on the marginal bone.

The role of dental implant abutment design on the aesthetic outcome: preliminary 3-month post-loading results from a multicentre split-mouth randomised controlled trial comparing two different abutment designs.

PubMed

Esposito, Marco; Cardaropoli, Daniele; Gobbato, Luca; Scutellà, Fabio; Fabianelli, Andrea; Mascellani, Saverio; Delli Ficorelli, Gianluca; Mazzocco, Fabio; Sbricoli, Luca; Trullenque-Eriksson, Anna

To evaluate whether there are aesthetic and clinical benefits to using a newly designed abutment (Curvomax), over a conventional control abutment (GingiHue). A total of 49 patients, who required at least two implants, had two sites randomised according to a split-mouth design to receive one abutment of each type at seven different centres. The time of loading (immediate, early or delayed) and of prosthesis (provisional crowns of fixed prosthesis) was decided by the clinicians, but they had to restore both implants in a similar way. Provisional prostheses were replaced by definitive ones 3 months after initial loading, when the follow-up for the initial part of this study was completed. Outcome measures were: prosthesis failures, implant failures, complications, pink esthetic score (PES), peri-implant marginal bone level changes, and patient preference. In total, 49 Curvomax and 49 GingiHue abutments were delivered. Two patients dropped out. No implant failure, prosthesis failure or complication was reported. There were no differences at 3 months post-loading for PES (difference = -0.15, 95% CI -0.55 to 0.25; P (paired t test) = 0.443) and marginal bone level changes (difference = -0.02 mm, 95% CI -0.20 to 0.16; P (paired t test) = 0.817). The majority of the patients (30) had no preference regarding the two abutment designs; 11 patients preferred the Curvomax, while five patients preferred the GingiHue abutments (P (McNemar test) = 0.210). The preliminary results of the comparison between two different abutment designs did not disclose any statistically significant differences between the evaluated abutments. However the large number of missing radiographs and clinical pictures casts doubt on the reliability of the results. Longer follow-ups of wider patient populations are needed to better understand whether there is an effective advantage with one of the two abutment designs. Conflict of interest statement: This research project was originally partially funded by Biomax (Andover, MA, USA), the manufacturer of the Curvomax abutments evaluated in this investigation. Biomax, under pressure from some investigators, asked to modify the original agreed protocol. In a following phase, Zimmer-Biomet (Palm Beach Gardens, Florida, USA), the manufacturer of the implants and the GingiHue abutments, took over the funding of this project. Data belonged to the authors and the sponsors did not interfere with the publication of results.

Peak insertion torque values of five mini-implant systems under different insertion loads.

PubMed

Quraishi, Erma; Sherriff, Martyn; Bister, Dirk

2014-06-01

To assess the effect of 1 and 3 kg insertion load on five makes of self-drilling mini-implants on peak insertion torque values to establish risk factors involved in the fracture of mini-implants. Two different loads were applied during insertion of 40 mini-implants from five different manufacturers (Dual Top(™) (1·6×8 mm), Infinitas(™) (1·5×9 mm), Ortho Easy(™) (1·7×8 mm), Spider Screw(™) (1·5×8 mm) and Vector TAS(™) (1·4×8 mm)) into acrylic blocks at 8 rev/min utilizing a Motorized Torque Measurement Stand. Peak insertion torque values for both loads were highest for Vector TAS followed by Ortho Easy and Dual Top and were nearly three times higher than Infinitas (original version) and Spider Screws(TM). The log-rank test showed statistically significant differences for both loads for Vector TAS, Ortho Easy and Spider Screws. Unlike other designs tested, both tapered mini-implant designs (Spider Screw and Infinitas) showed a tendency to buckle in the middle of the body but fractured at the tip. Non-tapered mini-implants fractured at significantly higher torque values compared to tapered designs under both loads. Increased pressure resulted in slightly higher maximum torque values at fracture for some of the mini-implant designs, although this is unlikely to be of clinical relevance. Tripling insertion pressure from 1 to 3 kg increased the risk of bending tapered mini-implants before fracture. © 2014 British Orthodontic Society.

Stress and strain distribution in three different mini dental implant designs using in implant retained overdenture: a finite element analysis study

PubMed Central

AUNMEUNGTONG, W.; KHONGKHUNTHIAN, P.; RUNGSIYAKULL, P.

2016-01-01

SUMMARY Finite Element Analysis (FEA) has been used for prediction of stress and strain between dental implant components and bone in the implant design process. Purpose Purpose of this study was to characterize and analyze stress and strain distribution occurring in bone and implants and to compare stress and strain of three different implant designs. Materials and methods Three different mini dental implant designs were included in this study: 1. a mini dental implant with an internal implant-abutment connection (MDIi); 2. a mini dental implant with an external implant-abutment connection (MDIe); 3. a single piece mini dental implant (MDIs). All implant designs were scanned using micro-CT scans. The imaging details of the implants were used to simulate models for FEA. An artificial bone volume of 9×9 mm in size was constructed and each implant was placed separately at the center of each bone model. All bone-implant models were simulatively loaded under an axial compressive force of 100 N and a 45-degree force of 100 N loading at the top of the implants using computer software to evaluate stress and strain distribution. Results There was no difference in stress or strain between the three implant designs. The stress and strain occurring in all three mini dental implant designs were mainly localized at the cortical bone around the bone-implant interface. Oblique 45° loading caused increased deformation, magnitude and distribution of stress and strain in all implant models. Conclusions Within the limits of this study, the average stress and strain in bone and implant models with MDIi were similar to those with MDIe and MDIs. The oblique 45° load played an important role in dramatically increased average stress and strain in all bone-implant models. Clinical implications Mini dental implants with external or internal connections have similar stress distribution to single piece mini dental implants. In clinical situations, the three types of mini dental implant should exhibit the same behavior to chewing force. PMID:28042449

Does Implant Design Affect Implant Primary Stability? A Resonance Frequency Analysis-Based Randomized Split-Mouth Clinical Trial.

PubMed

Gehrke, Sergio Alexandre; da Silva, Ulisses Tavares; Del Fabbro, Massimo

2015-12-01

The purpose of this study was to assess implant stability in relation to implant design (conical vs. semiconical and wide-pitch vs narrow-pitch) using resonance frequency analysis. Twenty patients with bilateral edentulous maxillary premolar region were selected. In one hemiarch, conical implants with wide pitch (group 1) were installed; in the other hemiarch, semiconical implants with narrow pitch were installed (group 2). The implant allocation was randomized. The implant stability quotient (ISQ) was measured by resonance frequency analysis immediately following implant placement to assess primary stability (time 1) and at 90 days after placement (time 2). In group 1, the mean and standard deviation ISQ for time 1 was 65.8 ± 6.22 (95% confidence interval [CI], 55 to 80), and for time 2, it was 68.0 ± 5.52 (95% CI, 57 to 77). In group 2, the mean and standard deviation ISQ was 63.6 ± 5.95 (95% CI, 52 to 78) for time 1 and 67.0 ± 5.71 (95% CI, 58 to 78) for time 2. The statistical analysis demonstrated significant difference in the ISQ values between groups at time 1 (P = .007) and no statistical difference at time 2 (P = .54). The greater primary stability of conical implants with wide pitch compared with semiconical implants with narrow pitch might suggest a preference for the former in case of the adoption of immediate or early loading protocols.

Immediate versus delayed loading of strategic mini dental implants for the stabilization of partial removable dental prostheses: a patient cluster randomized, parallel-group 3-year trial.

PubMed

Mundt, Torsten; Al Jaghsi, Ahmad; Schwahn, Bernd; Hilgert, Janina; Lucas, Christian; Biffar, Reiner; Schwahn, Christian; Heinemann, Friedhelm

2016-07-30

Acceptable short-term survival rates (>90 %) of mini-implants (diameter < 3.0 mm) are only documented for mandibular overdentures. Sound data for mini-implants as strategic abutments for a better retention of partial removable dental prosthesis (PRDP) are not available. The purpose of this study is to test the hypothesis that immediately loaded mini-implants show more bone loss and less success than strategic mini-implants with delayed loading. In this four-center (one university hospital, three dental practices in Germany), parallel-group, controlled clinical trial, which is cluster randomized on patient level, a total of 80 partially edentulous patients with unfavourable number and distribution of remaining abutment teeth in at least one jaw will receive supplementary min-implants to stabilize their PRDP. The mini-implant are either immediately loaded after implant placement (test group) or delayed after four months (control group). Follow-up of the patients will be performed for 36 months. The primary outcome is the radiographic bone level changes at implants. The secondary outcome is the implant success as a composite variable. Tertiary outcomes include clinical, subjective (quality of life, satisfaction, chewing ability) and dental or technical complications. Strategic implants under an existing PRDP are only documented for standard-diameter implants. Mini-implants could be a minimal invasive and low cost solution for this treatment modality. The trial is registered at Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS-ID: DRKS00007589 ( www.germanctr.de ) on January 13(th), 2015.

Stability of prototype two-piece zirconia and titanium implants after artificial aging: an in vitro pilot study.

PubMed

Kohal, Ralf-Joachim; Finke, Hans Christian; Klaus, Gerold

2009-12-01

Zirconia oral implants are a new topic in implant dentistry. So far, no data are available on the biomechanical behavior of two-piece zirconia implants. Therefore, the purpose of this pilot investigation was to test in vitro the fracture strength of two-piece cylindrical zirconia implants after aging in a chewing simulator. This laboratory in vitro investigation comprised three different treatment groups. Each group consisted of 16 specimens. In group 1, two-piece zirconia implants were restored with zirconia crowns (zirconia copings veneered with Triceram; Esprident, Ispringen, Germany), and in group 2 zirconia implants received Empress 2 single crowns (Ivoclar Vivadent AG, Schaan, Liechtenstein). The implants, including the abutments, in the two zirconia groups were identical. In group 3, similar titanium implants were reconstructed with porcelain-fused-to-metal crowns. Eight samples of each group were submitted to artificial aging with a long-term load test in the artificial mouth (chewing simulator). Subsequently, all not artificially aged samples and all artificially aged samples that survived the long-term loading of each group were submitted to a fracture strength test in a universal testing machine. For the pairwise comparisons in the different test groups with or without artificial loading and between the different groups at a given artificial loading condition, the Wilcoxon rank-sum test for independent samples was used. The significance level was set at 5%. One sample of group 1 (veneer fracture), none of group 2, and six samples of group 3 (implant abutment screw fractures) failed while exposed to the artificial mouth. The values for the fracture strength after artificial loading with 1.2 million cycles for group 1 were between 45 and 377 N (mean: 275.7 N), in group 2 between 240 and 314 N (mean: 280.7 N), and in the titanium group between 45 and 582 N (mean: 165.7 N). The fracture strength results without artificial load for group 1 amounted to between 270 and 393 N (mean: 325.1 N), for group 2 between 235 and 321 N (mean: 281.8 N), and between 474 and 765 N (mean: 595.2 N) for the titanium group. The failure mode during the fracture testing in the zirconia implant groups was a fracture of the implant head and a bending/fracture of the abutment screw in the titanium group. Within the limits of this pilot investigation, the biomechanical stability of all tested prototype implant groups seems to be - compared with the possibly exerted occlusal forces - borderline for clinical use. A high number of failures occurred already during the artificial loading in the titanium group at the abutment screw level. The zirconia implant groups showed irreparable implant head fractures at relatively low fracture loads. Therefore, the clinical use of the presented prototype implants has to be questioned.

Survival rates and bone loss after immediate loading of implants in fresh extraction sockets (single gaps). A clinical prospective study with 4 year follow-up

PubMed Central

Wojtovicz, Eduardo; España-Lopez, Antonio; Jimenez-Guerra, Alvaro; Monsalve-Guil, Loreto; Ortiz-Garcia, Ivan; Serrera-Figallo, Maria-Angeles

2018-01-01

Background The aim of this prospective study was to report the outcome of treatment with implants inserted after tooth extraction and immediately loaded. Material and Methods Fifty-six patients with single tooth loss were treated with 116 IPX Galimplant® implants with internal connections and a sandblasted, acid-etched surface. All implants were placed after tooth extraction using a flapless approach without bone regeneration, and they were then immediately loaded with cemented acrylic prostheses. After a period of three months, definitive cemented ceramic prostheses were placed. Patients were examined throughout a total of 4 years of follow-up. Marginal bone loss and survival rates were evaluated using digital periapical radiographs, taking into account clinical variables such as age, gender, smoking, history of periodontitis, etiology of extraction, placement site, diameter, and implant length. The Mann-Whitney U and Kruskal-Wallis non-parametric tests were used to compare differences between subgroups created based on the different clinical variables identified. Results Clinical results indicate an implant survival and success rate of 97.4%. Three implants were lost. Of the 116 immediate acrylic single crowns initially placed, 113 were replaced with definitive ceramic crowns after 3 months. A total of 77.8% of implants were inserted in the maxilla, while 22.2% were inserted in the mandible. No further complications were reported after the follow-up period (4 years). The mean marginal bone loss was 0.67 mm ± 0.40 mm. No differences were found among the subgroups of study patients. Conclusions This study indicates that dental implants that are inserted after tooth extraction and immediately loaded may constitute a successful and predictable alternative implant treatment. Key words:Dental implants, post-extraction implants, fresh sockets, immediate loading, immediate prostheses, implant dentistry. PMID:29476669

Biomechanical effects of two different collar implant structures on stress distribution under cantilever fixed partial dentures.

PubMed

Merıç, Gökçe; Erkmen, Erkan; Kurt, Ahmet; Eser, Atilim; özden, Ahmet Utku

2011-11-01

The purpose of the study was to compare the effects of two distinct collar geometries of implants on stress distribution in the bone around the implants supporting cantilever fixed partial dentures (CFPDs) as well as in the implant-abutment complex and superstructures. The three-dimensional finite element method was selected to evaluate the stress distribution. CFPDs which was supported by microthread collar structured (MCS) and non-microthread collar structured (NMCS) implants was modeled; 300 N vertical, 150 N oblique and 60 N horizontal forces were applied to the models separately. The stress values in the bone, implant-abutment complex and superstructures were calculated. In the MCS model, higher stresses were located in the cortical bone and implant-abutment complex in the case of vertical load while decreased stresses in cortical bone and implant-abutment complex were noted within horizontal and oblique loading. In the case of vertical load, decreased stresses have been noted in cancellous bone and framework. Upon horizontal and oblique loading, a MCS model had higher stress in cancellous bone and framework than the NMCS model. Higher von Mises stresses have been noted in veneering material for NMCS models. It has been concluded that stress distribution in implant-supported CFPDs correlated with the macro design of the implant collar and the direction of applied force.

Short Dental Implants Retaining Two-Implant Mandibular Overdentures in Very Old, Dependent Patients: Radiologic and Clinical Observation Up to 5 Years.

PubMed

Maniewicz, Sabrina; Buser, Ramona; Duvernay, Elena; Vazquez, Lydia; Loup, Angelica; Perneger, Thomas V; Schimmel, Martin; Müller, Frauke

To describe the survival rate and peri-implant bone loss in very old patients dependent for their activities of daily living (ADL), treated with mandibular two-implant overdentures (IODs) in the context of a previously reported randomized controlled trial. A total of 19 patients received two interforaminal Straumann implants (Regular Neck, 4.1 mm diameter, 8 mm length) that were subsequently loaded with Locator attachments, transforming their preexisting inferior conventional denture into an IOD. The primary outcome measures were implant survival rate and radiographically assessed peri-implant bone loss. Secondary outcome measures included peri-implant probing depth and Plaque Index scores, as well as implant mobility. Nutritional state (body mass index and blood markers) and cognitive state (Mini-Mental State Examination) were also analyzed. The patient cohort comprised eight men and 11 women with a mean age of 85.7 ± 6.6 years. The implant survival rate up to 5 years was 94.7%, with one early and one late implant failure. The mean loss of peri-implant bone height was 0.17 mm per year (95% confidence interval: 0.09 to 0.24; P < .001). Peri-implant probing depth and Plaque Index scores were low and stable during the first 2 years, and thereafter increased continuously. Correlation analysis suggests that a reduced cognitive function and nutritional state are not a particular risk factor for accelerated peri-implant bone loss. The high implant survival and acceptable peri-implant health suggest that neither age nor dependency for the ADLs is a contraindication for the placement of implants. Nevertheless, close monitoring of the patients concerning a potential further functional decline precluding denture management and performing oral hygiene measures is advised.

Influence of matrix attachment installation load on movement and resultant forces in implant overdentures.

PubMed

Goto, Takaharu; Nagao, Kan; Ishida, Yuichi; Tomotake, Yoritoki; Ichikawa, Tetsuo

2015-02-01

This in vitro study investigated the effect of attachment installation conditions on the load transfer and denture movements of implant overdentures, and aims to clarify the differences among the three types of attachments, namely ball, Locator, and magnet attachments. Three types of attachments, namely ball, Locator, and magnetic attachments were used. An acrylic resin mandibular edentulous model with two implants placed in the bilateral canine regions and removable overdenture were prepared. The two implants and bilateral molar ridges were connected to three-axis load-cell transducers, and a universal testing machine was used to apply a 50 N vertical force to each site of the occlusal table in the first molar region. The denture movement was measured using a G(2) motion sensor. Three installation conditions, namely, the application of 0, 50, and 100 N loads were used to install each attachment on the denture base. The load transfer and denture movement were then evaluated. The resultant force decreased with increasing installation load for all attachments. In particular, the resultant force on implants on the loading side of the Locator attachment significantly decreased when the installation load was increased from 0 to 50 N, and that for magnetic attachment significantly decreased when the installation load was increased from 50 to 100 N. For the residual ridges on the loading side, the direction of the forces for all attachments changed to downward with increasing installation load. Furthermore, the yaw Euler angle increased with increasing installation load for the magnetic attachment. Subject to the limitations of this study, the use of any installation load greater than 0 N is recommended for the installation of ball and Locator attachments on a denture base. Regarding magnetic attachments, our results also recommend installation on a denture base using any installation load greater than 0 N, and suggest that the resultant force acting on the implant can be decreased by increasing the installation load; however, a large installation load of 100 N should be avoided when installing the attachment on the denture base to avoid increasing the denture movement. © 2014 by the American College of Prosthodontists.

Mechanical Properties of Abutments: Resin-Bonded Glass Fiber-Reinforced Versus Titanium.

PubMed

Bassi, Mirko Andreasi; Bedini, Rosells; Pecci, Raffaela; Ioppolo, Pietro; Laritano, Dorina; Carinci, Francesco

2016-01-01

The clinical success and longevity of endosseous implants, after their prosthetic finalization, mainly depends on mechanical factors. Excessive mechanical stress has been shown to cause initial bone loss around implants in the presence of a rigid implant-prosthetic connection. The implant abutments are manufactured with high elastic modulus materials such as titanium, steel, precious alloys, or esthetic ceramics. These materials do not absorb any type of shock from the chewing loads or ensure protection of the bone-implant interface, especially when the esthetic restorative material is ceramic rather than composite resin. The mechanical resistance to cyclical load was evaluated in a tooth-colored fiber-reinforced abutment prototype (TCFRA) and compared to that of a similarly shaped titanium abutment (TA). Eight TCFRAs and eight TAs were adhesively cemented on as many titanium implants. The swinging the two types of abutments showed during the application of sinusoidal load was also analyzed. In the TA group, fracture and deformation occurred in 12.5% of samples, while debonding occurred in 62.5%. In the TCFRA group, only debonding was present, in 37.5% of samples. In comparison to the TAs, the TCFRAs exhibited greater swinging during the application of sinusoidal load. In the TA group extrusion prevailed, whereas in the TCFRA group intrusion was more frequent. TCFRA demonstrated a greater elasticity than did TAs to the flexural load, absorbing part of the transversal load applied on the fixture during the chewing function and thus reducing the stress on the bone-implant interface.

The effects of dynamic compressive loading on biodegradable implants of 50-50% polylactic Acid-polyglycolic Acid.

PubMed

Thompson, D E; Agrawal, C M; Athanasiou, K

1996-01-01

Biodegradable implants that release growth factors or other bioactive agents in a controlled manner are investigated to enhance the repair of musculoskeletal tissues. In this study, the in vitro release characteristics and mechanical properties of a 50:50 polylactic acid/polyglycolic acid two phase implant were examined over a 6-week period under no-load conditions or under a cyclic compressive load, such as that experienced when walking slowly during rehabilitation. The results demonstrated that a cyclic compressive load significantly slows the decrease of molecular chain size during the first week, significantly increases protein release for the first 2-3 weeks, and significantly stiffens the implant for the first 3 weeks. It was also shown that protein release is initially high and steadily decreases with time until the molecular weight declines to about 20% of its original value (approximately 4 weeks). Once this threshold is reached, increased protein release, surface deformation, and mass loss occurs. This study also showed that dynamic loading and the environment in which an implant is placed affect its biodegradation. Therefore, it may be essential that in vitro degradation studies of these or similar implants include a dynamic functional environment.

Nanotubular surface modification of metallic implants via electrochemical anodization technique.

PubMed

Wang, Lu-Ning; Jin, Ming; Zheng, Yudong; Guan, Yueping; Lu, Xin; Luo, Jing-Li

2014-01-01

Due to increased awareness and interest in the biomedical implant field as a result of an aging population, research in the field of implantable devices has grown rapidly in the last few decades. Among the biomedical implants, metallic implant materials have been widely used to replace disordered bony tissues in orthopedic and orthodontic surgeries. The clinical success of implants is closely related to their early osseointegration (ie, the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant), which relies heavily on the surface condition of the implant. Electrochemical techniques for modifying biomedical implants are relatively simple, cost-effective, and appropriate for implants with complex shapes. Recently, metal oxide nanotubular arrays via electrochemical anodization have become an attractive technique to build up on metallic implants to enhance the biocompatibility and bioactivity. This article will thoroughly review the relevance of electrochemical anodization techniques for the modification of metallic implant surfaces in nanoscale, and cover the electrochemical anodization techniques used in the development of the types of nanotubular/nanoporous modification achievable via electrochemical approaches, which hold tremendous potential for bio-implant applications. In vitro and in vivo studies using metallic oxide nanotubes are also presented, revealing the potential of nanotubes in biomedical applications. Finally, an outlook of future growth of research in metallic oxide nanotubular arrays is provided. This article will therefore provide researchers with an in-depth understanding of electrochemical anodization modification and provide guidance regarding the design and tuning of new materials to achieve a desired performance and reliable biocompatibility.

Nanotubular surface modification of metallic implants via electrochemical anodization technique

PubMed Central

Wang, Lu-Ning; Jin, Ming; Zheng, Yudong; Guan, Yueping; Lu, Xin; Luo, Jing-Li

2014-01-01

Due to increased awareness and interest in the biomedical implant field as a result of an aging population, research in the field of implantable devices has grown rapidly in the last few decades. Among the biomedical implants, metallic implant materials have been widely used to replace disordered bony tissues in orthopedic and orthodontic surgeries. The clinical success of implants is closely related to their early osseointegration (ie, the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant), which relies heavily on the surface condition of the implant. Electrochemical techniques for modifying biomedical implants are relatively simple, cost-effective, and appropriate for implants with complex shapes. Recently, metal oxide nanotubular arrays via electrochemical anodization have become an attractive technique to build up on metallic implants to enhance the biocompatibility and bioactivity. This article will thoroughly review the relevance of electrochemical anodization techniques for the modification of metallic implant surfaces in nanoscale, and cover the electrochemical anodization techniques used in the development of the types of nanotubular/nanoporous modification achievable via electrochemical approaches, which hold tremendous potential for bio-implant applications. In vitro and in vivo studies using metallic oxide nanotubes are also presented, revealing the potential of nanotubes in biomedical applications. Finally, an outlook of future growth of research in metallic oxide nanotubular arrays is provided. This article will therefore provide researchers with an in-depth understanding of electrochemical anodization modification and provide guidance regarding the design and tuning of new materials to achieve a desired performance and reliable biocompatibility. PMID:25258532

Numerical optimization of composite hip endoprostheses under different loading conditions

NASA Technical Reports Server (NTRS)

Blake, T. A.; Davy, D. T.; Saravanos, D. A.; Hopkins, D. A.

1992-01-01

The optimization of composite hip implants was investigated. Emphasis was placed on the effect of shape and material tailoring of the implant to improve the implant-bone interaction. A variety of loading conditions were investigated to better understand the relationship between loading and optimization outcome. Comparisons of the initial and optimal models with more complex 3D finite element models were performed. The results indicate that design improvements made using this method result in similar improvements in the 3D models. Although the optimization outcomes were significantly affected by the choice of loading conditions, certain trends were observed that were independent of the applied loading.

Influence of the overall stiffness of a load-bearing porous titanium implant on bone ingrowth in critical-size mandibular bone defects in sheep.

PubMed

Schouman, T; Schmitt, M; Adam, C; Dubois, G; Rouch, P

2016-06-01

The aim of this work was to assess the influence of reduction of the apparent mechanical properties of fully load-bearing porous titanium implants used in mandibular bone defects. Segmental 18mm long bone defects were created bilaterally in the lower jaws of adult ewes. One group of 6 ewes (group A) was treated with load-bearing 'rigid' (high stiffness) porous implants on the right side, and with control on the left side. A second group of 6 ewes (group B) was treated with 'flexible' porous and control implants exhibiting apparent mechanical properties ten times lower than the rigid implants. The mechanical behavior of the reconstructed hemi-mandibles was assessed by cantilever testing and bone ingrowth into the segmental defects was assessed by BV/TV measurement within the implant using micro-CT 12 weeks after implantation. A significantly higher rigidity was identified for porous implants compared with control implants at the anterior interface in group B. BV/TV of porous implants was significantly higher than that of control implants in group A. BV/TV differences were significant between porous and control implants in group B and were homogeneous along the main axis. Significantly higher BV/TV was identified in most sub-volumes of group B porous implants compared with group A. This work highlights the critical importance of the tuning of scaffolds to promote bone ingrowth with reference to the local strains occurring within the porous scaffold, which in this application was achieved using fully load-bearing low-stiffness porous titanium implants. Copyright © 2016 Elsevier Ltd. All rights reserved.

Clinical retrospective study of self-reported penicillin allergy on dental implant failures and infections.

PubMed

French, David; Noroozi, Mehdi; Shariati, Batoul; Larjava, Hannu

2016-01-01

The aim of this retrospective study was to investigate whether self-reported allergy to penicillin may contribute to a higher rate of postsurgical infection and implant failure. This retrospective, non-interventional, open cohort study reports on implant survival and infection complications of 5,576 implants placed in private practice by one periodontist, and includes 4,132 implants that were followed for at least 1 year. Logistic regression was applied to examine the relationship between self-reported allergy to penicillin and implant survival, while controlling for potential confounders such as smoking, implant site, bone augmentation, loading protocol, immediate implantation, and bone level at baseline. The cumulative survival rate (CSR) was calculated according to the life table method and the Cox proportional hazard model was fitted to data. Out of 5,106 implants placed in patients taking penicillin it was found that 0.8% failed, while 2.1% failed of the 470 implants placed for patients with self-reported allergy to penicillin (P = .002). Odds of failure for implants placed in penicillin-allergic patients were 3.1 times higher than in non-allergic patients. For immediate implant placement, penicillin-allergic patients had a failure rate 10-times higher than the non-allergic cohort. Timing of implant failure occurring within 6 months following implantation was 80% in the penicillin-allergic group versus 54% in the non-allergic group. From the 48 implant sites showing postoperative infection: penicillin-allergic patients had an infection rate of 3.4% (n = 16/470) versus 0.6% in the non-allergic group (n = 32/5,106) (P < .05). Self-reported penicillin allergy was associated with a higher rate of infection, and primarily affected early implant failure.

Bone microstrain values of 1-piece and 2-piece implants subjected to mechanical loading.

PubMed

Harel, Noga; Eshkol-Yogev, Inbar; Piek, Dana; Livne, Shiri; Lavi, David; Ormianer, Zeev

2013-06-01

The purpose of this study was to measure and compare the strain levels in peri-implant bone as generated by 1-piece (1P) and 2-piece (2P) implant systems. The implants (1P and 2P) were placed into bovine bone according to the manufacturer's protocol. Four linear strain gauges were placed around each implant neck and apex. Each model was loaded in static loading by a material testing machine in ascending forces ranging from 20 to 120 N. Microstrains (μ[Latin Small Letter Open E]) generated in the surrounding bone were measured by a strain gauge and recorded. Recorded microstrains were significantly higher for 1P implants than for 2P implants. Average recorded microstrain values were significantly lower in the neck (71.6 and 17.3 µs) compared with the apical (132 and 60 µs) regions of 1P and 2P implants, respectively (P < 0.0001). Within the limitations of this study, highest microstrains were generated in apical regions regardless of implant design, but the 2P implant ap-peared to provide a stress-damping effect in both the cervical and apical regions compared with the 1P implant.

Botulinum Toxin Type A as Preoperative Treatment for Immediately Loaded Dental Implants Placed in Fresh Extraction Sockets for Full-Arch Restoration of Patients With Bruxism.

PubMed

Mijiritsky, Eitan; Mortellaro, Carmen; Rudberg, Omri; Fahn, Miri; Basegmez, Cansu; Levin, Liran

2016-05-01

The aim of the present report was to describe the use of Botulinum toxin type A as preoperative treatment for immediately loaded dental implants placed in fresh extraction sockets for full-arch restoration of patients with bruxism. Patients with bruxism who were scheduled to receive immediately loaded full-arch implant supported fixed restorations were included in this retrospective clinical report. To reduce the occlusal forces applied in patients with bruxism, Botulinum toxin type A was introduced prior to the implant placement procedure. Patients were followed and implant survival as well as peri-implant bone level was assessed in each periodic follow-up visit. Adverse effects were also recorded. A control group with no use of Botulinum toxin was evaluated as well. A total of 26 patients (13 test and 13 control), with bruxism, aged 59.15 ± 11.43 years on average were included in this retrospective report and received immediately loaded dental implants placed in fresh extraction sockets for full-arch restoration. The test group treatment preceded by Botulinum toxin type A injection. Maxillary arches were supported by 8 to 10 implants while the mandibular arch was supported by 6 implants. All surgeries went uneventfully and no adverse effects were observed. The average follow-up time was 32.5 ± 10.4 months (range, 18-51). In the test group, no implant failures were recorded. One patient presented with 1 to 2 mm bone loss around 4 of the implants; the other implants presented with stable bone level. In the control group 1 patient lost 2 implants and another demonstrated 2 mm bone loss around 3 of the implants. The preoperative use of Botulinum toxin in patients with bruxism undergoing full-arch rehabilitation using immediately loaded dental implants placed in fresh extraction sockets seems to be a technique that deserves attention. Further long-term, large-scale randomized clinical trials will help to determine the additional benefit of this suggested treatment modality.

Influence of residual bone thickness on primary stability of hybrid self-tapping and cylindric non-self-tapping implants in vitro.

PubMed

Divac, Marija; Stawarczyk, Bogna; Sahrmann, Philipp; Attin, Thomas; Schmidlin, Patrick R

2013-01-01

To assess the primary stability of a hybrid self-tapping implant and a cylindric non-self-tapping implant in an in vitro test model using polyurethane foam. Eighty standardized blocks of cellular rigid polyurethane foam, 2 cm long and 1 cm wide, with different thicknesses of 2, 4, 6, and 9 mm (n = 10 per group) were cut. Two implant systems--a hybrid self-tapping (Tapered Effect [TE], Straumann) and a cylindric non-self-tapping (Standard Plus [SP] Wide Neck, Straumann) were placed in the block specimens. Subsequently, resonance frequency analysis (RFA) was performed. The RFA measurements were made in triplicate on four aspects of each implant (mesial, distal, buccal, and oral), and the mean RFA value was calculated. Subsequently, the tensile load of the implants was determined by pull-out tests. The data were analyzed using one-way and two-way analysis of variance followed by a post hoc Scheffe test and a t test (α = .05). Additionally, the simple linear correlation between the RFA and tensile load values was evaluated. No statistically significant differences were found between TE and SP in terms of RFA at different bone thicknesses. Starting from a bone thickness of 4 mm, TE implants showed significantly higher tensile load compared to SP implants (P = .016 to .040). A correlation was found between the RFA measurements and tensile load. Mechanically stable placement is possible with TE and SP implants in a trabecular bone model. RFA and tensile load increased with greater bone thickness.

Effect of increased crown height on stress distribution in short dental implant components and their surrounding bone: A finite element analysis.

PubMed

Bulaqi, Haddad Arabi; Mousavi Mashhadi, Mahmoud; Safari, Hamed; Samandari, Mohammad Mahdi; Geramipanah, Farideh

2015-06-01

Implants in posterior regions of the jaw require short dental implants with long crown heights, leading to increased crown-to-implant ratios and mechanical stress. This can lead to fracture and screw loosening. The purpose of this study was to investigate the dynamic nature and behavior of prosthetic components and preimplant bone and evaluate the effect of increased crown height space (CHS) and crown-to-implant ratio on stress concentrations under external oblique forces. The severely resorbed bone of a posterior mandible site was modeled with Mimics and Catia software. A second mandibular premolar tooth was modeled with CHS values of 8.8, 11.2, 13.6, and 16 mm. A Straumann implant (4.1×8 mm), a directly attached crown, and an abutment screw were modeled with geometric data and designed by using SolidWorks software. Abaqus software was used for the dynamic simulation of screw tightening and the application of an external load to the buccal cusp at a 75.8-degree angle with the occlusal plane. The distribution of screw load and member load at each step was compared, and the stress values were calculated within the dental implant complex and surrounding bone. During tightening, the magnitude and distribution of the preload and clamp load were uniform and equal at the cross section of all CHSs. Under an external load, the screw load decreased and member load increased. An increase in the CHS caused the corresponding distribution to become more nonuniform and increased the maximum compressive and tensile stresses in the preimplant bone. Additionally, the von Mises stress decreased at the abutment screw and increased at the abutment and fixture. Under nonaxial forces, increased CHS does not influence the decrease in screw load or increase in member load. However, it contributes to screw loosening and fatigue fracture by skewing the stress distribution to the transverse section of the implant. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Effect of plastic-covered ultrasonic scalers on titanium implant surfaces.

PubMed

Mann, M; Parmar, D; Walmsley, A D; Lea, S C

2012-01-01

Maintaining oral health around titanium implants is essential. The formation of a biofilm on the titanium surface will influence the continuing success of the implant. These concerns have led to modified ultrasonic scaler instruments that look to reduce implant damage while maximising the cleaning effect. This study aimed to assess the effect of instrumentation, with traditional and modified ultrasonic scalers, on titanium implant surfaces and to correlate this with the oscillations of the instruments. Two ultrasonic insert designs (metallic TFI-10 and a plastic-tipped implant insert) were selected. Each scaler probe was scanned using a scanning laser vibrometer, under loaded and unloaded conditions, to determine their oscillation characteristics. Loads were applied against a titanium implant (100g and 200 g) for 10 s. The resulting implant surfaces were then scanned using laser profilometry and scanning electron microscopy (SEM). Insert probes oscillated with an elliptical motion with the maximum amplitude at the probe tip. Laser profilometry detected defects in the titanium surface only for the metallic scaler insert. Defect widths at 200 g high power were significantly larger than all other load/power conditions (P<0.02). Using SEM, it was observed that modifications to the implant surface had occurred following instrumentation with the plastic-tipped insert. Debris was also visible around the defects. Metal scalers produce defects in titanium implant surfaces and load and power are important factors in the damage caused. Plastic-coated scaler probes cause minimal damage to implant surfaces and have a polishing action but can leave plastic deposits behind on the implant surface. © 2011 John Wiley & Sons A/S.

Effect on Bone Architecture of Marginal Grooves in Dental Implants Under Occlusal Loaded Conditions in Beagle Dogs.

PubMed

Kato, Hatsumi; Kuroshima, Shinichiro; Inaba, Nao; Uto, Yusuke; Sawase, Takashi

2018-02-01

The aim of this study was to clarify whether marginal grooves on dental implants affect osseointegration, bone structure, and the alignment of collagen fibers to determine bone quality under loaded conditions. Anodized Ti-6Al-4V alloy dental implants, with and without marginal grooves (test and control implants, respectively), were used (3.7 × 8.0 mm). Fourth premolars and first molars of 6 beagle mandibles were extracted. Two control and test implants were placed in randomly selected healed sites at 12 weeks after tooth extraction. Screw-retained single crowns for first molars were fabricated. Euthanasia was performed at 8 weeks after the application of occlusal forces. Implant marginal bone level, bone to implant contact (BIC), bone structure around dental implants, and the alignment of collagen fibers determining bone quality were analyzed. The marginal bone level in test implants was significantly higher than that in control implants. Occlusal forces significantly increased BIC in test implants ( P = .007), whereas BIC did not change in control implants, irrespective of occlusal forces ( P = .303). Moreover, occlusal forces significantly increased BIC in test implants compared with control implants ( P = .032). Additionally, occlusal forces preferentially aligned collagen fibers in test implants, but not control implants. Hence, marginal grooves on dental implants have positive effects on increased osseointegration and adapted bone quality based on the preferential alignment of collagen fibers around dental implants under loaded conditions.

3D finite element analysis of changes in stress levels and distributions for an osseointegrated implant after vertical bone loss.

PubMed

Yoon, Kyung-Ho; Kim, Su-Gwan; Lee, Jeong-Hoon; Suh, Seung-Woo

2011-10-01

The effect of stress levels and distributions around the internal nonsubmerged type implants after vertical bone resorption was investigated in this study. An HSII implant was placed in 4 cylindrical alveolar bone models with differing degrees of thread exposures. The load applied to each implant was von Mises stress and principal stress, 250 N in axial direction and 30 degrees lateral pressure. The difference in the load between the bone and the connective portion of the implant was obtained using ANSYS analysis. Bone loss in the cervical area of the implant was more obvious under lateral pressure. When more threads were exposed, bone level decreased and the maximum load applied on the fixture increased. It was concluded that higher bone level has a biomechanical advantage with respect to stress concentration.

Randomized controlled clinical trial comparing two dental implants with different neck configurations.

PubMed

Sanz-Martín, Ignacio; Sanz-Sánchez, Ignacio; Noguerol, Fernando; Cok, Susy; Ortiz-Vigón, Alberto; Sanz, Mariano

2017-06-01

Peri-implant bone levels can vary according to the implant neck macro-design and the implant-abutment interface. To compare the changes in soft and hard tissues when using a one-piece implant with a machined collar (TG) versus a two-piece implant with a progressive platform widening and a platform switching connection (SP). Partially edentulous patients willing to receive one or two implants in the posterior maxilla or mandible were randomized to the control (TG) or to the test group (SP). Final prostheses were delivered after 12 months. Radiographic measurements of interproximal bone levels (primary outcome) were assessed at implant loading and 1-year postloading. Clinical, patient related outcomes and adverse events were assessed at loading and after 6 and 12 months. Sixty-one implants were placed in 47 patients, 37 patients (18 in the TG group and 19 in the SP group), and 47 implants (23 TG and 24 SP) completed the 24-months follow up. At the patient level, a significantly greater bone resorption from baseline to implant loading was observed in the SP group (-0.42 ± 0.45 vs -0.07 ± 0.45; P = .001*), while from loading to the final visit, the TG group had significantly greater bone loss than the SP group (-0.26 ± 0.22 vs -0.11 ± 0.2; P = .020*). At 24 months after surgery, there were no significant differences between both groups (control: 0.33 ± 0.49 vs test: 0.53 ± 0.53; P = .230). Similarly, no significant differences were observed for the secondary outcomes. Both types of implant reported high survival rates and similar bone level changes, clinical parameters, and patient related outcomes after 12 months of loading. © 2017 Wiley Periodicals, Inc.

Finite element analysis of different loading conditions for implant-supported overdentures supported by conventional or mini implants.

PubMed

Solberg, K; Heinemann, F; Pellikaan, P; Keilig, L; Stark, H; Bourauel, C; Hasan, I

2017-05-01

The effect of implants' number on overdenture stability and stress distribution in edentulous mandible, implants and overdenture was numerically investigated for implant-supported overdentures. Three models were constructed. Overdentures were connected to implants by means of ball head abutments and rubber ring. In model 1, the overdenture was retained by two conventional implants; in model 2, by four conventional implants; and in model 3, by five mini implants. The overdenture was subjected to a symmetrical load at an angle of 20 degrees to the overdenture at the canine regions and vertically at the first molars. Four different loading conditions with two total forces (120, 300 N) were considered for the numerical analysis. The overdenture displacement was about 2.2 times higher when five mini implants were used rather than four conventional implants. The lowest stress in bone bed was observed with four conventional implants. Stresses in bone were reduced by 61% in model 2 and by 6% in model 3 in comparison to model 1. The highest stress was observed with five mini implants. Stresses in implants were reduced by 76% in model 2 and 89% increased in model 3 compared to model 1. The highest implant displacement was observed with five mini implants. Implant displacements were reduced by 29% in model 2, and increased by 273% in model 3 compared to model 1. Conventional implants proved better stability for overdenture than mini implants. Regardless the type and number of implants, the stress within the bone and implants are below the critical limits.

Effect of a freeze-dried CMC/PLGA microsphere matrix of rhBMP-2 on bone healing.

PubMed

Schrier, J A; Fink, B F; Rodgers, J B; Vasconez, H C; DeLuca, P P

2001-10-07

The hypothesis of this research was that implants of poly(lactide-co-glycolide) (PLGA) microspheres loaded with bone morphogenetic protein-2 (rhBMP-2) and distributed in a freeze-dried carboxymethylcellulose (CMC) matrix would produce more new bone than would matrix implants of non-protein-loaded microspheres or matrix implants of only CMC. To test this hypothesis it was necessary to fashion microsphere-loaded CMC implants that were simple to insert, fit precisely into a defect, and would not elicit swelling. Microspheres were produced via a water-in-oil-in-water double-emulsion system and were loaded with rhBMP-2 by soaking them in a buffered solution of the protein at a concentration of 5.4 mg protein per gram of PLGA. Following recovery of the loaded microspheres by lyophilization, matrices for implantation were prepared by lyophilizing a suspension of the microspheres in 2% CMC in flat-bottom tissue culture plates. Similar matrices were made with 2% CMC and with 2% CMC containing blank microspheres. A full-thickness calvarial defect model in New Zealand white rabbits was used to assess bone growth. Implants fit the defect well, allowing for direct application. Six weeks postsurgery, defects were collected and processed for undecalcified histology. In vitro, 60% of the loaded rhBMP-2 released from devices or microspheres in 5 to 7 days, with the unembedded microspheres releasing faster than those embedded in CMC. In vivo, the rhBMP-2 microspheres greatly enhanced bone healing, whereas nonloaded PLGA microspheres in the CMC implants had little effect. The results showed that a lyophilized device of rhBMP-2/PLGA microspheres in CMC was an effective implantable protein-delivery system for use in bone repair.

The effects of loading on the preload and dimensions of the abutment screw for a 3-unit cantilever-fixed prosthesis design.

PubMed

Setia, Gaurav; Yousef, Hoda; Ehrenberg, David; Luke, Allyn; Weiner, Saul

2013-08-01

The purpose of this study was to use an in vitro model system to compare the effects on the screw torque and screw dimensions within 2 commercially available implant systems from occlusal loading on a cantilevered-fixed partial denture. Cantilevered implant-supported 3-unit prostheses with 2 premolar abutments and 1 premolar pontic (7.3 mm in length) were made on resin casts containing 2 implant analogs for 2 implant systems: BioLok Silhouette Tapered Implant System (Birmingham, AL) and Zimmer Tapered Screw-Vent Implant System (Carlsbad, CA) with 10 samples in each group. Each sample was loaded with either of 2 protocols: (1) a load of 50 N on the cantilevered pontic unit and (2) a loading of 150 N on all 3 units. The outcome measures were (1) changes in residual torque of the abutment screws and (2) changes in screw dimension. The BioLok Silhouette Tapered Implant group demonstrated slight but statistically significant torque loss 18.8% to 28.5% in both abutment screws for both protocols, P ≤ 0.05, without any changes in screw dimension. In the Zimmer Tapered Screw-Vent Implant group, there was a significant elongation of the abutment screws and a markedly significant 44.4%, (P ≤ 0.01) loss in torque in the mesial screw and a 28.5%, (P ≤ 0.05) loss in torque in the distal screw when the cantilever alone was loaded. Differences in screw design influence the maintenance of preload and distortion of the shank. The influence of the interface design, namely an internal hex of 1 mm versus an external hex did not influence the preload. Cantilevered prostheses can cause loss of torque and dimensional changes in abutment screws.

Sensitivity and Specificity of Stability Criteria for Immediately Loaded Splinted Maxillary Implants.

PubMed

Wentaschek, Stefan; Scheller, Herbert; Schmidtmann, Irene; Hartmann, Sinsa; Weyhrauch, Michael; Weibrich, Gernot; Lehmann, Karl Martin

2015-10-01

To assess the suitability of dental implants for immediate loading, primary stability is usually evaluated intraoperatively. This retrospective study aimed to assess the suitability of three stability parameters - namely, insertion torque (IT), implant stability quotient (ISQ; measured by resonance frequency analysis), and Periotest (PT) values - as potential predictors for the risk of nonosseointegration of immediately loaded splinted implants. The stability parameters were routinely collected under immediate loading. Nineteen patients with 11 edentulous and 8 partially edentulous maxillae were treated with 105 dental implants, which were immediately loaded using temporary fixed dentures. The IT results, PT values, and ISQ results were recorded. Receiver operating characteristic analysis was performed to assess the quality of each parameter as a diagnostic test. After a 3-month observation period, 11 implants in four patients were not osseointegrated. The IT and ISQ (IT 25.0 ± 12.5 Ncm and 8.4 ± 2.3 Ncm; PT -1.5 ± 3.0 and +2.7 ± 3.0; and ISQ 62.6 ± 6.7 and 54.7 ± 6.2) differed significantly between the osseointegrated and failed implants (p < .005). The IT showed the greatest specificity at a sensitivity of 1 and the greatest area under the curve (AUC; 0.929), followed by the PT value (AUC = 0.836) and ISQ (AUC = 0.811). Among the intraoperative parameters analyzed, IT showed the highest specificity at a high sensitivity of 1. Therefore, the IT can be considered the most valid prognostic factor for osseointegration of immediately loaded splinted dental implants. © 2014 Wiley Periodicals, Inc.

Does Ferrule Effect Affect Implant-Abutment Stability?

PubMed

Mohajerfar, Maryam; Beyabanaki, Elaheh; Geramy, Allahyar; Siadat, Hakimeh; Alikhasi, Marzieh

2016-12-01

This study investigated the influence of placing implant-supported crowns on the torque loss of the abutment screw before and after loading. Twenty implant-abutment assemblies were randomly assigned to two groups. The first group was consisted of abutments with abutment-level finishing line (abutment-level), and in the second group the crown margin was placed on the implant shoulder (implant-level). Initial torque loss was recorded for all specimens. After 500000 cyclic load of 75 N and frequency of 2 Hz, post loading torque loss was recorded. Finite element model of each group was also modeled and screw energy, and stress were analyzed and compared between two groups. ANOVA for repeated measurements showed that the torque loss did not change significantly after cyclic loading (P=0.73). Crown margin also had no significant effect on the torque loss (P=0.56). However, the energy and stress of screw in abutment-level model (4.49 mJ and 22.74 MPa) was higher than implant-level model (3.52 mJ and 20.81 MPa). Although embracing the implant with crown produced less stress and energy in the abutment-implant screw, it did not have any significant influence on the torque loss of the screw. Copyright© 2016 Dennis Barber Ltd

Effects of immediate and delayed loading on peri-implant trabecular structures: a cone beam CT evaluation.

PubMed

Huang, Yan; Van Dessel, Jeroen; Liang, Xin; Depypere, Maarten; Zhong, Weijian; Ma, Guowu; Lambrichts, Ivo; Maes, Frederik; Jacobs, Reinhilde

2014-12-01

To develop a method for characterizing trabecular bone microarchitecture using cone beam computed tomography (CBCT) and to evaluate trabecular bone changes after rehabilitation using immediate versus delayed implant protocols. Six mongrel dogs randomly received 27 titanium implants in the maxillary incisor or mandibular premolar areas, following one of four protocols: (1) normal extraction socket healing; (2) immediate implant placement and immediate loading; (3) delayed implant placement and delayed loading; (4) delayed implant placement and immediate loading. The animals were euthanized at 8 weeks, and block biopsies were scanned using high resolution CBCT. Standard bone structural variables were assessed in coronal, middle, and apical levels. Coronal and middle regions had more compact, more platelike, and thicker trabeculae. Protocols (2), (3), and (4) had significantly higher values (p < 0.001) than protocol (1) for bone surface density, bone surface volume ratio, and connectivity density, while significantly lower values (p < 0.001) were found for trabecular separation and fractal dimension. However, protocols (2), (3), and (4) did not show significantly different bone remodeling. Compared with normal extraction healing, the implant protocols have an improved bone structural integration. Results do not suggest a different bone remodeling pattern when a delayed versus an immediate implant protocol is used. © 2013 Wiley Periodicals, Inc.

In situ microradioscopy and microtomography of fatigue-loaded dental two-piece implants.

PubMed

Wiest, Wolfram; Zabler, Simon; Rack, Alexander; Fella, Christian; Balles, Andreas; Nelson, Katja; Schmelzeisen, Rainer; Hanke, Randolf

2015-11-01

Synchrotron real-time radioscopy and in situ microtomography are the only techniques providing direct visible information on a micrometre scale of local deformation in the implant-abutment connection (IAC) during and after cyclic loading. The microgap formation at the IAC has been subject to a number of studies as it has been proposed to be associated with long-term implant success. The next step in this scientific development is to focus on the in situ fatigue procedure of two-component dental implants. Therefore, an apparatus has been developed which is optimized for the in situ fatigue analysis of dental implants. This report demonstrates both the capability of in situ radioscopy and microtomography at the ID19 beamline for the study of cyclic deformation in dental implants. The first results show that it is possible to visualize fatigue loading of dental implants in real-time radioscopy in addition to the in situ fatigue tomography. For the latter, in situ microtomography is applied during the cyclic loading cycles in order to visualize the opening of the IAC microgap. These results concur with previous ex situ studies on similar systems. The setup allows for easily increasing the bending force, to simulate different chewing situations, and is, therefore, a versatile tool for examining the fatigue processes of dental implants and possibly other specimens.

The effect of varying implant position in immediately loaded implant-supported mandibular overdentures.

PubMed

Shaarawy, Mohammed A; Aboelross, Ehab M

2013-06-01

This study was carried out to evaluate the effect of varying implant position in immediately loaded implant-supported mandibular overdentures on peri-implant bone density, muscle activity, and patient satisfaction. Fourteen completely edentulous patients were selected for the study. After complete denture construction, patients were divided into 2 equal groups. Four dental implants were installed bilaterally in the interforaminal region in the first group, while in the second group, 4 dental implants were inserted bilaterally: 2 in the interforaminal region and 2 in the first molar area. Immediately after suturing, telescopic abutments were screwed to the implants, and the retaining caps were picked up into the fitting surface of the lower denture, which was delivered to the patient. Patients were recalled for radiographic bone density evaluation just after denture delivery and then at 3, 6, and 12 months thereafter. Muscle activities of masseter and temporalis muscles as well as patient satisfaction were also evaluated. The results of the study showed a high success rate approximating 98.2% of the immediately loaded implants. The electromyographic (EMG) records of both muscles in group 1 were significantly higher during chewing hard food after 3 months compared with group 2 (P < .05). Bone density changes were comparable in the 2 groups except at the end of the follow-up period, when group 2 showed a significant increase in peri-implant bone density values of the posteriorly placed implants compared with group 1 (P < .05). From the results of this study, it may be concluded that wide distribution of immediately loaded implants used for supporting mandibular overdentures through posterior placement beyond the interforaminal area results in a favorable response in terms of increased peri-implant bone density as well as decreased EMG activity of masseter and temporalis muscles.

Stress on external hexagon and Morse taper implants submitted to immediate loading

PubMed Central

Odo, Caroline H.; Pimentel, Marcele J.; Consani, Rafael L.X.; Mesquita, Marcelo F.; Nóbilo, Mauro A.A.

2015-01-01

Background/Aims This study aimed to evaluate the stress distribution around external hexagon (EH) and Morse taper (MT) implants with different prosthetic systems of immediate loading (distal bar (DB), casting technique (CT), and laser welding (LW)) by using photoelastic method. Methods Three infrastructures were manufactured on a model simulating an edentulous lower jaw. All models were composed by five implants (4.1 mm × 13.0 mm) simulating a conventional lower protocol. The samples were divided into six groups. G1: EH implants with DB and acrylic resin; G2: EH implants with titanium infrastructure CT; G3: EH implants with titanium infrastructure attached using LW; G4: MT implants with DB and acrylic resin; G5: MT implants with titanium infrastructure CT; G6: MT implants with titanium infrastructure attached using LW. After the infrastructures construction, the photoelastic models were manufactured and a loading of 4.9 N was applied in the cantilever. Five pre-determined points were analyzed by Fringes software. Results Data showed significant differences between the connection types (p < 0.0001), and there was no significant difference among the techniques used for infrastructure. Conclusion The reduction of the stress levels was more influenced by MT connection (except for CT). Different bar types submitted to immediate loading not influenced stress concentration. PMID:26605142

COMMUNICATION: Drug loading of nanoporous TiO2 films

NASA Astrophysics Data System (ADS)

Ayon, Arturo A.; Cantu, Michael; Chava, Kalpana; Mauli Agrawal, C.; Feldman, Marc D.; Johnson, Dave; Patel, Devang; Marton, Denes; Shi, Emily

2006-12-01

The loading of therapeutic amounts of drug on a nanoporous TiO2 surface is described. This novel drug-loading scheme on a biocompatible surface, when employed on medical implants, will benefit patients who require the deployment of drug-eluting implants. Anticoagulants, analgesics and antibiotics can be considered on the associated implants for drug delivery during the time of maximal pain or risk for patients undergoing orthopedic procedures. Therefore, this scheme will maximize the chances of patient recovery.

Quantitative assessment of orthodontic mini-implant displacement: the effect of initial force application.

PubMed

Holst, Alexandra Ioana; Karl, Matthias; Karolczak, Marek; Goellner, Matthias; Holst, Stefan

2010-01-01

Primary stability and micromovement of orthodontic mini-implants depends on a number of factors and influences clinical success or failure. The purpose of this study was to assess the behavior of orthodontic mini-implants upon initial load application. Orthodontic mini-implants (n = 39) were inserted in the alveolar process of maxillary human cadaver specimens (n = 10). Increasing horizontal forces (up to 2.5 N) were applied, and triggered images were taken in 0.5-N load intervals. Additionally, peri-implant parameters based on micro-CT volume data were recorded. Data were subjected to a two-sided nonparametric Wilcoxon signed rank test, and between-group comparisons were assessed with a Mann-Whitney test (alpha = .05). Initial load application led to displacement beyond elastic recovery of the surrounding bone after force release (P < .001). Cortical thickness and insertion depth, despite numeric differences, did not reveal any statistical differences, while displacement of mini-implants was significantly affected by contact to neighboring teeth (P < .001). Insertion technique and initial load application on orthodontic mini-implants may be regarded as two crucial factors for success, while repeated application of orthodontic force does not seem to increase screw mobility.

Subconjunctivally Implanted Hydrogels for Sustained Insulin Release to Reduce Retinal Cell Apoptosis in Diabetic Rats.

PubMed

Imai, Hisanori; Misra, Gauri P; Wu, Linfeng; Janagam, Dileep R; Gardner, Thomas W; Lowe, Tao L

2015-12-01

Diabetic retinopathy (DR) is a leading cause of blindness in diabetic patients that involves early-onset retinal cell loss. Here, we report our recent work using subconjunctivally implantable hydrogels for sustained insulin release to the retina to prevent retinal degeneration. The hydrogels are synthesized by UV photopolymerization of N-isopropylacrylamide and a dextran macromer containing oligolactate-(2-hydroxyetheyl methacrylate) units. Insulin was loaded into the hydrogels during the synthesis. The ex vivo bioactivity of insulin released from the hydrogels was tested on fresh rat retinas using immunoprecipitation and immunoblotting to measure insulin receptor tyrosine and Akt phosphorylation. The biosafety and the effect on the blood glucose of the hydrogels were evaluated in rats 2 months after subconjunctival implantation. The release of insulin from the hydrogels was studied both in vitro in PBS (pH 7.4), and in vivo using confocal microscopy and RIA kit. The in vivo bioactivity of the released insulin was investigated in diabetic rats using DNA fragmentation method. The hydrogels could load insulin with approximately 98% encapsulation efficiency and continuously release FITC-insulin in PBS (pH = 7.4) at 37°C for at least 5 months depending on their composition. Insulin lispro released from the hydrogels was biologically active by increasing insulin receptor tyrosine and Akt serine phosphorylation of ex vivo retinas. In vivo studies showed normal retinal histology 2 months post subconjunctival implantation. Insulin released from subconjunctivally implanted hydrogels could be detected in the retina by using confocal microscopy and RIA kit for 1 week. The implanted hydrogels with insulin lispro did not change the blood glucose level of normal and diabetic rats, but significantly reduced the DNA fragmentation of diabetic retinas for 1 week. The developed hydrogels have great potential to sustain release of insulin to the retina via subconjunctival implantation to minimize DR without the risk of hypoglycemia.

Subconjunctivally Implanted Hydrogels for Sustained Insulin Release to Reduce Retinal Cell Apoptosis in Diabetic Rats

PubMed Central

Imai, Hisanori; Misra, Gauri P.; Wu, Linfeng; Janagam, Dileep R.; Gardner, Thomas W.; Lowe, Tao L.

2015-01-01

Purpose Diabetic retinopathy (DR) is a leading cause of blindness in diabetic patients that involves early-onset retinal cell loss. Here, we report our recent work using subconjunctivally implantable hydrogels for sustained insulin release to the retina to prevent retinal degeneration. Methods The hydrogels are synthesized by UV photopolymerization of N-isopropylacrylamide and a dextran macromer containing oligolactate-(2-hydroxyetheyl methacrylate) units. Insulin was loaded into the hydrogels during the synthesis. The ex vivo bioactivity of insulin released from the hydrogels was tested on fresh rat retinas using immunoprecipitation and immunoblotting to measure insulin receptor tyrosine and Akt phosphorylation. The biosafety and the effect on the blood glucose of the hydrogels were evaluated in rats 2 months after subconjunctival implantation. The release of insulin from the hydrogels was studied both in vitro in PBS (pH 7.4), and in vivo using confocal microscopy and RIA kit. The in vivo bioactivity of the released insulin was investigated in diabetic rats using DNA fragmentation method. Results The hydrogels could load insulin with approximately 98% encapsulation efficiency and continuously release FITC-insulin in PBS (pH = 7.4) at 37°C for at least 5 months depending on their composition. Insulin lispro released from the hydrogels was biologically active by increasing insulin receptor tyrosine and Akt serine phosphorylation of ex vivo retinas. In vivo studies showed normal retinal histology 2 months post subconjunctival implantation. Insulin released from subconjunctivally implanted hydrogels could be detected in the retina by using confocal microscopy and RIA kit for 1 week. The implanted hydrogels with insulin lispro did not change the blood glucose level of normal and diabetic rats, but significantly reduced the DNA fragmentation of diabetic retinas for 1 week. Conclusions The developed hydrogels have great potential to sustain release of insulin to the retina via subconjunctival implantation to minimize DR without the risk of hypoglycemia. PMID:26658505

Clinical and Radiographic Evaluation of Brånemark Implants with an Anodized Surface following Seven-to-Eight Years of Functional Loading

PubMed Central

Gelb, David; McAllister, Bradley; Nummikoski, Pirkka; Del Fabbro, Massimo

2013-01-01

The aim of this study was to evaluate the clinical and radiographic long-term outcomes of dental implants with an anodized TiUnite surface, placed in routine clinical practice. Two clinical centers participated in the study. One hundred and seven implants (80 in the maxilla and 27 in the mandible) in 52 patients were followed in the long term. Both one- and two-stage techniques were used for 38 and 69 implants, respectively. Thirty-eight single tooth restorations and 22 fixed partial prostheses were delivered, according to a delayed loading protocol, within 4 to 12 months since implant placement. All implants were stable at insertion and at the long-term follow-up visit, which occurred between 7 and 8 years of functional loading. The mean followup was 7.33 ± 0.47 years. The mean marginal bone level change at the long-term followup as compared to baseline was 1.49 ± 1.03 mm. No implant failure occurred. Healthy peri-implant mucosa was found around 95% of implants, whereas 91% of implants showed no visible plaque at the implant surfaces at the long-term followup. The study showed that dental implants with the TiUnite anodized surface demonstrate excellent long-term clinical and radiographic outcomes. PMID:23533412

Implant-Supported Fixed Partial Prostheses With Different Prosthetic Materials: A Three-Dimensional Finite Element Stress Analysis.

PubMed

Arinc, Hakan

2018-06-01

To evaluate the effects of prosthetic material on the degree of stress to the cortical bone, trabecular bone, framework, and implants using finite element analysis (FEA). A mandibular implant-supported fixed prosthesis was designed. Different prosthetic materials [cobalt-chromium-supported ceramic, zirconia-supported ceramic, and zirconia-reinforced polymethyl methacrylate (ZRPMMA)-supported resin] were used. FEA was used to evaluate stress under different loading conditions. Maximum principal (σmax), minimum principal (σmin), and von Mises (σvM) stress values were obtained. Similar σmax, σmin, and σvM values were observed in the cortical and trabecular bones and in implants under both loading conditions, with the exception of the ZRPMMA model, which showed the highest σmax, σmin, and σvM values in oblique loading. The ZRPMMA model had the lowest σvM value in the framework under both loading conditions. ZRPMMA had the lowest stress values in the framework, with increased stress values in the implants and bone tissue. Framework and veneering materials may influence stress values under different loading conditions.

A Bone-Implant Interaction Mouse Model for Evaluating Molecular Mechanism of Biomaterials/Bone Interaction.

PubMed

Liu, Wenlong; Dan, Xiuli; Wang, Ting; Lu, William W; Pan, Haobo

2016-11-01

The development of an optimal animal model that could provide fast assessments of the interaction between bone and orthopedic implants is essential for both preclinical and theoretical researches in the design of novel biomaterials. Compared with other animal models, mice have superiority in accessing the well-developed transgenic modification techniques (e.g., cell tracing, knockoff, knockin, and so on), which serve as powerful tools in studying molecular mechanisms. In this study, we introduced the establishment of a mouse model, which was specifically tailored for the assessment of bone-implant interaction in a load-bearing bone marrow microenvironment and could potentially allow the molecular mechanism study of biomaterials by using transgenic technologies. The detailed microsurgery procedures for developing a bone defect (Φ = 0.8 mm) at the metaphysis region of the mouse femur were recorded. According to our results, the osteoconductive and osseointegrative properties of a well-studied 45S5 bioactive glass were confirmed by utilizing our mouse model, verifying the reliability of this model. The feasibility and reliability of the present model were further checked by using other materials as objects of study. Furthermore, our results indicated that this animal model provided a more homogeneous tissue-implant interacting surface than the rat at the early stage of implantation and this is quite meaningful for conducting quantitative analysis. The availability of transgenic techniques to mechanism study of biomaterials was further testified by establishing our model on Nestin-GFP transgenic mice. Intriguingly, the distribution of Nestin + cells was demonstrated to be recruited to the surface of 45S5 glass as early as 3 days postsurgery, indicating that Nestin + lineage stem cells may participate in the subsequent regeneration process. In summary, the bone-implant interaction mouse model could serve as a potential candidate to evaluate the early stage tissue response near the implant surface in a bone marrow microenvironment, and it also shows great potential in making transgenic animal resource applicable to biomaterial studies, so that the design of novel biomaterials could be better guided.

Marginal bone-level alterations of loaded zirconia and titanium dental implants: an experimental study in the dog mandible.

PubMed

Thoma, Daniel S; Benic, Goran I; Muñoz, Fernando; Kohal, Ralf; Sanz Martin, Ignacio; Cantalapiedra, Antonio G; Hämmerle, Christoph H F; Jung, Ronald E

2016-04-01

The aim was to test whether or not the marginal bone-level alterations of loaded zirconia implants are similar to the bone-level alterations of a grade 4 titanium one-piece dental implant. In six dogs, all premolars and the first molars were extracted in the mandible. Four months later, three zirconia implants (BPI, VC, ZD) and a control titanium one-piece (STM) implant were randomly placed in each hemimandible and left for transmucosal healing (baseline). Six months later, CAD/CAM crowns were cemented. Sacrifice was scheduled at 6-month postloading. Digital X-rays were taken at implant placement, crowns insertion, and sacrifice. Marginal bone-level alterations were calculated, and intra- and intergroup comparisons performed adjusted by confounding factors. Implants were successfully placed. Until crown insertion, two implants were fractured (one VC, one ZD). At sacrifice, 5 more implants were (partly) fractured (one BPI, four ZD), and one lost osseointegration (VC). No decementation of crowns occurred. All implant systems demonstrated a statistically significant (except VC) loss of marginal bone between baseline and crown insertion ranging from 0.29 mm (VC; P = 0.116) to 0.80 mm (ZD; P = 0.013). The estimated marginal bone loss between baseline and 6 months of loading ranged between 0.19 mm (BPI) and 1.11 mm (VC), being statistically significant for STM and VC only (P < 0.05). The changes in marginal bone levels were statistically significantly different between zirconia implants and control implants (STM vs. BPI P = 0.007; vs. VC P = 0.001; vs. ZD P = 0.011). Zirconia implants were more prone to fracture prior to and after loading with implant-supported crowns compared to titanium implants. Individual differences and variability in the extent of the bone-level changes during the 12-month study period were found between the different implant types and materials. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Mandibular Denture Base Deformation with Locator and Ball Attachments of Implant-Retained Overdentures.

PubMed

ELsyad, Moustafa Abdou; Errabti, Hatem Mokhtar; Mustafa, Aisha Zakaria

2016-12-01

The aim of this in vitro study was to evaluate and compare mandibular denture base deformation between ball and Locator attachments of implant-retained overdentures. An experimental acrylic model covered with resilient silicone mucosal simulation was constructed. Two laboratory implants were placed in the canine areas of the model. Two duplicate experimental overdentures were constructed and connected to the implants with either ball (GI) or Locator (GII) attachments. To measure overdenture strain around the attachments, 3 strain gauges were attached to the lingual polished surface of the overdentures opposite to the right implant (loading side) 2 mm above the attachment level (Ch1), at the attachment level (Ch2), and 2 mm below the attachment level (Ch3). Another 3 gauges were bonded opposite to the left implant (non-loading side) in the same manner (Ch6, Ch7, and Ch8). To measure strain at the midline of the overdentures, two strain gauges were attached in the midline at 5 mm intervals (Ch4 and Ch5). A universal testing device was used to deliver vertical static load of 50 N unilaterally and bilaterally to the first molar area to measure strain using a multi-channel digital strain meter. During bilateral load application, GII recorded higher compressive strains than GI at the majority of channels. During unilateral load application, GI recorded higher tensile strains at Ch1, Ch2, and Ch3, and GII recorded higher strains than GI at Ch6, Ch7, and Ch8. During bilateral loading the highest strain was concentrated at Ch5 for both groups. During unilateral loading, the highest strain was concentrated at Ch2 for GI, and at Ch5 for GII. Ball attachments for implant-retained overdentures were associated with significant mandibular denture base deformation over the implants compared to Locator attachments. Therefore, denture base reinforcement may be recommended with ball attachmentz to increase fracture resistance of the base. © 2015 by the American College of Prosthodontists.

Bone quality and the immediate loading of implants-critical aspects based on literature, research, and clinical experience.

PubMed

Romanos, Georgios E

2009-06-01

Immediate loading of oral implants has been extensively described in the international literature and the requirements for long-term success are evaluated. The author presents here the critical aspects of the criteria for success as well as describes the characteristics of an implant macro- and microdesign for immediate loading to control the periimplant crestal bone loss and secure the long-term stability. Information from the literature and the clinical experience will be presented.

[Mechanical studies of lumbar interbody fusion implants].

PubMed

Bader, R J; Steinhauser, E; Rechl, H; Mittelmeier, W; Bertagnoli, R; Gradinger, R

2002-05-01

In addition to autogenous or allogeneic bone grafts, fusion cages composed of metal or plastic are being used increasingly as spacers for interbody fusion of spinal segments. The goal of this study was the mechanical testing of carbon fiber reinforced plastic (CFRP) fusion cages used for anterior lumbar interbody fusion. With a special testing device according to American Society for Testing and Materials (ASTM) standards, the mechanical properties of the implants were determined under four different loading conditions. The implants (UNION cages, Medtronic Sofamor Danek) provide sufficient axial compression, shear, and torsional strength of the implant body. Ultimate axial compression load of the fins is less than the physiological compression loads at the lumbar spine. Therefore by means of an appropriate surgical technique parallel grooves have to be reamed into the endplates of the vertebral bodies according to the fin geometry. Thereby axial compression forces affect the implants body and the fins are protected from damaging loading. Using a supplementary anterior or posterior instrumentation, in vivo failure of the fins as a result of physiological shear and torsional spinal loads is unlikely. Due to specific complications related to autogenous or allogeneic bone grafts, fusion cages made of metal or carbon fiber reinforced plastic are an important alternative implant in interbody fusion.

Porous, Dexamethasone-loaded polyurethane coatings extend performance window of implantable glucose sensors in vivo.

PubMed

Vallejo-Heligon, Suzana G; Brown, Nga L; Reichert, William M; Klitzman, Bruce

2016-01-01

Continuous glucose sensors offer the promise of tight glycemic control for insulin dependent diabetics; however, utilization of such systems has been hindered by issues of tissue compatibility. Here we report on the in vivo performance of implanted glucose sensors coated with Dexamethasone-loaded (Dex-loaded) porous coatings employed to mediate the tissue-sensor interface. Two animal studies were conducted to (1) characterize the tissue modifying effects of the porous Dex-loaded coatings deployed on sensor surrogate implants and (2) investigate the effects of the same coatings on the in vivo performance of Medtronic MiniMed SOF-SENSOR™ glucose sensors. The tissue response to implants was evaluated by quantifying macrophage infiltration, blood vessel formation, and collagen density around implants. Sensor function was assessed by measuring changes in sensor sensitivity and time lag, calculating the Mean Absolute Relative Difference (MARD) for each sensor treatment, and performing functional glucose challenge test at relevant time points. Implants treated with porous Dex-loaded coatings diminished inflammation and enhanced vascularization of the tissue surrounding the implants. Functional sensors with Dex-loaded porous coatings showed enhanced sensor sensitivity over a 21-day period when compared to controls. Enhanced sensor sensitivity was accompanied with an increase in sensor signal lag and MARD score. These results indicate that Dex-loaded porous coatings were able to elicit an attenuated tissue response, and that such tissue microenvironment could be conducive towards extending the performance window of glucose sensors in vivo. In the present article, a coating to extend the functionality of implantable glucose sensors in vivo was developed. Our study showed that the delivery of an anti-inflammatory agent with the presentation of micro-sized topographical cues from coatings may lead to improved long-term glucose sensor function in vivo. We believe that improved function of sensors treated with the novel coatings was a result of the observed decreases in inflammatory cell density and increases in vessel density of the tissue adjacent to the devices. Furthermore, extending the in vivo functionality of implantable glucose sensors may lead to greater adoption of these devices by diabetic patients. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up

PubMed Central

2016-01-01

This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26–67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results. PMID:27313616

3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up.

PubMed

Tunchel, Samy; Blay, Alberto; Kolerman, Roni; Mijiritsky, Eitan; Shibli, Jamil Awad

2016-01-01

This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26-67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results.

Retention of cast crown copings cemented to implant abutments.

PubMed

Dudley, J E; Richards, L C; Abbott, J R

2008-12-01

The cementation of crowns to dental implant abutments is an accepted form of crown retention that requires consideration of the properties of available cements within the applied clinical context. Dental luting agents are exposed to a number of stressors that may reduce crown retention in vivo, not the least of which is occlusal loading. This study investigated the influence of compressive cyclic loading on the physical retention of cast crown copings cemented to implant abutments. Cast crown copings were cemented to Straumann synOcta titanium implant abutments with three different readily used and available cements. Specimens were placed in a humidifier, thermocycled and subjected to one of four quantities of compressive cyclic loading. The uniaxial tensile force required to remove the cast crown copings was then recorded. The mean retention values for crown copings cemented with Panavia-F cement were statistically significantly greater than both KetacCem and TempBond non-eugenol cements at each compressive cyclic loading quantity. KetacCem and TempBond non-eugenol cements produced relatively low mean retention values that were not statistically significantly different at each quantity of compressive cyclic loading. Compressive cyclic loading had a statistically significant effect on Panavia-F specimens alone, but increased loading quantities produced no further statistically significant difference in mean retention. Within the limitations of the current in vitro conditions employed in this study, the retention of cast crown copings cemented to Straumann synOcta implant abutments with a resin, glass ionomer and temporary cement was significantly affected by cement type but not compressive cyclic loading. Resin cement is the cement of choice for the definitive non-retrievable cementation of cast crown copings to Straumann synOcta implant abutments out of the three cements tested.

Effect of abutment screw length and cyclic loading on removal torque in external and internal hex implants.

PubMed

Mohammed, Hnd Hadi; Lee, Jin-Han; Bae, Ji-Myung; Cho, Hye-Won

2016-02-01

The purpose of this study was to evaluate the effects of abutment screw length and cyclic loading on the removal torque (RTV) in external hex (EH) and internal hex (IH) implants. Forty screw-retained single crowns were connected to external and internal hex implants. The prepared titanium abutment screws were classified into 8 groups based on the number of threads (n = 5 per group): EH 12.5, 6.5, 3.5, 2.5 and IH 6.5, 5, 3.5, 2.5 threads. The abutment screws were tightened with 20 Ncm torque twice with 10-minute intervals. After 5 minutes, the initial RTVs of the abutment screws were measured with a digital torque gauge (MGT12). A customized jig was constructed to apply a load along the implant long axis at the central fossa of the maxillary first molar. The post-loading RTVs were measured after 16,000 cycles of mechanical loading with 50 N at a 1-Hz frequency. Statistical analysis included one-way analysis of variance and paired t-tests. The post-loading RTVs were significantly lower than the initial RTVs in the EH 2.5 thread and IH 2.5 thread groups (P<.05). The initial RTVs exhibited no significant differences among the 8 groups, whereas the post-loading RTVs of the EH 6.5 and EH 3.5 thread groups were higher than those of the IH 3.5 thread group (P<.05). Within the limitations of this study, the external hex implants with short screw lengths were more advantageous than internal hex implants with short screw lengths in torque maintenance after cyclic loading.

Effect of abutment screw length and cyclic loading on removal torque in external and internal hex implants

PubMed Central

Mohammed, Hnd Hadi; Lee, Jin-Han; Bae, Ji-Myung

2016-01-01

PURPOSE The purpose of this study was to evaluate the effects of abutment screw length and cyclic loading on the removal torque (RTV) in external hex (EH) and internal hex (IH) implants. MATERIALS AND METHODS Forty screw-retained single crowns were connected to external and internal hex implants. The prepared titanium abutment screws were classified into 8 groups based on the number of threads (n = 5 per group): EH 12.5, 6.5, 3.5, 2.5 and IH 6.5, 5, 3.5, 2.5 threads. The abutment screws were tightened with 20 Ncm torque twice with 10-minute intervals. After 5 minutes, the initial RTVs of the abutment screws were measured with a digital torque gauge (MGT12). A customized jig was constructed to apply a load along the implant long axis at the central fossa of the maxillary first molar. The post-loading RTVs were measured after 16,000 cycles of mechanical loading with 50 N at a 1-Hz frequency. Statistical analysis included one-way analysis of variance and paired t-tests. RESULTS The post-loading RTVs were significantly lower than the initial RTVs in the EH 2.5 thread and IH 2.5 thread groups (P<.05). The initial RTVs exhibited no significant differences among the 8 groups, whereas the post-loading RTVs of the EH 6.5 and EH 3.5 thread groups were higher than those of the IH 3.5 thread group (P<.05). CONCLUSION Within the limitations of this study, the external hex implants with short screw lengths were more advantageous than internal hex implants with short screw lengths in torque maintenance after cyclic loading. PMID:26949489

The influence of repeated abutment changes on peri-implant tissue stability: 3-year post-loading results from a multicentre randomised controlled trial.

PubMed

Bressan, Eriberto; Grusovin, Maria Gabriella; D'Avenia, Ferdinando; Neumann, Konrad; Sbricoli, Luca; Luongo, Giuseppe; Esposito, Marco

To evaluate the influence of at least three abutment disconnections in conventional loaded implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard and soft tissue changes. A secondary aim was to evaluate whether the presence of less than 2 mm of keratinised mucosa is associated with increased peri-implant marginal bone loss and soft tissue recessions. Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implants were placed with more than 35 Ncm, according to a parallel group design to receive definitive abutments that were loaded immediately (definitive abutment or immediate loading group) or transmucosal abutments, which were delayed loaded after 3 months and removed at least three times: 1. At impression taking (3 months after implant placement); 2. When checking the zirconium core on titanium abutments at single crowns or the fitting the metal structure at prostheses supported by multiple implants; 3. At delivery of the definitive prostheses (repeated disconnection or conventional loading group). Patients were treated at four centres and each patient contributed to the study, with only one prosthesis followed for 3 years after initial loading. Outcome measures were: prosthesis failures, implant failures, complications, pink aesthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone level changes and height of the keratinised mucosa. Forty patients were randomly allocated to each group according to a parallel group design. Six patients from the definitive abutment group dropped out or died, and one left from the repeated disconnection group. One implant, from the repeated disconnection group, fractured (difference = 3%; CI 95%: -2%, 8%; P = 1). Four provisional crowns and one definitive single crown had to be remade because of poor fitting, and one definitive crown and one definitive prosthesis because of ceramic and implant fracture, respectively, in the repeated disconnection group vs one provisional prosthesis from the definitive abutment group due to frequent debondings (difference = 15%; CI 95%: 2%, 28%; P = 0.060). Five patients from the definitive abutment group and four patients from the repeated disconnection group were affected by complications (difference = 4%; CI 95%: -11%, 20%; P = 0.725). PES scores assessed at 3 years post-loading were 11.7 (standard deviation = 1.8) mm for the definitive abutment group and 11.3 (1.5) mm for the repeated abutment changes group (difference = 0.4; CI 95%: -0.4, 1.2; P = 0.315). However, there was a difference of 0.26 out of a maximum score of 2 in favour of the definitive abutment group for soft tissue contour only. Buccal recessions at 3 years post-loading amounted to -0.1 (0.8) mm for the definitive abutment group and -0.1 (1.2) mm for the repeated abutment changes group (it was actually a soft tissue gain; difference = 0.01 mm CI 95%: -0.48, 0.50; P = 0.965). All patients declared being very satisfied or satisfied with the function and aesthetics of the prostheses and said they would undergo the same procedure again, with the exception of one patient from the repeated disconnection group who was uncertain regarding function. Mean peri-implant marginal bone loss 3 years after loading was 0.07 (0.18) mm for the definitive abutment group and 0.50 (0.93) mm for the repeated abutment changes group (difference = 0.43 mm; CI 95%: 0.13, 0.74; P = 0.007). The height of keratinised mucosa at 3 years post-loading was 2.8 (1.3) mm for the definitive abutment group and 2.8 (1.6) mm for the repeated abutment changes group (difference = 0.03; CI 95%: -0.67, 0.73; P = .926). Up to 3 years after initial loading there were no statistically significant differences between the two procedures, with the exception of 0.4 mm more marginal bone loss at implants subjected to three abutment disconnections. There were no significantly increased marginal bone loss (difference = 0.1 mm, CI 95%: -0.3, 0.5, P = 0.590) or buccal recessions (difference = 0.1 mm, CI 95%: -0.4, 0.7, P = 0.674) at implants with less than 2 mm of keratinised mucosa at loading. Three-year post-loading data showed that repeated abutment disconnections significantly increased bone loss of 0.43 mm, but this difference may not be considered clinically relevant; therefore clinicians can use the procedure they find more convenient for each specific patient. Immediately non-occlusally loaded dental implants are a viable alternative to conventional loading and no increased bone loss or buccal recessions were noticed at implants with less than 2 mm of keratinised mucosa. Conflict of interest statement: This trial was partially funded by Dentsply Sirona Implants, the manufacturer of the implants and other products evaluated in this investigation. However, data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results, with the exception of rejecting a proposal to change the protocol, after the trial was started, allowing the use of indexed abutments.

Effects of Immediate and Delayed Loading on the Outcomes of All-on-4 Treatment: A Prospective Study

PubMed Central

Najafi, Hossein; Siadat, Hakimeh; Rokn, Amirreza

2016-01-01

Objectives: The purpose of this study was to compare the outcomes of immediate and delayed rehabilitation of edentulous jaws by means of two straight and two tilted implants after one year of function. Materials and Methods: Thirty consecutive patients (16 males, 14 females) were enrolled in this study. Two anterior straight and two posterior tilted implants were placed in each patient. According to the implant insertion torque and the need for bone grafting, implants were loaded immediately (at 72 hours) or delayed (after four months) using a fixed metal resin prosthesis. Results: One axial implant failed in the delayed group after one year of loading, resulting in cumulative implant survival rate of 99.3%. The mean marginal bone loss was 0.84mm. No significant difference was found between axial and tilted implants in the two groups (P>0.05) Conclusions: Based on the results, immediate or delayed fabrication of final prosthesis on two tilted and two axial implants did not result in significant differences in survival rates or marginal bone loss. PMID:28243303

The Measurement Of Total Joint Loosening By X-Ray Photogrammetry

NASA Astrophysics Data System (ADS)

Lippert, Frederick G.; Veress, Sandor A.; Tiwari, Rama S.; Harrington, Richard M.

1980-07-01

Failure of total joint replacement due to loosening of the composents either between the implant and cement or between the cement and bone is emerging as a late complication with an incidence as high as 20 percent. Loosening may not only cause pain but progressive loss of support for the prosthesis with eventual structural failure. Early diagnosis is important so that revision may be carried when deterioration or pain occurs. No method is currently available which clearly establishes loosening at an early stage except surgical exploration. We have devised a method based on our in vivo photogrammetry studies of patellar tracking patterns using metallic markers placed in bone near both components of the total joint. Stereo x-rays taken with the joint loaded and unloaded are measured for relative motion between the implant and the metallic markers. Laboratory studies using prosthetic hip components mounted in plastic bone have revealed the ability of this method to detect pistoning movements as small as 80 microns. These findings were confirmed by physical measurements.

Fracture resistance of different implant abutments supporting 
all-ceramic single crowns after aging.

PubMed

Stimmelmayr, Michael; Heiß, Philipp; Erdelt, Kurt; Schweiger, Josef; Beuer, Florian

To test the mechanical properties of three different restorative materials for implant abutments supporting all-ceramic single crowns. Thirty implants with butt-joint connections were distributed into three test groups: Group A with 10 one-piece zirconia abutments, Group U with 10 titanium abutments, and Group T with 10 titanium-zirconia hybrid abutments. Monolithic zirconia single crowns were cemented and artificially aged. The crowns were loaded at a 30-degree angle in a universal testing machine until fracture or bending. Additionally, after removal of the restorations, the implant-abutment interface of the fixtures was inspected using a scanning electron microscope (SEM). In Group A, the abutments failed on average at 336.78 N, in Group U at 1000.12 N, and in Group T at 1296.55 N. The mean values between Groups T and U (P = 0.009), and between Group A and Groups T and U (P < 0.001) were significantly different. The abutments in Group A failed early due to fractures of the internal parts and parts close to the implant neck. In Groups T and U, failures occurred due to bending of the implant neck. This experimental study proves that hybrid and titanium abutments have similar mechanical properties. One-piece abutments made of zirconia showed significantly lower fracture resistance.

Immediate loading of tapered implants placed in postextraction sockets: retrospective analysis of the 5-year clinical outcome.

PubMed

Mura, Priamo

2012-08-01

The use of immediate implant loading protocols delivers obvious benefits to the patient. When applied in healed sites, this has not only been well documented in the totally edentolous mandible but has also been documented and reported to be predictable in the upper jaw, and in cases of partial edentoulism, as well. A further application of immediate loading protocol, although still controversial, especially when replacing single maxillary teeth in the anterior zone, is the immediate implant placement and provisionalization in postextractive sockets. In consideration of the oxidized surface promoting bone healing and the tapered shape of the implant body, the Replace Select Tapered TiUnite implants have been used for many years in our clinic when facing these clinical situations. This article will report about our long-term clinical experience with such implants and the relevant role of a correct surgical and prosthetic treatment planning. The aim of this retrospective study was to report on the 5-year clinical and radiologic outcome of patients treated with Replace Select Tapered TiUnite implants when used according to an immediate loading protocol in postextraction sites. In routine practice, 56 consecutive patients were treated with 79 implants. The patients, 23 males and 33 females, had a mean age of 50.9 years, range 21-76 years, at implant placement. Forty-seven implants were placed in the maxilla and 32 implants were placed in the mandible. All implants were placed in postextraction sites and were immediately loaded. Provisional restorations were delivered within 2 hours from surgery and all were in occlusion. Forty-three patients received a single implant while in the remaining 13 patients the implants were splinted. Definitive prosthetic restoration was delivered within 1 to 4 months following implant placement. Evaluations of soft tissue health and marginal bone remodeling were conducted. An independent radiologist performed the radiographic evaluation using the top of the implant as the reference point with negative values indicating a level below the reference point. Forty-eight patients, accounting for 66 implants, have passed the 5-year follow-up. No implants have failed resulting in a 5-year cumulative implant survival rate of 100%. Three patients, with six implants, withdrew during the course of the follow-up; one patient passed away and two patients moved. Five patients with seven implants did not show up at 5 years recall. At the 5-year follow-up, majority of the implants that were followed demonstrated normal periimplant mucosa and no visible plaque. The mean bone level at 5-year follow-up was -2.45mm (SD 1.29, n=63) demonstrating a level in line with the first thread. Mean marginal bone loss from implant inserting to 5 years was 0.56 mm (SD 1.98, n=63). In regard with complications, a fracture of the ceramic crown was reported 5 years after implant insertion in a patient who developed bruxism. No other biologic nor mechanical complications were reported. This retrospective 5-year follow-up study of 56 patients treated with implants immediately placed in postextraction sockets and immediately loaded demonstrates good treatment outcome with regard to implant survival, soft tissue condition, and marginal bone response. © 2010 Wiley Periodicals, Inc.

In-vitro development of a temporal abutment screw to protect osseointegration in immediate loaded implants.

PubMed

García-Roncero, Herminio; Caballé-Serrano, Jordi; Cano-Batalla, Jordi; Cabratosa-Termes, Josep; Figueras-Álvarez, Oscar

2015-04-01

In this study, a temporal abutment fixation screw, designed to fracture in a controlled way upon application of an occlusal force sufficient to produce critical micromotion was developed. The purpose of the screw was to protect the osseointegration of immediate loaded single implants. Seven different screw prototypes were examined by fixing titanium abutments to 112 Mozo-Grau external hexagon implants (MG Osseous®; Mozo-Grau, S.A., Valladolid, Spain). Fracture strength was tested at 30° in two subgroups per screw: one under dynamic loading and the other without prior dynamic loading. Dynamic loading was performed in a single-axis chewing simulator using 150,000 load cycles at 50 N. After normal distribution of obtained data was verified by Kolmogorov-Smirnov test, fracture resistance between samples submitted and not submitted to dynamic loading was compared by the use of Student's t-test. Comparison of fracture resistance among different screw designs was performed by the use of one-way analysis of variance. Confidence interval was set at 95%. Fractures occurred in all screws, allowing easy retrieval. Screw Prototypes 2, 5 and 6 failed during dynamic loading and exhibited statistically significant differences from the other prototypes. Prototypes 2, 5 and 6 may offer a useful protective mechanism during occlusal overload in immediate loaded implants.

Biocompatible polymer coating of titania nanotube arrays for improved drug elution and osteoblast adhesion.

PubMed

Gulati, Karan; Ramakrishnan, Saminathan; Aw, Moom Sinn; Atkins, Gerald J; Findlay, David M; Losic, Dusan

2012-01-01

Bacterial infection, extensive inflammation and poor osseointegration have been identified as the major reasons for [early] orthopaedic implant failures based on titanium. Creating implants with drug-eluting properties to locally deliver drugs is an appealing way to address some of these problems. To improve properties of titanium for orthopaedic applications, this study explored the modification of titanium surfaces with titaniananotube (TNT) arrays, and approach that combines drug delivery into bone and potentially improved bone integration. A titania layer with an array of nanotube structures (∼120 nm in diameter and 50 μm in length) was synthesized on titanium surfaces by electrochemical anodization and loaded with the water-insoluble anti-inflammatory drug indomethacin. A simple dip-coating process of polymer modification formed thin biocompatible polymer films over the drug-loaded TNTs to create TNTs with predictable drug release characteristics. Two biodegradable and antibacterial polymers, chitosan and poly(lactic-co-glycolic acid), were tested for their ability to extend the drug release time of TNTs and produce favourable bone cell adhesion properties. Dependent on polymer thickness, a significant improvement in the drug release characteristics was demonstrated, with reduced burst release (from 77% to >20%) and extended overall release from 4 days to more than 30 days. Excellent osteoblast adhesion and cell proliferation on polymer-coated TNTs compared with uncoated TNTs were also observed. These results suggest that polymer-modified implants with a TNT layer are capable of delivering a drug to a bone site over an extended period and with predictable kinetics. In addition, favourable bone cell adhesion suggests that such an implant would have good biocompatibility. The described approach is broadly applicable to a wide range of drugs and implants currently used in orthopaedic practice. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Clinical evaluation of immediate loading of titanium orthodontic implants

PubMed Central

Chopra, S.S.; Chakranarayan, A.

2015-01-01

Background Skeletal anchorage using dental implants, miniplates, miniscrews and microscrews provides an absolute anchorage for tooth movement. Miniscrew and microscrew implants have many benefits such as ease of placement and removal and immediate orthodontic force application. Methods Fifteen subjects in the permanent dentition with an overjet ≥6 mm received treatment with the 0.018-inch pre-adjusted edgewise appliance system (Roth prescription) and extraction of all first premolars. Titanium orthodontic implants were placed in both the upper quadrants and were immediately loaded with elastic chain from the implant head to the sectional arch wire. Result The overall success rate of immediate loaded titanium orthodontic micro implants (OMI) in the present study was 83.33%, with a mean chairside time of 15.33 min of placing two implants in each patient. Peri-implant inflammation was the only complication observed. Most failures were in the initial part of the study. There was no significant difference in the success rate of implants based on sex, side of placement (right or left) and type of malocclusion. Conclusion The OMIs used in the present study proved to be effective and well tolerated in producing immediate orthodontic anchorage for the retraction. PMID:25859080

Relationship Between Insertion Torque and Resonance Frequency Measurements, Performed by Resonance Frequency Analysis, in Micromobility of Dental Implants: An In Vitro Study.

PubMed

Brizuela-Velasco, Aritza; Álvarez-Arenal, Ángel; Gil-Mur, Francisco Javier; Herrero-Climent, Mariano; Chávarri-Prado, David; Chento-Valiente, Yelko; Dieguez-Pereira, Markel

2015-10-01

To evaluate the micromobility of dental implants under occlusal loading in relation to stability measurements of resonance frequency analysis and insertion torque. The sample comprised of 24 implants inserted in 12 fresh cow ribs. Insertion torque and Osstell implant stability quotient (ISQ) measurements were recorded. An "ad hoc" acrylic premolar was made on a temporary abutment and screwed to each implant, and a force of 100 N was subsequently applied at an angle of 6 degrees. Implant micromotion was measured using a Questar microscope with a resolution of 2 μm and an image analysis program. Data show a statistically significant inverse correlation between the ISQ values and implant micromotion under a load of 100 N (R = 0.86, P < 0.0001). The same relationship is found between insertion torque and implant micromotion, although the relationship is linear up to 34 N·cm and becomes exponential for higher values (R = 0.78, P < 0.0001). A direct correlation is established between insertion torque and ISQ values. There is an inverse relationship between both ISQ and insertion torque values and implant micromotion under a load of 100 N.

Primary stability, insertion torque and bone density of cylindric implant ad modum Branemark: is there a relationship? An in vitro study.

PubMed

Trisi, Paolo; De Benedittis, Simona; Perfetti, Giorgio; Berardi, Davide

2011-05-01

Protocols of immediate loading have been reported in several studies. It has also been demonstrated that the cause of failure of immediate loaded implants is due to the micromotion on the bone-implant interface induced by immediate loading. There should be a minimum gap between the implant and the peri-implant bone, without micromotions occurring above a definite threshold risk as they induce bone resorption and fibrosis around the implant. Measurement of the torque necessary to insert an implant in the bone is a parameter for measuring initial stability. The higher the implant insertion torque, the higher the initial stability attained. The aim of this study was to evaluate in vitro the correlation between the micromotion of cylindric screw implants ad modum Branemark and the insertion torque in bone of different densities. The test was carried out on 2 × 2 cm samples of fresh bovine bone of three different densities: hard (H), medium (M) and soft (S). One hundred and fifty hexa implants ad modum Branemark were used, 3.75 mm in diameter and 9 mm long. To screw in the implants, a customized manual key was used, controlled digitally to evaluate the peak insertion torques. Ten implants were prepared for each torque (20, 35, 45, 70 and 100 N/cm). The bone sample was then fixed on a loading device, which allowed evaluating the micromotion. On each sample, we applied a 25 N horizontal force. The results indicate that the peak insertion torque and the implant micromotion are statistically correlated, and statistically significant differences in H and M bone were found compared with S bone. In S bone, we noted a micromotion significantly higher than the risk threshold, and it was not possible to reach peak insertion torque above 35 N/cm. In H and M bone, the micromotion is below the threshold of all insertion torques. Increasing the peak insertion torque, we can reduce the extent of the micromotion between the implant and the bone when submitted to lateral forces in vitro. In soft bone, the micromotion was always high; hence, immediate loading of implants in low-density bone should be evaluated with care. © 2010 John Wiley & Sons A/S.

Load Transfer Characteristics of Various Designs of Three-Implant-Retained Mandibular Overdentures.

PubMed

Tokar, Emre; Uludag, Bulent

2015-01-01

Many different attachment systems (eg, bars, studs, magnets, telescopic copings) have been used to retain overdentures. The current study aimed to investigate the load transfer characteristics and to compare the stress levels of four attachment designs for mandibular overdentures retained by one central implant and two inclined distal implants. Photoelastic mandibular models fabricated with three screw-type implants (Tapered Screw-Vent, 3.75 × 13 mm) were placed in the parasymphyseal area. The center implant was vertically oriented to the midline, and the other implants were embedded in the canine areas with a 20-degree angulation relative to the center implant. Four overdentures with different attachment designs (bar, bar/ball, bar/distally placed Rk-1s, and Locators) were studied in the context of this model. Vertical loads (100 N) were applied to the central fossa of the right first molar area of each overdenture. Stress levels that developed in the denture-bearing areas and around the implants were observed photoelastically and evaluated visually. The studied attachment designs showed low and moderate stress levels. The greatest stress was found with the bar/ball design, while the lowest stress levels were observed with the Locator attachment design. Stresses were concentrated on the loaded side for each design. All tested designs experienced moderate stress around the posterior edentulous area. None of the designs experienced more than moderate stress. The lowest stress was noted with the Locator attachments, which transmitted little discernible stress around the implants.

Effect of cantilever length and alloy framework on the stress distribution in peri-implant area of cantilevered implant-supported fixed partial dentures

PubMed Central

SUEDAM, Valdey; MORETTI, Rafael Tobias; SOUSA, Edson Antonio Capello; RUBO, José Henrique

2016-01-01

ABSTRACT Because many mechanical variables are present in the oral cavity, the proper load transfer between the prosthesis and the bone is important for treatment planning and for the longevity of the implant-supported fixed partial denture. Objectives To verify the stress generated on the peri-implant area of cantilevered implant-supported fixed partial dentures and the potential effects of such variable. Material and Methods A U-shaped polyurethane model simulating the mandibular bone containing two implants (Ø 3.75 mm) was used. Six groups were formed according to the alloy’s framework (CoCr or PdAg) and the point of load application (5 mm, 10 mm and 15 mm of cantilever arm). A 300 N load was applied in pre-determined reference points. The tension generated on the mesial, lingual, distal and buccal sides of the peri-implant regions was assessed using strain gauges. Results Two-way ANOVA and Tukey statistical tests were applied showing significant differences (p<0.05) between the groups. Pearson correlation test (p<0.05) was applied showing positive correlations between the increase of the cantilever arm and the deformation of the peri-implant area. Conclusions This report demonstrated the CoCr alloy shows larger compression values compared to the PdAg alloy for the same distances of cantilever. The point of load application influences the deformation on the peri-implant area, increasing in accordance with the increase of the lever arm. PMID:27119758

A novel open-tray impression technique for fabrication of a provisional prosthesis on immediate load implants in a completely edentulous arch.

PubMed

Kaneko, Takahiro; Yamagishi, Kiyoshi; Horie, Norio; Shimoyama, Tetsuo

2013-01-01

To evaluate the clinical outcome of a novel open-tray impression technique for fabrication of a provisional prosthesis supported by immediately loaded implants in a completely edentulous arch. An open-tray impression technique was evaluated in this retrospective study that included patients treated between March 2006 and October 2009. Preoperatively, a diagnostic prosthesis was delivered, and a novel open tray was fabricated based on this prosthesis. After implant placement, the impression and interocclusal record were taken simultaneously using the novel open tray. Laboratory-fabricated, screw-retained, all-acrylic resin provisional restorations were delivered on the same day of surgery. The prosthesis was assessed from the day of surgery until replacement with a definitive prosthesis. The study included 21 patients (mean age, 64.5 years) and a total of 125 implants. Of these, 104 implants were immediately loaded. In all patients, well-fitting provisional restorations supported by a minimum of four implants were delivered. Fracture of the first molar cusp was observed in one case after 30 days. However, there was no extensive fracture in the framework or functional disorder of the prosthesis. No implant failed during the follow-up after implant surgery. This protocol enabled fabrication of a well-fitting acrylic resin provisional prosthesis supported by immediately loaded implants because the impression was taken while in centric occlusion and an occlusion identical to the diagnostic prosthesis could be reconstructed.

Spinal loads as influenced by external loads: a combined in vivo and in silico investigation.

PubMed

Zander, Thomas; Dreischarf, Marcel; Schmidt, Hendrik; Bergmann, Georg; Rohlmann, Antonius

2015-02-26

Knowledge of in vivo spinal loads and muscle forces remains limited but is necessary for spinal biomechanical research. To assess the in vivo spinal loads, measurements with telemeterised vertebral body replacements were performed in four patients. The following postures were investigated: (a) standing with arms hanging down on sides, (b) holding dumbbells to subject the patient to a vertical load, and (c) the forward elevation of arms for creating an additional flexion moment. The same postures were simulated by an inverse static model for validation purposes, to predict muscle forces, and to assess the spinal loads in subjects without implants. Holding dumbbells on sides increased implant forces by the magnitude of the weight of the dumbbells. In contrast, elevating the arms yielded considerable implant forces with a high correlation between the external flexion moment and the implant force. Predictions agreed well with experimental findings, especially for forward elevation of arms. Flexion moments were mainly compensated by erector spinae muscles. The implant altered the kinematics and, thus, the spinal loads. Elevation of both arms in vivo increased spinal axial forces by approximately 100N; each additional kg of dumbbell weight held in the hands increased the spinal axial forces by 60N. Model predictions suggest that in the intact situation, the force increase is one-third greater for these loads. In vivo measurements are essential for the validation of analytical models, and the combination of both methods can reveal unquantifiable data such as the spinal loads in the intact non-instrumented situation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Influence of bicortical techniques in internal connection placed in premaxillary area by 3D finite element analysis.

PubMed

Verri, Fellippo Ramos; Cruz, Ronaldo Silva; Lemos, Cleidiel Aparecido Araújo; de Souza Batista, Victor Eduardo; Almeida, Daniel Augusto Faria; Verri, Ana Caroline Gonçales; Pellizzer, Eduardo Piza

2017-02-01

The aim of study was to evaluate the stress distribution in implant-supported prostheses and peri-implant bone using internal hexagon (IH) implants in the premaxillary area, varying surgical techniques (conventional, bicortical and bicortical in association with nasal floor elevation), and loading directions (0°, 30° and 60°) by three-dimensional (3D) finite element analysis. Three models were designed with Invesalius, Rhinoceros 3D and Solidworks software. Each model contained a bone block of the premaxillary area including an implant (IH, Ø4 × 10 mm) supporting a metal-ceramic crown. 178 N was applied in different inclinations (0°, 30°, 60°). The results were analyzed by von Mises, maximum principal stress, microstrain and displacement maps including ANOVA statistical test for some situations. Von Mises maps of implant, screws and abutment showed increase of stress concentration as increased loading inclination. Bicortical techniques showed reduction in implant apical area and in the head of fixation screws. Bicortical techniques showed slight increase stress in cortical bone in the maximum principal stress and microstrain maps under 60° loading. No differences in bone tissue regarding surgical techniques were observed. As conclusion, non-axial loads increased stress concentration in all maps. Bicortical techniques showed lower stress for implant and screw; however, there was slightly higher stress on cortical bone only under loads of higher inclinations (60°).

Comparative histomorphometry and resonance frequency analysis of implants with moderately rough surfaces in a loaded animal model.

PubMed

Al-Nawas, B; Groetz, K A; Goetz, H; Duschner, H; Wagner, W

2008-01-01

Test of favourable conditions for osseointegration with respect to optimum bone-implant contact (BIC) in a loaded animal model. The varied parameters were surface roughness and surface topography of commercially available dental implants. Thirty-two implants of six types of macro and microstructure were included in the study (total 196). The different types were: minimally rough control: Branemark machined Mk III; oxidized surface: TiUnite MkIII and MkIV; ZL Ticer; blasted and etched surface: Straumann SLA; rough control: titanium plasma sprayed (TPS). Sixteen beagle dogs were implanted with the whole set of the above implants. After a healing period of 8 weeks, implants were loaded for 3 months. For the evaluation of the BIC areas, adequately sectioned biopsies were visualized by subsurface scans with confocal laser scanning microscopy (CLSM). The primary statistical analysis testing BIC of the moderately rough implants (mean 56.1+/-13.0%) vs. the minimally rough and the rough controls (mean 53.9+/-11.2%) does not reveal a significant difference (P=0.57). Mean values of 50-70% BIC were found for all implant types. Moderately rough oxidized implants show a median BIC, which is 8% higher than their minimally rough turned counterpart. The intraindividual difference between the TPS and the blasted and etched counterparts revealed no significant difference. The turned and the oxidized implants show median values of the resonance frequency [implant stability quotients (ISQ)] over 60; the nonself-tapping blasted and etched and TPS implants show median values below 60. In conclusion, the benefit of rough surfaces relative to minimally rough ones in this loaded animal model was confirmed histologically. The comparison of different surface treatment modalities revealed no significant differences between the modern moderately rough surfaces. Resonance frequency analysis seems to be influenced in a major part by the transducer used, thus prohibiting the comparison of different implant systems.

Finite element analysis of a novel implant distribution to support maxillary overdentures.

PubMed

Osman, Reham B; Elkhadem, Amr H; Ma, Sunyoung; Swain, Michael V

2013-01-01

To evaluate the biomechanics of a novel implant placement distribution and compare it with that of conventional maxillary overdenture support using three-dimensional finite element analysis (FEA). The application of zirconia implants in the context of this novel design was also evaluated. Detailed FEA models were created to analyze the loading responses of two different distributions of implants to support maxillary overdentures. The two implant distributions were as follows: the conventional design (D1) included four unsplinted implants in the premolar regions, whereas the novel design (D2) included one midpalatal implant, bilateral canine/premolar implants, and one anterior off-center crestal implant. Anatomical models were created with computed tomographic data and static loads were applied axially and obliquely. Von Mises stresses and equivalent strains generated in peri-implant bone and first principal stresses in the implants were calculated, including any denture displacement. Comparable stress and strain values were seen in the peri-implant bone for both designs. A significant decrease in the first principal stresses of D2 implants was observed with oblique loads. The maximum equivalent strain produced in the peri-implant region was mostly within the range for bone augmentation. D2 displayed lower maximum displacement values than D1. Maximum tensile stresses in the zirconia implants for either design were well below their fracture strength. A novel four-implant distribution involving midpalatal and crestal implants may be an alternative to the conventional design used for maxillary overdentures. This is particularly relevant when anatomical considerations prevent the placement of four anterior crestal implants. Zirconia implants may also be a valid option for a selected group of patients or for those requesting metal-free restorations. Prospective clinical studies are required to confirm these in vitro results.

Revival of pure titanium for dynamically loaded porous implants using additive manufacturing.

PubMed

Wauthle, Ruben; Ahmadi, Seyed Mohammad; Amin Yavari, Saber; Mulier, Michiel; Zadpoor, Amir Abbas; Weinans, Harrie; Van Humbeeck, Jan; Kruth, Jean-Pierre; Schrooten, Jan

2015-09-01

Additive manufacturing techniques are getting more and more established as reliable methods for producing porous metal implants thanks to the almost full geometrical and mechanical control of the designed porous biomaterial. Today, Ti6Al4V ELI is still the most widely used material for porous implants, and none or little interest goes to pure titanium for use in orthopedic or load-bearing implants. Given the special mechanical behavior of cellular structures and the material properties inherent to the additive manufacturing of metals, the aim of this study is to investigate the properties of selective laser melted pure unalloyed titanium porous structures. Therefore, the static and dynamic compressive properties of pure titanium structures are determined and compared to previously reported results for identical structures made from Ti6Al4V ELI and tantalum. The results show that porous Ti6Al4V ELI still remains the strongest material for statically loaded applications, whereas pure titanium has a mechanical behavior similar to tantalum and is the material of choice for cyclically loaded porous implants. These findings are considered to be important for future implant developments since it announces a potential revival of the use of pure titanium for additively manufactured porous implants. Copyright © 2015 Elsevier B.V. All rights reserved.

Strain Distribution in a Kennedy Class I Implant Assisted Removable Partial Denture under Various Loading Conditions

PubMed Central

Shahmiri, Reza; Aarts, John M.; Bennani, Vincent; Swain, Michael V.

2013-01-01

Purpose. This in vitro study investigates how unilateral and bilateral occlusal loads are transferred to an implant assisted removable partial denture (IARPD). Materials and Methods. A duplicate model of a Kennedy class I edentulous mandibular arch was made and then a conventional removable partial denture (RPD) fabricated. Two Straumann implants were placed in the second molar region, and the prosthesis was modified to accommodate implant retained ball attachments. Strain gages were incorporated into the fitting surface of both the framework and acrylic to measure microstrain (μStrain). The IARPD was loaded to 120Ns unilaterally and bilaterally in three different loading positions. Statistical analysis was carried out using SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA) with an alpha level of 0.05 to compare the maximum μStrain values of the different loading conditions. Results. During unilateral and bilateral loading the maximum μStrain was predominantly observed in a buccal direction. As the load was moved anteriorly the μStrain increased in the mesial area. Unilateral loading resulted in a twisting of the structure and generated a strain mismatch between the metal and acrylic surfaces. Conclusions. Unilateral loading created lateral and vertical displacement of the IARPD. The curvature of the dental arch resulted in a twisting action which intensified as the unilateral load was moved anteriorly. PMID:23737788

Immediate loading of unsplinted implants in the anterior mandible for overdentures: 3-year results.

PubMed

Roe, Phillip; Kan, Joseph Y K; Rungcharassaeng, Kitichai; Lozada, Jaime L

2011-01-01

This 3-year study evaluated the implant survival rate, peri-implant tissue response, prosthetic maintenance, and prosthetic complications in a series of patients who received two immediately loaded unsplinted threaded implants to retain a mandibular overdenture. Eight completely edentulous patients were evaluated clinically and radiographically immediately after implant placement, at 3 months, and at 1, 2, and 3 years after implant placement. Data were analyzed using repeated-measures one-way analysis of variance and the Wilcoxon signed rank test at a significance level of α = .05. At 3 years, all implants remained osseointegrated (16/16), with an overall mean marginal bone change of -0.58 ± 0.39 mm and a mean Periotest value of -7.19 ± 0.54. The modified Plaque Index scores showed marked improvement in oral hygiene during the first year, but some relapse was observed thereafter. Prosthetic maintenance and complications included replacement of the attachment inserts, abutment loosening, dislodgement of the attachment housing, overdenture reline, denture tooth fracture, and overdenture base fracture. This 3-year study suggests that, despite less than ideal oral hygiene and a high incidence of complete/partial fracture of overdentures, favorable implant survival rate and peri-implant tissue responses can be achieved in mandibular overdentures retained with two immediately loaded unsplinted threaded implants.

Fracture resistance of the implant-abutment connection in implants with internal hex and internal conical connections under oblique compressive loading: an in vitro study.

PubMed

Coppedê, Abílio Ricciardi; Bersani, Edmilson; de Mattos, Maria da Gloria Chiarello; Rodrigues, Renata Cristina Silveira; Sartori, Ivete Aparecida de Mattias; Ribeiro, Ricardo Faria

2009-01-01

The objective of this study was to verify if differences in the design of internal hex (IH) and internal conical (IC) connection implant systems influence fracture resistance under oblique compressive forces. Twenty implant-abutment assemblies were utilized: 10 with IH connections and 10 with IC connections. Maximum deformation force for IC implants (90.58 +/- 6.72 kgf) was statistically higher than that for IH implants (83.73 +/- 4.94 kgf) (P = .0182). Fracture force for the IH implants was 79.86 +/- 4.77 kgf. None of the IC implants fractured. The friction-locking mechanics and the solid design of the IC abutments provided greater resistance to deformation and fracture under oblique compressive loading when compared to the IH abutments.

Cemented fixation with PMMA or Bis-GMA resin hydroxyapatite cement: effect of implant surface roughness.

PubMed

Walsh, W R; Svehla, M J; Russell, J; Saito, M; Nakashima, T; Gillies, R M; Bruce, W; Hori, R

2004-09-01

Implant surface roughness is an important parameter governing the overall mechanical properties at the implant-cement interface. This study investigated the influence of surface roughness using polymethylmethcrylate (PMMA) and a Bisphenol-a-glycidylmethacyrlate resin-hydroxyapatite cement (CAP). Mechanical fixation at the implant-cement interface was evaluated in vitro using static shear and fatigue loading with cobalt chrome alloy (CoCr) dowels with different surface roughness preparations. Increasing surface roughness improved the mechanical properties at the implant-cement interface for both types of cement. CAP cement fixation was superior to PMMA under static and dynamic loading.

Biomechanics and strain mapping in bone as related to immediately-loaded dental implants

PubMed Central

Du, Jing; Lee, Jihyun; Jang, Andrew; Gu, Allen; Hossaini-Zadeh, Mehran; Prevost, Richard; Curtis, Don; Ho, Sunita

2015-01-01

The effects of alveolar bone socket geometry and bone-implant contact on implant biomechanics, and resulting strain distributions in bone were investigated. Following extraction of lateral incisors on a cadaver mandible, immediate implants were placed and bone-implant contact area, stability and bone strain were measured. In situ biomechanical testing coupled with micro X-ray microscope (μ-XRM) illustrated less stiff bone-implant complexes (701-822 N/mm) compared with bone-periodontal ligament (PDL)-tooth complexes (791-913 N/mm). X-ray tomograms illustrated that the cause of reduced stiffness was due to reduced and limited bone-implant contact. Heterogeneous elemental composition of bone was identified by using energy dispersive X-ray spectroscopy (EDS). The novel aspect of this study was the application of a new experimental mechanics method, that is, digital volume correlation, which allowed mapping of strains in volumes of alveolar bone in contact with a loaded implant. The identified surface and subsurface strain concentrations were a manifestation of load transferred to bone through bone-implant contact based on bone-implant geometry, quality of bone, implant placement, and implant design. 3D strain mapping indicated that strain concentrations are not exclusive to the bone-implant contact regions, but also extend into bone not directly in contact with the implant. The implications of the observed strain concentrations are discussed in the context of mechanobiology. Although a plausible explanation of surgical complications for immediate implant treatment is provided, extrapolation of results is only warranted by future systematic studies on more cadaver specimens and/or in vivo small scale animal models. PMID:26162549

Ultimate force and stiffness of 2-piece zirconium dioxide implants with screw-retained monolithic lithium-disilicate reconstructions.

PubMed

Joda, Tim; Voumard, Benjamin; Zysset, Philippe K; Brägger, Urs; Ferrari, Marco

2018-04-01

The aims were to analyze stiffness, ultimate force, and failure modes of a 2-piece zirconium dioxide (ZrO 2 ) implant system. Eleven 2-piece ZrO 2 implants, each mounted with ZrO 2 abutments plus bonded monolithic lithium disilicate (LS 2 ) restorations, were grouped for 3.3mm (A) and 4.1mm (B) diameter samples. Quasi-static load was monotonically applied under a standardized test set-up (loading configuration according to DIN ISO 14801). The ultimate force was defined as the maximum force that implants are able to carry out until fracture; stiffness was measured as the maximum slope during loading. An unpaired t-test was performed between group A and B for ultimate force and stiffness (p<0.05). Force-displacement curves revealed statistically homogenous inner-group results for all samples. Failure modes showed characteristic fractures at the neck configuration of the implants independent of the diameter. Mean stiffness was 1099N/mm (±192) for group A, and significantly lower compared to group B with 1630N/mm (±274) (p<0.01); whereas mean ultimate force was 348N (±53) for group A, and significantly increased for group B with 684N (±29) (p<0.0001). The examined 2-piece ZrO 2 implant system mounted to LS 2 -restorations seems to be a stable unit under in-vitro conditions with mechanical properties compared to loading capacity of physiological force. The metal-free implant reconstructions demonstrated high stiffness and ultimate force under quasi-static load for single tooth replacement under consideration of the dental indication of narrow and standard diameter implants. Copyright © 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Comparison of patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures: A preliminary study.

PubMed

Omura, Yuri; Kanazawa, Manabu; Sato, Daisuke; Kasugai, Shohei; Minakuchi, Shunsuke

2016-07-01

The aim of this preliminary study is to compare patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures retained by magnetic attachments. Nineteen participants with edentulous mandibles were randomly assigned into either an immediate loading group (immediate group) or a conventional loading group (conventional group). Each participant received 2 implants in the inter-foraminal region by means of flapless surgery. Prostheses in the immediate and conventional groups were loaded using magnetic attachments on the same day as implant placement or 3 months after surgery, respectively. All participants completed questionnaires (the Japanese version of the Oral Health Impact Profile for edentulous [OHIP-EDENT-J], the patient's denture assessment [PDA], and general satisfaction) before implant placement (baseline) and 1, 2, 3, 4, 5, 6, and 12 months after surgery. The median differences between baseline and each monthly score were compared using the Mann-Whitney U test. The differences in median and 95% confidence interval between two groups were analyzed. The immediate group showed slightly lower OHIP-EDENT-J summary score at 1 and 3 months than the conventional group (P=0.09). In the lower denture domain of PDA, the immediate group showed a statistically higher score at 3 months (P=0.04). There was no statistically significant difference in general satisfaction between the two groups. Based on this preliminary study, immediate loading of mandibular two-implant overdentures with magnetic attachments tends to improve oral health-related quality of life and patient assessment earlier than observed with a conventional loading protocol. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Prosthetic Influence and Biomechanics on Peri-Implant Strain: a Systematic Literature Review of Finite Element Studies.

PubMed

Maminskas, Julius; Puisys, Algirdas; Kuoppala, Ritva; Raustia, Aune; Juodzbalys, Gintaras

2016-01-01

To systematically review risks of mechanical impact on peri-implant strain and prosthetic influence on stability across finite element studies. An online literature search was performed on MEDLINE and EMBASE databases published between 2011 and 2016. Following keywords tiered screening and selection of the title, abstract and full-text were performed. Studies of finite element analysis (FEA) were considered for inclusion that were written in English and revealed stress concentrations or strain at peri-implant bone level. There were included 20 FEA studies in total. Data were organized according to the following topics: bone layers, type of bone, osseointegration level, bone level, design of implant, diameter and length of implant, implant-abutment connection, type of supra-construction, loading axis, measurement units. The stress or strain at implant-bone contact was measured over all studies and numerical values estimated. Risks of overloading were accented as non-axial loading, misfits, cantilevers and the stability of peri-implant bone was related with the usage of platform switch connection of abutment. Peri-implant area could be affected by non-axial loading, cantilever prosthetic elements, crown/implant ratio, type of implant-abutment connection, misfits, properties of restoration materials and antagonistic tooth. The heterogeneity of finite element analysis studies limits systematization of data. Results of these studies are comparable with other findings of in vitro , in vivo , prospective and retrospective studies.

A novel dynamic mechanical testing technique for reverse shoulder replacements.

PubMed

Dabirrahmani, Danè; Bokor, Desmond; Appleyard, Richard

2014-04-01

In vitro mechanical testing of orthopedic implants provides information regarding their mechanical performance under simulated biomechanical conditions. Current in vitro component stability testing methods for reverse shoulder implants are based on anatomical shoulder designs, which do not capture the dynamic nature of these loads. With glenoid component loosening as one of the most prevalent modes of failure in reverse shoulder replacements, it is important to establish a testing protocol with a more realistic loading regime. This paper introduces a novel method of mechanically testing reverse shoulder implants, using more realistic load magnitudes and vectors, than is currently practiced. Using a custom made jig setup within an Instron mechanical testing system, it is possible to simulate the change in magnitude and direction of the joint load during arm abduction. This method is a step towards a more realistic testing protocol for measuring reverse shoulder implant stability.

Cortical bone strains around straight and angulated immediate orthodontic microimplants: a pilot study.

PubMed

Cehreli, Secil; Yilmaz, Alev; Arman-Ozcirpici, Ayca

2013-04-01

To measure strains around orthodontic implants upon torque tightening and loading and to assess correlations between factors influencing primary stability. Self-drilling implants were placed into bovine iliac crest blocks after CT assessments. Upon bonding of strain gauges on bone adjacent to the implants, strain measurements were performed using a data acquisition system during torque tightening and 250 g orthodontic force application by elastic chains. The torque required to place straight implants (12.16 N.cm) was higher than 30- to 40-degree angulated implants (9.31 N.cm) (P < 0.05). Cortical bone strain amplitudes of both implant placements were comparable (P > 0.05). Strains during torque tightening of straight (196 με) and tilted (114 με) implants were higher than those obtained during orthodontic loading (20-30 με). Despite the positive and direct relationship found between torque and torque strain output, strong correlations between other parameters could not be detected. Vertically aligned and 30- to 40-degree angulated immediate orthodontic microimplants are associated with low amplitude strains upon torque tightening and orthodontic loading.

Assessment of different polymers and drug loads for fused deposition modeling of drug loaded implants.

PubMed

Kempin, Wiebke; Franz, Christian; Koster, Lynn-Christine; Schneider, Felix; Bogdahn, Malte; Weitschies, Werner; Seidlitz, Anne

2017-06-01

The 3D printing technique of fused deposition modeling® (FDM) has lately come into focus as a potential fabrication technique for pharmaceutical dosage forms and medical devices that allows the preparation of delivery systems with nearly any shape. This is particular promising for implants administered at application sites with a high anatomical variability where an individual shape adaption appears reasonable. In this work different polymers (Eudragit®RS, polycaprolactone (PCL), poly(l-lactide) (PLLA) and ethyl cellulose (EC)) were evaluated with respect to their suitability for FDM of drug loaded implants and their drug release behaviour was evaluated. The fluorescent dye quinine was used as a model drug to visualize drug distribution in filaments and implants. Quinine loaded filaments were produced by solvent casting and subsequent hot melt extrusion (HME) and model implants were printed as hollow cylinders using a standard FDM printer. Parameters were found at which model implants (hollow cylinders, outer diameter 4-5mm, height 3mm) could be produced from all tested polymers. The drug release which was examined by incubation of the printed implants in phosphate buffered saline solution (PBS) pH 7.4 was highly dependent on the used polymer. The fastest relative drug release of approximately 76% in 51days was observed for PCL and the lowest for Eudragit®RS and EC with less than 5% of quinine release in 78 and 100days, respectively. For PCL further filaments were prepared with different quinine loads ranging from 2.5% to 25% and thermal analysis proved the presence of a solid dispersion of quinine in the polymer for all tested concentrations. Increasing the drug load also increased the overall percentage of drug released to the medium since nearly the same absolute amount of quinine remained trapped in PCL at the end of drug release studies. This knowledge is valuable for future developments of printed implants with a desired drug release profile that might be controlled by the choice of the polymer and the drug load. Copyright © 2017 Elsevier B.V. All rights reserved.

An In Vitro Evaluation of the Loosening of Different Interchangeable Abutments in Internal-Connection-Type Implants.

PubMed

Park, Ji-Man; Baek, Chang-Hyun; Heo, Seong-Joo; Kim, Seong-Kyun; Koak, Jai-Young; Kim, Shin-Koo; Belser, Urs C

The aim of this study was to compare the loosening of interchangeable one-piece abutments connected to internal-connection-type implants after cyclic loading. Four implant abutment groups (n = 7 in each group) with Straumann tissue-level implants were assessed: Straumann solid abutment (group S), Southern Implants solid abutment (group SI), Implant Direct straight abutment (group ID), and Blue Sky Bio regular platform abutment (group BSB). The implant was firmly held in a special jig to ensure fixation. Abutment screws were tightened to manufacturers' recommended torque with a digital torque gauge. The hemispherical loading members were fabricated for the load cell of a universal testing machine to evenly distribute the force on the specimens and to fulfill the ISO 14801:2007 standard. A cyclic loading of 25 N at 30 degrees to the implant's long axis was applied for a duty of a half million cycles. Tightening torques were measured prior to the loading. Removal torques were measured after cyclic loading. The data were analyzed with one-way analysis of variance (ANOVA), and the significance level was set at P < .05. The mean removal torques after cyclic loading were 34.0 ± 1.1 Ncm (group S), 25.0 ± 1.5 Ncm (group SI), 23.9 ± 2.1 Ncm (group ID), and 27.9 ± 1.3 Ncm (group BSB). Removal torques of each group were statistically different in the order of group S > group BSB > groups SI and ID (P < .05). The mean reduction rates were -2.9% ± 3.2% (group S), -21.9% ± 4.8% (group SI), -20.2% ± 7.2% (group ID), and -6.9% ± 4.3% (group BSB) after a half million cycles, respectively. Reduction rates of groups S and BSB were statistically lower than those of groups SI and ID (P < .01). The standard deviation of group S was lower than group BSB. The removal torque of the original Straumann abutment was significantly higher than those of the copy abutments. The reduction rate of the groups S and BSB abutments was lower than those of the other copy abutments.

Load-bearing capacity of screw-retained CAD/CAM-produced titanium implant frameworks (I-Bridge®2) before and after cyclic mechanical loading.

PubMed

Dittmer, Marc Philipp; Nensa, Moritz; Stiesch, Meike; Kohorst, Philipp

2013-01-01

Implant-supported screw-retained fixed dental prostheses (FDPs) produced by CAD/ CAM have been introduced in recent years for the rehabilitation of partial or total endentulous jaws. However, there is a lack of data about the long-term mechanical characteristics. The aim of this study was to investigate the failure mode and the influence of extended cyclic mechanical loading on the load-bearing capacity of these frameworks. Ten five-unit FDP frameworks simulating a free-end situation in the mandibular jaw were manufactured according to the I-Bridge®2-concept (I-Bridge®2, Biomain AB, Helsingborg, Sweden) and each was screw-retained on three differently angulated Astra Tech implants (30º buccal angulation/0º angulation/30º lingual angulation). One half of the specimens was tested for static load-bearing capacity without any further treatment (control), whereas the other half underwent five million cycles of mechanical loading with 100 N as the upper load limit (test). All specimens were loaded until failure in a universal testing machine with an occlusal force applied at the pontics. Load-displacement curves were recorded and the failure mode was macro- and microscopically analyzed. The statistical analysis was performed using a t-test (p=0.05). All the specimens survived cyclic mechanical loading and no obvious failure could be observed. Due to the cyclic mechanical loading, the load-bearing capacity decreased from 8,496 N±196 N (control) to 7,592 N±901 N (test). The cyclic mechanical loading did not significantly influence the load-bearing capacity (p=0.060). The failure mode was almost identical in all specimens: large deformations of the framework at the implant connection area were obvious. The load-bearing capacity of the I-Bridge®2 frameworks is much higher than the clinically relevant occlusal forces, even with considerably angulated implants. However, the performance under functional loading in vivo depends on additional aspects. Further studies are needed to address these aspects.

Load-bearing capacity of screw-retained CAD/CAM-produced titanium implant frameworks (I-Bridge®2) before and after cyclic mechanical loading

PubMed Central

DITTMER, Marc Philipp; NENSA, Moritz; STIESCH, Meike; KOHORST, Philipp

2013-01-01

Implant-supported screw-retained fixed dental prostheses (FDPs) produced by CAD/ CAM have been introduced in recent years for the rehabilitation of partial or total endentulous jaws. However, there is a lack of data about the long-term mechanical characteristics. Objective The aim of this study was to investigate the failure mode and the influence of extended cyclic mechanical loading on the load-bearing capacity of these frameworks. Material and Methods Ten five-unit FDP frameworks simulating a free-end situation in the mandibular jaw were manufactured according to the I-Bridge®2-concept (I-Bridge®2, Biomain AB, Helsingborg, Sweden) and each was screw-retained on three differently angulated Astra Tech implants (30º buccal angulation/0º angulation/30º lingual angulation). One half of the specimens was tested for static load-bearing capacity without any further treatment (control), whereas the other half underwent five million cycles of mechanical loading with 100 N as the upper load limit (test). All specimens were loaded until failure in a universal testing machine with an occlusal force applied at the pontics. Load-displacement curves were recorded and the failure mode was macro- and microscopically analyzed. The statistical analysis was performed using a t-test (p=0.05). Results All the specimens survived cyclic mechanical loading and no obvious failure could be observed. Due to the cyclic mechanical loading, the load-bearing capacity decreased from 8,496 N±196 N (control) to 7,592 N±901 N (test). The cyclic mechanical loading did not significantly influence the load-bearing capacity (p=0.060). The failure mode was almost identical in all specimens: large deformations of the framework at the implant connection area were obvious. Conclusion The load-bearing capacity of the I-Bridge®2 frameworks is much higher than the clinically relevant occlusal forces, even with considerably angulated implants. However, the performance under functional loading in vivo depends on additional aspects. Further studies are needed to address these aspects. PMID:24037068

Modular adaptive implant based on smart materials.

PubMed

Bîzdoacă, N; Tarniţă, Daniela; Tarniţă, D N

2008-01-01

Applications of biological methods and systems found in nature to the study and design of engineering systems and modern technology are defined as Bionics. The present paper describes a bionics application of shape memory alloy in construction of orthopedic implant. The main idea of this paper is related to design modular adaptive implants for fractured bones. In order to target the efficiency of medical treatment, the implant has to protect the fractured bone, for the healing period, undertaking much as is possible from the daily usual load of the healthy bones. After a particular stage of healing period is passed, using implant modularity, the load is gradually transferred to bone, assuring in this manner a gradually recover of bone function. The adaptability of this design is related to medical possibility of the physician to made the implant to correspond to patient specifically anatomy. Using a CT realistic numerical bone models, the mechanical simulation of different types of loading of the fractured bones treated with conventional method are presented. The results are commented and conclusions are formulated.

Implant Dentistry: Monitoring of Bacteria Along the Transmucosal Passage of the Healing Screw in Absence of Functional Load

PubMed Central

MEYNARDI, F.; PASQUALINI, M.E.; ROSSI, F.; DAL CARLO, L.; NARDONE, M.; BAGGI, L.

2016-01-01

SUMMARY Purpose To assess the changes in bacterial profile along the transmucosal path of healing screws placed immediately after insertion of two-piece endosseus implants during the 4-month osseointegration phase, in absence of functional load. Materials and methods Two site-specific samples were collected at the peri-implant mucosa of the healing screws of 80 two-piece implants, for a total of 640 samples. Implants placement was performed following a single protocol with flapless technique, in order to limit bacterial contamination of the surgical site. Identical healing screws (5 mm diameter/4 mm height) were used for each of the 80 implants. During the 4 months of the study, the patients followed a standard oral care regimen with no special hygiene maneuvers at the collection sites. Results The present research documents that during the 4-month period prior to application of function load the bacterial profile of all sites exhibited a clear prevalence of cocci at the interface between implant neck and osteoalveolar crest margin. Conclusions A potentially pathogenic bacterial flora developed only along the peri-implant transmucosal path. PMID:28280528

Clinical evaluation of a novel dental implant system as single implants under immediate loading conditions - 4-month post-loading results from a multicentre randomised controlled trial.

PubMed

Esposito, Marco; Trullenque-Eriksson, Anna; Blasone, Rodolfo; Malaguti, Giuliano; Gaffuri, Cristiano; Caneva, Marco; Minciarelli, Armando; Luongo, Giuseppe

To evaluate the safety and clinical effectiveness of a novel dental implant system (GENESIS Implant System, Keystone Dental, Massachusetts, USA) using another dental implant system by the same manufacturer as a control (PRIMA Implant System, Keystone Dental). A total of 53 patients requiring at least two single crowns had their sites randomised according to a split-mouth design to receive both implant systems at six centres. If implants could be placed with a torque superior to 40 Ncm they were to be loaded immediately with provisional crowns, otherwise after 3 months of submerged healing. Provisional crowns were replaced by definitive crowns 4 months after initial loading, when the follow-up period for the initial part of this study was completed. Outcome measures were crown/implant failures, complications, pink esthetic score (PES), peri-implant marginal bone level changes, plaque score, marginal bleeding, patients and preference of the clinician. In total 53 PRIMA and 53 GENESIS implants were placed. Three patients dropped out but all of the remaining patients were followed up to 4-months post-loading. No PRIMA implant failed whereas four GENESIS implants failed. Only two complications were reported for PRIMA implants. There were no statistically significant differences for crown/implant failures (difference in proportions = 0.080; P (McNemar test) = 0.125) and complications (difference in proportions = -0.04; P (McNemar test) = 0.500) between the implant systems. There were no differences at 4-months post-loading for plaque (difference = -0.54, 95% CI: -3.01 to 1.93; P (Paired t-test) = 0.660), marginal bleeding (difference = -3.8, 95% CI: -7.63 to 0.019; P (Paired t-test) = 0.051), PES (difference = 0.47, 95% CI: -0.56 to 1.50; P (Paired t-test) = 0.365) and marginal bone level changes (difference in mm = -0.04, 95% CI: -0.33 to 0.26; P (Paired t-test) = 0.795). The majority of the patients (46) had no preference regarding the two implant systems evaluated. Three operators preferred GENESIS implants, two had no preference and one preferred GENESIS in medium and soft bone and PRIMA in hard bone. No statistically significant differences were observed between the systems' implant types, although four GENESIS implants failed versus none of the PRIMA type. Longer follow-ups of wider patient populations are needed to better understand whether there is an effective advantage with one of the two implant designs. Conflict-of-interest statement: This research project was originally funded by Keystone Italia, Dental spa (Verona, Italy), the manufacturer of the implants evaluated in this investigation. 
 
However, when Keystone Italia received the data of the present manuscript, they refused to honour the financial agreement for the present publication. Therefore, no further follow-ups of this trial will be considered. A legal action was initiated against Keystone Italia. The data belonged to the authors and by no means was the manufacturer allowed to interfere with the conduct of the trial or the publication of the results.

In-vitro development of a temporal abutment screw to protect osseointegration in immediate loaded implants

PubMed Central

2015-01-01

PURPOSE In this study, a temporal abutment fixation screw, designed to fracture in a controlled way upon application of an occlusal force sufficient to produce critical micromotion was developed. The purpose of the screw was to protect the osseointegration of immediate loaded single implants. MATERIALS AND METHODS Seven different screw prototypes were examined by fixing titanium abutments to 112 Mozo-Grau external hexagon implants (MG Osseous®; Mozo-Grau, S.A., Valladolid, Spain). Fracture strength was tested at 30° in two subgroups per screw: one under dynamic loading and the other without prior dynamic loading. Dynamic loading was performed in a single-axis chewing simulator using 150,000 load cycles at 50 N. After normal distribution of obtained data was verified by Kolmogorov-Smirnov test, fracture resistance between samples submitted and not submitted to dynamic loading was compared by the use of Student's t-test. Comparison of fracture resistance among different screw designs was performed by the use of one-way analysis of variance. Confidence interval was set at 95%. RESULTS Fractures occurred in all screws, allowing easy retrieval. Screw Prototypes 2, 5 and 6 failed during dynamic loading and exhibited statistically significant differences from the other prototypes. CONCLUSION Prototypes 2, 5 and 6 may offer a useful protective mechanism during occlusal overload in immediate loaded implants. PMID:25932315

Initial mechanical stability of cementless highly-porous titanium tibial components

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stone, Timothy Brandon; Amer, Luke D; Warren, Christopher P

Cementless fixation in total knee replacement has seen limited use since reports of early failure surfaced in the late 80s and early 90s. However the emergence of improved biomaterials, particularly porous titanium and tantalum, has led to a renewed interest in developing a cementless tibial component to enhance long-term survivorship of the implants. Cement is commonly employed to minimize micromotion in new implants but represents a weak interface between the implant and bone. The elimination of cement and application of these new biomaterials, which theoretically provide improved stability and ultimate osseointegration, would likely result in greater knee replacement success. Additionally,more » the removal of cement from the procedure would help minimize surgical durations and get rid of the time needed for curing, thereby the chance of infection. The purpose of this biomechanical study was twofold. The first goal was to assess whether vibration analysis techniques can be used to evaluate and characterize initial mechanical stability of cementless implants more accurately than the traditional method of micromotion determination, which employs linear variable differential transducers (LVDTs). Second, an evaluative study was performed to determine the comparative mechanical stability of five designs of cementless tibial components under mechanical loading designed to simulate in vivo forces. The test groups will include a cemented Triathlon Keeled baseplate control group, three different 2-peg cementless baseplates with smooth, mid, and high roughnesses and a 4-peg cement/ess baseplate with mid-roughness.« less

Simulation of peri-implant bone healing due to immediate loading in dental implant treatments.

PubMed

Chou, Hsuan-Yu; Müftü, Sinan

2013-03-15

The goal of this work was to investigate the role of immediate loading on the peri-implant bone healing in dental implant treatments. A mechano-regulatory tissue differentiation model that takes into account the stimuli through the solid and the fluid components of the healing tissue, and the diffusion of pluripotent stem cells into the healing callus was used. A two-dimensional axisymmetric model consisting of a dental implant, the healing callus tissue and the host bone tissue was constructed for the finite element analysis. Poroelastic material properties were assigned to the healing callus and the bone tissue. The effects of micro-motion, healing callus size, and implant thread design on the length of the bone-to-implant contact (BIC) and the bone volume (BV) formed in the healing callus were investigated. In general, the analysis predicted formation of a continuous layer of soft tissue along the faces of the implant which are parallel to the loading direction. This was predicted to be correlated with the high levels of distortional strain transferred through the solid component of the stimulus. It was also predicted that the external threads on the implant, redistribute the interfacial load, thus help reduce the high distortional stimulus and also help the cells to differentiate to bone tissue. In addition, the region underneath the implant apex was predicted to experience high fluid stimulus that results in the development of soft tissue. The relationship between the variables considered in this study and the outcome measures, BV and BIC, was found to be highly nonlinear. A three-way analysis of variance (ANOVA) of the results was conducted and it showed that micro-motion presents the largest hindrance to bone formation during healing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Carbon and metal-carbon implantations into tool steels for improved tribological performance

NASA Astrophysics Data System (ADS)

Hirvonen, J.-P.; Harskamp, F.; Torri, P.; Willers, H.; Fusari, A.; Gibson, N.; Haupt, J.

1997-05-01

The high-fluence implantation of carbon and dual implantations of metal-metalloid pairs into steels with different microstructures are briefly reviewed. A previously unexamined system, the implantation of Si and C into two kinds of tool steels, M3 and D2, have been studied in terms of microstructure and tribological performance. In both cases ion implantation transfers a surface into an amorphous layer. However, the tribological behavior of these two materials differs remarkably: in the case of ion-implanted M3 a reduction of wear in a steel pin is observed even at high pin loads, whereas in the case of ion-implanted D2 the beneficial effects of ion implantation were limited to the lowest pin load. The importance of an initial phase at the onset of sliding is emphasized and a number of peculiarities observed in ion-implanted M3 steel are discussed.

Effect of Implant Diameter and Ridge Dimension on Stress Distribution in Mandibular First Molar Sites-A Photoelastic Study.

PubMed

Termeie, Deborah; Klokkevold, Perry R; Caputo, Angelo A

2015-10-01

The long-term clinical success of a dental implant is dependent upon maintaining sufficient osseointegration to resist forces of occlusion. The purpose of this study was to investigate the effect of implant diameter on stress distribution around screw-type dental implants in mandibular first molar sites using photoelastic models. The design included models with different buccal-lingual dimension. Twelve composite photoelastic models were assembled using 2 different resins to simulate trabecular and cortical bone. Half of the models were fabricated with average dimensions for ridge width and the other half with narrower buccal-lingual dimensions. One internal connection implant (13 mm length) with either a standard (4 mm), wide (5 mm), or narrow (3.3 mm) diameter was embedded in the first molar position of each photoelastic model. Half the implants were tapered and the other half were straight. Full gold crowns in the shape of a mandibular first molar were fabricated and attached to the implants. Vertical and angled loads of 15 and 30 pounds were applied to specific points on the crown. Wide-diameter implants produced the least stress in all ridges while narrow-diameter implants generated the highest stress, especially in narrow ridges. It may be that the volume and quality of bone surrounding implants influences stress distribution with a greater ratio of cortical to trabecular bone, thus providing better support. Models with wide-diameter implants loaded axially had a more symmetrical stress distribution compared to standard and narrow diameter implants. A more asymmetrical stress pattern developed along the entire implant length with angled loads. Implant diameter and ridge width had considerable influence on stress distribution. Narrow-diameter implants produced more stress than wide diameter implants in all conditions tested.

Effect of radial head implant shape on joint contact area and location during static loading.

PubMed

Shannon, Hannah L; Deluce, Simon R; Lalone, Emily A; Willing, Ryan; King, Graham J W; Johnson, James A

2015-04-01

To examine the effect of implant shape on radiocapitellar joint contact area and location in vitro. We used 8 fresh-frozen cadaveric upper extremities. An elbow loading simulator examined joint contact in pronation, neutral rotation, and supination with the elbow at 90° flexion. Muscle tendons were attached to pneumatic actuators to allow for computer-controlled loading to achieve the desired forearm rotation. We performed testing with the native radial head, an axisymmetric implant, a reverse-engineered patient-specific implant, and a population-based quasi-anatomic implant. Implants were inserted using computer navigation. Contact area and location were quantified using a casting technique. We found no significant difference between contact locations for the native radial head and the 3 implants. All of the implants had a contact area lower than the native radial head; however, only the axisymmetric implant was significantly different. There was no significant difference in contact area between implant shapes. The similar contact areas and locations of the 3 implant designs suggest that the shape of the implant may not be important with respect to radiocapitellar joint contact mechanics when placed optimally using computer navigation. Further work is needed to explore the sensitivity of radial head implant malpositioning on articular contact. The lower contact area of the radial head implants relative to the native radial head is similar to previous benchtop studies and is likely the result of the greater stiffness of the implant. Radial head implant shape does not appear to have a pronounced influence on articular contact, and both axisymmetric and anatomic metal designs result in elevated cartilage stress relative to the intact state. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

An animal model to evaluate skin-implant-bone integration and gait with a prosthesis directly attached to the residual limb

PubMed Central

Farrell, Brad J; Prilutsky, Boris I; Kistenberg, Robert S; Dalton, John F; Pitkin, Mark

2014-01-01

Background Despite the number of advantages of bone-anchored prostheses, their use in patients is limited due to the lack of complete skin-implant integration. The objective of the present study was to develop an animal model that would permit both detailed investigations of gait with a bone-anchored limb prosthesis and histological analysis of the skin-implant-bone interface after physiological loading of the implant during standing and walking. Methods Full-body mechanics of walking in two cats was recorded and analyzed before and after implantation of a percutaneous porous titanium pylon into the right tibia and attachment of a prosthesis. The rehabilitation procedures included initial limb casting, progressively increasing loading of implant, and standing and locomotor training. Detailed histological analysis of bone and skin ingrowth into implant was performed at the end of the study. Findings The two animals adopted the bone-anchored prosthesis for standing and locomotion, although loads on the prosthetic limb during walking decreased by 22% and 62%, respectively, 4 months after implantation. The animals shifted body weight to the contralateral side and increased propulsion forces by the contralateral hindlimb. Histological analysis of the limb implants demonstrated bone and skin ingrowth. Interpretation The developed animal model to study prosthetic gait and tissue integration with the implant demonstrated that porous titanium implants may permit bone and skin integration and prosthetic gait with a prosthesis. Future studies with this model will help optimize the implant and prosthesis properties. PMID:24405567

R&D on dental implants breakage

NASA Astrophysics Data System (ADS)

Croitoru, Sorin Mihai; Popovici, Ion Alexandru

2017-09-01

Most used dental implants for human dental prostheses are of two steps type: first step means implantation and, after several months healing and osseointegration, second step is prosthesis fixture. For sure, dental implants and prostheses are meant to last for a lifetime. Still, there are unfortunate cases when dental implants break. This paper studies two steps dental implants breakage and proposes a set of instruments for replacement and restoration of the broken implant. First part of the paper sets the input data of the study: structure of the studied two steps dental implants based on two Romanian patents and values of the loading forces found in practice and specialty papers. In the second part of the paper, using DEFORM 2D™ FEM simulation software, worst case scenarios of loading dental implants are studied in order to determine which zones and components of the dental implant set are affected (broken). Last part of the paper is dedicated to design and presentation of a set for extracting and cutting tools used to restore the broken implant set.

Comparative Microstrain Study of Internal Hexagon and Plateau Design of Short Implants Under Vertical Loading.

PubMed

Nishioka, Renato Sussumu; Rodrigues, Vinicius Anéas; De Santis, Leandro Ruivo; Nishioka, Gabriela Nogueira De Melo; Santos, Vivian Mayumi Miyazaki; Souza, Francisley Ávila

2016-02-01

To quantify microstrain development during axial loading using strain gauge analysis for short implants, varying the type of fixture-abutment joint and thread design. An internal hexagon implant (4 × 8 mm) and a plateau design implant (4 × 8 mm) were embedded on the center of 10 polyurethane blocks with dimensions of 190 × 30 × 12 mm. The respective abutments were screwed onto the implants. Four strain gauges (SGs) were bonded onto the surface of each block, and 4 vertical SGs were bonded onto the side of each block. Axial load of 30 kgf was applied for 10 seconds in the center of each implant. The data were analyzed statistically by analysis of variance for repeated measures and Tukey test (P < 0.05). The interaction between implant and region factors have been statistically significant (P = 0.0259). Tukey test revealed a difference on plateau's horizontal region. The cervical region presented higher microstrain values, when compared with the medium and apical regions of the implants. Within the purpose of the study, the type of fixture-abutment joint is a relevant factor to affect the amount of stress/strain in bone simulation. The microstrain development was concentrated on the cervical region of the implant.

Frequency Splitting Analysis and Compensation Method for Inductive Wireless Powering of Implantable Biosensors.

PubMed

Schormans, Matthew; Valente, Virgilio; Demosthenous, Andreas

2016-08-04

Inductive powering for implanted medical devices, such as implantable biosensors, is a safe and effective technique that allows power to be delivered to implants wirelessly, avoiding the use of transcutaneous wires or implanted batteries. Wireless powering is very sensitive to a number of link parameters, including coil distance, alignment, shape, and load conditions. The optimum drive frequency of an inductive link varies depending on the coil spacing and load. This paper presents an optimum frequency tracking (OFT) method, in which an inductive power link is driven at a frequency that is maintained at an optimum value to ensure that the link is working at resonance, and the output voltage is maximised. The method is shown to provide significant improvements in maintained secondary voltage and system efficiency for a range of loads when the link is overcoupled. The OFT method does not require the use of variable capacitors or inductors. When tested at frequencies around a nominal frequency of 5 MHz, the OFT method provides up to a twofold efficiency improvement compared to a fixed frequency drive. The system can be readily interfaced with passive implants or implantable biosensors, and lends itself to interfacing with designs such as distributed implanted sensor networks, where each implant is operating at a different frequency.

Influence of semipermanent cement application used in immediately loaded, implant-supported restorations on crestal bone resorption.

PubMed

Błaszczyszyn, Artur; Kubasiewicz-Ross, Paweł; Gedrange, Tomasz; Dominiak, Marzena

2013-01-01

The paper presents clinical-radiological research on the impact of the new semi-cement luting agent in the immediately loaded implant-supported restoration on alveolar ridge resorption. 25 patients with a partially edentulous alveolar ridge in the anterior section of the maxilla or mandible were included in the study. The implants were inserted with the application of traditional burs or with a Piezosurgery device supplied by Mectron. Taking into account the method of implant bed preparation, the scientific material was divided into two groups. The implants were loaded immediately with single crown restorations cemented with the Implantlink semi cement application. The following indices were taken into consideration: pocket depth around implant calculated at four measuring points, marginal alveolar bone loss measured using radio-visiography, the 3-degree Wachtel scale of healing of the soft tissue. In addition, the presence and possible width or height of any recession around the implants was measured. The success of the implant treatment was assessed according to the Albrektsson success criteria. The research results were subjected to statistical analysis. The results of our study revealed no influence of the Implant-link semi cement on the crestal bone level, regardless of the bone bed preparation technique.

Risk factors associated with early implant failure: A 5-year retrospective clinical study.

PubMed

Olmedo-Gaya, Maris Victoria; Manzano-Moreno, Francisco J; Cañaveral-Cavero, Esther; de Dios Luna-del Castillo, Juan; Vallecillo-Capilla, Manuel

2016-02-01

The replacement of lost teeth with dental implants is a widespread treatment whose associated problems are also frequently encountered. Nevertheless, the factors associated with early implant failure have not been well documented. Further analyses of the factors influencing osseointegration establishment are required to maximize the predictability of the procedure and minimize implant failures. The purpose of this retrospective clinical study was to explore the association between possible risk factors and early implant failure. This retrospective clinical study evaluated 142 participants who received 276 external connection BTI implants between 2007 and 2011. Participant variables (age, sex, systemic disease, tobacco use, alcohol consumption, bruxism, and degree of periodontal disease), implant variables (type of edentulism, localization, area, diameter, length, and bone quality), intervention variables (expansion mechanisms, sinus augmentation techniques, bone regeneration, and implant insertion), and postoperative variables (presence of pain/inflammation at 1 week postsurgery) were studied. A multilevel logistic regression model (mixed effects-type model) was used to determine the influence of variables on early implant failure. Early implant failure was significantly associated with the male sex (P=.001), severe periodontal disease (P=.005), short implants (P=.001), expansion technique (P=.002), and postoperative pain/inflammation at 1 week postsurgery (P<.001). Early dental implant failure is more frequent in men and in individuals with severe periodontal disease, short implants, pain/inflammation at 1 week postsurgery, or bone expansion treatment. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Socket grafting with or without buccal augmentation with anorganic bovine bone at immediate post-extractive implants: 6-month after loading results from a multicenter randomised controlled clinical trial.

PubMed

Zuffetti, Francesco; Esposito, Marco; Capelli, Matteo; Galli, Fabio; Testori, Tiziano; Del Fabbro, Massimo

2013-01-01

To evaluate whether grafting with additional anorganic bovine bone to augment horizontally the buccal plate (internal and external grafting [IEG]) at single post-extractive implants preserves the alveolar ridge, improving aesthetics, better than internal socket grafting alone (ISGA). A total of 78 patients, treated in four Italian private practices, requiring a single immediate post-extractive implant, having at least 1 mm of implant-to-buccal bone gap after implant insertion and a preserved buccal bone, had the residual bone-to-implant gap filled with anorganic bovine bone. Thirty-nine randomly allocated patients received additional buccal horizontal augmentation of about 2 mm thickness with the same bone substitute (IEG group) covered with collagen resorbable membranes. Implants were submerged for 4 months before being loaded with provisional acrylic crowns. Definitive crowns were delivered after 6 months. Outcome measures were crown/implant failures, complications and aesthetics recorded by blinded assessors 6 months after initial loading, at delivery of definitive crowns. Six months after initial loading, 8 patients dropped out, did not complete the treatment or were treated twice and therefore had to be excluded (4 from each group). There were no statistically significant differences for implant failures and complications between the two groups. Two implants failed in the IEG group versus 1 in the ISGA group. Four complications occurred, 2 in each group. The mean implant aesthetic score (IAS) was 7.8 at ISGA sites and 8.0 at IEG sites. There were no statistically significant differences between the two groups (P = 0.492; difference 0.2 mm; 95% CI -0.769, 0.369) for IAS score. There were no statistically significant differences in the outcomes between the centres. The use of adjunctive anorganic bovine bone placed buccally at preserved buccal sites of immediate post-extractive implants may not improve the aesthetic outcome, however additional research is needed to confirm or reject these preliminary findings.

The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting-A retrospective study in 31 patients.

PubMed

Petsinis, Vassilis; Kamperos, Georgios; Alexandridi, Foteini; Alexandridis, Konstantinos

2017-08-01

To evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting. A retrospective study was conducted in search of patients treated with dental implants while receiving glucocorticosteroid therapy for various systemic diseases. In these cases, a conventional two-stage surgical protocol was used, without bone regeneration procedures. The osseointegration was clinically and radiographically tested at the uncovering of the implants. The follow-up after loading was set at a minimum of 3 years. A total of 31 patients were included in the study. Of the 105 dental implants placed, 104 were osseointegrated (99%). No bone absorption was radiographically noted at the uncovering of the osseointegrated implants. All of the osseointegrated implants were successfully loaded for the prosthetic restoration. The mean follow-up period after loading was 71 months, with an implant survival rate of 99%. Glucocorticosteroid intake for systemic diseases does not have a significant impact on the osseointegration and the 3-year survival of dental implants placed with a conventional two-stage surgical protocol and without bone grafting. Therefore, it should not be considered a contraindication for dental implant placement. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Wear at the titanium-titanium and the titanium-zirconia implant-abutment interface: a comparative in vitro study.

PubMed

Stimmelmayr, Michael; Edelhoff, Daniel; Güth, Jan-Frederik; Erdelt, Kurt; Happe, Arndt; Beuer, Florian

2012-12-01

The purpose of this study was to determine and measure the wear of the interface between titanium implants and one-piece zirconia abutments in comparison to titanium abutments. 6 implants were secured into epoxy resin blocks. The implant interface of these implants and 6 corresponding abutments (group Zr: three one-piece zirconia abutments; group Ti: three titanium abutments) were examined by a microscope and scanning electron micrograph (SEM). Also the implants and the abutments were scanned by 3D-Micro Computer Tomography (CT). The abutments were connected to the implants and cyclically loaded with 1,200,000 cycles at 100N in a two-axis fatigue testing machine. Afterwards, all specimens were unscrewed and the implants and abutments again were scanned by microscope, SEM and CT. The microscope and SEM images were compared, the CT data were superimposed and the wear was calculated by inspection software. The statistical analysis was carried out with an unpaired t-test. Abutment fracture or screw loosening was not observed during cyclical loading. Comparing the microscope and SEM images more wear was observed on the implants connected to zirconia abutments. The maximum wear on the implant shoulder calculated by the inspection software was 10.2μm for group Zr, and 0.7μm for group Ti. The influence of the abutment material on the measured wear was statistically significant (p≤0.001; Levene-test). Titanium implants showed higher wear at the implant interface following cyclic loading when connected to one-piece zirconia implant abutments compared to titanium abutments. The clinical relevance is not clear; hence damage of the internal implant connection could result in prosthetic failures up to the need of implant removal. Copyright © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Finite element analysis of stress-breaking attachments on maxillary implant-retained overdentures.

PubMed

Tanino, Fuminori; Hayakawa, Iwao; Hirano, Shigezo; Minakuchi, Shunsuke

2007-01-01

The purpose of this study was to examine the effect of stress-breaking attachments at the connections between maxillary palateless overdentures and implants. Three-dimensional finite element models were used to reproduce an edentulous human maxilla with an implant-retained overdenture. Two-implant models (in the canine tooth positions on both sides) and four-implant models (in the canine and second premolar tooth positions on both sides) were examined. Stress-breaking material connecting the implants and denture was included around each abutment. Axial loads of 100 N were applied to the occlusal surface at the left first molar tooth positions. In each model, the influence of the stress-breaking attachments was compared by changing the elastic modulus from 1 to 3,000 MPa and the thickness of the stress-breaking material from 1 to 3 mm. Maximum stress at the implant-bone interface and stress at the cortical bone surface just under the loading point were calculated. In all models, maximum stress at the implant-bone interface with implants located in the canine tooth position was generated at the peri-implant bone on the loading side. As the elastic modulus of the stress-breaking materials increased, the stress increased at the implant-bone interface and decreased at the cortical bone surface. Moreover, stress at the implant-bone interface with 3-mm-thick stress-breaking material was smaller than that with 1-mm-thick material. Within the limitations of this experiment, stress generated at the implant-bone interface could be controlled by altering the elastic modulus and thickness of the stress-breaking materials.

Evaluation of Stress Distribution of Mini Dental Implant-Supported Overdentures in Complete Cleft Palate Models: A Three-Dimensional Finite Element Analysis Study.

PubMed

Soğancı, Gökçe; Yazıcıoğlu, Hüseyin

2016-01-01

Mini dental implants could be an alternative treatment method for prosthetic treatment of edentulous cleft palate. The aim of this study was to analyze stress distribution around the cortical bone and different plans using a varied number of mini dental implants in edentulous unilateral complete cleft palates. Three edentulous maxillary models were modified to create unilateral complete cleft palates. Mini dental implants (2.4 × 15 mm) were located as two mini implants at the premolar region, four mini implants at the premolar and molar region, and six mini implants at the first premolar, second premolar, and first molar regions in the models, respectively. Mucosa, o-ring/ball attachments, and overdentures were simulated. Vertical and horizontal loads of 100 N were applied on both the right and left molar teeth of the overdenture for each model. Maximum and minimum principal stress values and the distribution at cortical bone around the implants and cleft palates were evaluated by finite element analysis. Stress values under vertical loads were lower than values under horizontal loadings for all models. Stress values were found to be lower in the first model than in the second and third models. The highest stress values were found around implants in the second model. The unilateral feature of a complete cleft pattern affected the stress distribution. Stresses occured mostly around implants when the overdenture was supported by six implants; however, the stress distribution around implants was low with two implants because of tissue support.

Conductive polymer sensor arrays for smart orthopaedic implants

NASA Astrophysics Data System (ADS)

Micolini, Carolina; Holness, F. B.; Johnson, James A.; Price, Aaron D.

2017-04-01

This study proposes and demonstrates the design, implementation, and characterization of a 3D-printed smartpolymer sensor array using conductive polyaniline (PANI) structures embedded in a polymeric substrate. The piezoresistive characteristics of PANI were studied to evaluate the efficacy of the manufacturing of an embedded pressure sensor. PANI's stability throughout loading and unloading cycles together with the response to incremental loading cycles was investigated. It is demonstrated that this specially developed multi-material additive manufacturing process for polyaniline is a good candidate for the manufacture of implant components with smart-polymer sensors embedded for the analysis of joint loads in orthopaedic implants.

Microleakage Evaluation at Implant-Abutment Interface Using Radiotracer Technique

PubMed Central

Siadat, Hakimeh; Arshad, Mahnaz; Mahgoli, Hossein-Ali; Fallahi, Babak

2016-01-01

Objectives: Microbial leakage through the implant-abutment (I-A) interface results in bacterial colonization in two-piece implants. The aim of this study was to compare microleakage rates in three types of Replace abutments namely Snappy, GoldAdapt, and customized ceramic using radiotracing. Materials and Methods: Three groups, one for each abutment type, of five implants and one positive and one negative control were considered (a total of 17 regular body implants). A torque of 35 N/cm was applied to the abutments. The samples were immersed in thallium 201 radioisotope solution for 24 hours to let the radiotracers leak through the I-A interface. Then, gamma photons received from the radiotracers were counted using a gamma counter device. In the next phase, cyclic fatigue loading process was applied followed by the same steps of immersion in the radioactive solution and photon counting. Results: Rate of microleakage significantly increased (P≤0.05) in all three types of abutments (i.e. Snappy, GoldAdapt, and ceramic) after cyclic loading. No statistically significant differences were observed between abutment types after cyclic loading. Conclusions: Microleakage significantly increases after cyclic loading in all three Replace abutments (GoldAdapt, Snappy, ceramic). Lowest microleakage before and after cyclic loading was observed in GoldAdapt followed by Snappy and ceramic. PMID:28392814

Zygomatic implant-retained fixed complete denture for an elderly patient.

PubMed

Baig, Mirza Rustum; Rajan, Gunaseelan; Yunus, Norsiah

2012-06-01

Dental rehabilitation of a completely edentulous geriatric patient has always been a challenge to the clinician, especially in treating those with higher expectations and demands. Treatment duration and the amount of residual alveolar bone available are often important considerations when planning for dental implant-based fixed treatment for these patients. With the introduction of zygomatic implants, a graftless alternative solution has emerged for deficient maxillary bone with provision for immediate loading. This article describes the treatment of a completely edentulous elderly patient using zygomatic implants in conjunction with conventional implants. The implants were immediately loaded using a definitive acrylic resin fixed denture reinforced with a cast metal framework, to provide function and aesthetics. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Osseointegration of dental implants in Macaca fascicularis

NASA Astrophysics Data System (ADS)

Dewi, R. S.; Odang, R. W.; Odelia, L.

2017-08-01

Osseointegration is an important factor in determining the success of a dental implant. It can be assessed from the osseointegration that occurs between the implant and the bone. The implant stability is determined by the osseous support at the implant-bone interface, which is commonly evaluated by histomorphometric analysis. This study aimed to evaluate whether the osseointegration level measured by a Low Resonance Frequency Analyzer (LRFA) gave results as good as those obtained by histomorphometric examination. Six male Macaca fascicularis were used in this study. In each animal, two types of loading were performed: immediate and delayed loading. Clinical examination and LRFA measurement were performed to determine osseointegration at the first and second weeks and at the first, second, third, and fourth months. After four months, histomorphometric examination was performed. The relationship between the histomorphometric examination and LRFA measurement was compared using the Pearson correlation coefficient. There was no significant difference in the osseointegration between immediate loading and delayed loading (p > 0.05) The bone-implant contact percentage in the first group did not differ significantly from that in the second group. Statistical analysis showed that there was a strong correlation between LRFA measurement and histomorphometric examination. Osseointegration could be evaluated through LRFA measurement as well as through histomorphometric examination.

All-Ceramic Single Crown Restauration of Zirconia Oral Implants and Its Influence on Fracture Resistance: An Investigation in the Artificial Mouth

PubMed Central

Kohal, Ralf-Joachim; Kilian, Jolanta Bernadette; Stampf, Susanne; Spies, Benedikt Christopher

2015-01-01

The aim of the current investigation was to evaluate the fracture resistance of one-piece zirconia oral implants with and without all-ceramic incisor crowns after long-term thermomechanical cycling. A total of 48 implants were evaluated. The groups with crowns (C, 24 samples) and without crowns (N, 24 samples) were subdivided according to the loading protocol, resulting in three groups of 8 samples each: Group “0” was not exposed to cyclic loading, whereas groups “5” and “10” were loaded with 5 and 10 million chewing cycles, respectively. This resulted in 6 different groups: C0/N0, C5/N5 and C10/N10. Subsequently, all 48 implants were statically loaded to fracture and bending moments were calculated. All implants survived the artificial aging. For the static loading the following average bending moments were calculated: C0: 326 Ncm; C5: 339 Ncm; C10: 369 Ncm; N0: 339 Ncm; N5: 398 Ncm and N10: 355 Ncm. To a certain extent, thermomechanical cycling resulted in an increase of fracture resistance which did not prove to be statistically significant. Regarding its fracture resistance, the evaluated ceramic implant system made of Y-TZP seems to be able to resist physiological chewing forces long-term. Restauration with all-ceramic single crowns showed no negative influence on fracture resistance. PMID:28788018

Load Transfer Characteristics of Three-Implant-Retained Overdentures with Different Interimplant Distances.

PubMed

Tokar, Emre; Uludag, Bulent; Karacaer, Ozgul

Implant-retained overdentures are the first choice of rehabilitation for edentulous mandibles. Bone morphology and anatomical landmarks may be influenced by the location and angulation of implants and distances between the implants. The purpose of this study was to investigate stress distribution characteristics and to compare stress levels of three different attachment designs of three-implant-retained mandibular overdentures with three different interimplant distances. Three photoelastic mandibular models with three implants were fabricated using an edentulous mandible cast with moderate residual ridge resorption. The center implants were embedded parallel to the midline, and the distal implants were aligned at a 20-degree angulation corresponding to the center implants. Distances between the center and distal implants were set at 11, 18, and 25 mm at the photoelastic models. Bar, bar-ball, and Locator attachment-retained overdentures were prepared for the models. Vertical loads were applied to the overdentures, and stress levels and distribution were evaluated by a circular polariscope. The greatest observed stress level was moderate for the tested overdenture designs. The Locator attachment system showed the lowest stress level for the 11-mm and 25-mm photoelastic models. The bar attachment design transmitted less stress compared with the other tested designs for the 18-mm photoelastic model. Stresses were observed on the loaded side of the photoelastic models. The lowest stress was found with the Locator and bar attachments for the 11-mm photoelastic model, which transmitted little or no discernible stress around the implants.

Rehabilitation of postrior atrophic edentulous jaws: prostheses supported by 5 mm short implants or by longer implants in augmented bone? One-year results from a pilot randomised clinical trial.

PubMed

Esposito, Marco; Pellegrino, Gerardo; Pistilli, Roberto; Felice, Pietro

2011-01-01

To evaluate whether 5 mm short dental implants could be an alternative to augmentation with anorganic bovine bone and placement of at least 10 mm long implants in posterior atrophic jaws. Fifteen patients with bilateral atrophic mandibles (5-7 mm bone height above the mandibular canal), and 15 patients with bilateral atrophic maxillae (4-6 mm bone height below the maxillary sinus) and bone thickness of at least 8 mm, were randomised according to a splitmouth design to receive one to three 5 mm short implants or at least 10 mm long implants in augmented bone. Mandibles were vertically augmented with interpositional bone blocks and maxillary sinuses with particulated bone via a lateral window. Implants were placed after 4 months, submerged and loaded, after 4 months, with provisional prostheses. Four months later, definitive provisionally cemented prostheses were delivered. Outcome measures were: prosthesis and implant failures, any complication and peri-implant marginal bone level changes. In 5 augmented mandibles, the planned 10 mm long implants could not be placed and shorter implants (7 and 8.5 mm) had to be used instead. One year after loading no patient dropped out. Two long (8.5 mm in the mandible and 13 mm in the maxilla) implants and one 5 mm short maxillary implant failed. There were no statistically significant differences in failures or complications. Patients with short implants lost on average 1 mm of peri-implant bone and patients with longer implants lost 1.2 mm. This difference was statistically significant. This pilot study suggests that 1 year after loading, 5 mm short implants achieve similar if not better results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation since the treatment is faster, cheaper and associated with less morbidity, however their long-term prognosis is unknown.

Co-precipitation of tobramycin into biomimetically coated orthopedic fixation pins employing submicron-thin seed layers of hydroxyapatite.

PubMed

Sörensen, Jan H; Lilja, Mirjam; Åstrand, Maria; Sörensen, Torben C; Procter, Philip; Strømme, Maria; Steckel, Hartwig

2014-01-01

The migration, loosening and cut-out of implants and nosocomial infections are current problems associated with implant surgery. New innovative strategies to overcome these issues are emphasized in today's research. The current work presents a novel strategy involving co-precipitation of tobramycin with biomimetic hydroxyapatite (HA) formation to produce implant coatings that control local drug delivery to prevent early bacterial colonization of the implant. A submicron- thin HA layer served as seed layer for the co-precipitation process and allowed for incorporation of tobramycin in the coating from a stock solution of antibiotic concentrations as high as 20 mg/ml. Concentrations from 0.5 to 20 mg/ml tobramycin and process temperatures of 37 °C and 60 °C were tested to assess the optimal parameters for a thin tobramycin- delivering HA coating on discs and orthopedic fixation pins. The morphology and thickness of the coating and the drug-release profile were evaluated via scanning electron microscopy and high performance liquid chromatography. The coatings delivered pharmaceutically relevant amounts of tobramycin over a period of 12 days. To the best of our knowledge, this is the longest release period ever observed for a fast-loaded biomimetic implant coating. The presented approach could form the foundation for development of combination device/antibiotic delivery vehicles tailored to meet well-defined clinical needs while combating infections and ensuring fast implant in-growth.

Influence of the implant abutment types and the dynamic loading on initial screw loosening

PubMed Central

Kim, Eun-Sook

2013-01-01

PURPOSE This study examined the effects of the abutment types and dynamic loading on the stability of implant prostheses with three types of implant abutments prepared using different fabrication methods by measuring removal torque both before and after dynamic loading. MATERIALS AND METHODS Three groups of abutments were produced using different types of fabrication methods; stock abutment, gold cast abutment, and CAD/CAM custom abutment. A customized jig was fabricated to apply the load at 30° to the long axis. The implant fixtures were fixed to the jig, and connected to the abutments with a 30 Ncm tightening torque. A sine curved dynamic load was applied for 105 cycles between 25 and 250 N at 14 Hz. Removal torque before loading and after loading were evaluated. The SPSS was used for statistical analysis of the results. A Kruskal-Wallis test was performed to compare screw loosening between the abutment systems. A Wilcoxon signed-rank test was performed to compare screw loosening between before and after loading in each group (α=0.05). RESULTS Removal torque value before loading and after loading was the highest in stock abutment, which was then followed by gold cast abutment and CAD/CAM custom abutment, but there were no significant differences. CONCLUSION The abutment types did not have a significant influence on short term screw loosening. On the other hand, after 105 cycles dynamic loading, CAD/CAM custom abutment affected the initial screw loosening, but stock abutment and gold cast abutment did not. PMID:23509006

Influence of implant collar design on stress and strain distribution in the crestal compact bone: a three-dimensional finite element analysis.

PubMed

Shen, Wan-Ling; Chen, Chen-Sheng; Hsu, Ming-Lun

2010-01-01

To evaluate the influence of implant collar geometry on the distribution of stress and strain in the crestal compact bone contiguous to an implant collar for four types of bone under axial and oblique loads. Finite element models of threaded implants with three kinds of implant collar designs (divergent, straight, and convergent) with their corresponding suprastructures embedded in the posterior mandible were created with ANSYS software. Eight different test conditions incorporating four types of bone (orthotropic and effectively isotropic in part 1 and high and low densities in part 2) under separate 100-N axial and 35.6-degree oblique forces were created to investigate the stress and strain distributions in the crestal compact bone around the implant collars. In all eight conditions, the divergent collar demonstrated the lowest maximum von Mises and principal stresses and strains in the crestal compact bone contiguous to the implant collar, followed by the straight and convergent collars. The oblique load induced higher peak values than the axial load. The orthotropic design amplified and increased the pathologic microstrains and tensile stresses in the crestal compact bone compared to the effectively isotropic design, especially in models with a convergent collar design. In part 2 of the study, the maximum von Mises stresses and strains increased with a decrease in the cancellous bone density. Under oblique loading, the convergent and straight collars showed pathologic microstrain values as well as excessive ultimate tensile stresses in the orthotropic bone model with low-density cancellous bone. Within the limitations, it was concluded that stress and strain distributions in the adjacent compact bone are influenced by the implant collar design. The divergent implant collar design was associated with the lowest stress and strain concentrations in the crestal compact bone.

The mechanical response of a polyetheretherketone femoral knee implant under a deep squatting loading condition.

PubMed

de Ruiter, Lennert; Janssen, Dennis; Briscoe, Adam; Verdonschot, Nico

2017-12-01

The current study was designed to investigate the mechanical response of a polyetheretherketone-on-polyethylene total knee replacement device during a deep squat. Application of this high-demand loading condition can identify weaknesses of the polyetheretherketone relative to cobalt-chromium. This study investigated whether the implant is strong enough for this type of loading, whether cement stresses are considerably changed and whether a polyetheretherketone femoral component is likely to lead to reduced periprosthetic bone loss as compared to a cobalt-chromium component. A finite element model of a total knee arthroplasty subjected to a deep squat loading condition, which was previously published, was adapted with an alternative total knee arthroplasty design made of either polyetheretherketone or cobalt-chromium. The maximum tensile and compressive stresses within the implant and cement mantle were analysed against their yield and fatigue stress levels. The amount of stress shielding within the bone was compared between the polyetheretherketone and cobalt-chromium cases. Relative to its material strength, tensile peak stresses were higher in the cobalt-chromium implant; compressive peak stresses were higher in the polyetheretherketone implant. The stress patterns differed substantially between polyetheretherketone and cobalt-chromium. The tensile stresses in the cement mantle supporting the polyetheretherketone implant were up to 33% lower than with the cobalt-chromium component, but twice as high for compression. Stress shielding was reduced to a median of 1% for the polyetheretherketone implant versus 56% for the cobalt-chromium implant. Both the polyetheretherketone implant and the underlying cement mantle should be able to cope with the stress levels present during a deep squat. Relative to the cobalt-chromium component, stress shielding of the periprosthetic femur was substantially less with a polyetheretherketone femoral component.

A Systematic Review on Immediate Loading of Implants Used to Support Overdentures Opposed by Conventional Prostheses: Factors That Might Influence Clinical Outcomes.

PubMed

Zygogiannis, Kostas; Wismeijer, Daniel; Aartman, Irene Ha; Osman, Reham B

2016-01-01

Different treatment protocols in terms of number, diameter, and suprastructure design have been proposed for immediately loaded implants that are used to support mandibular overdentures opposed by maxillary conventional dentures. The aim of this study was to investigate the influence of these protocols on survival rates as well as clinical and prosthodontic outcomes. Several electronic databases were searched for all relevant articles published from 1966 to June 2014. Only randomized controlled trials and prospective studies with a minimum follow-up of 12 months were selected. The primary outcomes of interest were the success and survival rates of the implants. Prosthodontic complications were also evaluated. Fourteen studies fulfilled the inclusion criteria. Of the studies identified, nine were randomized controlled trials and five were prospective studies. The mean follow-up period was 3 years or less for the vast majority of the studies. The reported survival and success rates were comparable to that of conventional loading for most of the included studies. No specific immediate loading protocol seemed to perform better in terms of clinical and prosthodontic outcomes. Immediate loading protocols of mandibular overdentures seem to be a viable alternative to conventional loading. It was not possible to recommend a specific treatment protocol related to the number, diameter of the implants, and attachment system used. Long-term, well-designed studies comparing different immediate loading modalities could help to establish a protocol that delivers the most clinically predictable, efficient, and cost-effective outcome for edentulous patients in need of implant overdentures.

P2 porous titanium implants improve tendon healing in an acute rat supraspinatus repair model.

PubMed

Tucker, Jennica J; Gordon, Joshua A; Zanes, Robert C; Zuskov, Andrey; Vinciguerra, John D; Bloebaum, Roy D; Soslowsky, Louis J

2017-03-01

Current techniques in rotator cuff repair often lack structural integrity. P 2 porous titanium-coated constructs (DJO Surgical, Austin, TX, USA) promote osseointegration and soft tissue ingrowth. This study examined the ability of this material to improve the structural integrity of supraspinatus tendon repair in a rat model. We hypothesized that P 2 implants placed at the tendon-to-bone interface would improve mechanical and histologic measures of supraspinatus healing. Forty rats underwent supraspinatus repairs with P 2 implants in 1 shoulder and standard repair in the other. Rats were humanely killed at time 0 (n = 3), 2 weeks (n = 8), 4 weeks (n = 15), and 12 weeks (n = 14). Tendon-to-bone composite specimens were harvested and evaluated mechanically and histologically. Tendon cross-sectional area was decreased in the P 2 implant group at 4 weeks, percentage of relaxation was increased at 2 weeks, elastic modulus was increased at 4 weeks, and maximum load and maximum stress were both increased at 2 and 4 weeks. Histologic analysis revealed no foreign body reactions within or around the P 2 implant, and healthy viable bone was visible within the P 2 implant. The results support our hypothesis, specifically in early healing, in this randomized controlled animal study. These data support the use of P 2 porous titanium implants to improve tendon-to-bone healing. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The effect of one-time abutment placement on interproximal bone levels and peri-implant soft tissues: a prospective randomized clinical trial.

PubMed

Molina, Ana; Sanz-Sánchez, Ignacio; Martín, Conchita; Blanco, Juan; Sanz, Mariano

2017-04-01

To compare the effect of placing the definitive abutment at the time of implant placement versus at a later stage, on the soft and hard tissue changes around dental implants. Platform-switched implants were placed in the posterior maxilla or mandible of partial edentulous patients and they were randomized to receive the definitive abutment at the moment of implant placement, or 6-12 weeks later. Final prostheses were delivered 2-4 weeks later. Radiographic assessment of vertical bone level changes (primary outcome), clinical status of peri-implant tissues, changes in soft tissues margin, papilla filling, patient-related outcomes and adverse events were assessed 6 and 12 months after loading. 60 implants were placed in 40 patients, replacing single or multiple absent teeth. One implant was lost 1 week after insertion (overall survival rate: 98.3%). A statistically significant greater bone resorption from surgery to 6 months post-loading was observed for those implants subjected to abutment change (control group: -1.24 ± 0.79 mm; test group: -0.61 ± 0.40 mm; P = 0.028). Periodontal clinical parameters and patient-related outcomes, however, did not demonstrate significant differences between groups at any time point. A significant increase in papilla height was observed from loading to 12 months in all implants (control group: 1.17 ± 1.47 mm; test group: 0.98 ± 0.89 mm) and a slight but not significant coronal migration of the gingival margin. The connection and disconnection of healing abutments is associated with significantly increased bone loss during the healing period between implant placement and 6 months post-loading, when compared to one-time abutment placement. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The effect of in situ augmentation on implant anchorage in proximal humeral head fractures.

PubMed

Unger, Stefan; Erhart, Stefanie; Kralinger, Franz; Blauth, Michael; Schmoelz, Werner

2012-10-01

Fracture fixation in patients suffering from osteoporosis is difficult as sufficient implant anchorage is not always possible. One method to enhance implant anchorage is implant/screw augmentation with PMMA-cement. The present study investigated the feasibility of implant augmentation with PMMA-cement to enhance implant anchorage in the proximal humerus. A simulated three part humeral head fracture was stabilised with an angular stable plating system in 12 pairs of humeri using six head screws. In the augmentation group the proximal four screws were treated with four cannulated screws, each augmented with 0.5ml of PMMA-cement, whereas the contra lateral side served as a non-augmented control. Specimens were loaded in varus-bending or axial-rotation using a cyclic loading protocol with increasing load magnitude until failure of the osteosynthesis occurred. Augmented specimens showed a significant higher number of load cycles until failure than non-augment specimens (varus-bending: 8516 (SD 951.6) vs. 5583 (SD 2273.6), P=0.014; axial-rotation: 3316 (SD 348.8) vs. 2050 (SD 656.5), P=0.003). Non-augmented specimens showed a positive correlation of load cycles until failure and measured bone mineral density (varus-bending: r=0.893, P=0.016; axial-rotation: r=0.753, P=0.084), whereas no correlation was present in augmented specimens (varus-bending: r=0,258, P=0.621; axial-rotation r=0.127, P=0.810). These findings suggest that augmentation of cannulated screws is a feasible method to enhance implant/screw anchorage in the humeral head. The improvement of screw purchase is increasing with decreasing bone mineral density. Copyright © 2012 Elsevier Ltd. All rights reserved.

Immediate loading of implants placed in patients with untreated periodontal disease: a 5-year prospective cohort study.

PubMed

Maló, Paulo; Nobre, Miguel de Araújo; Lopes, Armando; Ferro, Ana; Gravito, Inês

2014-01-01

To report the 5-year outcome of immediately loaded dental implants in patients with untreated periodontal disease. This prospective cohort study included 103 consecutive patients (51 females and 52 males) with an average age of 52 years (range: 22 to 80 years) who were rehabilitated with 380 implants supporting 145 prostheses in both jaws (40 single; 33 partial and 72 complete rehabilitations). The implants were inserted in patients with active and untreated periodontitis. The patients did not receive any previous periodontal treatment before implant surgery, except for an oral hygiene session immediately before the implant surgery. In maintenance (every 6 months) patients received periodontal treatment as needed. Outcome measures were: prostheses failures; implant failures; complications; and marginal bone level changes. Fifteen patients dropped out of the study (14.6%). Two patients lost two implants (FDI positions nos.12 and 42), rendering a cumulative survival rate of 97.9% and 99.4% at 5 years of followup using the patient and implant as unit of analysis, respectively. The average (standard deviation) marginal bone resorption was 0.71 mm (0.42 mm) at 5 years. Mechanical complications occurred in 14 patients, consisting of prostheses fractures (10 provisional prostheses and 4 definitive prostheses). Thirteen implants (3.9%) in 13 patients (14.8%) presented peri-implant pathology. Within the limitations of this study, it is possible to conclude that the rehabilitation of patients with untreated periodontitis using immediately loaded dental implants is feasible in the medium-term, when periodontal therapy is provided after rehabilitation and the patients are regularly maintained.

Retention System and Splinting on Morse Taper Implants in the Posterior Maxilla by 3D Finite Element Analysis.

PubMed

Lemos, Cleidiel Aparecido Araujo; Verri, Fellippo Ramos; Santiago, Joel Ferreira; Almeida, Daniel Augusto de Faria; Batista, Victor Eduardo de Souza; Noritomi, Pedro Yoshito; Pellizzer, Duardo Piza

2018-01-01

The purpose of this study was to evaluate different retention systems (cement- or screw-retained) and crown designs (non-splinted or splinted) of fixed implant-supported restorations, in terms of stress distributions in implants/components and bone tissue, by 3-dimensional (3D) finite element analysis. Four 3D models were simulated with the InVesalius, Rhinoceros 3D, and SolidWorks programs. Models were made of type III bone from the posterior maxillary area. Models included three 4.0-mm-diameter Morse taper (MT) implants with different lengths, which supported metal-ceramic crowns. Models were processed by the Femap and NeiNastran programs, using an axial force of 400 N and oblique force of 200 N. Results were visualized as the von Mises stress and maximum principal stress (σmax). Under axial loading, there was no difference in the distribution of stress in implants/components between retention systems and splinted crowns; however, in oblique loading, cemented prostheses showed better stress distribution than screwed prostheses, whereas splinted crowns tended to reduce stress in the implant of the first molar. In the bone tissue cemented prostheses showed better stress distribution in bone tissue than screwed prostheses under axial and oblique loading. The splinted design only had an effect in the screwed prosthesis, with no influence in the cemented prosthesis. Cemented prostheses on MT implants showed more favorable stress distributions in implants/components and bone tissue. Splinting was favorable for stress distribution only for screwed prostheses under oblique loading.

The effects of progressive lateralization of the joint center of rotation of reverse total shoulder implants.

PubMed

Costantini, Oren; Choi, Daniel S; Kontaxis, Andreas; Gulotta, Lawrence V

2015-07-01

There has been a renewed interest in lateralizing the center of rotation (CoR) in implants used in reverse shoulder arthroplasty. The aim of this study was to determine the sensitivity of lateralization of the CoR on the glenohumeral joint contact forces, muscle moment arms, torque across the bone-implant interface, and the stability of the implant. A 3-dimensional virtual model was used to investigate how lateralization affects deltoid muscle moment arm and glenohumeral joint contact forces. This model was virtually implanted with 5 progressively lateralized reverse shoulder prostheses. The joint contact loads and deltoid moment arms were calculated for each lateralization over the course of 3 simulated standard humerothoracic motions. Lateralization of the CoR leads to an increase in the overall joint contact forces across the glenosphere. Most of this increased loading occurred through compression, although increases in anterior/posterior and superior/inferior shear were also observed. Moment arms of the deltoid consistently decreased with lateralization. Bending moments at the implant interface increased with lateralization. Progressive lateralization resulted in improved stability ratios. Lateralization results in increased joint loading. Most of that loading occurs through compression, although there were also increases in shear forces. Anterior/posterior shear is currently not accounted for in implant fixation studies, leaving its effect on implant fixation unknown. Future studies should incorporate shear forces into their models to more accurately assess fixation methods. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Comparison of fracture resistance of pressable metal ceramic custom implant abutment with a commercially fabricated CAD/CAM zirconia implant abutment.

PubMed

Protopapadaki, Maria; Monaco, Edward A; Kim, Hyeong-Il; Davis, Elaine L

2013-11-01

The predictable nature of the hot pressing ceramic technique has several applications, but no study was identified that evaluated its application to the fabrication of custom implant abutments. The purpose of this study was to compare the fracture resistance of an experimentally designed pressable metal ceramic custom implant abutment (PR) with that of a duplicate zirconia abutment (ZR). Two groups of narrow platform (NP) (Nobel Replace) implant abutment specimens were fabricated (n=10). The experimental abutment (PR) had a metal substructure cast with ceramic alloy (Lodestar) and veneered with leucite pressable glass ceramic (InLine PoM). Each PR abutment was individually scanned and 10 duplicate CAD/CAM ZR abutments were fabricated for the control group. Ceramic crowns (n=20) with the average dimensions of a human lateral incisor were pressed with lithium disilicate glass ceramic (IPS e.max Press) and bonded on the abutments with a resin luting agent (Multilink Automix). The specimens were subjected to thermocycling, cyclic loading, and finally static loading to failure with a computer-controlled Universal Testing Machine. An independent t test (1 sided) determined whether the mean values of the fracture load differed significantly (α=.05) between the 2 groups. No specimen failed during cyclic loading. Upon static loading, the mean (SD) load to failure was significantly higher for the PR group (525.89 [143.547] N) than for the ZR group (413.70 [35.515] N) for internal connection narrow platform bone-level implants (P=.025). Failure was initiated at the screw and internal connection level for both groups. It is possible to fabricate PR abutments that are stronger than ZR abutments for Nobel Biocare internal connection NP bone-level implants. The screw and the internal connection are the weak links for both groups. Copyright © 2013 Editorial Council for the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Fracture analysis of randomized implant-supported fixed dental prostheses

PubMed Central

Esquivel-Upshaw, Josephine F.; Mehler, Alex; Clark, Arthur E.; Neal, Dan; Anusavice, Kenneth J.

2014-01-01

Objective Fractures of posterior fixed dental all-ceramic prostheses can be caused by one or more factors including prosthesis design, flaw distribution, direction and magnitude of occlusal loading, and nature of supporting infrastructure (tooth root/implant), and presence of adjacent teeth. This clinical study of implant-supported, all-ceramic fixed dental prostheses, determined the effects of (1) presence of a tooth distal to the most distal retainer; (2) prosthesis loading either along the non-load bearing or load bearing areas; (3) presence of excursive contacts or maximum intercuspation contacts in the prosthesis; and (4) magnitude of bite force on the occurrence of veneer ceramic fracture. Methods 89 implant-supported FDPs were randomized as either a three-unit posterior metal-ceramic (Au-Pd-Ag alloy and InLine POM, Ivoclar, Vivadent) FDP or a ceramic-ceramic (ZirCAD and ZirPress, Ivoclar, Vivadent) FDP. Two implants (Osseospeed, Dentsply) and custom abutments (Atlantis, Dentsply) supported these FDPs, which were cemented with resin cement (RelyX Universal Cement). Baseline photographs were made with markings of teeth from maximum intercuspation (MI) and excursive function. Patients were recalled at 6 months and 1 to 3 years. Fractures were observed, their locations recorded, and images compared with baseline photographs of occlusal contacts. Conclusion No significant relationship exists between the occurrence of fracture and: (1) the magnitude of bite force; (2) a tooth distal to the most distal retainer; and (3) contacts in load-bearing or non-load-bearing areas. However, there was a significantly higher likelihood of fracture in areas with MI contacts only. Clinical Significance This clinical study demonstrates that there is a need to evaluate occlusion differently with implant-supported prostheses than with natural tooth supported prostheses because of the absence of a periodontal ligament. Implant supported prostheses should have minimal occlusion and lighter contacts than ones supported by natural dentition. PMID:25016139

Experimental pre-clinical assessment of the primary stability of two cementless femoral knee components.

PubMed

Berahmani, Sanaz; Hendriks, Maartje; Wolfson, David; Wright, Abraham; Janssen, Dennis; Verdonschot, Nico

2017-11-01

To achieve long-lasting fixation of cementless implants, an adequate primary stability is required. We aimed to compare primary stability of a new cementless femoral knee component (Attune®) against a conventional implant (LCS®) under different loading conditions. Six pairs of femora were prepared following the normal surgical procedure. Calibrated CT-scans and 3D-optical scans of the bones were obtained to measure bone mineral density (BMD) and cut accuracy, respectively. Micromotions were measured in nine regions of interest at the bone-implant interface using digital image correlation. The reconstructions were subjected to the implant-specific's peak tibiofemoral load of gait and a deep knee bend loading profiles. Afterwards, the implants were pushed-off at a flexion angle of 150°. Micromotions of Attune were significantly lower than LCS under both loading conditions (P ≤ 0.001). Cut accuracy did not affect micromotions, and BMD was only a significant factor affecting the micromotions under simplified gait loading. No significant difference was found in high-flex push-off force, but Attune required a significantly higher load to generate excessive micromotions during push-off. Parallel anterior and posterior bone cuts in the LCS versus the tapered bone cuts of the Attune may explain the difference between the two designs. Additionally, the rims at the borders of the LCS likely reduced the area of contact with the bone for the LCS, which may have affected the initial fixation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Redesign of a fixture mount to be used as an impression coping and a provisional abutment as well

PubMed Central

Chang, Glenn Hsuan-Chen; Tian, Chen; Hung, Yuen-Siang

2011-01-01

Purpose: An integrated fixture mount/impression coping/ temporary abutment can provide many advantages for immediate loading of dental implants, such as simpler procedure, less chair time, cost reduction, and comfort for the patients. Materials and Methods: A newly designed dental implant fixture mount (DIFMA) can be used as an impression coping for taking an immediate impression. An immediate load provisional prosthesis can then be fabricated shortly after implant placement to immediately load the implants. This fixture mount can also serve as a temporary abutment for immediate chair-side fabrication of provisional prosthesis. Two clinical cases are presented. Results: A clinical case utilizing the fixture mount abutment (DIFMA)/implant assembly is presented. The precision of fitting between the impression copings and implants is secured with this system. The chair time for taking an immediate impression is greatly reduced. Less cost for the restoration is provided and patient comfort is delivered. Conclusions: More patient satisfaction can be conferred by employing the fixture mount in the process of immediate impression taking and as an immediate provisional abutment. PMID:22090763

Effect of Heavy Smoking on Dental Implants Placed in Male Patients Posterior Mandibles: A Prospective Clinical Study.

PubMed

Sun, Cong; Zhao, Jinxiu; Jianghao, Chen; Hong, Tao

2016-12-01

The objective of this study was to evaluate the implant stability and peri-implant tissue response in heavy smokers receiving dental implants due to partially edentulous posterior mandibles. Forty-five ITI Straumann dental implants were placed into the partially edentulous posterior mandibles of 16 heavy smokers and 16 nonsmokers. One implant in each patient was evaluated for implant stability after surgery and before loading, and for the modified plaque index (mPLI), modified sulcus bleeding index (mSBI), probing depth (PD), and marginal bone loss (MBL) after loading. Meanwhile, the osteogenic capability of jaw marrow samples collected from patients was evaluated via an in vitro mineralization test. For both groups, the implant stability quotient (ISQ) initially decreased from the initial ISQ achieved immediately after surgery and then increased starting from 2 weeks postsurgery. However, at 3, 4, 6, and 8 weeks postsurgery, the ISQ differed significantly between nonsmokers and heavy smokers. All implants achieved osseointegration without complications at least by the end of the 12th week postsurgery. At 6 or 12 months postloading, the MBL and PD were significantly higher in heavy smokers than in nonsmokers, whereas the mSBI and mPLI did not differ significantly between the 2 groups. The 1-year cumulative success rate of implants was 100% for both groups. Within the limitations of the present clinical study (such as small sample size and short study duration), which applied the loading at 3 months postoperation, heavy smoking did not affect the cumulative survival rate of dental implants placed at the posterior mandible in male patients, but heavy smoking did negatively affect bone healing around dental implants by decreasing the healing speed. These results implied that it might be of importance to select the right time point to apply the implant loading for heavy smokers. In addition, heavy smoking promoted the loss of marginal bone and the further development of dental pockets. Further clinical studies with larger patient populations are warranted to confirm our findings over a longer study duration.

Life prediction of different commercial dental implants as influence by uncertainties in their fatigue material properties and loading conditions.

PubMed

Pérez, M A

2012-12-01

Probabilistic analyses allow the effect of uncertainty in system parameters to be determined. In the literature, many researchers have investigated static loading effects on dental implants. However, the intrinsic variability and uncertainty of most of the main problem parameters are not accounted for. The objective of this research was to apply a probabilistic computational approach to predict the fatigue life of three different commercial dental implants considering the variability and uncertainty in their fatigue material properties and loading conditions. For one of the commercial dental implants, the influence of its diameter in the fatigue life performance was also studied. This stochastic technique was based on the combination of a probabilistic finite element method (PFEM) and a cumulative damage approach known as B-model. After 6 million of loading cycles, local failure probabilities of 0.3, 0.4 and 0.91 were predicted for the Lifecore, Avinent and GMI implants, respectively (diameter of 3.75mm). The influence of the diameter for the GMI implant was studied and the results predicted a local failure probability of 0.91 and 0.1 for the 3.75mm and 5mm, respectively. In all cases the highest failure probability was located at the upper screw-threads. Therefore, the probabilistic methodology proposed herein may be a useful tool for performing a qualitative comparison between different commercial dental implants. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Early speech perception in Mandarin-speaking children at one-year post cochlear implantation.

PubMed

Chen, Yuan; Wong, Lena L N; Zhu, Shufeng; Xi, Xin

2016-01-01

The aim in this study was to examine early speech perception outcomes in Mandarin-speaking children during the first year of cochlear implant (CI) use. A hierarchical early speech perception battery was administered to 80 children before and 3, 6, and 12 months after implantation. Demographic information was obtained to evaluate its relationship with these outcomes. Regardless of dialect exposure and whether a hearing aid was trialed before implantation, implant recipients were able to attain similar pre-lingual auditory skills after 12 months of CI use. Children speaking Mandarin developed early Mandarin speech perception faster than those with greater exposure to other Chinese dialects. In addition, children with better pre-implant hearing levels and younger age at implantation attained significantly better speech perception scores after 12 months of CI use. Better pre-implant hearing levels and higher maternal education level were also associated with a significantly steeper growth in early speech perception ability. Mandarin-speaking children with CIs are able to attain early speech perception results comparable to those of their English-speaking counterparts. In addition, consistent single language input via CI probably enhances early speech perception development at least during the first-year of CI use. Copyright © 2015 Elsevier Ltd. All rights reserved.

Designer Dual Therapy Nanolayered Implant Coatings Eradicate Biofilms and Accelerate Bone Tissue Repair.

PubMed

Min, Jouha; Choi, Ki Young; Dreaden, Erik C; Padera, Robert F; Braatz, Richard D; Spector, Myron; Hammond, Paula T

2016-04-26

Infections associated with orthopedic implants cause increased morbidity and significant healthcare cost. A prolonged and expensive two-stage procedure requiring two surgical steps and a 6-8 week period of joint immobilization exists as today's gold standard for the revision arthroplasty of an infected prosthesis. Because infection is much more common in implant replacement surgeries, these issues greatly impact long-term patient care for a continually growing part of the population. Here, we demonstrate that a single-stage revision using prostheses coated with self-assembled, hydrolytically degradable multilayers that sequentially deliver the antibiotic (gentamicin) and the osteoinductive growth factor (BMP-2) in a time-staggered manner enables both eradication of established biofilms and complete and rapid bone tissue repair around the implant in rats with induced osteomyelitis. The nanolayered construct allows precise independent control of release kinetics and loading for each therapeutic agent in an infected implant environment. Antibiotics contained in top layers can be tuned to provide a rapid release at early times sufficient to eliminate infection, followed by sustained release for several weeks, and the underlying BMP-2 component enables a long-term sustained release of BMP-2, which induced more significant and mechanically competent bone formation than a short-term burst release. The successful growth factor-mediated osteointegration of the multilayered implants with the host tissue improved bone-implant interfacial strength 15-fold when compared with the uncoated one. These findings demonstrate the potential of this layered release strategy to introduce a durable next-generation implant solution, ultimately an important step forward to future large animal models toward the clinic.

Tendon-Holding Capacities of Two Newly Designed Implants for Tendon Repair: An Experimental Study on the Flexor Digitorum Profundus Tendon of Sheep

PubMed Central

Ağır, İsmail; Aytekin, Mahmut Nedim; Başçı, Onur; Çaypınar, Barış; Erol, Bülent

2014-01-01

Background: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques Materials and Methods: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. Results: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. Conclusion: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques. PMID:25067965

Mechanical torque measurement predicts load to implant cut-out: a biomechanical study investigating DHS anchorage in femoral heads.

PubMed

Suhm, Norbert; Hengg, Clemens; Schwyn, Ronald; Windolf, Markus; Quarz, Volker; Hänni, Markus

2007-08-01

Bone strength plays an important role in implant anchorage. Bone mineral density (BMD) is used as surrogate parameter to quantify bone strength and to predict implant anchorage. BMD can be measured by means of quantitative computer tomography (QCT) or dual energy X-ray absorptiometry (DXA). These noninvasive methods for BMD measurement are not available pre- or intra-operatively. Instead, the surgeon could determine bone strength by direct mechanical measurement. We have evaluated mechanical torque measurement for (A) its capability to quantify local bone strength and (B) its predictive value towards load at implant cut-out. Our experimental study was performed using sixteen paired human cadaver proximal femurs. BMD was determined for all specimens by QCT. The torque to breakaway of the cancellous bone structure (peak torque) was measured by means of a mechanical probe at the exact position of subsequent DHS placement. The fixation strength of the DHS achieved was assessed by cyclic loading in a stepwise protocol beginning with 1,500 N increasing 500 N every 5,000 cycles until 4,000 N. A highly significant correlation of peak torque with BMD (QCT) was found (r = 0.902, r (2) = 0.814, P < 0.001). Peak torque correlated highly significant with the load at implant cut-out (r = 0.795, P < 0.001). All specimens with a measured peak torque below 6.79 Nm failed at the first load level of 1,500 N. The specimens with a peak torque above 8.63 Nm survived until the last load level of 4,000 N. Mechanical peak torque measurement is able to quantify bone strength. In an experimental setup, peak torque identifies those specimens that are likely to fail at low load. In clinical routine, implant migration and cut-out depend on several parameters, which are difficult to control, such as fracture type, fracture reduction achieved, and implant position. The predictive value of peak torque towards cut-out in a clinical set-up therefore has to be carefully validated.

Computational mechanobiology to study the effect of surface geometry on peri-implant tissue differentiation.

PubMed

Andreykiv, A; van Keulen, F; Prendergast, P J

2008-10-01

The geometry of an implant surface to best promote osseointegration has been the subject of several experimental studies, with porous beads and woven mesh surfaces being among the options available. Furthermore, it is unlikely that one surface geometry is optimal for all loading conditions. In this paper, a computational method is used to simulate tissue differentiation and osseointegration on a smooth surface, a surface covered with sintered beads (this simulated the experiment (Simmons, C., and Pilliar, R., 2000, Biomechanical Study of Early Tissue Formation Around Bone-Interface Implants: The Effects of Implant Surface Geometry," Bone Engineering, J. E. Davies, ed., Emsquared, Chap. A, pp. 369-379) and established that the method gives realistic results) and a surface covered by porous tantalum. The computational method assumes differentiation of mesenchymal stem cells in response to fluid flow and shear strain and models cell migration and proliferation as continuum processes. The results of the simulation show a higher rate of bone ingrowth into the surfaces with porous coatings as compared with the smooth surface. It is also shown that a thicker interface does not increase the chance of fixation failure.

Retrospective study of 68 implants placed in the pterygomaxillary region using drills and osteotomes.

PubMed

Peñarrocha, Miguel; Carrillo, Celia; Boronat, Araceli; Peñarrocha, Maria

2009-01-01

The aim of this study was to evaluate the success rate of implants placed in the pterygomaxillary region using drills and osteotomes with a minimum of 12 months' follow-up. Bone loss after 1 year of loading and patient satisfaction with the prosthesis were evaluated. A retrospective case study was made. The sample was composed of patients rehabilitated with pterygoid implants between January 2000 and January 2006. The inclusion criteria were patients in good general health with severe atrophy of the posterior maxilla who had been rehabilitated with one or two pterygoid implants inserted using drills and osteotomes and had been followed for 12 months after implant loading. Implant success was defined according to the criteria of Albrektsson et al. Bone loss was measured on panoramic radiographs on the mesial and distal of each implant, and the largest value (whether mesial or distal) was selected as the bone loss for the implant in question. Subjects indicated satisfaction with the new prosthesis on a visual analogue scale. Forty-five patients were treated with 268 implants (200 anterior and 68 pterygoid). The success rate of pterygoid implants was 97.05%. The mean bone loss around implants in the pterygomaxillary region after 1 year of loading was 0.71 mm (range, 0 to 3.20). All prostheses were stable at the end of the observation period. Patients were satisfied with comfort and stability, ability to speak, ease of cleaning, and esthetics and functionality of the prosthesis. Placement of implants in the posterior pterygomaxillary region using drills and osteotomes is a viable alternative treatment modality for rehabilitation of atrophic posterior maxilla. Patients were satisfied with a prosthesis supported by pterygoid implants.

Dopamine-assisted fixation of drug-loaded polymeric multilayers to osteoarticular implants for tuberculosis therapy.

PubMed

Li, Dan; Li, Litao; Ma, Yunlong; Zhuang, Yaping; Li, Dawei; Shen, Hong; Wang, Xing; Yang, Fei; Ma, Yuanzheng; Wu, Decheng

2017-03-28

Currently, the major issues in the treatment of osteoarticular tuberculosis (TB) after implant placement are low drug concentration at the infected focus and drug resistance resulting from the long-term chemotherapy. The application of drug-loaded polymeric multilayers on implantable devices offers a promising solution to the problems. Herein, a poly(ethylene glycol)-based hydrogel film embedded with isoniazid (INH)-loaded alginate microparticles was fixed to Ti implants via adhesive polydopamine, subsequently capped by poly(lactic-co-glycolic acid) membranes for the sustained and localized delivery of the anti-TB drug. The antibacterial efficacy of the released INH was confirmed by a 4.5 ± 0.8 cm inhibition zone formed in the fourth week after inoculation of Mycobacterium tuberculosis. The INH-loaded Ti implants showed no toxicity to the osteoblast cell and provided a consistent drug release for nearly one week in vitro. The release profile in vivo showed a high local concentration and low systemic exposure. The local INH concentration could be kept higher than its minimum inhibitory concentration over a period of 8 weeks, which proves that it is a promising strategy to improve the severe osteoarticular TB treatment.

Sinus Floor Elevation with Modified Crestal Approach and Single Loaded Short Implants: A Case Report with 4 Years of Follow-Up

PubMed Central

Perelli, Michele; Abundo, Roberto; Corrente, Giuseppe; Saccone, Carlo

2017-01-01

Tooth extraction is usually followed by bone reduction. In the maxillary posterior region, this remodelling combined with sinus pneumatisation and periodontal defects may lead to a reduced basal bone height available for implant placement. Sinus floor elevation can be performed with different surgical techniques. Crestal approach has demonstrated to be effective, less invasive, and associated with a reduced morbidity. This article reports a modified sinus floor elevation by means of rotary, noncutting instruments, addition of xenograft, and 2 short-threaded implant placements. The aim of the study was to evaluate the implant's success and intrasinus radiographical bone gain after 4 years of functional loading. The premolar implant site presented a starting basal bone height of 6 mm, while the molar site was of 2 mm. In the first surgical step, sinus floor elevation was performed mesially and the implant was inserted, and distally only sinus floor elevation was performed. After 6 months, the mesial implant was uncovered and the second implant was inserted; 4 months later, the second fixture was uncovered, and both fixtures were loaded with single provisional screw-retained crowns and later with single screw-retained porcelain fused to metal crowns. Implants integrated successfully, and crestal bone remodelling did not exceed the smooth collar. Bone gain was 3 mm for the mesial implant and more than 5 mm for the distal one. PMID:29403665

Sinus Floor Elevation with Modified Crestal Approach and Single Loaded Short Implants: A Case Report with 4 Years of Follow-Up.

PubMed

Perelli, Michele; Abundo, Roberto; Corrente, Giuseppe; Saccone, Carlo; Arduino, Paolo G

2017-01-01

Tooth extraction is usually followed by bone reduction. In the maxillary posterior region, this remodelling combined with sinus pneumatisation and periodontal defects may lead to a reduced basal bone height available for implant placement. Sinus floor elevation can be performed with different surgical techniques. Crestal approach has demonstrated to be effective, less invasive, and associated with a reduced morbidity. This article reports a modified sinus floor elevation by means of rotary, noncutting instruments, addition of xenograft, and 2 short-threaded implant placements. The aim of the study was to evaluate the implant's success and intrasinus radiographical bone gain after 4 years of functional loading. The premolar implant site presented a starting basal bone height of 6 mm, while the molar site was of 2 mm. In the first surgical step, sinus floor elevation was performed mesially and the implant was inserted, and distally only sinus floor elevation was performed. After 6 months, the mesial implant was uncovered and the second implant was inserted; 4 months later, the second fixture was uncovered, and both fixtures were loaded with single provisional screw-retained crowns and later with single screw-retained porcelain fused to metal crowns. Implants integrated successfully, and crestal bone remodelling did not exceed the smooth collar. Bone gain was 3 mm for the mesial implant and more than 5 mm for the distal one.

Comparative analysis of stress in a new proposal of dental implants.

PubMed

Valente, Mariana Lima da Costa; de Castro, Denise Tornavoi; Macedo, Ana Paula; Shimano, Antonio Carlos; Dos Reis, Andréa Cândido

2017-08-01

The purpose of this study was to compare, through photoelastic analysis, the stress distribution around conventional and modified external hexagon (EH) and morse taper (MT) dental implant connections. Four photoelastic models were prepared (n=1): Model 1 - conventional EH cylindrical implant (Ø 4.0mm×11mm - Neodent®), Model 2 - modified EH cylindrical implant, Model 3 - conventional MT Conical implant (Ø 4.3mm×10mm - Neodent®) and Model 4 - modified MT conical implant. 100 and 150N axial and oblique loads (30° tilt) were applied in the devices coupled to the implants. A plane transmission polariscope was used in the analysis of fringes and each position of interest was recorded by a digital camera. The Tardy method was used to quantify the fringe order (n), that calculates the maximum shear stress (τ) value in each selected point. The results showed lower stress concentration in the modified cylindrical implant (EH) compared to the conventional model, with application of 150N axial and 100N oblique loads. Lower stress was observed for the modified conical (MT) implant with the application of 100 and 150N oblique loads, which was not observed for the conventional implant model. The comparative analysis of the models showed that the new design proposal generates good stress distribution, especially in the cervical third, suggesting the preservation of bone tissue in the bone crest region. Copyright © 2017 Elsevier B.V. All rights reserved.

A 5-year prospective study on single immediate implants in the aesthetic zone.

PubMed

Cosyn, Jan; Eghbali, Aryan; Hermans, Alexander; Vervaeke, Stijn; De Bruyn, Hugo; Cleymaet, Roberto

2016-08-01

There is a paucity of long-term data on soft tissue aesthetics of single immediate implants. The objective of this study was to evaluate the 5-year clinical and aesthetic outcome of this treatment concept. Twenty-two periodontally healthy patients (12 men, 10 women; mean age 50) with low risk for aesthetic complications (thick gingival biotype, intact buccal bone wall, both neighbouring teeth present) were consecutively treated with a single immediate implant in the aesthetic zone (15-25). Flapless surgery was performed and the gap between the implant and buccal bone wall was systematically filled with bovine bone particles. Implants were immediately non-functionally loaded with a screw-retained provisional crown. Cases demonstrating major alveolar process changes and/or advanced mid-facial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6 months. The clinical and aesthetic results at 5 years were compared to those obtained at 1 year. Seventeen patients attended the 5-year re-assessment, of whom five had been treated with a CTG for early aesthetic complications. There was one early implant failure and one complication after 1 year (porcelain chipping). Mean marginal bone loss was 0.12 mm at 1 year and 0.19 mm at 5 years (p = 0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5 years (p ≤ 0.007), whereas mid-facial contour (p = 0.005) and alveolar process deficiency (p = 0.008) deteriorated. Mean mid-facial recession was on average 0.28 mm (SD 0.48) at 1 year and 0.53 mm (SD 0.53) at 5 years (p = 0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession (>1 mm) at 5 years. All three were in a central incisor position and none had been treated with a CTG. Thus, 8/17 implants showed aesthetic complications (five early and three late aesthetic complications). Implants in a lateral incisor position showed stable soft tissue levels. The pink aesthetic score was on average 12.15 at 1 year and 11.18 at 5 years (p = 0.030). Single immediate implants showed high implant survival and limited marginal bone loss in the long term. However, mid-facial recession, mid-facial contour and alveolar process deficiency deteriorated after 1 year. With an aesthetic complication rate of 8/17 in well-selected patients who had been treated by experienced clinicians, type I placement may not be recommended for daily practice. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Levetiracetam-loaded biodegradable polymer implants in the tetanus toxin model of temporal lobe epilepsy in rats.

PubMed

Halliday, Amy J; Campbell, Toni E; Nelson, Timothy S; McLean, Karen J; Wallace, Gordon G; Cook, Mark J

2013-01-01

Approximately one-third of people with epilepsy receive insufficient benefit from currently available anticonvulsant medication, and some evidence suggests that this may be due to a lack of effective penetration into brain parenchyma. The current study investigated the ability of biodegradable polymer implants loaded with levetiracetam to ameliorate seizures following implantation above the motor cortex in the tetanus toxin model of temporal lobe epilepsy in rats. The implants led to significantly shorter seizures and a trend towards fewer seizures for up to 1 week. The results of this study indicate that drug-eluting polymer implants represent a promising evolving treatment option for intractable epilepsy. Future research is warranted to investigate issues of device longevity and implantation site. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Effect of Framework Design on Stress Distribution in Implant-Supported FPDs: A 3-D FEM Study

PubMed Central

Eraslan, Oguz; Inan, Ozgur; Secilmis, Asli

2010-01-01

Objectives: The biomechanical behavior of the superstructure plays an important role in the functional longevity of dental implants. However, information about the influence of framework design on stresses transmitted to the implants and supporting tissues is limited. The purpose of this study was to evaluate the effects of framework designs on stress distribution at the supporting bone and supporting implants. Methods: In this study, the three-dimensional (3D) finite element stress analysis method was used. Three types of 3D mathematical models simulating three different framework designs for implant-supported 3-unit posterior fixed partial dentures were prepared with supporting structures. Convex (1), concave (2), and conventional (3) pontic framework designs were simulated. A 300-N static vertical occlusal load was applied on the node at the center of occlusal surface of the pontic to calculate the stress distributions. As a second condition, frameworks were directly loaded to evaluate the effect of the framework design clearly. The Solidworks/Cosmosworks structural analysis programs were used for finite element modeling/analysis. Results: The analysis of the von Mises stress values revealed that maximum stress concentrations were located at the loading areas for all models. The pontic side marginal edges of restorations and the necks of implants were other stress concentration regions. There was no clear difference among models when the restorations were loaded at occlusal surfaces. When the veneering porcelain was removed, and load was applied directly to the framework, there was a clear increase in stress concentration with a concave design on supporting implants and bone structure. Conclusions: The present study showed that the use of a concave design in the pontic frameworks of fixed partial dentures increases the von Mises stress levels on implant abutments and supporting bone structure. However, the veneering porcelain element reduces the effect of the framework and compensates for design weaknesses. PMID:20922156

Spectral-Temporal Modulated Ripple Discrimination by Children With Cochlear Implants.

PubMed

Landsberger, David M; Padilla, Monica; Martinez, Amy S; Eisenberg, Laurie S

A postlingually implanted adult typically develops hearing with an intact auditory system, followed by periods of deafness (or near deafness) and adaptation to the implant. For an early implanted child whose brain is highly plastic, the auditory system matures with consistent input from a cochlear implant. It is likely that the auditory system of early implanted cochlear implant users is fundamentally different than postlingually implanted adults. The purpose of this study is to compare the basic psychophysical capabilities and limitations of these two populations on a spectral resolution task to determine potential effects of early deprivation and plasticity. Performance on a spectral resolution task (Spectral-temporally Modulated Ripple Test [SMRT]) was measured for 20 bilaterally implanted, prelingually deafened children (between 5 and 13 years of age) and 20 hearing children within the same age range. Additionally, 15 bilaterally implanted, postlingually deafened adults, and 10 hearing adults were tested on the same task. Cochlear implant users (adults and children) were tested bilaterally, and with each ear alone. Hearing listeners (adults and children) were tested with the unprocessed SMRT and with a vocoded version that simulates an 8-channel cochlear implant. For children with normal hearing, a positive correlation was found between age and SMRT score for both the unprocessed and vocoded versions. Older hearing children performed similarly to hearing adults in both the unprocessed and vocoded test conditions. However, for children with cochlear implants, no significant relationship was found between SMRT score and chronological age, age at implantation, or years of implant experience. Performance by children with cochlear implants was poorer than performance by cochlear implanted adults. It was also found that children implanted sequentially tended to have better scores with the first implant compared with the second implant. This difference was not observed for adults. An additional finding was that SMRT score was negatively correlated with age for adults with implants. Results from this study suggest that basic psychophysical capabilities of early implanted children and postlingually implanted adults differ when assessed in the sound field using their personal implant processors. Because spectral resolution does not improve with age for early implanted children, it seems likely that the sparse representation of the signal provided by a cochlear implant limits spectral resolution development. These results are supported by the finding that postlingually implanted adults, whose auditory systems matured before the onset of hearing loss, perform significantly better than early implanted children on the spectral resolution test.

Influence of implant number on the movement of mandibular implant overdentures.

PubMed

Oda, Ken; Kanazawa, Manabu; Takeshita, Shin; Minakuchi, Shunsuke

2017-03-01

The rotational movement of an implant overdenture (IOD) has a negative effect on the perceived masticatory ability of the denture wearer. However, the influence of implant number on the movement of IODs has not been investigated. The purpose of this in vitro study was to evaluate the denture movement of mandibular IODs anchored by different numbers of implants. An edentulous mandibular test model with artificial mucosa and 5 experimental overdentures (N=5) was fabricated. The locator attachment system with blue nylon inserts was chosen for this study. Three implant positions were prepared: anterior midline (1-IOD), bilateral lateral incisor regions (2-IOD), and anterior midline and bilateral canine regions (3-IOD). Vertical loads of 50 N were applied to the mid-anterior region, the left canine region, the left premolar region, and the left first molar region. The vertical and horizontal displacements at the right distal edge and the vertical displacements at the loading point were measured. The displacement values were statistically analyzed using a 1-way analysis of variance and the post hoc Tukey honest significant difference test with the implant number as a factor. In addition, the values of the vertical and horizontal displacements at the distal edge of the overdenture were statistically compared using a paired t test, and the values of the vertical displacement at the distal edge of the overdenture were statistically analyzed by a repeated measures analysis of variance and the post hoc Tukey honest significance difference test with the loading point as a factor (a=.05). Upon anterior loading, the 2-IOD showed significantly larger vertical displacements at the right distal edge than the 1-IOD or 3-IOD (P<.01). The horizontal displacements at the right distal edge were small compared with the vertical displacements at the same point, although the displacement of the 2-IOD was significantly larger than that of the 1-IOD upon anterior loading (P=.03). The magnitude of the vertical displacement at the loading point of the 2-IOD was significantly larger than that of the 3-IOD upon anterior loading (P<.01). No statistically significant differences were shown under the other conditions for each loading (P>.05). Within the limitations of this in vitro study, the following conclusions were drawn: During mastication with the anterior teeth, the use of 2 implants for anchoring an IOD increased the rotation of the denture base more than the use of 1 or 3 implants. The horizontal movements of the IODs were small compared with the vertical movements. Denture movement under the occlusal force in the molar region was smaller than that in the anterior region. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Peri-Implant Strain in an In Vitro Model.

PubMed

Hussaini, Souheil; Vaidyanathan, Tritala K; Wadkar, Abhinav P; Quran, Firas A Al; Ehrenberg, David; Weiner, Saul

2015-10-01

An in vitro experimental model was designed and tested to determine the influence that peri-implant strain may have on the overall crestal bone. Strain gages were attached to polymethylmethacrylate (PMMA) models containing a screw-type root form implant at sites 1 mm from the resin-implant interface. Three different types of crown superstructures (cemented, 1-screw [UCLA] and 2-screw abutment types) were tested. Loading (1 Hz, 200 N load) was performed using a MTS Mechanical Test System. The strain gage data were stored and organized in a computer for statistical treatment. Strains for all abutment types did not exceed the physiological range for modeling and remodeling of cancellous bone, 200-2500 με (microstrain). For approximately one-quarter of the trials, the strain values were less than 200 με the zone for bone atrophy. The mean microstrain obtained was 517.7 με. In conclusion, the peri-implant strain in this in vitro model did not exceed the physiologic range of bone remodeling under axial occlusal loading.

Use of micro-CT-based finite element analysis to accurately quantify peri-implant bone strains: a validation in rat tibiae.

PubMed

Torcasio, Antonia; Zhang, Xiaolei; Van Oosterwyck, Hans; Duyck, Joke; van Lenthe, G Harry

2012-05-01

Although research has been addressed at investigating the effect of specific loading regimes on bone response around the implant, a precise quantitative understanding of the local mechanical response close to the implant site is still lacking. This study was aimed at validating micro-CT-based finite element (μFE) models to assess tissue strains after implant placement in a rat tibia. Small implants were inserted at the medio-proximal site of 8 rat tibiae. The limbs were subjected to axial compression loading; strain close to the implant was measured by means of strain gauges. Specimen-specific μFE models were created and analyzed. For each specimen, 4 different models were created corresponding to different representations of the bone-implant interface: bone and implant were assumed fully osseointegrated (A); a low stiffness interface zone was assumed with thickness of 40 μm (B), 80 μm (C), and 160 μm (D). In all cases, measured and computational strains correlated highly (R (2) = 0.95, 0.92, 0.93, and 0.95 in A, B, C, and D, respectively). The averaged calculated strains were 1.69, 1.34, and 1.15 times higher than the measured strains for A, B, and C, respectively, and lower than the experimental strains for D (factor = 0.91). In conclusion, we demonstrated that specimen-specific FE analyses provide accurate estimates of peri-implant bone strains in the rat tibia loading model. Further investigations of the bone-implant interface are needed to quantify implant osseointegration.

Finite Element Simulation of NiTi Umbrella-Shaped Implant Used on Femoral Head under Different Loadings.

PubMed

Mehrabi, Reza; Dorri, Milad; Elahinia, Mohammad

2017-03-12

In this study, an umbrella-shaped device that is used for osteonecrosis treatment is simulated. The femoral head is subjected to various complex loadings as a result of a person's daily movements. Implant devices used in the body are made of shape memory alloy materials because of their remarkable resistance to wear and corrosion, good biocompatibility, and variable mechanical properties. Since this NiTi umbrella-shaped implant is simultaneously under several loadings, a 3-D model of shape memory alloy is utilized to investigate the behavior of the implant under different conditions. Shape memory and pseudo-elasticity behavior of NiTi is analyzed using a numerical model. The simulation is performed within different temperatures and in an isothermal condition with varied and complex loadings. The objective of this study is to evaluate the performance of the device under thermal and multi-axial forces via numerically study. Under tensile loading, the most critical points are on the top part of the implant. It is also shown that changes in temperature have a minor effect on the Von Mises stress. Applied forces and torques have significant influence on the femoral head. Simulations results indicate that the top portion of the umbrella is under the most stress when embedded in the body. Consequently, the middle, curved portion of the umbrella is under the least amount of stress.

Finite Element Simulation of NiTi Umbrella-Shaped Implant Used on Femoral Head under Different Loadings

PubMed Central

Mehrabi, Reza; Dorri, Milad; Elahinia, Mohammad

2017-01-01

In this study, an umbrella-shaped device that is used for osteonecrosis treatment is simulated. The femoral head is subjected to various complex loadings as a result of a person’s daily movements. Implant devices used in the body are made of shape memory alloy materials because of their remarkable resistance to wear and corrosion, good biocompatibility, and variable mechanical properties. Since this NiTi umbrella-shaped implant is simultaneously under several loadings, a 3-D model of shape memory alloy is utilized to investigate the behavior of the implant under different conditions. Shape memory and pseudo-elasticity behavior of NiTi is analyzed using a numerical model. The simulation is performed within different temperatures and in an isothermal condition with varied and complex loadings. The objective of this study is to evaluate the performance of the device under thermal and multi-axial forces via numerically study. Under tensile loading, the most critical points are on the top part of the implant. It is also shown that changes in temperature have a minor effect on the Von Mises stress. Applied forces and torques have significant influence on the femoral head. Simulations results indicate that the top portion of the umbrella is under the most stress when embedded in the body. Consequently, the middle, curved portion of the umbrella is under the least amount of stress. PMID:28952502

Microencapsulation of hydrophilic drug substances using biodegradable polyesters. Part II: Implants allowing controlled drug release--a feasibility study using bisphosphonates.

PubMed

Weidenauer, U; Bodmer, D; Kissel, T

2004-03-01

The prolonged delivery of hydrophilic drug salts from hydrophobic polymer carriers at high drug loading is an ambitious goal. Pamidronate disodium salt (APD) containing implants prepared from spray-dried microparticles were investigated using a laboratory ram extruder. An APD-containing polymer matrix consisting of an APD-chitosan implant embedded in the biodegradable polymer D,L-poly(lactide-co-glycolide acid-glucose) (PLG-GLU) was compared with a matrix system with the micronized drug distributed in the PLG-GLU. The APD-chitosan matrix system showed a triphasic release behaviour at loading levels of 6.86 and 15.54% (w/w) over 36 days under in-vitro conditions. At higher loading (31.92%), a drug burst was observed within 6 days due to the formation of pores and channels in the polymeric matrix. In contrast, implants containing the micronized drug showed a more continuous release profile over 48 days up to a loading of 31.78% (w/w). At a drug loading of 46.17% (w/w), a drug burst was observed. Using micronized drug salts and reducing the surface area available for diffusion, parenteral delivery systems for highly water-soluble drug candidates were shown to be technically feasible at high drug loadings.

Fracture resistance of inter-joined zirconia abutment of dental implant system with injection molding technique.

PubMed

Yang, Jianjun; Wang, Ke; Liu, Guangyuan; Wang, Dashan

2013-11-01

Zirconia powder in nanometers can be fabricated into inter-joined abutment of dental implant system with the injection shaping technique. This study was to detect the resistance of inter-joined zirconia abutment with different angle loading for clinical applications. The inter-joined abutments were shaped with the technique of injection of zirconia powder in nanometers. Sixty Osstem GSII 5 × 10 mm implants were used with 30 zirconia abutments and 30 Osstem GSII titanium abutments for fixation using 40 N torque force. The loading applications included 90°, 30°, and 0° formed by the long axis of abutments and pressure head of universal test machine. The fracture resistances of zirconia and titanium abutments were documented and analyzed. The inter-joined zirconia abutments were assembled to the Osstem GSII implants successfully. In the 90° loading mode, the fracture resistance of zirconia abutment group and titanium abutment group were 301.5 ± 15.4 N and 736.4 ± 120.1 N, respectively. And those in the 30° groups were 434.7 ± 36.1 N and 1073.1 ± 74 N, correspondingly. Significant difference in the two groups was found using t-test and Wilcoxon test. No damage on the abutments of the two groups but S-shaped bending on the implants was found when the 0° loading was 1300-2000 N. Through the assembly of Zirconia abutments and implants, all the components presented sufficient resistance acquired for the clinical application under loadings with different angle. © 2012 John Wiley & Sons A/S.

Finite element analysis of an implant-assisted removable partial denture.

PubMed

Shahmiri, Reza; Aarts, John M; Bennani, Vincent; Atieh, Momen A; Swain, Michael V

2013-10-01

This study analyzes the effects of loading a Kennedy class I implant-assisted removable partial denture (IARPD) using finite element analysis (FEA). Standard RPDs are not originally designed to accommodate a posterior implant load point. The null hypothesis is that the introduction of posteriorly placed implants into an RPD has no effect on the load distribution. A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8 × 12 mm) Straumann® implant and titanium matrix, tooth roots, and periodontal ligaments were modeled using a combination of reverse engineering in Rapidform XOR2 and solid modeling in Solidworks 2008 FEA program. The model incorporated an RPD and was loaded with a bilateral force of 120 N. ANSYS Workbench 11.0 was used to analyze deformation in the IARPD and elastic strain in the metal framework. FEA identified that the metal framework developed high strain patterns on the major and minor connectors, and the acrylic was subjected to deformation, which could lead to acrylic fractures. The ideal position of the neutral axis was calculated to be 0.75 mm above the ridge. A potentially destructive mismatch of strain distribution was identified between the acrylic and metal framework, which could be a factor in the failure of the acrylic. The metal framework showed high strain patterns on the major and minor connectors around the teeth, while the implant components transferred the load directly to the acrylic. © 2013 by the American College of Prosthodontists.

In vitro synchrotron-based radiography of micro-gap formation at the implant-abutment interface of two-piece dental implants.

PubMed

Rack, A; Rack, T; Stiller, M; Riesemeier, H; Zabler, S; Nelson, K

2010-03-01

Micro-gap formation at the implant-abutment interface of two-piece dental implants was investigated in vitro using high-resolution radiography in combination with hard X-ray synchrotron radiation. Images were taken with the specimen under different mechanical loads of up to 100 N. The aim of this investigation was to prove the existence of micro-gaps for implants with conical connections as well as to study the mechanical behavior of the mating zone of conical implants during loading. Synchrotron-based radiography in comparison with classical laboratory radiography yields high spatial resolution in combination with high contrast even when exploiting micro-sized features in highly attenuating objects. The first illustration of a micro-gap which was previously indistinguishable by laboratory methods underlines that the complex micro-mechanical behavior of implants requires further in vitro investigations where synchrotron-based micro-imaging is one of the prerequisites.

Influence of Thickness and Contact Surface Geometry of Condylar Stem of TMJ Implant on Its Stability

NASA Astrophysics Data System (ADS)

Arabshahi, Zohreh; Kashani, Jamal; Kadir, Mohammed Rafiq Abdul; Azari, Abbas

The aim of this study is to examine the effect thickness and contact surface geometry of condylar stem of TMJ implant on its stability in total reconstruction system and evaluate the micro strain resulted in bone at fixation screw holes in jaw bone embedded with eight different designs of temporomandibular joint implants. A three dimensional model of a lower mandible of an adult were developed from a Computed Tomography scan images. Eight different TMJ implant designs and fixation screws were modeled. Three dimensional finite element models of eight implanted mandibles were analyzed. The forces assigned to the masticatory muscles for incisal clenching were applied consisting of nine important muscular loads. In chosen loading condition, The results indicated that the anatomical curvature contact surface design of TMJ implant can moderately improve the stability and the strain resulted in fixation screw holes in thinner TMJ implant was diminished in comparison with other thicknesses.

One-Piece Implant-Retained Mandibular Overdentures By Pre-Fabricated Titanium Telescopic Attachments and Frictional Varnish: A Two-Year Prospective Study.

PubMed

Nik, Shahram Namjoy; Nejatian, Touraj

2016-12-01

Clinical efficiency of one-piece screw-type implants with telescopic were attachments evaluated in this study. Twenty-four patients received a mandibular implant-supported overdenture and maxillary complete denture. Ninety-six one-piece implants were inserted in the inter-foraminal area. Implants were immediately loaded with an implant-retained overdenture and telescopic attachments which had frictional retention elements. There was 0.25±0.24 mm, 0.32±0.25 mm, 0.43±0.30 mm, 0.61±0.30 mm and of bone resorption after 3, 6, 12 and 24 months, respectively. The need to activate the frictional retention was the most common complication. Treatment outcomes for prefabricated telescopic retained overdentures on one-piece implants are similar to that obtained in cases of delayed loading. Copyright© 2016 Dennis Barber Ltd.

Soft tissue around three different implant types after 1.5 years of functional loading without oral hygiene: a preliminary study in baboons.

PubMed

Watzak, Georg; Zechner, Werner; Tangl, Stefan; Vasak, Christoph; Donath, Karl; Watzek, Georg

2006-04-01

The purpose of this study was to determine the peri-implant soft tissue dimension (PSD) and peri-implant bone level (BL) of dental implants with different designs and surface modifications after functional loading without oral hygiene. Three types of dental implants were placed in the posterior jaws of adult baboons, three of the same design per quadrant, and fitted with fixed partial dentures. After 1.5 years of functional loading and plaque accumulation, all implants showed severe peri-implant mucositis and comparatively high BL. A histomorphometric evaluation of the sulcus depth (SD), the dimension of the junctional epithelium (JE) and the connective tissue contact (CTC) resulted in no significant differences between the three implant designs, neither in the maxilla nor in the mandible (P>0.05). The sum of SD, JE and CTC forming the PSD was nearly the same in the maxilla (commercially pure titanium, CpTi: 3.5 mm 2.9/4.1 confidence interval (CI); titanium plasma sprayed (TPS): 3.5 mm 2.9/4.2 CI; sand blasted acid-etched (GBAE): 3.2 mm 2.7/3.9 CI) and in the mandible (CpTi: 3.2 mm 2.6/3.8 CI; TPS: 3.2 mm 2.6/3.8 CI; GBAE: 3.2 mm 2.7/3.9 CI; P>0.05). There was no difference in BL around the three implant designs (maxilla: CpTi: 0.9 mm 0.5/1.6 CI; TPS: 0.9 mm 0.5/1.5CI; GBAE: 0.9 mm 0.5/1.6 CI; mandible: CpTi: 0.8 mm 0.5/1.2 CI; TPS: 0.6 mm 0.4/0.9 CI; GBAE: 0.7 mm 0.5/1.1 CI; P>0.05). Overall, the data presented did not show any significant differences in peri-implant soft tissue conditions in baboons. Moreover, plaque accumulation and propagation of peri-implant mucositis after 1.5 years of functional loading was not influenced by implant design and surface modifications in baboons.

Early infection risk with primary versus staged Hemodialysis Reliable Outflow (HeRO) graft implantation.

PubMed

Griffin, Andrew S; Gage, Shawn M; Lawson, Jeffrey H; Kim, Charles Y

2017-01-01

This study evaluated whether the use of a staged Hemodialysis Reliable Outflow (HeRO; Merit Medical, South Jordan, Utah) implantation strategy incurs increased early infection risk compared with conventional primary HeRO implantation. A retrospective review was performed of 192 hemodialysis patients who underwent HeRO graft implantation: 105 patients underwent primary HeRO implantation in the operating room, and 87 underwent a staged implantation where a previously inserted tunneled central venous catheter was used for guidewire access for the venous outflow component. Within the staged implantation group, 32 were performed via an existing tunneled hemodialysis catheter (incidentally staged), and 55 were performed via a tunneled catheter inserted across a central venous occlusion in an interventional radiology suite specifically for HeRO implantation (intentionally staged). Early infection was defined as episodes of bacteremia or HeRO infection requiring resection ≤30 days of HeRO implantation. For staged HeRO implantations, the median interval between tunneled catheter insertion and conversion to a HeRO graft was 42 days. The overall HeRO-related infection rate ≤30 days of implantation was 8.6% for primary HeRO implantation and 2.3% for staged implantations (P = .12). The rates of early bacteremia and HeRO resection requiring surgical resection were not significantly different between groups (P = .19 and P = .065, respectively), nor were age, gender, laterality, anastomosis to an existing arteriovenous access, human immunodeficiency virus status, diabetes, steroids, chemotherapy, body mass index, or graft location. None of the patient variables, techniques, or graft-related variables correlated significantly with the early infection rate. The staged HeRO implantation strategy did not result in an increased early infection risk compared with conventional primary implantation and is thus a reasonable strategy for HeRO insertion in hemodialysis patients with complex central venous disease. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Feasibility of a nickel-metal hydride battery for totally implantable artificial hearts.

PubMed

Okamoto, E; Yoshida, T; Fujiyoshi, M; Shimanaka, M; Takeuchi, A; Mitamura, Y; Mikami, T

1996-01-01

An implantable rechargeable battery is one of the key technologies for totally implantable artificial hearts. The nickel-metal hydride (Ni-MH) battery is promising for its high energy density of 1.5-2.0 times that of a nickel-cadmium battery. In this study, the effects of pulsatile discharge loads on the operating time and cycle life of Ni-MH batteries at 39 degrees C were studied. Two battery cells (TH-3M, 1,200 mAh, phi 14.5 x 49 mm; Toshiba, Tokyo, Japan) in series were charge/discharge cycled at 39 degrees C using a charge current of 1CA (1,200 mA) and then were fully discharged to 1.0 V/cell under either pulsatile discharge loads, which mimicked a systole (1 A for 0.3 sec) and a diastole (0.4 A for 0.3 sec), or a non pulsatile discharge load equivalent to the average of the pulsatile loads (0.7 A). Each cycle life test was interrupted on the 482nd cycle under pulsatile load, and on the 423rd cycle under non pulsatile load, because of malfunction of each battery charger. The tests showed that the pulsatile discharge cells had significantly (p < 0.001) less operating time (74.0 +/- 7.15 min) throughout the test period (up to 482 days) compared to the cells under equivalent non pulsatile discharge loads (93.7 +/- 7.74 min). The pulsatile-discharged Ni-MH cells provide significantly less operating time than the constantly discharged cells; the Ni-MH battery has an operating time of over 78 min and a cycle life of almost 500 cycles at 39 degrees C. In conclusion, the Ni-MH battery is feasible as an implantable back-up battery for a totally implantable artificial heart system.

Fracture load of complete-arch implant-supported prostheses reinforced with nylon-silica mesh: An in vitro study.

PubMed

Gonçalves, Fernanda de Cássia Papaiz; Amaral, Marina; Borges, Alexandre Luiz Souto; Gonçalves, Luiz Fernando Martins; Paes-Junior, Tarcisio José de Arruda

2018-04-01

Complete-arch implant-supported prostheses without a framework have a high risk of failure: a straightforward and inexpensive reinforcement material, such as nylon mesh, could improve their longevity. The purpose of this in vitro study was to evaluate a nylon-silica mesh compound on the fracture strength of acrylic resin and the fracture load of complete-arch implant-supported prostheses. Twenty-four complete mandibular arch implant-supported prostheses were divided into 2 groups according to cantilever length (molar and premolar) and subdivided into another 2 subgroups according to the presence or absence of reinforcing mesh. The specimens were submitted to a maximum load-to-fracture test in a universal testing machine, with a 100-N load cell, a 2 mm/min crosshead speed, and a spherical metal tip diameter of 4 mm at different points (molar and premolar). These were submitted to 1-way analysis of variance for repeated measurement and the post hoc Tukey multiple comparison test (α=.05). The mean maximum load ±standard deviation for the molar group was 393.4 ±95.0 N with reinforcement and 305.4 ±76.3 N without reinforcement (P=.02); and for the premolar group was 1083.3 ±283.7 N with reinforcement and 605.3 ±90.5 N without reinforcement (P=.001). Reinforcement with nylon mesh increased the mean maximum load of implant-supported complete-arch prostheses at both cantilever lengths. The cantilever to the premolar (5 mm) presented the highest maximum load values to fracture. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Influence of implant diameter in the displacement of dental implants in trabecular bovine bone under a static lateral load: experimental results and computational modeling.

PubMed

Engelke, Wilfried; Decco, Oscar A; Cura, Andrea C; Maldonado, Isai; Crippa, Federico G

2014-12-01

Primary stability and micromovement of dental implants depend on structural properties of the surrounding bone and on implant dimension and design. The purpose of this study was to provide objective data for the influence of implant diameter on the displacement of titanium screw implants. Ninety Semados implants (length 15 mm, diameter 3.25, 3.75, and 4.5 mm; Bego, Bremen, Germany) were inserted in trabecular bone specimens. All implants were inserted with a torque up to 30 N·cm and loaded horizontally with 10, 20, and 30 N for 2 seconds. All implants showed primary stability. With increasing force, a gradual increase of micromovement was observed (Kruskal-Wallis test, P = 0.000). No significant differences were found (Kruskal-Wallis test, P = 0.148) comparing different diameters for every force. Variation of the diameter of standard implants between 3.25 and 4.5 mm does not seem to influence the primary stability in trabecular bone specimen. Differences between experimental and computational results may be due to the simplification used when modeling.

Carbon fibre versus metal framework in full-arch immediate loading rehabilitations of the maxilla - a cohort clinical study.

PubMed

Pera, F; Pesce, P; Solimano, F; Tealdo, T; Pera, P; Menini, M

2017-05-01

Frameworks made of carbon fibre-reinforced composites (CFRC) seem to be a viable alternative to traditional metal frameworks in implant prosthodontics. CFRC provide stiffness, rigidity and optimal biocompatibility. The aim of the present prospective study was to compare carbon fibre frameworks versus metal frameworks used to rigidly splint implants in full-arch immediate loading rehabilitations. Forty-two patients (test group) were rehabilitated with full-arch immediate loading rehabilitations of the upper jaw (total: 170 implants) following the Columbus Bridge Protocol with four to six implants with distal tilted implants. All patients were treated with resin screw-retained full-arch prostheses endowed with carbon fibre frameworks. The mean follow-up was 22 months (range: 18-24). Differences in the absolute change of bone resorption over time between the two implant sides (mesial and distal) were assessed performing a Mann-Whitney U-test. The outcomes were statistically compared with those of patients rehabilitated following the same protocol but using metal frameworks (control group: 34 patients with 163 implants - data reported in Tealdo, Menini, Bevilacqua, Pera, Pesce, Signori, Pera, Int J Prosthodont, 27, 2014, 207). Ten implants failed in the control group (6·1%); none failed in the test group (P = 0·002). A statistically significant difference in the absolute change of bone resorption around the implants was found between the two groups (P = 0·004), with greater mean peri-implant bone resorption in the control group (1 mm) compared to the test group (0·8 mm). Carbon fibre frameworks may be considered as a viable alternative to the metal ones and showed less marginal bone loss around implants and a greater implant survival rate during the observation period. © 2017 John Wiley & Sons Ltd.

Prefabricated Bar System for Immediate Loading in Edentulous Patients: A 5-Year Follow-Up Prospective Longitudinal Study

PubMed Central

Gherlone, Enrico F.; Rapanelli, Andrea; Crespi, Roberto; Gastaldi, Giorgio

2018-01-01

Objectives The aim of this clinical study was to evaluate a new type of prefabricated bar system, supported by axial and tilted implants at 5-year follow-up. Materials and Methods Twenty-nine consecutive participants (19 females, 10 males) (mean age 61.4 years), edentulous in one or both jaws, with severe atrophy of the posterior regions, were treated according to the All-on-four® protocol with immediately loaded axial (64) and tilted (64) implants supporting complete-arch screw-retained prostheses (12 maxillary, 20 mandibular) featuring a prefabricated bar as framework. Follow-up visits were performed at 3, 6, 12, 24, 48, and 60 months after implant insertion. Radiographic assessments were made using panoramic radiographs obtained immediately after surgery and at each follow-up visit. Bone level measurements around the axial and tilted implants were compared by means of the Student's t-test. Results One axial implant failed in the lower jaw and did not compromise prosthetic function. The 60-month overall implant survival rate was 100% for axially positioned implants and 98.44% for tilted implants. The implant survival rates were 100% in the maxilla and 98.75% in the mandible. None of the 32 fixed prostheses were lost during the observation period, representing a prosthetic survival rate of 100%. No statistically significant differences (P > 0.05) in marginal bone loss between tilted and axial implants were detected in either jaw over time. Conclusions The use of the evaluated prefabricated bar for immediately loaded implants placed according to the All-on-four concept may significantly reduce implant failures; however, more long-term prospective clinical trials are needed to affirm the effectiveness of the surgical-prosthetic protocol. PMID:29682552

Success of dental implants in vascularised fibular osteoseptocutaneous flaps used as onlay grafts after marginal mandibulectomy.

PubMed

Chang, Y-M; Pan, Y-H; Shen, Y-F; Chen, J-K; ALDeek, N F; Wei, F-C

2016-12-01

We have evaluated the survival of dental implants placed in vascularised fibular flap onlay grafts placed over marginal mandibulectomies and the effects on marginal bone loss of different types of soft tissue around implants under functional loading. From 2001-2009 we studied a total of 11 patients (1 woman and10 men), three of whom had had ameloblastoma and eight who had had squamous cell carcinomas resected. A total of 38 dental implants were placed either at the time of transfer of the vascularised fibular ostoseptocutaneous flaps (nine patients with 30 implants) or secondarily (two patients with eight implants). Four patients were given palatal mucosal grafts to replace intraoral skin flaps around the dental implants (n=13), and the other seven had the skin flaps around the dental implants thinned (n=25) at the second stage of implantation of the osteointegrated teeth. All vascularised fibular osteoseptocutaneous flaps were successfully transferred, and all implants survived a mean (range) of 73 (33-113) months after occlusal functional loading. The mean (SD) marginal bone loss was 0.5 (0.3) mm on both mesial and distal sides in patients who had palatal mucosal grafts, but 1.8 (1.6) mm, and 1.7 (1.5) mm, respectively, on the mesial and distal sides in the patients who had had thinning of their skin flaps. This difference is significant (p=0.008) with less resorption of bone in the group who had palatal mucosal grafts. Palatal mucosa around the implants helps to reduce resorption of bone after functional loading of implants. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Biomechanical investigation of an alternative concept to angular stable plating using conventional fixation hardware.

PubMed

Windolf, Markus; Klos, Kajetan; Wähnert, Dirk; van der Pol, Bas; Radtke, Roman; Schwieger, Karsten; Jakob, Roland P

2010-05-21

Angle-stable locking plates have improved the surgical management of fractures. However, locking implants are costly and removal can be difficult. The aim of this in vitro study was to evaluate the biomechanical performance of a newly proposed crossed-screw concept ("Fence") utilizing conventional (non-locked) implants in comparison to conventional LC-DCP (limited contact dynamic compression plate) and LCP (locking compression plate) stabilization, in a human cadaveric diaphyseal gap model. In eight pairs of human cadaveric femora, one femur per pair was randomly assigned to receive a Fence construct with either elevated or non-elevated plate, while the contralateral femur received either an LCP or LC-DCP instrumentation. Fracture gap motion and fatigue performance under cyclic loading was evaluated successively in axial compression and in torsion. Results were statistically compared in a pairwise setting. The elevated Fence constructs allowed significantly higher gap motion compared to the LCP instrumentations (axial compression: p

The effects of simulated bone loss on the implant-abutment assembly and likelihood of fracture: an in vitro study.

PubMed

Manzoor, Behzad; Suleiman, Mahmood; Palmer, Richard M

2013-01-01

The crestal bone level around a dental implant may influence its strength characteristics by offering protection against mechanical failures. Therefore, the present study investigated the effect of simulated bone loss on modes, loads, and cycles to failure in an in vitro model. Different amounts of bone loss were simulated: 0, 1.5, 3.0, and 4.5 mm from the implant head. Forty narrow-diameter (3.0-mm) implant-abutment assemblies were tested using compressive bending and cyclic fatigue testing. Weibull and accelerated life testing analysis were used to assess reliability and functional life. Statistical analyses were performed using the Fisher-Exact test and the Spearman ranked correlation. Compressive bending tests showed that the level of bone loss influenced the load-bearing capacity of implant-abutment assemblies. Fatigue testing showed that the modes, loads, and cycles to failure had a statistically significant relationship with the level of bone loss. All 16 samples with bone loss of 3.0 mm or more experienced horizontal implant body fractures. In contrast, 14 of 16 samples with 0 and 1.5 mm of bone loss showed abutment and screw fractures. Weibull and accelerated life testing analysis indicated a two-group distribution: the 0- and 1.5-mm bone loss samples had better functional life and reliability than the 3.0- and 4.5-mm samples. Progressive bone loss had a significant effect on modes, loads, and cycles to failure. In addition, bone loss influenced the functional life and reliability of the implant-abutment assemblies. Maintaining crestal bone levels is important in ensuring biomechanical sustainability and predictable long-term function of dental implant assemblies.

Immediate provisionalization of immediate implants in the esthetic zone: a prospective case series evaluating implant survival, esthetics, and bone maintenance.

PubMed

Levin, Barry P; Wilk, Brian L

2013-05-01

This prospective study evaluates immediately placed and immediately provisionalized implants in the esthetic zone. All implants were TiO2-blasted, fluoride-modified, grade 4 titanium, with a coronal microthread design. Bone grafting and guided bone regeneration (GBR) was performed at all sites, and screw-retained temporary restorations were delivered on the day of surgery. All of the provisional crown(s) were out of occlusal function and remained in place for at least 8 weeks prior to initiation of definitive restorative therapy. Bone maintenance (BM) was considered successful if radiographs demonstrated proximal bone levels even or coronal to the implant platform. Of the 29 implants placed, 25 (86 percent) achieved bone maintenance at least 12 months post-loading with the final restorations. This study was considered successful, with 100 percent implant survival after at least 1 year loading of the final restoration, and 100 percent of patients were satisfied with the esthetics of their implant treatment.

[Researches on biomechanics of micro-implant-bone interface and optimum design of micro implant's neck].

PubMed

Deng, Feng; Zhang, Lei; Zhang, Yi; Song, Jin-lin; Fan, Yuboa

2007-07-01

To compare and analyze the stress distribution at the micro-implant-bone interface based on the different micro-implant-bone conditioned under orthodontic load, and to optimize the design of micro implant's neck. An adult skull with all tooth was scanned by spiral CT, and the data were imported into computer for three-dimensional reconstruction with software Mimics 9.0. The three dimensional finite element models of three micro-implant-bone interfaces(initial stability, full osseointegration and fibrous integration) were analyzed by finite element analysis software ABAQUS6.5. The primary stress distributions of different micro-implant-bone conditions were evaluated when 2N force was loaded. Then the diameter less than 1.5 mm of the micro implant's neck was added with 0.2 mm, to compare the stress distribution of the modified micro-implant-bone interface with traditional type. The stress mostly concentrated on the neck of micro implant and the full osseointegration interface in all models showed the lowest strain level. Compared with the traditional type, the increasing diameter neck of the micro implant obviously decreased the stress level in all the three conditions. The micro-implant-bone interface and the diameter of micro implant's neck both are the important influence factors to the stress distribution of micro implant.

Implant Insertion Torque: Its Role in Achieving Primary Stability of Restorable Dental Implants.

PubMed

Greenstein, Gary; Cavallaro, John

2017-02-01

A literature review was conducted to determine the role of insertion torque in attaining primary stability of dental implants. The review is comprised of articles that discussed the amount of torque needed to achieve primary implant stability in healed ridges and fresh extraction sockets prior to immediate implant loading. Studies were appraised that addressed the effects of minimum and maximum forces that can be used to successfully place implants. The minimum torque that can be employed to attain primary stability is undefined. Forces ≥30 Ncm are routinely used to place implants into healed ridges and fresh extraction sockets prior to immediate loading of implants. Increased insertion torque (≥50 Ncm) reduces micromotion and does not appear to damage bone. In general, the healing process after implant insertion provides a degree of biologic stability that is similar whether implants are placed with high or low initial insertion torque. Primary stability is desirable when placing implants, but the absence of micromotion is what facilitates predictable implant osseointegration. Increased insertion torque helps achieve primary stability by reducing implant micromotion. Furthermore, tactile information provided by the first surgical twist drill can aid in selecting the initial insertion torque to achieve predictable stability of inserted dental implants.

Biodegradable implants from poly-(alpha-hydroxy acid) polymers for isoniazid delivery.

PubMed

Hurley, L; Andersen, B R

1999-11-01

In vitro and in vivo study of an isoniazid (INH) drug delivery system. To develop a system for the treatment of tuberculosis using a subcutaneous polymer implant with a large drug load released slowly over a long period. INH delivery by biodegradable poly-(alpha-hydroxy acid) polymers was evaluated using ground polymer and compression molded implants. Rate of drug release and structural stability of the implant in an aqueous environment were measured, as were in vivo evaluations of the duration of measurable levels of INH in serum and urine. Factors that influenced the suitability of an implant in an in vitro system included polymer molecular weight and crystallinity, polymer and drug particle size, drug loading dose, and press temperature and pressure. The implant characteristics that most closely approached optimal conditions include a polymer of 100% L-lactide with low intrinsic viscosity, polymer particle size <75 micron, and INH particle = 126-180 micron, INH loading dose not to exceed 46%, and press conditions of 70 degrees C and 345000 kPa. Studies of subcutaneous implants in rabbits and baboons show that INH is released from the implant for 15 to 26 weeks. An INH-containing polymer was developed that was structurally stable in an aqueous environment and that released INH over a period of at least 15 weeks. Studies with infected animals will be necessary to determine the dose required for prophylaxis and treatment of active disease.

Optimization in multi-implant placement for immediate loading in edentulous arches using a modified surgical template and prototyping: a case report.

PubMed

Jayme, Sérgio J; Muglia, Valdir A; de Oliveira, Rafael R; Novaes, Arthur B Júnior

2008-01-01

Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance throughout the treatment period. Placement of dental implants requires precise planning that accounts for anatomic limitations and restorative goals. Diagnosis can be made with the assistance of computerized tomographic scanning, but transfer of planning to the surgical field is limited. Recently, novel CAD/CAM techniques such as stereolithographic rapid prototyping have been developed to build surgical guides in an attempt to improve precision of implant placement. The aim of this case report was to show a modified surgical template used throughout implant placement as an alternative to a conventional surgical guide.

The effect of number and distribution of unsplinted maxillary implants on the load transfer in implant-retained maxillary overdentures: an in vitro study.

PubMed

Damghani, Sahar; Masri, Radi; Driscoll, Carl F; Romberg, Elaine

2012-06-01

There is little information as to how the number and distribution of implants affect the amount of load transmitted to the palate in implant-retained maxillary overdentures. The purpose of this study was to evaluate the effect of the number and distribution of dental implants on the load transmitted to the palate. Eight implant analogues were placed in a replica of an average sized edentulous maxilla corresponding to the position of canines, first and second premolars, and first molars. The anteroposterior distance between the centers of implants in each quadrant was 8 mm. Fifteen denture bases were fabricated to fit the edentulous maxilla analogue. The denture bases were attached to the oral analogue using 6 different configurations of attachments (6 groups): Either no Locator attachments were used (control group), or the 2 most anterior attachments were attached, or 4 implants were engaged with a distance of 8, 16, or 24 mm between the centers of implants on left and right side, and finally, when all 8 attachments were activated. A force-measuring sensor was used to measure the force transmitted to the palate when a static force of 245 N was applied on the occlusal rims of the denture bases. Data (Newtons) were analyzed using 1-way ANOVA and Tukey's HSD test α=.05). The mean (SD) amount of force measured on the palate when the overdentures were supported by 4 Locator attachments; [49.84 (26.52) at 8 mm spacing], [24.42 (15.05) at 16 mm spacing], [35.66 (22.94) at 24 mm spacing] was significantly lower than when no attachments [90.98 (20.20), control], or when 2 Locator attachments were used [76.07 (27.63)] (P<.001). When the overdentures were supported by 8 Locator attachments, the force measured on the palate [20.67(16.06) N] was significantly lower than that for the control group (P<.001), overdentures supported by 2 Locator attachments (P<.001), and overdentures supported by 4 Locator attachments when the distance between the anterior and posterior implants was 8 mm P=.006). The distribution of implants had a significant effect on the force measured on the palate of the oral analogue in overdentures retained by Locator attachments. When the distance between the 4 implants was 16 or more mm, the load was not significantly lower than the 8 implant design, suggesting that the palate of a 4 implant-retained overdenture with a distance of 16 mm or more, does not contribute significantly to the load transfer to underlying hard palate in the in vitro analogue evaluated. Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Specimen-specific modeling of hip fracture pattern and repair.

PubMed

Ali, Azhar A; Cristofolini, Luca; Schileo, Enrico; Hu, Haixiang; Taddei, Fulvia; Kim, Raymond H; Rullkoetter, Paul J; Laz, Peter J

2014-01-22

Hip fracture remains a major health problem for the elderly. Clinical studies have assessed fracture risk based on bone quality in the aging population and cadaveric testing has quantified bone strength and fracture loads. Prior modeling has primarily focused on quantifying the strain distribution in bone as an indicator of fracture risk. Recent advances in the extended finite element method (XFEM) enable prediction of the initiation and propagation of cracks without requiring a priori knowledge of the crack path. Accordingly, the objectives of this study were to predict femoral fracture in specimen-specific models using the XFEM approach, to perform one-to-one comparisons of predicted and in vitro fracture patterns, and to develop a framework to assess the mechanics and load transfer in the fractured femur when it is repaired with an osteosynthesis implant. Five specimen-specific femur models were developed from in vitro experiments under a simulated stance loading condition. Predicted fracture patterns closely matched the in vitro patterns; however, predictions of fracture load differed by approximately 50% due to sensitivity to local material properties. Specimen-specific intertrochanteric fractures were induced by subjecting the femur models to a sideways fall and repaired with a contemporary implant. Under a post-surgical stance loading, model-predicted load sharing between the implant and bone across the fracture surface varied from 59%:41% to 89%:11%, underscoring the importance of considering anatomic and fracture variability in the evaluation of implants. XFEM modeling shows potential as a macro-level analysis enabling fracture investigations of clinical cohorts, including at-risk groups, and the design of robust implants. © 2013 Published by Elsevier Ltd.

Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

PubMed

Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

2016-02-01

Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Application of uniform design to improve dental implant system.

PubMed

Cheng, Yung-Chang; Lin, Deng-Huei; Jiang, Cho-Pei

2015-01-01

This paper introduces the application of uniform experimental design to improve dental implant systems subjected to dynamic loads. The dynamic micromotion of the Zimmer dental implant system is calculated and illustrated by explicit dynamic finite element analysis. Endogenous and exogenous factors influence the success rate of dental implant systems. Endogenous factors include: bone density, cortical bone thickness and osseointegration. Exogenous factors include: thread pitch, thread depth, diameter of implant neck and body size. A dental implant system with a crest module was selected to simulate micromotion distribution and stress behavior under dynamic loads using conventional and proposed methods. Finally, the design which caused minimum micromotion was chosen as the optimal design model. The micromotion of the improved model is 36.42 μm, with an improvement is 15.34% as compared to the original model.

Mechanical design, analysis, and laboratory testing of a dental implant with axial flexibility similar to natural tooth with periodontal ligament.

PubMed

Pektaş, Ömer; Tönük, Ergin

2014-11-01

At the interface between the jawbone and the roots of natural teeth, a thin, elastic, shock-absorbing tissue, called the periodontal ligament, forms a cushion which provides certain flexibility under mechanical loading. The dental restorations supported by implants, however, involve comparatively rigid connections to the jawbone. This causes overloading of the implant while bearing functional loading together with neighboring natural teeth, which leads to high stresses within the implant system and in the jawbone. A dental implant, with resilient components in the upper structure (abutment) in order to mimic the mechanical behavior of the periodontal ligament in the axial direction, was designed, analyzed in silico, and produced for mechanical testing. The aims of the design were avoiding high levels of stress, loosening of the abutment connection screw, and soft tissue irritations. The finite element analysis of the designed implant revealed that the elastic abutment yielded a similar axial mobility with the natural tooth while keeping stress in the implant at safe levels. The in vitro mechanical testing of the prototype resulted in similar axial mobility predicted by the analysis and as that of a typical natural tooth. The abutment screw did not loosen under repeated loading and there was no static or fatigue failure. © IMechE 2014.

Fatigue failure of dental implants in simulated intraoral media.

PubMed

Shemtov-Yona, K; Rittel, D

2016-09-01

Metallic dental implants are exposed to various intraoral environments and repetitive loads during service. Relatively few studies have systematically addressed the potential influence of the environment on the mechanical integrity of the implants, which is therefore the subject of this study. Four media (groups) were selected for room temperature testing, namely dry air, saliva substitute, same with 250ppm of fluoride, and saline solution (0.9%). Monolithic Ti-6Al-4V implants were loaded until fracture, using random spectrum loading. The study reveals that the only aggressive medium of all is the saline solution, as it shortens significantly the spectrum fatigue life of the implants. The quantitative scanning electron fractographic analysis indicates that all the tested implants grew fatigue cracks of similar lengths prior to catastrophic fracture. However, the average crack growth rate in the saline medium was found to largely exceed that in other media, suggesting a decreased fracture toughness. The notion of a characteristic timescale for environmental degradation was proposed to explain the results of our spectrum tests that blend randomly low and high cycle fatigue. Random spectrum fatigue testing is powerful technique to assess and compare the mechanical performance of dental implants for various designs and/or environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

In vivo evaluation of a novel nanocomposite porous 3D scaffold in a rabbit model: histological analysis

PubMed Central

Mahmood, Saffanah Khuder; Razak, Intan-Shameha Abdul; Ghaji, Mustafa Saddam; Yusof, Loqman Mohamed; Mahmood, Zaid Khudhur; Rameli, Mohd Adha Bin P; Zakaria, Zuki Abu Bakar

2017-01-01

The healing of load-bearing segmental defects in long bones is a challenge due to the complex nature of the weight that affects the bone part and due to bending, shearing, axial, and torsional forces. An innovative porous 3D scaffolds implant of CaCO3 aragonite nanocomposite derived from cockle shell was advanced for substitute bone solely for load-bearing cases. The biomechanical characteristics of such materials were designed to withstand cortical bone strength. In promoting bone growth to the implant material, an ideal surface permeability was formed by means of freeze drying and by adding copolymers to the materials. The properties of coating and copolymers supplement were also assessed for bone-implant connection resolutions. To examine the properties of the material in advanced biological system, an experimental trial in an animal model was carried out. Critical sized defect of bone was created in rabbit’s radial bone to assess the material for a load-bearing application with a short and extended period assessment with histological evaluation of the incorporated implanted material to the bone of the host. Trials in animal models proved that the material has the capability of enduring load-bearing conditions for long-term use devoid of breaking or generating stress that affects the host bone. Histological examination further confirmed the improved integration of the implanted materials to the host bone with profound bone development into and also above the implanted scaffold, which was attained with negligible reaction of the tissues to a foreign implanted material. PMID:29238193

Nondestructive evaluation of orthopaedic implant stability in THA using highly nonlinear solitary waves

NASA Astrophysics Data System (ADS)

Yang, Jinkyu; Silvestro, Claudio; Sangiorgio, Sophia N.; Borkowski, Sean L.; Ebramzadeh, Edward; De Nardo, Luigi; Daraio, Chiara

2012-01-01

We propose a new biomedical sensing technique based on highly nonlinear solitary waves to assess orthopaedic implant stability in a nondestructive and efficient manner. We assemble a granular crystal actuator consisting of a one-dimensional tightly packed array of spherical particles, to generate acoustic solitary waves. Via direct contact with the specimen, we inject acoustic solitary waves into a biomedical prosthesis, and we nondestructively evaluate the mechanical integrity of the bone-prosthesis interface, studying the properties of the waves reflected from the contact zone between the granular crystal and the implant. The granular crystal contains a piezoelectric sensor to measure the travelling solitary waves, which allows it to function also as a sensor. We perform a feasibility study using total hip arthroplasty (THA) samples made of metallic stems implanted in artificial composite femurs using polymethylmethacrylate for fixation. We first evaluate the sensitivity of the proposed granular crystal sensor to various levels of prosthesis insertion into the composite femur. Then, we impose a sequence of harsh mechanical loading on the THA samples to degrade the mechanical integrity at the stem-cement interfaces, using a femoral load simulator that simulates aggressive, accelerated physiological loading. We investigate the implant stability via the granular crystal sensor-actuator during testing. Preliminary results suggest that the reflected waves respond sensitively to the degree of implant fixation. In particular, the granular crystal sensor-actuator successfully detects implant loosening at the stem-cement interface following violent cyclic loading. This study suggests that the granular crystal sensor and actuator has the potential to detect metal-cement defects in a nondestructive manner for orthopaedic applications.

Comparative analysis of numerical and experimental data of orthodontic mini-implants.

PubMed

Chatzigianni, Athina; Keilig, Ludger; Duschner, Heinz; Götz, Hermann; Eliades, Theodore; Bourauel, Christoph

2011-10-01

The purpose of this study was to compare numerical simulation data derived from finite element analysis (FEA) to experimental data on mini-implant loading. Nine finite element (FE) models of mini-implants and surrounding bone were derived from corresponding experimental specimens. The animal bone in the experiment consisted of bovine rib. The experimental groups were based on implant type, length, diameter, and angle of insertion. One experimental specimen was randomly selected from each group and was digitized in a microCT scanner. The FE models consisted of bone pieces containing Aarhus mini-implants with dimensions 1.5 × 7 mm and 1.5 × 9 mm or LOMAS mini-implants (dimensions 1.5 × 7 mm, 1.5 × 9 mm, and 2 × 7 mm). Mini-implants were inserted in two different ways, perpendicular to the bone surface or at 45 degrees to the direction of the applied load. Loading and boundary conditions in the FE models were adjusted to match the experimental situation, with the force applied on the neck of the mini-implants, along the mesio-distal direction up to a maximum of 0.5 N. Displacement and rotation of mini-implants after force application calculated by FEA were compared to previously recorded experimental deflections of the same mini-implants. Analysis of data with the Altman-Bland test and the Youden plot demonstrated good agreement between numerical and experimental findings (P = not significant) for the models selected. This study provides further evidence of the appropriateness of the FEA as an investigational tool in relevant research.

Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance.

PubMed

Windolf, Markus; Muths, Raphael; Braunstein, Volker; Gueorguiev, Boyko; Hänni, Markus; Schwieger, Karsten

2009-01-01

Compaction of cancellous bone is believed to prevent cut-out. This in vitro study quantified the compaction in the femoral head due to insertion of a dynamic hip screw-blade with and without predrilling and investigated the resulting implant anchorage under cyclic loading. Eight pairs of human cadaveric femoral heads were instrumented with a dynamic hip screw-blade made of Polyetheretherketon. Pairwise instrumentation was performed either with or without predrilling the specimens. CT scanning was performed before and after implantation, to measure bone-compaction. Subsequently the implant was removed and a third scan was performed to analyze the relaxation of the bone structure. Commercial implants were reinserted and the specimens were cyclically loaded until onset of cut-out occurred. The bone-implant interface was monitored by means of fluoroscopic imaging throughout the experiment. Paired t-tests were performed to identify differences regarding compaction, relaxation and cycles to failure. Bone density in the surrounding of the implant increased about 30% for the non-predrilled and 20% for the predrilled group when inserting the implant. After implant removal the predrilled specimens fully relaxed; the non-predrilled group showed about 10% plastic deformation. No differences were found regarding cycles to failure (P=0.32). Significant bone-compaction due to blade insertion was verified. Even though compaction was lower when predrilling the specimens, mainly elastic deformation was present, which is believed to primarily enhance the implant anchorage. Cyclic loading tests confirmed this thesis. The importance of the implantation technique with regard to predrilling is therefore decreased.

Evaluation of stress patterns produced by implant-retained overdentures and implant-retained fixed partial denture.

PubMed

Mazaro, José Vitor Quinelli; Filho, Humberto Gennari; Vedovatto, Eduardo; Pellizzer, Eduardo Piza; Rezende, Maria Cristina Rosifini Alves; Zavanelli, Adriana Cristina

2011-11-01

The purposes of this study were to photoelastically measure the biomechanical behavior of 4 implants retaining different cantilevered bar mandibular overdenture designs and to compare a fixed partial denture (FPD). A photoelastic model of a human edentulous mandible was fabricated, which contained 4 screw-type implants (3.75 × 10 mm) embedded in the parasymphyseal area. An FPD and 3 overdenture designs with the following attachments were evaluated: 3 plastic Hader clips, 1 Hader clip with 2 posterior resilient cap attachments, and 3 ball/O-ring attachments. Vertical occlusal forces of 100 N were applied between the central incisor and unilaterally to the right and left second premolars and second molars. Stresses that developed in the supporting structure were monitored photoelastically and recorded photographically. The results showed that the anterior loading, the overdenture with 3 plastic Hader clips, displayed the largest stress concentration at the medium implant. With premolar loading, the FPD and overdenture with 3 plastic Hader clips displayed the highest stresses to the ipsilateral terminal implant. With molar loading, the overdenture with 3 ball/O-ring attachments displayed the most uniform stress distribution in the posterior edentulous ridge, with less overloading in the terminal implant. It was concluded that vertical forces applied to the bar-clip overdenture and FPD created immediate stress patterns of greater magnitude and concentration on the ipsilateral implants, whereas the ball/O-ring attachments transferred minimal stress to the implants. The increased cantilever in the FPD caused the highest stresses to the terminal implant.

Anti-inflammation performance of curcumin-loaded mesoporous calcium silicate cement.

PubMed

Chen, Yuan-Chien; Shie, Ming-You; Wu, Yuan-Haw Andrew; Lee, Kai-Xing Alvin; Wei, Li-Ju; Shen, Yu-Fang

2017-09-01

Calcium silicate (CS) cements have excellent bioactivity and can induce the bone-like apatite formation. They are good biomaterials for bone tissue engineering and bone regenerative medicine. However, they have degradability and the dissolved CS can cause the inflammatory response at the early post-implantation stage. The purpose of this study was to design and prepare the curcumin-loaded mesoporous CS (MesoCS/curcumin) cements as a strategy to reduce the inflammatory reaction after implantation. The MesoCS/curcumin cements were designed and prepared. The characteristics of MesoCS/curcumin specimens were examined by transmission electron microscopy (TEM), X-ray diffraction (XRD) and scanning electron microscopy (SEM). Their physical properties, biocompatibility, and anti-inflammatory ability were also evaluated. The MesoCS/curcumin cements displayed excellent biocompatibility and physical properties. Their crystalline characterizations were very similar with MesoCS cements. After soaking in simulated body fluid, the bone-like apatite layer of the MesoCS/curcumin cements could be formed. In addition, it could inhibit the expression of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) after inflammation reaction induced by lipopolysaccharides and had good anti-inflammatory ability. Adding curcumin in MesoCS cements can reduce the inflammatory reaction, but does not affect the original biological activity and properties of MesoCS cements. It can provide a good strategy to inhibit the inflammatory reaction after implantation for bone tissue engineering and bone regenerative medicine. Copyright © 2017. Published by Elsevier B.V.

Surgical Treatment of Implants Affected by Periimplantitis After 15 Years of Loading: A Case Report.

PubMed

Nícoli, Lélis Gustavo; Pigossi, Suzane Cristina; Marcantonio, Cláudio; Leal Zandim-Barcelos, Daniela; Marcantonio, Elcio

2016-04-01

The aim of this case report is to describe the surgical treatment of 2 implants affected by periimplantitis after 15 years of loading. The treatment included mechanical and chemical decontamination with topical application of tetracycline associated with a regenerative approach. Both defects were filled with particulate autogenous bone from tuber and covered with resorbable collagen membrane. The follow-up of 30 and 13 months of the implants 24 and 14, respectively, showed an absence of clinical signs of periimplant inflammation and near-complete bone regeneration. The therapy approach was effective in eliminating periimplant inflammation and promoting bone gain around the implants.

Teicoplanin-loaded borate bioactive glass implants for treating chronic bone infection in a rabbit tibia osteomyelitis model.

PubMed

Zhang, Xin; Jia, Weitao; Gu, Yifei; Xiao, Wei; Liu, Xin; Wang, Deping; Zhang, Changqing; Huang, Wenhai; Rahaman, Mohamed N; Day, Delbert E; Zhou, Nai

2010-08-01

The treatment of chronic osteomyelitis (bone infection) remains a clinical challenge. In this work, pellets composed of a chitosan-bonded mixture of borate bioactive glass particles (<50microm) and teicoplanin powder (antibiotic), were evaluated in vitro and in vivo for treating chronic osteomyelitis induced by methicillin-resistant Staphylococcus aureus (MRSA) in a rabbit model. When immersed in phosphate-buffered saline, the pellets showed sustained release of teicoplanin over 20-30 days, while the bioactive glass converted to hydroxyapatite (HA) within 7 days, eventually forming a porous HA structure. Implantation of the teicoplanin-loaded pellets in a rabbit tibia osteomyelitis model resulted in the detection of teicoplanin in the blood for about 9 days. The implants converted to a bone-like HA graft, and supported the ingrowth of new bone into the tibia defects within 12 weeks of implantation. Microbiological, histological and scanning electron microscopy techniques showed that the implants provided a cure for the bone infection. The results indicate that the teicoplanin-loaded borate bioactive glass implant, combining sustained drug release with the ability to support new bone ingrowth, could provide a method for treating chronic osteomyelitis. Copyright 2010 Elsevier Ltd. All rights reserved.

Effect of surface treatment on stress distribution in immediately loaded dental implants--a 3D finite element analysis.

PubMed

Bahrami, Babak; Shahrbaf, Shirin; Mirzakouchaki, Behnam; Ghalichi, Farzan; Ashtiani, Mohammed; Martin, Nicolas

2014-04-01

To investigate, by means of FE analysis, the effect of surface roughness treatments on the distribution of stresses at the bone-implant interface in immediately loaded mandibular implants. An accurate, high resolution, digital replica model of bone structure (cortical and trabecular components) supporting an implant was created using CT scan data and image processing software (Mimics 13.1; Materialize, Leuven, Belgium). An anatomically accurate 3D model of a mandibular-implant complex was created using a professional 3D-CAD modeller (SolidWorks, DassaultSystèmes Solid Works Corp; 2011). Finite element models were created with one of the four roughness treatments on the implant fixture surface. Of these, three were surface treated to create a uniform coating determined by the coefficient of friction (μ); these were either (1) plasma sprayed or porous-beaded (μ=1.0), (2) sandblasted (μ=0.68) or (3) polished (μ=0.4). The fourth implant had a novel two-part surface roughness consisting of a coronal polished component (μ=0.4) interfacing with the cortical bone, and a body plasma treated surface component (μ=1) interfacing with the trabecular bone. Finite element stress analysis was carried out under vertical and lateral forces. This investigation showed that the type of surface treatment on the implant fixture affects the stress at the bone-implant interface of an immediately loaded implant complex. Von Mises stress data showed that the two-part surface treatment created the better stress distribution at the implant-bone interface. The results from this FE computational analysis suggest that the proposed two-part surface treatment for IL implants creates lower stresses than single uniform treatments at the bone-implant interface, which might decrease peri-implant bone loss. Future investigations should focus on mechanical and clinical validation of these FE results. Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

The relative effect of surface strontium chemistry and super-hydrophilicity on the early osseointegration of moderately rough titanium surface in the rabbit femur.

PubMed

Park, Jin-Woo; Kwon, Tae-Geon; Suh, Jo-Young

2013-06-01

It is unclear whether surface bioactive chemistry or hydrophilicity plays a more dominant role in the osseointegration of micro-structured titanium implants having the same surface topography at the micrometer and submicrometer scales. To understand their comparative effect on enhancing the early osseointegration of micro-rough-surfaced implants, this study compared the bone healing-promoting effect of surface strontium (Sr) chemistry that has been shown in numerous studies to super-hydrophilicity in the early osseointegration of moderately rough-surfaced clinical oral implants (SLA(®) implant) in rabbit cancellous bone. Hydrothermal treatment was performed to incorporate Sr ions into the surface of clinical SLA implants (SLA/Sr implant). The surface characteristics were evaluated by using field emission-scanning electron microscopy, X-ray photoelectron spectroscopy and optical profilometry. Twenty screw implants (10 control and 10 experimental) were placed in the femoral condyles of 10 New Zealand White rabbits. The early osseointegration of the SLA/Sr implant was compared with a chemically modified super-hydrophilic SLA implant (SLActive(®) implant) by histomorphometric and resonance frequency analysis after 2 weeks of implantation. The SLA/Sr and SLActive implants exhibited an identical surface topography and average R(a) values at the micron and submicron scales. The SLA/Sr implant displayed a high amount of surface Sr content (15.6 at.%). There was no significant difference in the implant stability quotient (ISQ) values between the two groups. However, histomorphometric analysis revealed a significantly higher bone-to-implant contact percentage in the SLA/Sr implants compared with the SLActive implants in rabbit cancellous bone (P < 0.01). The results indicate that the surface Sr chemistry surpasses the effect of super-hydrophilicity in promoting the early bone apposition of moderately rough Ti surface in cancellous bone. © 2012 John Wiley & Sons A/S.

Radiographic evaluation of marginal bone levels adjacent to parallel-screw cylinder machined-neck implants and rough-surfaced microthreaded implants using digitized panoramic radiographs.

PubMed

Nickenig, Hans-Joachim; Wichmann, Manfred; Schlegel, Karl Andreas; Nkenke, Emeka; Eitner, Stephan

2009-06-01

The purpose of this split-mouth study was to compare macro- and microstructure implant surfaces at the marginal bone level during a stress-free healing period and under functional loading. From January to February 2006, 133 implants (70 rough-surfaced microthreaded implants and 63 machined-neck implants) were inserted in the mandible of 34 patients with Kennedy Class I residual dentitions and followed until February 2008. The marginal bone level was radiographically determined, using digitized panoramic radiographs, at four time points: at implant placement (baseline level), after the healing period, after 6 months of functional loading, and at the end of follow-up. The median follow-up time was 1.9 (range: 1.9-2.1) years. The machined-neck group had a mean crestal bone loss of 0.5 mm (range: 0-2.3) after the healing period, 0.8 mm after 6 months (range: 0-2.4), and 1.1 mm (range: 0-3) at the end of follow-up. The rough-surfaced microthreaded implant group had a mean bone loss of 0.1 mm (range: -0.4-2) after the healing period, 0.4 mm (range: 0-2.1) after 6 months, and 0.5 mm (range: 0-2.1) at the end of follow-up. The two implant types showed significant differences in marginal bone levels (healing period: P=0.01; end of follow-up: P<0.01). Radiographic evaluation of marginal bone levels adjacent to machined-neck or rough-surfaced microthreaded implants showed that implants with the microthreaded design caused minimal changes in crestal bone levels during healing (stress-free) and under functional loading.

Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory split-mouth randomised controlled clinical trial.

PubMed

Wiesner, Günter; Esposito, Marco; Worthington, Helen; Schlee, Markus

2010-01-01

Nothing to declare. To evaluate whether connective tissue grafts performed at implant placement could be effective in augmenting peri-implant soft tissues. Ten partially edentulous patients requiring at least one single implant in the premolar or molar areas of both sides of the mandible were randomised to have one side augmented at implant placement with a connective soft tissue graft harvested from the palate or no augmentation. After 3 months of submerged healing, abutments were placed and within 1 month definitive crowns were permanently cemented. Outcome measures were implant success, any complications, peri-implant marginal bone level changes, patient satisfaction and preference, thickness of the soft tissues and aesthetics (pink aesthetic score) evaluated by an independent and blinded assessor 1 year after loading. One year after loading, no patients dropped out, no implants failed and no complications occurred. Both groups lost statistically significant amounts of peri-implant bone 1 year after loading (0.8 mm in the grafted group and 0.6 mm in the non-grafted group), but there was no statistically significant difference between groups. Soft tissues at augmented sites were 1.3 mm thicker (P < 0.001) and had a significantly better pink aesthetic score (P < 0.001). Patients were highly satisfied (no statistically significant differences between treatments) though they preferred the aesthetics of the augmented sites (P = 0.031). However, five patients would not undergo the grafting procedure again and two were uncertain. Connective tissue grafts are effective in increasing soft tissue thickness, thus improving aesthetics. Longer follow-ups are needed to evaluate the stability of peri-implant tissues over time.

Randomized controlled multicenter study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures. Part 2: clinical and radiographic outcomes at 1 year of loading.

PubMed

Schincaglia, Gian Pietro; Thoma, Daniel S; Haas, Robert; Tutak, Marcin; Garcia, Abel; Taylor, Thomas D; Hämmerle, Christoph H F

2015-11-01

To compare, clinically and radiographically, short dental implants (6 mm) to long implants (11-15 mm) placed with sinus grafting. Participants with 5-7 mm of bone height in the posterior maxilla were randomly allocated to receive short implants (GS) or long implants with sinus grafting (GG). Implants were loaded with single crowns 6 months after placement (PR). Patients were re-evaluated 12 months after loading (FU-1). Outcome variables included: Implant survival rate (CSR), marginal bone level alteration (MBL), periodontal probing depth (PPD), bleeding on probing (BoP), plaque control record (PCR) and crown-to-implant ratios (C/I). Statistical analysis was performed using parametric tests. In 97 subjects, 132 implants were re-evaluated at FU-1. The CSR was 100%. The MBL from implant placement (IP) to (PR) was -0.22 ± 0.4 mm for GG and -0.3 ± 0.45 mm for GS (p < 0.001). MBL from IP to FU-1 was -0.37 ± 0.59 mm for GG and -0.22 ± 0.3 mm for GS (p < 0.001). Intergroup comparisons showed non-significant differences for MBL (p > 0.05), PPD (p = 1) and PCR (p = 0.09). BoP was higher in the GS (p = 0.04). The C/I was 0.99 ± 0.17 for GG and 1.86 ± 0.23 for GS (p < 0.001). No correlation was observed between C/I and MBL, (GG: p = 0.13; GS: p = 0.38). Both treatment modalities provided similar outcomes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Endosseous titanium implants as anchors for mesiodistal tooth movement in the beagle dog.

PubMed

Saito, S; Sugimoto, N; Morohashi, T; Ozeki, M; Kurabayashi, H; Shimizu, H; Yamasaki, K; Shiba, A; Yamada, S; Shibasaki, Y

2000-12-01

The purpose of this study was to determine the anchorage potential of titanium implants (Branemark; 3.75 x 7 mm) with the use of a sectional arch wire technique for orthodontic mesiodistal tooth movement, as assessed by the osseointegration of implants and tooth movement. Two implants were surgically placed in healed mandibular extraction sites of the second and third premolars on each side in 4 adult male beagle dogs. The implants were surgically uncovered 18 weeks later, and second-stage abutments with soldered edgewise tubes were attached. Segmented edgewise rectangular archwires (0.017 x 0. 025 inch) with a T-loop or an L-loop were placed between the implants and the fourth premolars on both sides as the anchorage unit. One segment in each dog served as a loaded side, and the archwire was calibrated to produce 200 g of lateral force on the fourth premolar. The contralateral segment served as an unloaded side and was not subjected to orthodontic force. Sectional wires were activated biweekly 24, 28, 28, and 32 weeks, respectively, depending on the magnitude and the appearance of mesial tipping movement of the fourth premolar. After mandibular impressions were taken to measure the distance between the first molar and the fourth premolar, the animals were euthanized and dissected mandibles were prepared. The specimens were then embedded in polyester resin and cut to take backscattered electron images. On the basis of these images, the percentage of peri-implant bone volume was calculated and defined as an index of osseointegration. The differences between the initial and final fourth premolar to first molar distances varied (7.40, 8.85, 10.50, and 3.30 mm) on the loaded side, whereas the unloaded side showed no movement. Not only was there no statistical difference in the percent of peri-implant bone volume between the loaded and unloaded sides, but there was also no statistical difference between the compression and tension sides in both loaded and unloaded implants, which suggests that the implants maintained rigid osseointegration. In conclusion, the present study demonstrated that endosseous titanium implants can function as anchors for long-term orthodontic mesiodistal movement.

Stability of tapered and parallel-walled dental implants: A systematic review and meta-analysis.

PubMed

Atieh, Momen A; Alsabeeha, Nabeel; Duncan, Warwick J

2018-05-15

Clinical trials have suggested that dental implants with a tapered configuration have improved stability at placement, allowing immediate placement and/or loading. The aim of this systematic review and meta-analysis was to evaluate the implant stability of tapered dental implants compared to standard parallel-walled dental implants. Applying the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, randomized controlled trials (RCTs) were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analyzed using statistical software. A total of 1199 studies were identified, of which, five trials were included with 336 dental implants in 303 participants. Overall meta-analysis showed that tapered dental implants had higher implant stability values than parallel-walled dental implants at insertion and 8 weeks but the difference was not statistically significant. Tapered dental implants had significantly less marginal bone loss compared to parallel-walled dental implants. No significant differences in implant failure rate were found between tapered and parallel-walled dental implants. There is limited evidence to demonstrate the effectiveness of tapered dental implants in achieving greater implant stability compared to parallel-walled dental implants. Superior short-term results in maintaining peri-implant marginal bone with tapered dental implants are possible. Further properly designed RCTs are required to endorse the supposed advantages of tapered dental implants in immediate loading protocol and other complex clinical scenarios. © 2018 Wiley Periodicals, Inc.

CAD/CAM glass ceramics for single-tooth implant crowns: a finite element analysis.

PubMed

Akça, Kvanç; Cavusoglu, Yeliz; Sagirkaya, Elcin; Aybar, Buket; Cehreli, Murat Cavit

2013-12-01

To evaluate the load distribution of CAD/CAM mono-ceramic crowns supported with single-tooth implants in functional area. A 3-dimensional numerical model of a soft tissue-level implant was constructed with cement-retained abutment to support glass ceramic machinable crown. Implant-abutment complex and the retained crown were embedded in a Ø 1.5 × 1.5 cm geometric matrix for evaluation of mechanical behavior of mono-ceramic CAD/CAM aluminosilicate and leucite glass crown materials. Laterally positioned axial load of 300 N was applied on the crowns. Resulting principal stresses in the mono-ceramic crowns were evaluated in relation to different glass ceramic materials. The highest compressive stresses were observed at the cervical region of the buccal aspect of the crowns and were 89.98 and 89.99 MPa, for aluminosilicate and leucite glass ceramics, respectively. The highest tensile stresses were observed at the collar of the lingual part of the crowns and were 24.54 and 25.39 MPa, respectively. Stresses induced upon 300 N static loading of CAD/CAM aluminosalicate and leucite glass ceramics are below the compressive strength of the materials. Impact loads may actuate the progress to end failure of mono-ceramic crowns supported by metallic implant abutments.

Cervical total disc replacement exhibits similar stiffness to intact cervical functional spinal units tested on a dynamic pendulum testing system.

PubMed

Esmende, Sean M; Daniels, Alan H; Paller, David J; Koruprolu, Sarath; Palumbo, Mark A; Crisco, Joseph J

2015-01-01

The pendulum testing system is capable of applying physiologic compressive loads without constraining the motion of functional spinal units (FSUs). The number of cycles to equilibrium observed under pendulum testing is a measure of the energy absorbed by the FSU. To examine the dynamic bending stiffness and energy absorption of the cervical spine, with and without implanted cervical total disc replacement (TDR) under simulated physiologic motion. A biomechanical cadaver investigation. Nine unembalmed, frozen human cervical FSUs from levels C3-C4 and C5-C6 were tested on the pendulum system with axial compressive loads of 25, 50, and 100 N before and after TDR implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°, resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and the bending stiffness (Newton-meter/°) was calculated and compared for each testing mode. In flexion/extension, with increasing compressive loading from 25 to 100 N, the average number of cycles to equilibrium for the intact FSUs increased from 6.6 to 19.1, compared with 4.1 to 12.7 after TDR implantation (p<.05 for loads of 50 and 100 N). In flexion, with increasing compressive loading from 25 to 100 N, the bending stiffness of the intact FSUs increased from 0.27 to 0.59 Nm/°, compared with 0.21 to 0.57 Nm/° after TDR implantation. No significant differences were found in stiffness between the intact FSU and the TDR in flexion/extension and lateral bending at any load (p<.05). Cervical FSUs with implanted TDR were found to have similar stiffness, but had greater energy absorption than intact FSUs during cyclic loading with an unconstrained pendulum system. These results provide further insight into the biomechanical behavior of cervical TDR under approximated physiologic loading conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

Dynamic biomechanical examination of the lumbar spine with implanted total disc replacement using a pendulum testing system.

PubMed

Daniels, Alan H; Paller, David J; Koruprolu, Sarath; McDonnell, Matthew; Palumbo, Mark A; Crisco, Joseph J

2012-11-01

Biomechanical cadaver investigation. To examine dynamic bending stiffness and energy absorption of the lumbar spine with and without implanted total disc replacement (TDR) under simulated physiological motion. The pendulum testing system is capable of applying physiological compressive loads without constraining motion of functional spinal units (FSUs). The number of cycles to equilibrium observed under pendulum testing is a measure of the energy absorbed by the FSU. Five unembalmed, frozen human lumbar FSUs were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Synthes ProDisc-L TDR implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5º resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N·m/º) was calculated and compared for each testing mode. In flexion/extension, the TDR constructs reached equilibrium with significantly (P < 0.05) fewer cycles than the intact FSU with compressive loads of 282 N, 385 N, and 488 N. Mean dynamic bending stiffness in flexion, extension, and lateral bending increased significantly with increasing load for both the intact FSU and TDR constructs (P < 0.001). In flexion, with increasing compressive loading from 181 N to 488 N, the bending stiffness of the intact FSUs increased from 4.0 N·m/º to 5.5 N·m/º, compared with 2.1 N·m/º to 3.6 N·m/º after TDR implantation. At each compressive load, the intact FSU was significantly stiffer than the TDR (P < 0.05). Lumbar FSUs with implanted TDR were found to be less stiff, but absorbed more energy during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion-preserving devices are not fully known, these results provide further insight into the biomechanical behavior of these devices under approximated physiological loading conditions.

In vitro and in vivo investigation of bisphosphonate-loaded hydroxyapatite particles for peri-implant bone augmentation.

PubMed

Kettenberger, Ulrike; Luginbuehl, Vera; Procter, Philip; Pioletti, Dominique P

2017-07-01

Locally applied bisphosphonates, such as zoledronate, have been shown in several studies to inhibit peri-implant bone resorption and recently to enhance peri-implant bone formation. Studies have also demonstrated positive effects of hydroxyapatite (HA) particles on peri-implant bone regeneration and an enhancement of the anti-resorptive effect of bisphosphonates in the presence of calcium. In the present study, both hydroxyapatite nanoparticles (nHA) and zoledronate were combined to achieve a strong reinforcing effect on peri-implant bone. The nHA-zoledronate combination was first investigated in vitro with a pre-osteoclastic cell assay (RAW 264.7) and then in vivo in a rat model of postmenopausal osteoporosis. The in vitro study confirmed that the inhibitory effect of zoledronate on murine osteoclast precursor cells was enhanced by loading the drug on nHA. For the in vivo investigation, either zoledronate-loaded or pure nHA were integrated in hyaluronic acid hydrogel. The gels were injected in screw holes that had been predrilled in rat femoral condyles before the insertion of miniature screws. Micro-CT-based dynamic histomorphometry and histology revealed an unexpected rapid mineralization of the hydrogel in vivo through formation of granules, which served as scaffold for new bone formation. The delivery of zoledronate-loaded nHA further inhibited a degradation of the mineralized hydrogel as well as a resorption of the peri-implant bone as effectively as unbound zoledronate. Hyaluronic acid with zoledronate-loaded nHA, thanks to its dual effect on inducing a rapid mineralization and preventing resorption, is a promising versatile material for bone repair and augmentation. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Clinical evaluation of satisfaction in patients rehabilitated with an immediately loaded implant-supported prosthesis: a controlled prospective study.

PubMed

Scala, Rudy; Cucchi, Alessandro; Ghensi, Paolo; Vartolo, Francesco

2012-01-01

The purpose of this controlled prospective study was to compare the satisfaction of patients rehabilitated with an immediately loaded implant-supported prosthesis and patients rehabilitated with a conventional denture in the mandible. Selected mandibular partially or totally edentulous patients were included in this prospective study. Patients' mandibles were completely rehabilitated with immediately loaded implants supporting a screw-retained full-arch prosthesis (test group) or with a conventional denture (control group). The Satisfaction Profile (SAT-P), which investigates a number of psychologic aspects related to the function and esthetics of the stomatognathic apparatus, was administered to each patient 1 month before and 3 months after provisional prosthetic rehabilitation. The questionnaire comprised four different SAT-P items: quality of eating, eating behavior, mood, and self-confidence. A visual analog scale was used to elicit patient responses. SAT-P item scores were analyzed statistically by means of the Student t test and the chi-square test (or the Mann-Whitney nonparametric test), with P < .05 considered significant. Forty-one patients were consecutively treated with 205 immediately loaded implants supporting a screw-retained full-arch prosthesis (test group); 38 patients were consecutively treated with a conventional denture (control group). Statistically significant differences were observed between the test and control groups for all four SAT-P items. The test group reported greater satisfaction for all items versus the control group. In both groups, the differences between pre- and postrehabilitation values were statistically significant. Each patient was satisfied with their treatment outcomes, but patients who received an implant-supported prosthesis were more satisfied than the patients who received a conventional denture. The results suggest that a screw-retained full-arch prosthesis on immediately loaded implants is a predictable means of enhancing patient satisfaction.

Biomechanical evaluation of CIBOR spine interbody fusion device.

PubMed

Chong, Alexander C M; Harrer, Seth W; Heggeness, Michael H; Wooley, Paul H

2017-07-01

The CIBOR PEEK spinal interbody fusion device is an anterior lumbar interbody fusion construct with a hollow center designed to accommodate an osteoinductive carbon foam insert to promote bony ingrowth to induce fusion where rigid stabilization is needed. Three different sizes of the device were investigated. Part-I: implants were tested under axial compression and rotation using polyurethane foam blocks. Part-II: simulated 2-legged stance using cadaveric specimen using the L5-S1 lumbar spine segment. Part-III: a survey feedback form was used to investigate two orthopedic surgeons concern regarding the implant. In Part-I, the subsidence hysteresis under axial compression loading was found to be statistical significant difference between these three implant sizes. It was noted that the implants had migration as rotation applied, and the amount of subsidence was a factor of the axial compression loads applied. In Part-II, a minor subsidence and carbon foam debris were observed when compared to each implant size. Poor contact surface of the implant with the end plates of the L5 or S1 vertebrae from the anterior view under maximum loads was observed; however, the implant seemed to be stable. Each surgeon has their own subjective opinion about the CIBOR implant. Two out of the three different sizes of the device (medium and large sizes) provided appropriate rigid stabilization at the physiological loads. Neither orthopedic surgeon was 100% satisfied with overall performance of the implant, but felt potential improvement could be made. This study indicates an option for operative treatment of spine interbody fusion, as the CIBOR spine interbody fusion device has a hollow center. This hollow center is designed to accommodate a carbon foam insert to promote bony ingrowth. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1157-1168, 2017. © 2016 Wiley Periodicals, Inc.

Fracture toughness of titanium–cement interfaces: effects of fibers and loading angles

PubMed Central

Khandaker, Morshed; Utsaha, Khatri Chhetri; Morris, Tracy

2014-01-01

Ideal implant–cement or implant–bone interfaces are required for implant fixation and the filling of tissue defects created by disease. Micron- to nanosize osseointegrated features, such as surface roughness, fibers, porosity, and particles, have been fused with implants for improving the osseointegration of an implant with the host tissue in orthopedics and dentistry. The effects of fibers and loading angles on the interface fracture toughness of implant–cement specimens with and without fibers at the interface are not yet known. Such studies are important for the design of a long-lasting implant for orthopedic applications. The goal of this study was to improve the fracture toughness of an implant–cement interface by deposition of micron- to nanosize fibers on an implant surface. There were two objectives in the study: 1) to evaluate the influence of fibers on the fracture toughness of implant–cement interfaces with and without fibers at the interfaces, and 2) to evaluate the influence of loading angles on implant–cement interfaces with and without fibers at the interfaces. This study used titanium as the implant, poly(methyl methacrylate) (PMMA) as cement, and polycaprolactone (PCL) as fiber materials. An electrospinning unit was fabricated for the deposition of PCL unidirectional fibers on titanium (Ti) plates. The Evex tensile test stage was used to determine the interface fracture toughness (KC) of Ti–PMMA with and without PCL fibers at 0°, 45°, and 90° loading angles, referred to in this article as tension, mixed, and shear tests. The study did not find any significant interaction between fiber and loading angles (P>0.05), although there was a significant difference in the KC means of Ti–PMMA samples for the loading angles (P<0.05). The study also found a significant difference in the KC means of Ti–PMMA samples with and without fibers (P<0.05). The results showed that the addition of the micron- to nanosize PCL fibers on Ti improved the quality of the Ti–PMMA union. The results of the study are essential for fatigue testing and finite-element analysis of implant–cement interfaces to evaluate the performance of orthopedic and orthodontic implants. PMID:24729704

Combination of Heel-strike like Mechanical Loading with Deproteinized Cancellous Bone Scaffold Implantation to Repair Segmental Bone Defects in Rabbits.

PubMed

Huang, Guofeng; Liu, Guojun; Zhang, Feng; Gao, Jianting; Wang, Jiangze; Chen, Qi; Wu, Benwen; Ding, Zhenqi; Cai, Taoyi

2017-01-01

Under physiological conditions bone defects often occur at mechanical load bearing sites and bone substitutes used for regeneration should be similarly subjected to mechanical loading stress. In this study, we investigated whether a novel heel-strike like mechanical loading method can be used as a complementary therapy to promote bone regeneration following bone substitute grafting. To test this, three groups of rabbits with segmental bone defects in the tibia were implanted with bovine deproteinized cancellous bone scaffold (DCBS), with one group also receiving heel-strike like mechanical loading generated by a rap stress stimulator. From weeks 4-12 post-operation X-ray and micro-CT scanning showed that rabbits receiving combination therapy had significantly more callus at the bone defect. Moreover, bone defects in the combination group were completely replaced with new bone at week 12, while the DCBS implantation alone group healed only partially and rabbits receiving neither DCBS nor mechanical loading developed only small calluses throughout the observation period. Analysis of micro-CT scanning results demonstrated that new bone density in the combination group was significantly higher than the DCBS only group at weeks 4 and 12 ( p <0.05). H&E staining results also indicated a significantly higher percentage of new bone in the bone defect area and a lower percentage of residual scaffold in the combination group compared to the DCBS only group ( p <0.05). Thus, this heel-strike like mechanical loading method appears to accelerate bone regeneration following substitute implantation by restoring a local mechanical loading environment in segmental bone defects.

Dissolution behavior and early bone apposition of calcium phosphate-coated machined implants

PubMed Central

Hwang, Ji-Wan; Lee, Eun-Ung; Lee, Jung-Seok; Jung, Ui-Won; Lee, In-Seop

2013-01-01

Purpose Calcium phosphate (CaP)-coated implants promote osseointegration and survival rate. The aim of this study was to (1) analyze the dissolution behavior of the residual CaP particles of removed implants and (2) evaluate bone apposition of CaP-coated machined surface implants at the early healing phase. Methods Mandibular premolars were extracted from five dogs. After eight weeks, the implants were placed according to drilling protocols: a nonmobile implant (NI) group and rotational implant (RI) group. For CaP dissolution behavior analysis, 8 implants were removed after 0, 1, 2, and 4 weeks. The surface morphology and deposition of the coatings were observed. For bone apposition analysis, block sections were obtained after 1-, 2-, and 4-week healing periods and the specimens were analyzed. Results Calcium and phosphorus were detected in the implants that were removed immediately after insertion, and the other implants were composed mainly of titanium. There were no notable differences between the NI and RI groups in terms of the healing process. The bone-to-implant contact and bone density in the RI group showed a remarkable increase after 2 weeks of healing. Conclusions It can be speculated that the CaP coating dissolves early in the healing phase and chemically induces early bone formation regardless of the primary stability. PMID:24455442

Vancomycin-Loaded Polymethylmethacrylate Spacers Fail to Eradicate Periprosthetic Joint Infection in a Clinically Representative Mouse Model.

PubMed

Carli, Alberto V; Bhimani, Samrath; Yang, Xu; de Mesy Bentley, Karen L; Ross, F Patrick; Bostrom, Mathias P G

2018-06-06

Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty. Current animal models of PJI do not effectively recreate the clinical condition and thus provide limited help in understanding why treatments fail. We developed a mouse model of the first-stage surgery of a 2-stage revision for PJI involving a 3-dimensionally printed Ti-6Al-4V implant and a mouse-sized cement spacer that elutes vancomycin. Vancomycin was mixed with polymethylmethacrylate (PMMA) cement and inserted into custom-made mouse-sized spacer molds. Twenty C57BL/6 mice received a proximal tibial implant and an intra-articular injection of 3 × 10 colony-forming units of Staphylococcus aureus Xen36. At 2 weeks, 9 mice underwent irrigation and debridement of the leg with revision of the implant to an articulating vancomycin-loaded PMMA spacer. Postoperatively, mice underwent radiography and serum inflammatory-marker measurements. Following euthanasia of the mice at 6 weeks, bone and soft tissues were homogenized to quantify bacteria within periprosthetic tissues. Implants and articulating spacers were either sonicated to quantify adherent bacteria or examined under scanning electron microscopy (SEM) to characterize the biofilm. Vancomycin-loaded PMMA spacers eluted vancomycin for ≤144 hours and retained antimicrobial activity. Control mice had elevated levels of inflammatory markers, radiographic evidence of septic loosening of the implant, and osseous destruction. Mice treated with a vancomycin-loaded PMMA spacer had significantly lower levels of inflammatory markers (p < 0.01), preserved tibial bone, and no intra-articular purulence. Retrieved vancomycin-loaded spacers exhibited significantly lower bacterial counts compared with implants (p < 0.001). However, bacterial counts in periprosthetic tissue did not significantly differ between the groups. SEM identified S. aureus encased within biofilm on control implants, while vancomycin-loaded spacers contained no bacteria. This animal model is a clinically representative model of PJI treatment. The results suggest that the antimicrobial effects of PMMA spacers are tightly confined to the articular space and must be utilized in conjunction with thorough tissue debridement and systemic antibiotics. These data provide what we believe to be the first insight into the effect of antibiotic-loaded cement spacers in a clinically relevant animal model and justify the adjunctive use of intravenous antibiotics when performing a 2-stage revision for PJI.

Coherent Synchrotron-Based Micro-Imaging Employed for Studies of Micro-Gap Formation in Dental Implants

NASA Astrophysics Data System (ADS)

Rack, T.; Zabler, S.; Rack, A.; Stiller, M.; Riesemeier, H.; Cecilia, A.; Nelson, K.

2011-09-01

Biocompatible materials such as titanium are regularly applied in oral surgery. Titanium-based implants for the replacement of missing teeth demand a high mechanical precision in order to minimize micro-bacterial leakage, especially when two-piece concepts are used. Synchrotron-based hard x-ray radiography, unlike conventional laboratory radiography, allows high spatial resolution in combination with high contrast even when micro-sized features in such highly attenuating objects are visualized. Therefore, micro-gap formation at interfaces in two-piece dental implants with the sample under different mechanical loads can be studied. We show the existence of micro-gaps in implants with conical connections and study the mechanical behavior of the mating zone of conical implants during loading. The micro-gap is a potential source of implant failure, i.e., bacterial leakage, which can be a stimulus for an inflammatory process.

Coherent Synchrotron-Based Micro-Imaging Employed for Studies of Micro-Gap Formation in Dental Implants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rack, T.; Stiller, M.; Nelson, K.

Biocompatible materials such as titanium are regularly applied in oral surgery. Titanium-based implants for the replacement of missing teeth demand a high mechanical precision in order to minimize micro-bacterial leakage, especially when two-piece concepts are used. Synchrotron-based hard x-ray radiography, unlike conventional laboratory radiography, allows high spatial resolution in combination with high contrast even when micro-sized features in such highly attenuating objects are visualized. Therefore, micro-gap formation at interfaces in two-piece dental implants with the sample under different mechanical loads can be studied. We show the existence of micro-gaps in implants with conical connections and study the mechanical behavior ofmore » the mating zone of conical implants during loading. The micro-gap is a potential source of implant failure, i.e., bacterial leakage, which can be a stimulus for an inflammatory process.« less

Biomechanical behaviour of a jawbone loaded with a prosthetic system supported by monophasic and biphasic implants.

PubMed

Inchingolo, F; Paracchini, L; DE Angelis, F; Cielo, A; Orefici, A; Spitaleri, D; Santacroce, L; Gheno, E; Palermo, A

2016-01-01

Modern implantology is based on the use of endosseous dental implants and on the study of osseointegration processes. The loss of marginal bone around a dental implant can be caused by many factors; the proper distribution of the masticatory loads is important and is closely dependent on the quality and quantity of bone tissue surrounding the implant. In fact, bone has the ability to adapt its microstructure, through processes of resorption and neoformation of new bone matrix, as a result of the mechanical stimuli that are generated during the chewing cycles. The purpose of this article is to redefine in a modern key and in light of current industrial and engineering technology, clinical and biomechanical concepts that characterize the monophasic implants, in order to assess proper use by evaluating the biomechanical differences with the biphasic implants.

In vitro comparison of fracture load of implant-supported, zirconia-based, porcelain- and composite-layered restorations after artificial aging.

PubMed

Komine, Futoshi; Taguchi, Kohei; Fushiki, Ryosuke; Kamio, Shingo; Iwasaki, Taro; Matsumura, Hideo

2014-01-01

This study evaluated fracture load of single-tooth, implant-supported, zirconia-based, porcelain- and indirect composite-layered restorations after artificial aging. Forty-four zirconia-based molar restorations were fabricated on implant abutments and divided into four groups, namely, zirconia-based all-ceramic restorations (ZAC group) and three types of zirconia-based composite-layered restorations (ZIC-P, ZIC-E, and ZIC groups). Before layering an indirect composite material, the zirconia copings in the ZIC-P and ZIC-E groups were primed with Clearfil Photo Bond and Estenia Opaque Primer, respectively. All restorations were cemented on the abutments with glass-ionomer cement and then subjected to thermal cycling and cyclic loading. All specimens survived thermal cycling and cyclic loading. The fracture load of the ZIC-P group (2.72 kN) was not significantly different from that of the ZAC group (3.05 kN). The fracture load of the zirconia-based composite-layered restoration primed with Clearfil Photo Bond (ZIC-P) was comparable to that of the zirconia-based all-ceramic restoration (ZAC) after artificial aging.

Effect of thread size on the implant neck area: preliminary results at 1 year of function.

PubMed

Kang, Young-Il; Lee, Dong-Won; Park, Kwang-Ho; Moon, Ik-Sang

2012-10-01

To evaluate and compare the effect of the coronal thread size on the marginal bone loss around the fixtures, when both implants were provided with threads to the top of fixture. Two groups of implants, one with a macro-thread to the top of the fixture (A) and the other with a micro-thread to the top of the fixture (B), were placed adjacent to each other in the partially edentulous areas of 20 patients. Bone loss around each implant was analyzed after 1 year of functional loading. The bone losses after loading were compared using Wilcoxon's signed-rank test. The mean marginal bone losses (A, 0.154 ± 0.144 mm; B, 0.125 ± 0.136 mm) were not statistically significant between the two groups (P = 0.669). There was no significant difference between implant with macro- and micro-neck thread in terms of marginal bone loss after 1 year of loading. © 2011 John Wiley & Sons A/S.

Determination of the frictional coefficient of the implant-antler interface: experimental approach.

PubMed

Hasan, Istabrak; Keilig, Ludger; Staat, Manfred; Wahl, Gerhard; Bourauel, Christoph

2012-10-01

The similar bone structure of reindeer antler to human bone permits studying the osseointegration of dental implants in the jawbone. As the friction is one of the major factors that have a significant influence on the initial stability of immediately loaded dental implants, it is essential to define the frictional coefficient of the implant-antler interface. In this study, the kinetic frictional forces at the implant-antler interface were measured experimentally using an optomechanical setup and a stepping motor controller under different axial loads and sliding velocities. The corresponding mean values of the static and kinetic frictional coefficients were within the range of 0.5-0.7 and 0.3-0.5, respectively. An increase in the frictional forces with increasing applied axial loads was registered. The measurements showed an evidence of a decrease in the magnitude of the frictional coefficient with increasing sliding velocity. The results of this study provide a considerable assessment to clarify the suitable frictional coefficient to be used in the finite element contact analysis of antler specimens.

Influence of Abutment Angle on Implant Strain When Supporting a Distal Extension Removable Partial Dental Prosthesis: An In Vitro Study.

PubMed

Hirata, Kiyotaka; Takahashi, Toshihito; Tomita, Akiko; Gonda, Tomoya; Maeda, Yoshinobu

This study evaluated the impact of angled abutments on strain in implants supporting a distal extension removable partial denture. An in vitro model of an implant supporting a distal extension removable partial denture was developed. The implant was positioned with a 17- or 30-degree mesial inclination, with either a healing abutment or a corrective multiunit abutment. Levels of strain under load were compared, and the results were compared using t test (P = .05). Correcting angulation with a multiunit angled abutment significantly decreased strain (P < .05) when compared with a healing abutment. An angled abutment decreased the strain on an inclined implant significantly more than a healing abutment when loaded under a distal extension removable partial denture.

Dental-Implantate und ihre Werkstoffe

NASA Astrophysics Data System (ADS)

Newesely, Heinrich

1983-07-01

Some new trends in materials for dental implants, which also effect in the operative techniques and implant design, are described. Advantages and shortcomings of the different material types are exemplified and correlated with their bioinert resp. bioactive functions. The practical interest in metallic implants focussed in titanium resp. oxide ceramics in the ceramic field, whereas the special goal of implant research follows from the improvement of the bioactive principle with loaded calcium phosphate implants.

Histological Evidence of the Osseointegration of Fractured Direct Metal Laser Sintering Implants Retrieved after 5 Years of Function.

PubMed

Mangano, Francesco; Mangano, Carlo; Piattelli, Adriano; Iezzi, Giovanna

2017-01-01

Direct metal laser sintering (DMLS) is an additive manufacturing technique that allows the fabrication of dental implants layer by layer through the laser fusion of titanium microparticles. The surface of DMLS implants is characterized by a high open porosity with interconnected pores of different sizes; therefore, it has the potential to enhance and accelerate bone healing. To date, however, there are no histologic/histomorphometric studies in the literature evaluating the interface between bone and DMLS implants in the long-term. To evaluate the interface between bone and DMLS implants retrieved after 5 years of functional loading. Two fractured DMLS implants were retrieved from the human jaws, using a 5 mm trephine bur. Both the implants were clinically stable and functioned regularly before fracture. The specimens were processed for histologic/histomorphometric evaluation; the bone-to-implant contact (BIC%) was calculated. Compact, mature lamellar bone was found over most of the DMLS implants in close contact with the implant surface; the histomorphometric evaluation showed a mean BIC% of 66.1% (±4.5%). The present histologic/histomorphometric study showed that DMLS implants were well integrated in bone, after 5 years of loading, with the peri-implant bone undergoing continuous remodeling at the interface.

Histological Evidence of the Osseointegration of Fractured Direct Metal Laser Sintering Implants Retrieved after 5 Years of Function

PubMed Central

Piattelli, Adriano

2017-01-01

Background Direct metal laser sintering (DMLS) is an additive manufacturing technique that allows the fabrication of dental implants layer by layer through the laser fusion of titanium microparticles. The surface of DMLS implants is characterized by a high open porosity with interconnected pores of different sizes; therefore, it has the potential to enhance and accelerate bone healing. To date, however, there are no histologic/histomorphometric studies in the literature evaluating the interface between bone and DMLS implants in the long-term. Purpose To evaluate the interface between bone and DMLS implants retrieved after 5 years of functional loading. Methods Two fractured DMLS implants were retrieved from the human jaws, using a 5 mm trephine bur. Both the implants were clinically stable and functioned regularly before fracture. The specimens were processed for histologic/histomorphometric evaluation; the bone-to-implant contact (BIC%) was calculated. Results Compact, mature lamellar bone was found over most of the DMLS implants in close contact with the implant surface; the histomorphometric evaluation showed a mean BIC% of 66.1% (±4.5%). Conclusions The present histologic/histomorphometric study showed that DMLS implants were well integrated in bone, after 5 years of loading, with the peri-implant bone undergoing continuous remodeling at the interface. PMID:28929117

Sources of variability in language development of children with cochlear implants: age at implantation, parental language, and early features of children's language construction.

PubMed

Szagun, Gisela; Schramm, Satyam A

2016-05-01

The aim of the present study was to analyze the relative influence of age at implantation, parental expansions, and child language internal factors on grammatical progress in children with cochlear implants (CI). Data analyses used two longitudinal corpora of spontaneous speech samples, one with twenty-two and one with twenty-six children, implanted between 0;6 and 3;10. Analyses were performed on the combined and separate samples. Regression analyses indicate that early child MLU is the strongest predictor of child MLU two and two-and-a-half years later, followed by parental expansions and age at implantation. Associations between earliest MLU gains and MLU two years later point to stability of individual differences. Early type and token frequencies of determiners predict MLU two years later more strongly than early frequency of lexical words. We conclude that features of CI children's very early language have considerable predictive value for later language outcomes.

Clinical outcomes of an osteotome technique and simultaneous placement of Neoss implants in the posterior maxilla.

PubMed

Volpe, Stefano; Lanza, Massimiliano; Verrocchi, Damiano; Sennerby, Lars

2013-02-01

Insufficient bone volume often hamper placement of dental implants in the posterior maxilla. The aim of the present clinical study was to evaluate retrospectively the clinical outcome of implant placement in the resorbed posterior maxilla using an osteotome technique without adding any grafting material. Twenty patients with 5 to 9 mm of residual alveolar bone height in the posterior maxilla received twenty-nine implants (Neoss Ltd., Harrogate, UK) using an osteotomy technique without bone grafts. Intraoral radiographs were taken before and after implant placement, at the time of loading and after 11 to 32 months of loading (mean 16.4 months), to evaluate bone formation below the sinus membrane and marginal bone loss. Implant stability measurements (Osstell(TM) , Gothenburg, Sweden) were performed after implant installation and at abutment connection 5 months later. All implants were installed with the prosthetic platform level with the bone crest. No implant was lost giving a survival rate of 100% after a mean follow-up time of 16.4 months. The average vertical bone height was 7.2 ± 1.5 mm at placement and 10.0 ± 1.0 mm after 11 to 32 months. The average increase of 2.8 ± 1.1 mm was statistically significant. There was a statistically significant improvement in implant stability from 70.7 ± 9.2 implant stability quotient (ISQ) at placement to 76.7 ± 5.7 ISQ at abutment connection, 5 months later. The mean marginal bone loss amounted to 0.7 ± 0.3 mm after 11 to 32 months of loading. It is concluded that the osteotome technique evaluated resulted in predictable intrasinus bone formation, firm implant stability, and good clinical outcomes as no implants were lost and minimal marginal bone loss was observed. © 2011 Wiley Periodicals, Inc.

Influence of custom-made implant designs on the biomechanical performance for the case of immediate post-extraction placement in the maxillary esthetic zone: a finite element analysis.

PubMed

Chen, Jianyu; Zhang, Zhiguang; Chen, Xianshuai; Zhang, Xiao

2017-05-01

Due to the increasing adoption of immediate implantation strategies and the rapid development of the computer aided design/computer aided manufacturing technology, a therapeutic concept based on patient-specific implant dentistry has recently been reintroduced by many researchers. However, little information is available on the designs of custom-made dental implant systems, especially their biomechanical behavior. The influence of the custom-made implant designs on the biomechanical performance for both an immediate and a delayed loading protocol in the maxillary esthetic zone was evaluated by means of the finite element (FE) method. FE models of three dental implants were considered: a state of the art cylindrical implant and two custom-made implants designed by reverse engineering technology, namely a root-analogue implant and a root-analogue threaded implant. The von Mises stress distributions and micro-motions around the bone-implant interfaces were calculated using ANSYS software. In a comparison of the three implant designs for both loading protocols, a favorable biomechanical performance was observed for the use of root-analogue threaded implant which approximated the geometry of natural anterior tooth and maintained the original long-axis. The results indicated that bone-implant interfacial micro-motion was reduced and a favorable stress distribution after osseointegration was achieved.

Influence of abutment design on the success of immediately loaded dental implants: experimental and numerical studies.

PubMed

Hasan, I; Röger, B; Heinemann, F; Keilig, L; Bourauel, C

2012-09-01

The aim of the present study was to investigate experimentally and numerically the influence of a fine threaded- against a roughened-cervical region of immediately loaded dental implants in combination with straight and 20°-angled abutments on the implant primary stability. A total of 30 implants were inserted in bovine rib-segments, 14 cervically roughened implants and 16 implants with fine cervical threads. Each implant system received two abutments, straight and 20°-angled. Implant displacements and rotations were measured using a biomechanical measurement system. Subsequently, eight samples were selected for geometrical reconstruction and numerical investigation of stress and strain distributions in the bone by means of the finite element method. Experimentally, both implant systems showed similar behaviour with the straight abutments concerning displacements and rotations. However, fine threaded implants showed much less displacement and rotation against roughened implants when angled abutments were considered. Numerically, stresses were within 35-45 MPa in the cortical bone for both implant systems. The strains showed highest values within the spongious bone with the roughened implants connected to angled abutments. The results indicate that implants with fine cervical threads could be recommended in particular with angled abutments. The outcomes of this study are currently confirmed by long-term clinical investigations. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

Ground reaction forces on stairs. Part II: knee implant patients versus normals.

PubMed

Stacoff, Alex; Kramers-de Quervain, Inès A; Luder, Gerhard; List, Renate; Stüssi, Edgar

2007-06-01

The goal of this study was to compare selected parameters of vertical ground reaction forces (GRF) of good outcome patients with different prosthesis designs with a matched control group during level walking, stair ascent and descent. Forty subjects, 29 with three main implant designs (including four subjects with a passive knee flexion restriction), and 11 healthy controls were measured with 8-10 repetitions. Vertical ground reaction forces were measured during two consecutive steps with force plates embedded in the walkway and the staircase. Defined parameters of the force signals were used to compare the results of the test groups. The results show, that, postoperatively, good outcome patients produce gait patterns of the vertical ground reaction force which are comparable to normal healthy subjects with the exception of a few distinct differences: a significant reduction (p<0.05) in the vertical loading on the operated side during level walking at take-off, at weight acceptance and take-off during stair ascent of the normal stair. During stair descent, the patients did not reduce load on the operated side, but increased load variation and side-to-side asymmetry; thus, the mechanical loads on the implants were high, which may be important information with respect to loading protocols of knee implant simulators. No systematic differences in any of the test parameters were found between posterior cruciate-retaining (LCS MB and Innex CR) versus non-retaining (LCS RP and Innex UCOR) implant designs. The restricted group showed significant reductions (p<0.05) of several loading parameters as well as an increased side-to-side asymmetry. About one third of the force parameters of the good outcome patients showed a side-to-side asymmetry between two consecutive steps, which was over a proposed level of acceptance.

Fracture mode during cyclic loading of implant-supported single-tooth restorations.

PubMed

Hosseini, Mandana; Kleven, Erik; Gotfredsen, Klaus

2012-08-01

Fracture of veneering ceramics in zirconia-based restorations has frequently been reported. Investigation of the fracture mode of implant-supported ceramic restorations by using clinically relevant laboratory protocols is needed. This study compared the mode of fracture and number of cyclic loads until veneering fracture when ceramic and metal ceramic restorations with different veneering ceramics were supported by implants. Thirty-two implant-supported single-tooth restorations were fabricated. The test group was composed of 16 ceramic restorations of zirconia abutment-retained crowns with zirconia copings veneered with glass-ceramics (n=8) and feldspathic ceramics (n=8). The control group was composed of 16 metal ceramic restorations of titanium abutment-retained crowns with gold alloy copings veneered with glass (n=8) and feldspathic ceramics (n=8). The palatal surfaces of the crowns were exposed to cyclic loading of 800 N with a frequency of 2 Hz, which continued to 4.2 million cycles or until fracture of the copings, abutments, or implants. The number of cycles and the fracture modes were recorded. The fracture modes were analyzed by descriptive analysis and the Mann-Whitney test (α=.05). The differences in loading cycles until veneering fracture were estimated with the Cox proportional hazards analysis. Veneering fracture was the most frequently observed fracture mode. The severity of fractures was significantly more in ceramic restorations than in metal ceramic restorations. Significantly more loading cycles until veneering fracture were estimated with metal ceramic restorations veneered with glass-ceramics than with other restorations. The metal ceramic restorations demonstrated fewer and less severe fractures and resisted more cyclic loads than the ceramic restorations, particularly when the metal ceramic crowns were veneered with glass-ceramics. Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

A preliminary randomized clinical trial comparing diode laser and scalpel periosteal incision during implant surgery: impact on postoperative morbidity and implant survival.

PubMed

Shahnaz, Aysan; Jamali, Raika; Mohammadi, Farnush; Khorsand, Afshin; Moslemi, Neda; Fekrazad, Reza

2018-01-01

The aim of this preliminary randomized clinical trial was to compare: (1) post-operative morbidity after application of laser or scalpel incision for flap advancement during implant surgery and bone grafting and (2) implant survival rate following flap advancement with laser or scalpel incision after 6 months of loading. Eighteen patients who were scheduled for dental implant placement and simultaneous bone grafting were randomly assigned to test or control groups. Diode laser (810 nm, 2 W, pulse interval 200 μs; pulse length 100 μs, 400-μm initiated fiber tip), or scalpel (control) was used to sever the periosteum to create a tension-free flap. Visual analogue scale (VAS) pain score, rate of nonsteroid anti-inflammatory drug (NSAID) consumption, intensity of swelling, and ecchymosis were measured for the six postsurgical days. Six months after loading, implant survival was assessed. VAS pain score (during the first four postoperative days), rate of NSAID consumption (during the first three postoperative days), and intensity of swelling (during the first five postoperative days) were significantly lower in the test group compared to the control group (All P values < 0.05). One patient in the control group experienced ecchymosis. All implants were successful in function. Application of laser for performing periosteal releasing incision reduced the incidence and severity of postoperative morbidity of the patients undergone implant surgery in conjunction with bone augmentation procedure. We did not find any detrimental effect of laser incision on the implant survival within 6 months of loading.

The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty.

PubMed

Olsen, Michael; Al Saied, Mohamed; Morison, Zachary; Sellan, Michael; Waddell, James P; Schemitsch, Emil H

2014-12-01

Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended. © IMechE 2014.

Evaluation of the success and complication rates of self-drilling orthodontic mini-implants.

PubMed

Gurdan, Z; Szalma, J

2018-05-01

Orthodontic mini-implants are important devices for successful anchorage management in orthodontics; however, the survival of these devices depends on several clinical factors. The aim of our study was to calculate the success and complication rates of orthodontic mini-implants. In this retrospective study, patients of our orthodontic department were enrolled, getting overall 59 orthodontic mini-implants during their orthodontic treatment in a 2-year period. Every patient had one or more of the 1.6 mm × 8 mm in size self-drilling mini-implants (Jeil Dual Top Anchor System, Jeil Medical Corp., Seoul, Korea). Screw loading was performed immediately after insertions, keeping tension forces under 150 g. Soft tissue and bone infections, implant mobility and screw loss, implant fracture, and neighboring tooth injury were registered. Relationships between variables were tested using the Chi-square test for statistical significance. The success rate of the orthodontic mini-implants was 89.8% in this study while the average loading period was 8.1 months. Soft-tissue infections varied between 6.3% and 33.3% of the cases while screw mobility varied between 3.1% and 20.8% of the cases regarding the anatomic localization. Screw mobility was significantly more frequent in the buccal fold than in the palate (P = 0.034). Screw mobility was significantly more frequent in the buccal fold than in the palate (P = 0.034) and screw mobility was found more frequently in case of intrusions than by extrusions (P = 0.036). The overall success rate of mini-implants was found acceptable in this study, however, screw mobility in the buccal fold showed a high incidence, suggesting the thorough consideration of the immediate loading by buccal mini-implants.

Effect of platform switching on the peri-implant bone: A finite element study

PubMed Central

Martínez-González, Amparo; Peiró, Germán; Ródenas, Juan-José; López-Mollá, María-Victoria

2015-01-01

Background There exists a relation between the presence and location of the micro-gap and the loss of peri implant bone. Several authors have shown that the treatments based on the use of platform switching result in less peri-implant bone loss and an increased tissue stability. The purpose of this study was to analyse the effect of the platform switching on the distribution of stresses on the peri-implant bone using the finite element method. Material and Methods A realistic 3D full-mandible finite element model representing cortical bone and trabecular bone was used to study the distribution of the stress on the bone induced by an implant of diameter 4.1 mm. Two abutments were modelled. The first one, of diameter 4.1 mm, was used in the reference model to represent a conventional implant. The second one, of diameter 3.2 mm, was used to represent the implant with platform switching. Both models were subjected to axial and oblique masticatory loads. Results The analyses showed that, although no relevant differences can be found for the trabecular bone, the use of platform switching reduces the maximum stress level in the cortical bone by almost 36% with axial loads and by 40% with oblique loads. Conclusions The full 3D Finite Element model, that can be used to investigate the influence of other parameters (implant diameter, connexion type, …) on the biomechanical behaviour of the implant, showed that this stress reduction can be a biomechanical reasons to explain why the platform switching seems to reduce or eliminate crestal bone resorption after the prosthetic restoration. Key words:Dental implant, platform switching, finite element method. PMID:26535094

Effect of Integration Patterns Around Implant Neck on Stress Distribution in Peri-Implant Bone: A Finite Element Analysis.

PubMed

Han, Jingyun; Sun, Yuchun; Wang, Chao

2017-08-01

To investigate the biomechanical performance of different osseointegration patterns between cortical bone and implants using finite element analysis. Fifteen finite element models were constructed of the mandibular fixed prosthesis supported by implants. Masticatory loads (200 N axial, 100 N oblique, 40 N horizontal) were applied. The cortical bone/implant interface was divided equally into four layers: upper, upper-middle, lower-middle, and lower. The bone stress and implant displacement were calculated for 5 degrees of uniform integration (0, 20%, 40%, 60%, and 100%) and 10 integration patterns. The stress was concentrated in the bone margin and gradually decreased as osseointegration progressed, when the integrated and nonintegrated areas were alternated on the bone-implant surface. Compared with full integration, the integration of only the lower-middle layer or lower half layers significantly decreased von Mises, tensile, and compressive stresses in cortical bone under oblique and horizontal loads, and these patterns did not induce higher stress in the cancellous bone. For the integration of only the upper or upper-middle layer, stress in the cortical and cancellous bones significantly increased and was considerably higher than in the case of nonintegration. In addition, the maximum stress in the cortical bone was sensitive to the quantity of integrated nodes at the bone margin; lower quantity was associated with higher stress. There was no significant difference in the displacement of implants among 15 models. Integration patterns of cortical bone significantly affect stress distribution in peri-implant bone. The integration of only the lower-middle or lower half layers helps to increase the load-bearing capacity of peri-implant bone and decrease the risk of overloading, while upper integration may further increase the risk of bone resorption. © 2016 by the American College of Prosthodontists.

Analysis of load distribution in tooth-implant supported fixed partial dentures by the use of resilient abutment.

PubMed

Glisić, Mirko; Stamenković, Dragoslav; Grbović, Aleksandar; Todorović, Aleksandar; Marković, Aleksa; Trifković, Branka

2016-01-01

Differences between the tooth and implant response to load can lead to many biological and technical implications in the conditions of occlusal forces. The objective of this study was to analyze load distribution in tooth/implant-supported fixed partial dentures with the use of resilient TSA (Titan Shock Absorber, BoneCare GmbH, Augsburg, Germany) abutment and conventional non-resilient abutment using finite element method. This study presents two basic 3D models. For one model a standard non-resilient abutment is used, and on the implant of the second model a resilient TSA abutment is applied. The virtual model contains drawn contours of tooth, mucous membranes, implant, cortical bones and spongiosa, abutment and suprastructure. The experiment used 500 N of vertical force, applied in three different cases of axial load. Calculations of von Mises equivalent stresses of the tooth root and periodontium, implants and peri-implant tissue were made. For the model to which a non-resilient abutment is applied, maximum stress values in all three cases are observed in the cortical part of the bone (maximum stress value of 49.7 MPa). Measurements of stress and deformation in the bone tissue in the model with application of the resilientTSA abutment demonstrated similar distribution; however, these values are many times lower than in the model with non-resilient TSA abutment (maximum stress value of 28.9 MPa). Application of the resilient TSA abutment results in more equal distribution of stress and deformations in the bone tissue under vertical forces. These values are many times lower than in the model with the non-resilient abutment.

Stress Distribution in Single Dental Implant System: Three-Dimensional Finite Element Analysis Based on an In Vitro Experimental Model.

PubMed

Rezende, Carlos Eduardo Edwards; Chase-Diaz, Melody; Costa, Max Doria; Albarracin, Max Laurent; Paschoeto, Gabriela; Sousa, Edson Antonio Capello; Rubo, José Henrique; Borges, Ana Flávia Sanches

2015-10-01

This study aimed to analyze the stress distribution in single implant system and to evaluate the compatibility of an in vitro model with finite element (FE) model. The in vitro model consisted of Brånemark implant; multiunit set abutment of 5 mm height; metal-ceramic screw-retained crown, and polyurethane simulating the bone. Deformations were recorded in the peri-implant region in the mesial and distal aspects, after an axial 300 N load application at the center of the occlusal aspect of the crown, using strain gauges. This in vitro model was scanned with micro CT to design a three-dimensional FE model and the strains in the peri-implant bone region were registered to check the compatibility between both models. The FE model was used to evaluate stress distribution in different parts of the system. The values obtained from the in vitro model (20-587 με) and the finite element analysis (81-588 με) showed agreement among them. The highest stresses because of axial and oblique load, respectively were 5.83 and 40 MPa for the cortical bone, 55 and 1200 MPa for the implant, and 80 and 470 MPa for the abutment screw. The FE method proved to be effective for evaluating the deformation around single implant. Oblique loads lead to higher stress concentrations.

Periodontitis and periimplantitis: one and the same?

PubMed

Meffert, R M

1993-12-01

Research shows that the same anaerobic, gram-negative pathogens are present in the periodontal and implant pocket or crevice. The implants in a partially edentulous case are probably more at risk due to the bacteria being more pathogenic and a seeding mechanism from the tooth pocket to the implant crevice. In the face of a normal microbial flora, retrograde periimplantitis or radiographic bone loss without gingival changes may be due to trauma because of overloading, loading too soon, and/or loading in a lateral direction. Finally, the combination of an infective process (periimplantitis) and noninfective or traumatic process (retrograde periimplantitis) will result in rapid osseous destruction and, possibly, loss of the implant fixture(s).

Effect of Framework in an Implant-Supported Full-Arch Fixed Prosthesis: 3D Finite Element Analysis.

PubMed

Menini, Maria; Pesce, Paolo; Bevilacqua, Marco; Pera, Francesco; Tealdo, Tiziano; Barberis, Fabrizio; Pera, Paolo

2015-01-01

The aim of this study was to analyze through a three-dimensional finite element analysis (3D-FEA) stress distribution on four implants supporting a full-arch implant-supported fixed prosthesis (FFP) using different prosthesis designs. A 3D edentulous maxillary model was created and four implants were virtually placed into the maxilla and splinted, simulating an FFP without framework, with a cast metal framework, and with a carbon fiber framework. An occlusal load of 150 N was applied, stresses were transmitted into peri-implant bone, and prosthodontic components were recorded. 3D-FEA revealed higher stresses on the implants (up to +55.16%), on peri-implant bone (up to +56.93%), and in the prosthesis (up to +70.71%) when the full-acrylic prosthesis was simulated. The prosthesis with a carbon fiber framework showed an intermediate behavior between that of the other two configurations. This study suggests that the presence of a rigid framework in full-arch fixed prostheses provides a better load distribution that decreases the maximum values of stress at the levels of implants, prosthesis, and maxillary bone.

Establishing Antibacterial Multilayer Films on the Surface of Direct Metal Laser Sintered Titanium Primed with Phase-Transited Lysozyme

PubMed Central

Guan, Binbin; Wang, Haorong; Xu, Ruiqing; Zheng, Guoying; Yang, Jie; Liu, Zihao; Cao, Man; Wu, Mingyao; Song, Jinhua; Li, Neng; Li, Ting; Cai, Qing; Yang, Xiaoping; Li, Yanqiu; Zhang, Xu

2016-01-01

Direct metal laser sintering is a technology that allows the fabrication of titanium (Ti) implants with a functional gradation of porosity and surface roughness according to three-dimensional (3D) computer data. The surface roughness of direct metal laser sintered titanium (DMLS-Ti) implants may provide abundant binding sites for bacteria. Bacterial colonization and subsequent biofilm formation can cause unsatisfactory cell adhesion and implant-related infections. To prevent such infections, a novel phase-transited lysozyme (PTL) was utilized as an initial functional layer to simply and effectively prime DMLS-Ti surfaces for subsequent coating with antibacterial multilayers. The purpose of the present study was to establish a surface with dual biological functionality. The minocycline-loaded polyelectrolyte multilayers of hyaluronic acid (HA) and chitosan (CS) formed via a layer-by-layer (LbL) self-assembly technique on PTL-functionalized DMLS-Ti were designed to inhibit pathogenic microbial infections while allowing the DMLS-Ti itself and the modified coatings to retain acceptable biocompatibility. The experimental results indicate that the DMLS-Ti and the hydrogel treated surfaces can inhibit early bacterial adhesion while completely preserving osteoblast functions. This design is expected to gain considerable interest in the medical field and to have good potential for applications in multifunctional DMLS-Ti implants. PMID:27821857

Establishing Antibacterial Multilayer Films on the Surface of Direct Metal Laser Sintered Titanium Primed with Phase-Transited Lysozyme.

PubMed

Guan, Binbin; Wang, Haorong; Xu, Ruiqing; Zheng, Guoying; Yang, Jie; Liu, Zihao; Cao, Man; Wu, Mingyao; Song, Jinhua; Li, Neng; Li, Ting; Cai, Qing; Yang, Xiaoping; Li, Yanqiu; Zhang, Xu

2016-11-08

Direct metal laser sintering is a technology that allows the fabrication of titanium (Ti) implants with a functional gradation of porosity and surface roughness according to three-dimensional (3D) computer data. The surface roughness of direct metal laser sintered titanium (DMLS-Ti) implants may provide abundant binding sites for bacteria. Bacterial colonization and subsequent biofilm formation can cause unsatisfactory cell adhesion and implant-related infections. To prevent such infections, a novel phase-transited lysozyme (PTL) was utilized as an initial functional layer to simply and effectively prime DMLS-Ti surfaces for subsequent coating with antibacterial multilayers. The purpose of the present study was to establish a surface with dual biological functionality. The minocycline-loaded polyelectrolyte multilayers of hyaluronic acid (HA) and chitosan (CS) formed via a layer-by-layer (LbL) self-assembly technique on PTL-functionalized DMLS-Ti were designed to inhibit pathogenic microbial infections while allowing the DMLS-Ti itself and the modified coatings to retain acceptable biocompatibility. The experimental results indicate that the DMLS-Ti and the hydrogel treated surfaces can inhibit early bacterial adhesion while completely preserving osteoblast functions. This design is expected to gain considerable interest in the medical field and to have good potential for applications in multifunctional DMLS-Ti implants.

Establishing Antibacterial Multilayer Films on the Surface of Direct Metal Laser Sintered Titanium Primed with Phase-Transited Lysozyme

NASA Astrophysics Data System (ADS)

Guan, Binbin; Wang, Haorong; Xu, Ruiqing; Zheng, Guoying; Yang, Jie; Liu, Zihao; Cao, Man; Wu, Mingyao; Song, Jinhua; Li, Neng; Li, Ting; Cai, Qing; Yang, Xiaoping; Li, Yanqiu; Zhang, Xu

2016-11-01

Direct metal laser sintering is a technology that allows the fabrication of titanium (Ti) implants with a functional gradation of porosity and surface roughness according to three-dimensional (3D) computer data. The surface roughness of direct metal laser sintered titanium (DMLS-Ti) implants may provide abundant binding sites for bacteria. Bacterial colonization and subsequent biofilm formation can cause unsatisfactory cell adhesion and implant-related infections. To prevent such infections, a novel phase-transited lysozyme (PTL) was utilized as an initial functional layer to simply and effectively prime DMLS-Ti surfaces for subsequent coating with antibacterial multilayers. The purpose of the present study was to establish a surface with dual biological functionality. The minocycline-loaded polyelectrolyte multilayers of hyaluronic acid (HA) and chitosan (CS) formed via a layer-by-layer (LbL) self-assembly technique on PTL-functionalized DMLS-Ti were designed to inhibit pathogenic microbial infections while allowing the DMLS-Ti itself and the modified coatings to retain acceptable biocompatibility. The experimental results indicate that the DMLS-Ti and the hydrogel treated surfaces can inhibit early bacterial adhesion while completely preserving osteoblast functions. This design is expected to gain considerable interest in the medical field and to have good potential for applications in multifunctional DMLS-Ti implants.

Assessing the local mechanical environment in medial opening wedge high tibial osteotomy using finite element analysis.

PubMed

Pauchard, Yves; Ivanov, Todor G; McErlain, David D; Milner, Jaques S; Giffin, J Robert; Birmingham, Trevor B; Holdsworth, David W

2015-03-01

High-tibial osteotomy (HTO) is a surgical technique aimed at shifting load away from one tibiofemoral compartment, in order the reduce pain and progression of osteoarthritis (OA). Various implants have been designed to stabilize the osteotomy and previous studies have been focused on determining primary stability (a global measure) that these designs provide. It has been shown that the local mechanical environment, characterized by bone strains and segment micromotion, is important in understanding healing and these data are not currently available. Finite element (FE) modeling was utilized to assess the local mechanical environment provided by three different fixation plate designs: short plate with spacer, long plate with spacer and long plate without spacer. Image-based FE models of the knee were constructed from healthy individuals (N = 5) with normal knee alignment. An HTO gap was virtually added without changing the knee alignment and HTO implants were inserted. Subsequently, the local mechanical environment, defined by bone compressive strain and wedge micromotion, was assessed. Furthermore, implant stresses were calculated. Values were computed under vertical compression in zero-degree knee extension with loads set at 1 and 2 times the subject-specific body weight (1 BW, 2 BW). All studied HTO implant designs provide an environment for successful healing at 1 BW and 2 BW loading. Implant von Mises stresses (99th percentile) were below 60 MPa in all experiments, below the material yield strength and significantly lower in long spacer plates. Volume fraction of high compressive strain ( > 3000 microstrain) was below 5% in all experiments and no significant difference between implants was detected. Maximum vertical micromotion between bone segments was below 200 μm in all experiments and significantly larger in the implant without a tooth. Differences between plate designs generally became apparent only at 2 BW loading. Results suggest that with compressive loading of 2 BW, long spacer plates experience the lowest implant stresses, and spacer plates (long or short) result in smaller wedge micromotion, potentially beneficial for healing. Values are sensitive to subject bone geometry, highlighting the need for subject-specific modeling. This study demonstrates the benefits of using image-based FE modeling and bone theory to fine-tune HTO implant design.

Understanding long-term silver release from surface modified porous titanium implants.

PubMed

Shivaram, Anish; Bose, Susmita; Bandyopadhyay, Amit

2017-08-01

Prevention of orthopedic device related infection (ODRI) using antibiotics has met with limited amount of success and is still a big concern during post-surgery. As an alternative, use of silver as an antibiotic treatment to prevent surgical infections is being used due to the well-established antimicrobial properties of silver. However, in most cases silver is used in particulate form with wound dressings or with short-term devices such as catheters but not with load-bearing implants. We hypothesize that strongly adherent silver to load-bearing implants can offer longer term solution to infection in vivo. Keeping that in mind, the focus of this study was to understand the long term release study of silver ions for a period of minimum 6months from silver coated surface modified porous titanium implants. Implants were fabricated using a LENS™ system, a powder based additive manufacturing technique, with at least 25% volume porosity, with and without TiO 2 nanotubes in phosphate buffer saline (pH 7.4) to see if the total release of silver ions is within the toxic limit for human cells. Considering the fact that infection sites may reduce the local pH, silver release was also studied in acetate buffer (pH 5.0) for a period of 4weeks. Along with that, the osseointegrative properties as well as cytotoxicity of porous titanium implants were assessed in vivo for a period of 12weeks using a rat distal femur model. In vivo results indicate that porous titanium implants with silver coating show comparable, if not better, biocompatibility and bonding at the bone-implant interface negating any concerns related to toxicity related to silver to normal cells. The current research is based on our recently patented technology, however focused on understanding longer-term silver release to mitigate infection related problems in load-bearing implants that can even arise several months after the surgery. Prevention of orthopedic device related infection using antibiotics has met with limited success and is still a big concern during post-surgery. Use of silver as an antibiotic treatment to prevent surgical infections is being explored due to the well-established antimicrobial properties of silver. However, in most cases silver is used in particulate form with wound dressings or with short-term devices such as catheters but not with load-bearing implants. We hypothesize that strongly adherent silver to load-bearing implants can offer longer-term solution towards infection in vivo. Keeping that in mind, the focus of this study was to understand the long-term release of silver ions, for a period of minimum 6months, from silver coated surface modified porous titanium implants. Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Stability of the anterior arm of three different Hyrax hybrid expanders: an in vitro study

PubMed Central

de la Iglesia, Gonzalo; Walter, André; de la Iglesia, Fernando; Winsauer, Heinz; Puigdollers, Andreu

2018-01-01

ABSTRACT Introduction: The force applied to the teeth by fixed orthopaedic expanders has previously been studied, but not the force applied to the orthodontic mini-implant (OMI) used to expand the maxilla with Hyrax hybrid expanders (HHE). Objective: The aim of this article was to evaluate the clinical safety of the components (OMI, abutment and double wire arms) of three different force-transmitting systems (FTS) for conducting orthopaedic maxillary expansion: Jeil Medical & Tiger Dental™, Microdent™ and Ortholox™. Methods: For the realization of this in vitro study of the resistance to mechanical load, three different abutment types (bonded, screwed on, and coupling) and three different OMIs’ diameters (Jeil™ 2.5 mm, Microdent™ 1.6 mm and Ortholox™ 2.2 mm) were used. Ten tests for each of these three FTS were carried out in a static lateral load in artificial bone blocks (Sawbones™) by a Galdabini universal testing machine, then comparing its performance. Comparisons of loads, deformations and fractures were carried out by means of radiographs of FTS components in each case. Results: At 1- mm load and within the elastic deformation, FTS values ranged from 67 ± 13 N to 183 ± 48 N. Under great deformations, Jeil & Tiger™ was the one who withstood the greatest loads, with an average 378 ± 22 N; followed by Microdent™, with 201 ± 18 N, and Ortholox™, with 103 ± 10 N. At 3 mm load, the OMIs shaft bends and deforms when the diameter is smaller than 2.5 mm. The abutment fixation is crucial to transmit forces and moments. Conclusions: The present study shows the importance of a rigid design of the different components of HHEs, and also that HHEs would be suitable for maxillary expansion in adolescents and young adults, since its mean expansion forces exceed 120N. Furthermore, early abutment detachment or smaller mini-implants diameter would only be appropriate for children. PMID:29791684

Differences in crestal bone-to-implant contact following an under-drilling compared to an over-drilling protocol. A study in the rabbit tibia.

PubMed

Cohen, Omer; Ormianer, Zeev; Tal, Haim; Rothamel, Daniel; Weinreb, Miron; Moses, Ofer

2016-12-01

The objective of this study is to compare bone-to-implant contact (BIC) between implants inserted at high torque due to under-drilling of the crestal bone to those inserted at low torque due to over-drilling of the crestal bone. Forty implants with diameters of 3.75 mm (group A) or 3.55 mm (group B) were inserted in the proximal tibiae of NZW rabbits in two separate surgeries on day 0 or 21. Osteotomy of the crestal bone was finalized with a 3.65-mm drill. In group A, implants were inserted at torque ≥35 Ncm (under-drilling) and in group B with torque <10 Ncm (over-drilling). Implants and their surrounding bone were retrieved on day 42, thus creating 3- and 6-week observation periods, processed for non-decalcified histology and stained with toluidine blue. Crestal BIC (c-BIC) and total BIC (t-BIC) were measured. Wilcoxon test was used to evaluate differences between groups. Three weeks post-surgery, the mean c-BIC in group A was 16.3 ± 3.3 vs 31.5 ± 3.4 % in group B (P < 0.05). At 6 weeks, a similar trend was observed (group A: 28.7 ± 3.6 %; group B: 38.4 ± 4.9 %) (P > 0.05). No differences in t-BIC were noted at 3 weeks and at 6 weeks between the groups. Insertion of implants with an over-drilling protocol of the crestal aspect of the osteotomy resulted in increased short-term crestal bone-to-implant contact. Insertion of implants with a high torque following an under-drilling protocol, commonly used for immediate loading, may reduce crestal bone-to-implant contact at early healing stages.

Biomechanical Three-Dimensional Finite Element Analysis of Single Implant-Supported Prostheses in the Anterior Maxilla, with Different Surgical Techniques and Implant Types.

PubMed

Verri, Fellippo Ramos; Santiago, Joel Ferreira; Almeida, Daniel Augusto; de Souza Batista, Victor Eduardo; Araujo Lemos, Cleidiel Aparecido; Mello, Caroline Cantieri; Pellizzer, Eduardo Piza

The aim of this study was to use three-dimensional finite element analysis to analyze the stress distribution transferred by single implant-supported prostheses placed in the anterior maxilla using different connections (external hexagon, internal hexagon, or Morse taper), inclinations of the load (0, 30, or 60 degrees), and surgical techniques for placement (monocortical/conventional, bicortical, or bicortical with nasal floor elevation). Nine models representing a bone block of this region were simulated by computer-aided design software (InVesalius, Rhinoceros, SolidWorks). Each model received one implant, which supported a cemented metalloceramic crown. Using FEMAP software, finite elements were discretized while simulating a 178-N load at 0, 30, and 60 degrees relative to the long axis of the implant. The problem was solved in NEi Nastran software, and postprocessing was performed in FEMAP. Von Mises stress and maximum principal stress maps were made. The von Mises stress analysis revealed that stress increased with increasing inclination of the load, from 0 to 30 to 60 degrees. Morse taper implants showed less stress concentration around the cervical and apical areas of the implant. The bicortical technique, associated or not with nasal floor elevation, contributed to decreasing the stress concentration in the apical area of the implant. Maximum principal stress analysis showed that the increase in inclination was proportional to the increase in stress on the bone tissue in the cervical area. Lower stress concentrations in the cortical bone were obtained with Morse taper implants and the bicortical technique compared with other connections and surgical techniques, respectively. Increasing the inclination of the applied force relative to the long axis of the implant tended to overload the peri-implant bone tissue and the internal structure of the implants. The Morse taper connection and bicortical techniques seemed to be more favorable than other connections or techniques, respectively, for restoring the anterior maxilla.

Three-dimensional finite element analysis of vertical and angular misfit in implant-supported fixed prostheses.

PubMed

Assunção, Wirley Gonçalves; Gomes, Erica Alves; Rocha, Eduardo Passos; Delben, Juliana Aparecida

2011-01-01

Three-dimensional finite element analysis was used to evaluate the effect of vertical and angular misfit in three-piece implant-supported screw-retained fixed prostheses on the biomechanical response in the peri-implant bone, implants, and prosthetic components. Four three-dimensional models were fabricated to represent a right posterior mandibular section with one implant in the region of the second premolar (2PM) and another in the region of the second molar (2M). The implants were splinted by a three-piece implant-supported metal-ceramic prosthesis and differed according to the type of misfit, as represented by four different models: Control = prosthesis with complete fit to the implants; UAM (unilateral angular misfit) = prosthesis presenting unilateral angular misfit of 100 μm in the mesial region of the 2M; UVM (unilateral vertical misfit) = prosthesis presenting unilateral vertical misfit of 100 μm in the mesial region of the 2M; and TVM (total vertical misfit) = prosthesis presenting total vertical misfit of 100 μm in the platform of the framework in the 2M. A vertical load of 400 N was distributed and applied on 12 centric points by the software Ansys, ie, a vertical load of 150 N was applied to each molar in the prosthesis and a vertical load of 100 N was applied at the 2PM. The stress values and distribution in peri-implant bone tissue were similar for all groups. The models with misfit exhibited different distribution patterns and increased stress magnitude in comparison to the control. The highest stress values in group UAM were observed in the implant body and retention screw. The groups UVM and TVM exhibited high stress values in the platform of the framework and the implant hexagon, respectively. The three types of misfit influenced the magnitude and distribution of stresses. The influence of misfit on peri-implant bone tissue was modest. Each type of misfit increased the stress values in different regions of the system.

Phelligridin D-loaded oral nanotube titanium implant enhances osseointegration and prevents osteolysis in rat mandible.

PubMed

Kim, Ji-Eun; Takanche, Jyoti Shrestha; Kim, Jeong-Seok; Lee, Min-Ho; Jeon, Jae-Gyu; Park, Il-Song; Yi, Ho-Keun

2018-04-12

Poor bone quality and osteolysis are the major causes of implant failure in dentistry. Here, this study tested the effect of phelligridin D-loaded nanotubes titanium (Ti) for bone formation around the dental implants. The purpose of this study was to enhance osseointegration of phelligridin D-loaded implant into the bone for bone formation and prevention of osteolysis. Cell viability, crystal violet staining, Western blot, alizarin red S staining, alkaline phosphatase activity, tartrate-resistant acid phosphatase staining, micro-computed tromography (μ-CT), hematoxylin and eosin (H&E) and immunohistochemical staining were used in vitro and in vivo to test the biocompatibility of phelligridin D. Phelligridin D enhanced osteoblast differentiation and mineralization by increasing bone morphogenic protein-2/7 (BMP-2/7), Osterix, Runx-2, osteoprotegerin (OPG), alkaline phosphatase and inhibited osteoclast differentiation by decreasing receptor activator of nuclear factor kappa-B ligand (RANKL) in MC-3T3 E1 cells. Further, phelligridin D promoted bone regeneration around nanotube Ti implant surface by increasing the levels of BMP-2/7 and OPG in a rat model. Phelligridin D also inhibited osteolysis by suppressing the expression of RANKL. These findings strongly suggest that phelligridin D is a new compound representing a potential therapeutic candidate for implant failure caused by osteolysis and poor bone quality of teeth.

Biomechanical 3-Dimensional Finite Element Analysis of Obturator Protheses Retained with Zygomatic and Dental Implants in Maxillary Defects

PubMed Central

Akay, Canan; Yaluğ, Suat

2015-01-01

Background The objective of this study was to investigate the stress distribution in the bone around zygomatic and dental implants for 3 different implant-retained obturator prostheses designs in a Aramany class IV maxillary defect using 3-dimensional finite element analysis (FEA). Material\\Methods A 3-dimensional finite element model of an Aramany class IV defect was created. Three different implant-retained obturator prostheses were modeled: model 1 with 1 zygomatic implant and 1 dental implant, model 2 with 1 zygomatic implant and 2 dental implants, and model 3 with 2 zygomatic implants. Locator attachments were used as a superstructure. A 150-N load was applied 3 different ways. Qualitative analysis was based on the scale of maximum principal stress; values obtained through quantitative analysis are expressed in MPa. Results In all loading conditions, model 3 (when compared models 1 and 2) showed the lowest maximum principal stress value. Model 3 is the most appropirate reconstruction in Aramany class IV maxillary defects. Two zygomatic implants can reduce the stresses in model 3. The distribution of stresses on prostheses were more rational with the help of zygoma implants, which can distribute the stresses on each part of the maxilla. Conclusions Aramany class IV obturator prosthesis placement of 2 zygomatic implants in each side of the maxilla is more advantageous than placement of dental implants. In the non-defective side, increasing the number of dental implants is not as suitable as zygomatic implants. PMID:25714086

Micromotion and stress distribution of immediate loaded implants: a finite element analysis.

PubMed

Fazel, A; Aalai, S; Rismanchian, M; Sadr-Eshkevari, P

2009-12-01

Primary stability and micromotion of the implant fixture is mostly influenced by its macrodesign. To assess and compare the peri-implant stress distribution and micromotion of two types of immediate loading implants, immediate loaded screw (ILS) Nisastan and Xive (DENTSPLY/Friadent, Monnheim, Germany), and to determine the best macrodesign of these two implants by finite element analysis. In this experimental study, the accurate pictures of two fixtures (ILS: height = 13, diameter = 4 mm and Xive: height = 13, diameter = 3.8 mm) were taken by a new digital camera (Nikon Coolpix 5700 [Nikon, Japan], resolution = 5.24 megapixel, lens = 8x optical, 4x digital zoom). Following accurate measurements, the three-dimensional finite element computer model was simulated and inserted in simulated mandibular bone (D(2)) in SolidWorks 2003 (SolidWork Corp., MA, USA) and Ansys 7.1 (Ansys, Inc., Canonsburg, PA, USA). After loading (500 N, 75 degrees above horizon), the displacement was displayed and von Mises stress was recorded. It was found that the primary stability of ILS was greater (152 microm) than Xive (284 microm). ILS exhibited more favorable stress distribution. Maximum stress concentration found in periapical bone around Xive ( approximately 30 MPa) was lesser than Nisastan ( approximately 37 MPa). Macrodesign of ILS leads to better primary stability and stress distribution. Maximum stress around Xive was less.

Nanoindentation of silicon implanted with hydrogen: effect of implantation dose on silicon’s mechanical properties and nanoindentation-induced phase transformation

NASA Astrophysics Data System (ADS)

Jelenković, Emil V.; To, Suet; Goncharova, Lyudmila V.; Wong, Sing Fai

2017-07-01

Implantation of hydrogen in single-crystal silicon (c-Si) is known to affect its machining. However, very little is reported on the material and mechanical properties of hydrogen-implanted silicon (Si). In this article, near-surface regions (~0-500 nm) of lightly doped (1 0 0) Si were modified by varying the hydrogen concentration using ion implantation. The maximum hydrogen concentration was varied from ~4  ×  1020 to ~3.2  ×  1021 cm-3. The implanted Si was investigated by nanoindentation. From the dynamic nanoindentation test, it was found that in hydrogen-implanted Si hardness is increased significantly, while the elastic modulus is reduced. The nanoindentation-induced Si phase transformation was studied under different load/unload rates and loads. Raman spectroscopy revealed that the hydrogen implantation tends to suppress Si-XII and Si-III phases and facilitates amorphous Si formation during the unloading stage of nanoindentation. Both the mechanical properties and phase transformations were qualitatively related not only to the hydrogen concentration, but also to the implantation-generated defects and strain.

On stress/strain shielding and the material stiffness paradigm for dental implants.

PubMed

Korabi, Raoof; Shemtov-Yona, Keren; Rittel, Daniel

2017-10-01

Stress shielding considerations suggest that the dental implant material's compliance should be matched to that of the host bone. However, this belief has not been confirmed from a general perspective, either clinically or numerically. To characterize the influence of the implant stiffness on its functionality using the failure envelope concept that examines all possible combinations of mechanical load and application angle for selected stress, strain and displacement-based bone failure criteria. Those criteria represent bone yielding, remodeling, and implant primary stability, respectively MATERIALS AND METHODS: We performed numerical simulations to generate failure envelopes for all possible loading configurations of dental implants, with stiffness ranging from very low (polymer) to extremely high, through that of bone, titanium, and ceramics. Irrespective of the failure criterion, stiffer implants allow for improved implant functionality. The latter reduces with increasing compliance, while the trabecular bone experiences higher strains, albeit of an overall small level. Micromotions remain quite small irrespective of the implant's stiffness. The current paradigm favoring reduced implant material's stiffness out of concern for stress or strain shielding, or even excessive micromotions, is not supported by the present calculations, that point exactly to the opposite. © 2017 Wiley Periodicals, Inc.

Marginal bone level changes in association with different vertical implant positions: a 3-year retrospective study

PubMed Central

2017-01-01

Purpose To retrospectively evaluate the relationship between the vertical position of the implant-abutment interface and marginal bone loss over 3 years using radiological analysis. Methods In total, 286 implant surfaces of 143 implants from 61 patients were analyzed. Panoramic radiographic images were taken immediately after implant installation and at 6, 12, and 36 months after loading. The implants were classified into 3 groups based on the vertical position of the implant-abutment interface: group A (above bone level), group B (at bone level), and group C (below bone level). The radiographs were analyzed by a single examiner. Results Changes in marginal bone levels of 0.99±1.45, 1.13±0.91, and 1.76±0.78 mm were observed at 36 months after loading in groups A, B, and C, respectively, and bone loss was significantly greater in group C than in groups A and B. Conclusions The vertical position of the implant-abutment interface may affect marginal bone level change. Marginal bone loss was significantly greater in cases where the implant-abutment interface was positioned below the marginal bone. Further long-term study is required to validate our results. PMID:28861287

Changes in general and oral health-related quality of life in immediate or conventionally loaded dental implants: a nonrandomized clinical trial.

PubMed

Dolz, Javier; Silvestre, Francisco J; Montero, Javier

2014-01-01

To evaluate changes in the general and oral health-related quality of life (using the European Quality of Life indicator and the Oral Health Impact Profile-49 [OHIP-49], respectively) of patients treated with conventionally or immediately loaded implants. This clinical trial consisted of a clinical oral examination and a questionnaire-based interview carried out before and after both surgery and definitive prosthetic rehabilitation in a consecutive sample of patients requiring dental implants. According to the clinical diagnosis and patient preference, patients were assigned to the immediate loading group (IL group; n = 29) or the conventional loading group (CL group; n = 75). The change summary scores and effect sizes were calculated in the intermediate stage and at the final follow-up, taking baseline scores as reference. The oral health-related quality of life and oral satisfaction after implant therapy were significantly better than at baseline, with an even greater benefit when the implants were loaded immediately than when prosthetic rehabilitation was delayed. However, there were no significant differences in between-group comparisons in the ratings of general health status. The effect size for the OHIP-49 exceeded the threshold value of 0.8 for the domains functional limitation, pain/discomfort, and psychological discomfort in both groups and also for physical disability and psychological disability in the IL group. A gradual improvement in oral well-being scores, but not in those of general well-being, were observed for both groups from the intermediate stage to the final evaluation. This benefit was markedly greater for the IL group.

A comparative study of gold UCLA-type and CAD/CAM titanium implant abutments

PubMed Central

Park, Ji-Man; Lee, Jai-Bong; Heo, Seong-Joo

2014-01-01

PURPOSE The aim of this study was to evaluate the interface accuracy of computer-assisted designed and manufactured (CAD/CAM) titanium abutments and implant fixture compared to gold-cast UCLA abutments. MATERIALS AND METHODS An external connection implant system (Mark III, n=10) and an internal connection implant system (Replace Select, n=10) were used, 5 of each group were connected to milled titanium abutment and the rest were connected to the gold-cast UCLA abutments. The implant fixture and abutment were tightened to torque of 35 Ncm using a digital torque gauge, and initial detorque values were measured 10 minutes after tightening. To mimic the mastication, a cyclic loading was applied at 14 Hz for one million cycles, with the stress amplitude range being within 0 N to 100 N. After the cyclic loading, detorque values were measured again. The fixture-abutment gaps were measured under a microscope and recorded with an accuracy of ±0.1 µm at 50 points. RESULTS Initial detorque values of milled abutment were significantly higher than those of cast abutment (P<.05). Detorque values after one million dynamic cyclic loadings were not significantly different (P>.05). After cyclic loading, detorque values of cast abutment increased, but those of milled abutment decreased (P<.05). There was no significant difference of gap dimension between the milled abutment group and the cast abutment group after cyclic loading. CONCLUSION In conclusion, CAD/CAM milled titanium abutment can be fabricated with sufficient accuracy to permit screw joint stability between abutment and fixture comparable to that of the traditional gold cast UCLA abutment. PMID:24605206

Computational wear assessment of hard on hard hip implants subject to physically demanding tasks.

PubMed

Nithyaprakash, R; Shankar, S; Uddin, M S

2018-05-01

Hip implants subject to gait loading due to occupational activities are potentially prone to failures such as osteolysis and aseptic loosening, causing painful revision surgeries. Highly risky gait activities such as carrying a load, stairs up or down and ladder up or down may cause excessive loading at the hip joint, resulting in generation of wear and related debris. Estimation of wear under the above gait activities is thus crucial to design and develop a new and improved implant component. With this motivation, this paper presents an assessment of wear generation of PCD-on-PCD (poly crystalline diamond) hip implants using finite element (FE) analysis. Three-dimensional (3D) FE model of hip implant along with peak gait and peak flexion angle for each activity was used to estimate wear of PCD for 10 million cycles. The maximum and minimum initial contact pressures of 206.19 MPa and 151.89 MPa were obtained for carrying load of 40 kg and sitting down or getting up activity. The simulation results obtained from finite element model also revealed that the maximum linear wear of 0.585 μm occurred for the patients frequently involved in sitting down or getting up gait activity and maximum volumetric wear of 0.025 mm 3 for ladder up gait activity. The stair down activity showed the least linear and volumetric wear of 0.158 μm and 0.008 mm 3 , respectively, at the end of 10 million cycles. Graphical abstract Computational wear assessment of hip implants subjected to physically demanding tasks.

In Vivo Bone Formation Within Engineered Hydroxyapatite Scaffolds in a Sheep Model.

PubMed

Lovati, A B; Lopa, S; Recordati, C; Talò, G; Turrisi, C; Bottagisio, M; Losa, M; Scanziani, E; Moretti, M

2016-08-01

Large bone defects still represent a major burden in orthopedics, requiring bone-graft implantation to promote the bone repair. Along with autografts that currently represent the gold standard for complicated fracture repair, the bone tissue engineering offers a promising alternative strategy combining bone-graft substitutes with osteoprogenitor cells able to support the bone tissue ingrowth within the implant. Hence, the optimization of cell loading and distribution within osteoconductive scaffolds is mandatory to support a successful bone formation within the scaffold pores. With this purpose, we engineered constructs by seeding and culturing autologous, osteodifferentiated bone marrow mesenchymal stem cells within hydroxyapatite (HA)-based grafts by means of a perfusion bioreactor to enhance the in vivo implant-bone osseointegration in an ovine model. Specifically, we compared the engineered constructs in two different anatomical bone sites, tibia, and femur, compared with cell-free or static cell-loaded scaffolds. After 2 and 4 months, the bone formation and the scaffold osseointegration were assessed by micro-CT and histological analyses. The results demonstrated the capability of the acellular HA-based grafts to determine an implant-bone osseointegration similar to that of statically or dynamically cultured grafts. Our study demonstrated that the tibia is characterized by a lower bone repair capability compared to femur, in which the contribution of transplanted cells is not crucial to enhance the bone-implant osseointegration. Indeed, only in tibia, the dynamic cell-loaded implants performed slightly better than the cell-free or static cell-loaded grafts, indicating that this is a valid approach to sustain the bone deposition and osseointegration in disadvantaged anatomical sites.

Stress distribution pattern of screw-retained restorations with segmented vs. non-segmented abutments: A finite element analysis

PubMed Central

Aalaei, Shima; Rajabi Naraki, Zahra; Nematollahi, Fatemeh; Beyabanaki, Elaheh; Shahrokhi Rad, Afsaneh

2017-01-01

Background. Screw-retained restorations are favored in some clinical situations such as limited inter-occlusal spaces. This study was designed to compare stresses developed in the peri-implant bone in two different types of screw-retained restorations (segmented vs. non-segmented abutment) using a finite element model. Methods. An implant, 4.1 mm in diameter and 10 mm in length, was placed in the first molar site of a mandibular model with 1 mm of cortical bone on the buccal and lingual sides. Segmented and non-segmented screw abutments with their crowns were placed on the simulated implant in each model. After loading (100 N, axial and 45° non-axial), von Mises stress was recorded using ANSYS software, version 12.0.1. Results. The maximum stresses in the non-segmented abutment screw were less than those of segmented abutment (87 vs. 100, and 375 vs. 430 MPa under axial and non-axial loading, respectively). The maximum stresses in the peri-implant bone for the model with segmented abutment were less than those of non-segmented ones (21 vs. 24 MPa, and 31 vs. 126 MPa under vertical and angular loading, respectively). In addition, the micro-strain of peri-implant bone for the segmented abutment restoration was less than that of non-segmented abutment. Conclusion. Under axial and non-axial loadings, non-segmented abutment showed less stress concentration in the screw, while there was less stress and strain in the peri-implant bone in the segmented abutment. PMID:29184629

Biomechanical interactions of endodontically treated tooth implant-supported prosthesis under fatigue test with acoustic emission monitoring.

PubMed

Huang, Shao-Fu; Chen, Wan-Rung; Lin, Chun-Li

2016-02-24

This study investigated the biomechanical interactions in endodontically treated tooth implant-supported prosthesis (TISP) with implant system variations under dynamic cyclic loads monitored using the acoustic emission (AE) technique. Macrostructure implants using a taper integrated screw-in (TIS; 2-piece implant) and a retaining-screw (RS; 3-piece implant) connected to an abutment were used for this investigation and their corresponding mechanical resistances in conformity with the ISO 14801 standard were evaluated. The endodontically treated TISP samples were constructed containing TIS and RS implants splinted to the second premolar with fatigue tests performed by applying occlusal force onto the premolar simulating the bending moment effect. The numbers of accumulated AE signals in the fatigue tests and failure modes for the sample were recorded to evaluate the mechanical resistance. The maximum load in the static test for RS (3-piece) implant (797N) was significantly higher than that for the TIS (2-piece) implant (559N). Large deformations were found at abutment screws in both RS and TIS implants. Although the numbers of accumulated AE signals for the TIS implant (72511) were higher than those for the RS implant (437), statistical non-significant differences were found between TIS and RS implants. No obvious damage was noted in endodontically treated TISP samples using RS implants but two of the corresponding TIS implants fractured in the abutment screws. Splints with RS (3-piece) implant prosthesis produce better mechanical responses than the TIS (2-piece) implant when connected to an endodontically treated tooth restored with a post core and crown.

Computer-assisted surgery and intraoral welding technique for immediate implant-supported rehabilitation of the edentulous maxilla: case report and technical description.

PubMed

Albiero, Alberto Maria; Benato, Renato

2016-09-01

Complications are frequently reported when combining computer assisted flapless surgery with an immediate loaded prefabricated prosthesis. The authors have combined computer-assisted surgery with the intraoral welding technique to obtain a precise passive fit of the immediate loading prosthesis. An edentulous maxilla was rehabilitated with four computer assisted implants welded together intraorally and immediately loaded with a provisional restoration. A perfect passive fit of the metal framework was obtained that enabled proper osseointegration of implants. Computer assisted preoperative planning has been shown to be effective in reducing the intraoperative time of the intraoral welding technique. No complications were observed at 1 year follow-up. This guided-welded approach is useful to achieve a passive fit of the provisional prosthesis on the inserted implants the same day as the surgery, reducing intraoperative time with respect to the traditional intraoral welding technique. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Subject specific finite element modeling of periprosthetic femoral fracture using element deactivation to simulate bone failure.

PubMed

Miles, Brad; Kolos, Elizabeth; Walter, William L; Appleyard, Richard; Shi, Angela; Li, Qing; Ruys, Andrew J

2015-06-01

Subject-specific finite element (FE) modeling methodology could predict peri-prosthetic femoral fracture (PFF) for cementless hip arthoplasty in the early postoperative period. This study develops methodology for subject-specific finite element modeling by using the element deactivation technique to simulate bone failure and validate with experimental testing, thereby predicting peri-prosthetic femoral fracture in the early postoperative period. Material assignments for biphasic and triphasic models were undertaken. Failure modeling with the element deactivation feature available in ABAQUS 6.9 was used to simulate a crack initiation and propagation in the bony tissue based upon a threshold of fracture strain. The crack mode for the biphasic models was very similar to the experimental testing crack mode, with a similar shape and path of the crack. The fracture load is sensitive to the friction coefficient at the implant-bony interface. The development of a novel technique to simulate bone failure by element deactivation of subject-specific finite element models could aid prediction of fracture load in addition to fracture risk characterization for PFF. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

When is an implant ready for a tooth?

PubMed

Tupac, Robert G

2003-12-01

The capability of placing an osseointegrated implant at the time of tooth extraction and immediately placing a restoration on the implant depends upon a number of factors. This paper describes the traditional Brånemark protocol, the evolution of single-stage surgery, the guidelines for immediate placement, the measurement of implant stability, and the considerations critical to immediately loading.

Clinical evaluation of split-crest technique with ultrasonic bone surgery for narrow ridge expansion: status of soft and hard tissues and implant success.

PubMed

Anitua, Eduardo; Begoña, Leire; Orive, Gorka

2013-04-01

The aim of this study was to evaluate the split-crest technique with ultrasonic bone surgery for implant placement in patients with narrow ridges, focusing on the status of soft and hard tissues and on implant success rate, at least 6 months after implant loading. During September 2007 and November 2008, 15 patients received 37 implants (BTI implants) with split-crest surgical procedure using ultrasonic bone surgery. Plasma rich in growth factors (PRGF®) was applied during split crest procedure to promote tissue regeneration. Implant surfaces were humidified with PRGF to accelerate osseointegration. Patients were recalled for a final clinical evaluation at least 6 months after implant loading. Clinical assessment included the status of soft and hard tissues around implants, and implants' success rate. Thirty-seven implants in 15 patients were evaluated between July 2009 and January 2010. The status of soft tissues was very good, showing adequate plaque index, bleeding index, and probing depth values. Success rate of implants at the end of follow-up (between 11 and 28 months after insertion) was 100%. Bone ridge was measured and compared at final examination showing a mean ridge expansion of 3.35 mm (SD: 0.34). Split-crest with ultrasonic bone surgery can be considered an effective and safe procedure for narrow ridge expansion. © 2011 Wiley Periodicals, Inc.

The Use of Light/Chemically Hardened Polymethylmethacrylate, Polyhydroxyethylmethacrylate, and Calcium Hydroxide Graft Material in Combination With Polyanhydride Around Implants in Minipigs: Part I: Immediate Stability and Function

PubMed Central

Hasturk, Hatice; Kantarci, Alpdogan; Ghattas, Mazen; Schmidt, Marcella; Giordano, Russell A.; Ashman, Arthur; Diekwisch, Thomas G.; Van Dyke, Thomas

2015-01-01

Background The present study is designed as a proof-of-concept study to evaluate light/chemical hardening technology and a newly formulated polymethylmethacrylate, polyhydroxyethylmethacrylate, and calcium hydroxide (PPCH) plus polyanhydride (PA) (PPCH-PA) composite graft material as a bone substitute compared to positive and negative controls in a minipig model. Methods PPCH-PA (composite graft); PPCH alone (positive control), PA alone (positive control), and no graft (negative control) were compared. Four mandibular premolar teeth per quadrant were extracted; a total of 48 implants were placed into sockets in three minipigs. Abutments were placed protruding into the oral cavity 4 mm in height for immediate loading. Crestal areas and intrabony spaces were filled with PPCH-PA, PPCH, or PA using a three-phase delivery system in which all graft materials were hardened by a light cure. In the negative control group, implant sites were left untreated. At 12 weeks, block sections containing implants were obtained. Evaluations included periodontal probing, pullout-force load, and stability measurements to determine implant stability, radiographs to examine bone levels, and scanning electron microscopy (SEM)–energy-dispersed spectroscopy to determine bone-to-implant contact. Results Probing measurements did not reveal any pathologic pocket formation or bone loss. Radiographs revealed that immediate implant placement and loading resulted in bone at or slightly apical to the first thread of the implant in all groups at 12 weeks. Stability test values showed a relative clinical stability for all implants (range: −7 to +1); however, implants augmented with PPCH-PA exhibited a statistically significantly greater stability compared to all other groups (P <0.05). The newly formed bone in PPCH-PA–treated sites was well organized with less marrow spaces and well-distributed osteocytes. SEM revealed a tighter implant–socket interface in the PPCH-PA group compared to other groups with reduced microfissures and implant–bone interface fractures during pullout testing, whereas implants treated with PA or no graft showed ≈10-μm microfissures between the implant and bone with fractures of the intrathread bone. Conclusions The newly formulated chemically hardened graft material PPCH-PA was useful in immediate implant placement after tooth extraction and resulted in greater stability and a well-organized implant–bone interface with immediate loading, especially in those areas where cancellous bone was present. The results of this proof-of-concept study warranted further research investigating different healing times and longer durations. PMID:21342001

Learning curve for new technology?: a nationwide register-based study of 46,363 total knee arthroplasties.

PubMed

Peltola, Mikko; Malmivaara, Antti; Paavola, Mika

2013-12-04

The risk of early revision is increased for the first patients operatively treated with a newly introduced knee prosthesis. In this study, we explored the learning curves associated with ten knee implant models to determine their effect on early revision risk. We studied register data from all seventy-five surgical units that performed knee arthroplasty in Finland from 1998 to 2007. Of 54,925 patients (66,098 knees), 39,528 patients (46,363 knees) underwent arthroplasty for osteoarthritis of the knee with the ten most common total knee implants and were followed with complete data until December 31, 2010, or the time of death. We used a Cox proportional-hazards regression model for calculating the hazard ratios for early revision for the first fifteen arthroplasties and subsequent increments of numbers of arthroplasties. We found large differences among knee implants at the introduction with regard to the risk of early revision, as well as for the overall risk of early revision. A learning curve was found for four implant models, while six models did not show a learning effect on the risk of early revision. The survivorship of the studied prostheses showed substantial differences. Knee implants have model-specific learning curves and early revision risks. Some models are more difficult to implement than others. The manufacturers should consider the learning effect when designing implants and instrumentation. The surgeons should thoroughly familiarize themselves with the new knee implants before use.

[Sinus floor elevation and augmentation. Evidence-based analysis of prognosis and risk factors].

PubMed

Strietzel, F P

2004-03-01

It was the aim of this investigation to analyze evidence of prognosis, predictors, and risk factors concerning sinus floor elevation and augmentation (SFEA). A MEDLINE search was performed to analyze the literature published between 1990 and 2002, limited to keywords ("sinus floor elevation and dental implants", "complications", "success"), study type (randomized as well as clinical prospective studies, retrospective studies, reviews), and language (German or English). Of 229 publications identified, 72 met the inclusion criteria (22 prospective and 47 retrospective studies, 3 reviews). Considering the augmentation material [autogenous bone (AB), bone substitution materials (BSM), and combinations of AB and BSM], the frequency of implant loss was not significantly different (AB 8%, BSM 9%, AB + BSM 5%, p>0.09) after an observation period of 2-4 years. The average duration of the healing period was 6 months (AB) and 8 months (BSM) with simultaneous SFEA and implantation and 6-7 months (AB and BSM) for the staged approach after an average healing period of 6 months for the augmentation materials. Frequency of implant loss was not different between simultaneous and staged approaches (7-8%). Postoperative sinusitis occurred in 3-8% of the cases. Smoking, positive sinusitis history, obstructive pathoses of the nose and ostium, allergic rhino-pathoses, use of short implants (<13 mm), treatment of edentulous maxilla compared to partially edentulous maxilla, bruxism, and uncontrolled early loading of implants were identified as predictors for complications. Presupposing proper consideration of indications, SFEA should be considered as an evidence-based and clinically established method for implant prosthetic rehabilitation of the atrophic posterior maxilla with an overall cumulative survival rate of 90% within an average observation period of 4 years.

Microbiological outcome of two screw-shaped titanium implant systems placed following a split-mouth randomised protocol, at the 12th year of follow-up after loading.

PubMed

Van Assche, Nele; Pittayapat, Pisha; Jacobs, Reinhilde; Pauwels, Martine; Teughels, Wim; Quirynen, Marc

2011-01-01

To compare the subgingival microbiota around two differently designed implant systems that were in function for more than 12 years in a randomised split-mouth study design, and to compare the outcome with natural dentition. A total of 18 partially edentulous patients received at least two TiOblast™ (Astra Tech) and two Brånemark (Nobel Biocare) implants following a split-mouth design. At the last follow-up visit, periodontal parameters (probing depth, bleeding on probing and plaque) were recorded and intraoral radiographs were taken to calculate bone loss. Subgingival plaque samples were collected for culture, qPCR and checkerboard DNA-DNA hybridisation analysis. These data were related to implant design and bone loss. This study setup allowed a comparison of 34 Astra Tech (Impl A) with 32 Brånemark (Impl B) implants. During the 12-year follow up, five patients dropped out. One Brånemark implant was lost before abutment connection in a dropout patient. Mean bone loss between loading and year 12 was 0.7 mm (range: -0.8-5.8) (Impl A), and 0.4 mm (range: -1.1-4.1) (Impl B). No significant microbiological differences (qualitative and quantitative) could be observed between both implant types. Compared to teeth, subgingival plaque samples from implants did not reach the concentration of pathogens, even after 12 years of function. These data show that both implant systems (with differences in macro-design and surface characteristics), in patients with good oral hygiene and a stable periodontal condition, can maintain a successful treatment outcome without significant subgingival microbiological differences after 12 years of loading. The presence of periodontopathogens did not necessarily result in bone loss.

Fracture Resistance and Mode of Failure of Ceramic versus Titanium Implant Abutments and Single Implant-Supported Restorations.

PubMed

Sghaireen, Mohd G

2015-06-01

The material of choice for implant-supported restorations is affected by esthetic requirements and type of abutment. This study compares the fracture resistance of different types of implant abutments and implant-supported restorations and their mode of failure. Forty-five Oraltronics Pitt-Easy implants (Oraltronics Dental Implant Technology GmbH, Bremen, Germany) (4 mm diameter, 10 mm length) were embedded in clear autopolymerizing acrylic resin. The implants were randomly divided into three groups, A, B and C, of 15 implants each. In group A, titanium abutments and metal-ceramic crowns were used. In group B, zirconia ceramic abutments and In-Ceram Alumina crowns were used. In group C, zirconia ceramic abutments and IPS Empress Esthetic crowns were used. Specimens were tested to failure by applying load at 130° from horizontal plane using an Instron Universal Testing Machine. Subsequently, the mode of failure of each specimen was identified. Fracture resistance was significantly different between groups (p < .05). The highest fracture loads were associated with metal-ceramic crowns supported by titanium abutments (p = .000). IPS Empress crowns supported by zirconia abutments had the lowest fracture loads (p = .000). Fracture modes of metal-ceramic crowns supported by titanium abutments included screw fracture and screw bending. Fracture of both crown and abutment was the dominant mode of failure of In-Ceram/IPS Empress crowns supported by zirconia abutments. Metal-ceramic crowns supported by titanium abutments were more resistant to fracture than In-Ceram crowns supported by zirconia abutments, which in turn were more resistant to fracture than IPS Empress crowns supported by zirconia abutments. In addition, failure modes of restorations supported by zirconia abutments were more catastrophic than those for restorations supported by titanium abutments. © 2013 Wiley Periodicals, Inc.

Micro-engineered first wall tungsten armor for high average power laser fusion energy systems

NASA Astrophysics Data System (ADS)

Sharafat, Shahram; Ghoniem, Nasr M.; Anderson, Michael; Williams, Brian; Blanchard, Jake; Snead, Lance; HAPL Team

2005-12-01

The high average power laser program is developing an inertial fusion energy demonstration power reactor with a solid first wall chamber. The first wall (FW) will be subject to high energy density radiation and high doses of high energy helium implantation. Tungsten has been identified as the candidate material for a FW armor. The fundamental concern is long term thermo-mechanical survivability of the armor against the effects of high temperature pulsed operation and exfoliation due to the retention of implanted helium. Even if a solid tungsten armor coating would survive the high temperature cyclic operation with minimal failure, the high helium implantation and retention would result in unacceptable material loss rates. Micro-engineered materials, such as castellated structures, plasma sprayed nano-porous coatings and refractory foams are suggested as a first wall armor material to address these fundamental concerns. A micro-engineered FW armor would have to be designed with specific geometric features that tolerate high cyclic heating loads and recycle most of the implanted helium without any significant failure. Micro-engineered materials are briefly reviewed. In particular, plasma-sprayed nano-porous tungsten and tungsten foams are assessed for their potential to accommodate inertial fusion specific loads. Tests show that nano-porous plasma spray coatings can be manufactured with high permeability to helium gas, while retaining relatively high thermal conductivities. Tungsten foams where shown to be able to overcome thermo-mechanical loads by cell rotation and deformation. Helium implantation tests have shown, that pulsed implantation and heating releases significant levels of implanted helium. Helium implantation and release from tungsten was modeled using an expanded kinetic rate theory, to include the effects of pulsed implantations and thermal cycles. Although, significant challenges remain micro-engineered materials are shown to constitute potential candidate FW armor materials.

[Impact of anchorage implant design factors on its primary stability].

PubMed

Zhang, J N; Lu, H P; Zhong, C

2017-08-09

During the past decade, the anchorage implants have been widely used in the orthodontic treatment. Many scholars have studied the influence of different factors on anchorage implant's primary stability, including anchorage implant's material properties, structural design, surgical procedure, bone condition, loading force's magnitude and direction. This article is to review the influence of anchorage implant's shape, dimension, neck design and thread design on its primary stability.

Three-Dimensional Finite Element Analysis of the Stress Distribution at the Internal Implant-Abutment Connection.

PubMed

Cho, Sung-Yong; Huh, Yoon-Hyuk; Park, Chan-Jin; Cho, Lee-Ra

2016-01-01

This study investigated stress distribution in four different implant-abutment interface conditions in the internal tapered connection implant system. Four different implant diameters (3.5 mm, 4.0 mm, 4.5 mm, and 5.0 mm) and two abutment types (hexagonal and conical) were simulated. Four unique implant-abutment interface conditions were assumed based on wall thickness, mating surface length, distance to the vertical stop, and abutment shape. Axial and oblique loading was applied during abutment screw preload, and the Von Mises stresses were measured at the implant-abutment and abutment-screw interfaces. The implant-abutment interface stress decreased as the wall thickness increased. As the mating surface increased, the stress distribution trended downward, and when the distance to the implant vertical stop was 0 μm, the Von Mises stress was extremely high at the vertical stop. Despite their different shapes, the abutments showed similar stress distributions. However, the maximum Von Mises stress was higher in the conical connection than in the hexagonal connection, particularly at the contralateral side to loading. To decrease the stress distribution at the implant-abutment interface, the implant wall thickness, mating surface contact length, distance to the vertical stop, and abutment shape should be carefully considered.

Effect of joining the sectioned implant-supported prosthesis on the peri-implant strain generated in simulated mandibular model.

PubMed

Singh, Ipsha; Nair, K Chandrasekharan; Shetty, Jayakar

2017-01-01

The aim of this study is to evaluate the strain developed in simulated mandibular model before and after the joining of an implant-supported screw-retained prosthesis by different joining techniques, namely, arc welding, laser welding, and soldering. A specimen simulating a mandibular edentulous ridge was fabricated in heat-cured acrylic resin. 4-mm holes were drilled in the following tooth positions; 36, 33, 43, 46. Implant analogs were placed in the holes. University of California, Los Angeles, abutment was attached to the implant fixture. Eight strain gauges were attached to the acrylic resin model. Six similar models were made. Implant-supported screw-retained fixed prosthesis was fabricated in nickel-chromium alloy. A load of 400 N was applied on the prosthesis using universal testing machine. Resultant strain was measured in each strain gauge. All the prostheses were sectioned at the area between 36 and 33, 33 and 43, and 43 and 46 using 35 micrometer carborundum disc, and strain was measured in each strain gauge after applying a load of 400 N on the prosthesis. Specimens were joined by arc welding, soldering, and laser welding. After joining, a load of 400 N was applied on each prosthesis and the resultant strain was measured in each strain gauge. Highest mean strain values were recorded before sectioning of the prostheses (889.9 microstrains). Lowest mean strain values were recorded after sectioning the prosthesis and before reuniting it (225.0 microstrains). Sectioning and reuniting the long-span implant prosthesis was found to be a significant factor in influencing the peri-implant strain.

Trans-Oval-Window Implants, A New Approach for Drug Delivery to the Inner Ear: Extended Dexamethasone Release From Silicone-based Implants.

PubMed

Sircoglou, Julie; Gehrke, Maria; Tardivel, Meryem; Siepmann, Florence; Siepmann, Juergen; Vincent, Christophe

2015-09-01

The purpose of this study was to develop a new strategy to deliver drugs to the inner ear from dexamethasone (DXM)-loaded silicone implants and to evaluate the distribution of the drug in the cochlea with confocal microscopy. Systemic drug administration for the treatment of inner ear disorders is tricky because of the blood-cochlear barrier, a difficult anatomical access, the small size of the cochlea, and can cause significant adverse effects. An effective way to overcome these obstacles is to administer drugs locally. In vitro, the drug release from DXM-loaded silicone-based thin films and tiny implants into artificial perilymph was thoroughly analyzed by high-performance liquid chromatography. In vivo, a silicone implant loaded with 10% DXM and 5% polyethylene glycol 400 was implanted next to the stapes's footplate of gerbils. Delivery of DXM into the inner ear was proved by confocal microscopy imaging of the whole cochlea and the organ of Corti. The study showed a continuous and prolonged release during 90 days in vitro. This was confirmed by confocal microscopy that allowed detection of DXM by fluorescence labeling in the cell body of the hair cells for at least 30 days. Interestingly, fluorescence was already observed after 20 minutes of implantation, reached a climax at day 7, and could still be detected 30 days after implantation. Thus, we developed a new device for local corticosteroids delivery into the oval window with an extended drug release of DXM to the inner ear.

Three-dimensional finite element analysis of stress distribution on different bony ridges with different lengths of morse taper implants and prosthesis dimensions.

PubMed

Toniollo, Marcelo Bighetti; Macedo, Ana Paula; Rodrigues, Renata Cristina Silveira; Ribeiro, Ricardo Faria; de Mattos, Maria da Gloria Chiarello

2012-11-01

This finite element analysis (FEA) compared stress distribution on different bony ridges rehabilitated with different lengths of morse taper implants, varying dimensions of metal-ceramic crowns to maintain the occlusal alignment. Three-dimensional FE models were designed representing a posterior left side segment of the mandible: group control, 3 implants of 11 mm length; group 1, implants of 13 mm, 11 mm and 5 mm length; group 2, 1 implant of 11 mm and 2 implants of 5 mm length; and group 3, 3 implants of 5 mm length. The abutments heights were 3.5 mm for 13- and 11-mm implants (regular), and 0.8 mm for 5-mm implants (short). Evaluation was performed on Ansys software, oblique loads of 365N for molars and 200N for premolars. There was 50% higher stress on cortical bone for the short implants than regular implants. There was 80% higher stress on trabecular bone for the short implants than regular implants. There was higher stress concentration on the bone region of the short implants neck. However, these implants were capable of dissipating the stress to the bones, given the applied loads, but achieving near the threshold between elastic and plastic deformation to the trabecular bone. Distal implants and/or with biggest occlusal table generated greatest stress regions on the surrounding bone. It was concluded that patients requiring short implants associated with increased proportions implant prostheses need careful evaluation and occlusal adjustment, as a possible overload in these short implants, and even in regular ones, can generate stress beyond the physiological threshold of the surrounding bone, compromising the whole system.

Electrically active bioceramics: a review of interfacial responses.

PubMed

Baxter, F R; Bowen, C R; Turner, I G; Dent, A C E

2010-06-01

Electrical potentials in mechanically loaded bone have been implicated as signals in the bone remodeling cycle. Recently, interest has grown in exploiting this phenomenon to develop electrically active ceramics for implantation in hard tissue which may induce improved biological responses. Both polarized hydroxyapatite (HA), whose surface charge is not dependent on loading, and piezoelectric ceramics, which produce electrical potentials under stress, have been studied in order to determine the possible benefits of using electrically active bioceramics as implant materials. The polarization of HA has a positive influence on interfacial responses to the ceramic. In vivo studies of polarized HA have shown polarized samples to induce improvements in bone ingrowth. The majority of piezoelectric ceramics proposed for implant use contain barium titanate (BaTiO(3)). In vivo and in vitro investigations have indicated that such ceramics are biocompatible and, under appropriate mechanical loading, induce improved bone formation around implants. The mechanism by which electrical activity influences biological responses is yet to be clearly defined, but is likely to result from preferential adsorption of proteins and ions onto the polarized surface. Further investigation is warranted into the use of electrically active ceramics as the indications are that they have benefits over existing implant materials.

Stress analysis in platform-switching implants: a 3-dimensional finite element study.

PubMed

Pellizzer, Eduardo Piza; Verri, Fellippo Ramos; Falcón-Antenucci, Rosse Mary; Júnior, Joel Ferreira Santiago; de Carvalho, Paulo Sérgio Perri; de Moraes, Sandra Lúcia Dantas; Noritomi, Pedro Yoshito

2012-10-01

The aim of this study was to evaluate the influence of the platform-switching technique on stress distribution in implant, abutment, and peri-implant tissues, through a 3-dimensional finite element study. Three 3-dimensional mandibular models were fabricated using the SolidWorks 2006 and InVesalius software. Each model was composed of a bone block with one implant 10 mm long and of different diameters (3.75 and 5.00 mm). The UCLA abutments also ranged in diameter from 5.00 mm to 4.1 mm. After obtaining the geometries, the models were transferred to the software FEMAP 10.0 for pre- and postprocessing of finite elements to generate the mesh, loading, and boundary conditions. A total load of 200 N was applied in axial (0°), oblique (45°), and lateral (90°) directions. The models were solved by the software NeiNastran 9.0 and transferred to the software FEMAP 10.0 to obtain the results that were visualized through von Mises and maximum principal stress maps. Model A (implants with 3.75 mm/abutment with 4.1 mm) exhibited the highest area of stress concentration with all loadings (axial, oblique, and lateral) for the implant and the abutment. All models presented the stress areas at the abutment level and at the implant/abutment interface. Models B (implant with 5.0 mm/abutment with 5.0 mm) and C (implant with 5.0 mm/abutment with 4.1 mm) presented minor areas of stress concentration and similar distribution pattern. For the cortical bone, low stress concentration was observed in the peri-implant region for models B and C in comparison to model A. The trabecular bone exhibited low stress that was well distributed in models B and C. Model A presented the highest stress concentration. Model B exhibited better stress distribution. There was no significant difference between the large-diameter implants (models B and C).

Survival Rate of Dental Implants in Patients with History of Periodontal Disease: A Retrospective Cohort Study.

PubMed

Correia, Francisco; Gouveia, Sónia; Felino, António Campos; Costa, Ana Lemos; Almeida, Ricardo Faria

To evaluate the differences between the survival rates of implants placed in patients with no history of periodontal disease (NP) and in patients with a history of chronic periodontal disease (CP). A retrospective cohort study was conducted in which all consenting patients treated with dental implants in a private clinic in Oporto, Portugal, from November 2, 2002 through February 11, 2011 were included. All patients were treated consecutively by the same experimental operator. This study aimed to analyze how the primary outcomes (presence of disease, time of placement, and time of loading) and the secondary outcomes (severity-generalized periodontitis, brand, implant length, prosthesis type, prosthesis metal-ceramic extension) influence the survival rate of dental implants. The survival analysis was performed through the Kaplan-Meier method, and the equality of survival distributions for all groups was tested with the log-rank test with a significance level of .05 for all comparisons. The sample consisted of 202 patients (47% NP and 53% CP) and 689 implants (31% NP and 69% CP). The survival rate in the NP and CP groups showed no statistically significant differences (95.8% versus 93.1%; P ≥ .05). Implants were lost before loading in 54.9% of the cases. The majority of the implants were lost in the first year and stabilized after the second year. Survival rates in the NP and CP patients showed no statistically significant differences when comparing the following factors: subclassification of the disease, implant brands, implant length (short/standard), type of prosthesis, extension of the prosthesis metal-ceramic, and time of placement and loading (P ≥ .05). This work disclosed no statistically significant differences in terms of survival rates when compared with the control group. Placing implants in patients with a history of periodontal disease appears to be viable and safe.

Finite element analysis of provisional structures of implant-supported complete prostheses.

PubMed

Carneiro, Bruno Albuquerque; de Brito, Rui Barbosa; França, Fabiana Mantovani Gomes

2014-04-01

The use of provisional resin implant-supported complete dentures is a fast and safe procedure to restore mastication and esthetics of patients soon after surgery and during the adaptation phase to the new denture. This study assessed stress distribution of provisional implant-supported fixed dentures and the all-on-4 concept using self-curing acrylic resin (Tempron) and bis-acrylic resin (Luxatemp) to simulate functional loads through the three-dimensional finite element method. Solidworks software was used to build three-dimensional models using acrylic resin (Tempron, model A) and bis-acrylic resin (Luxatemp, model B) for denture captions. Two loading patterns were applied on each model: (1) right unilateral axial loading of 150 N on the occlusal surfaces of posterior teeth and (2) oblique loading vector of 150 N at 45°. The results showed that higher stress was found on the bone crest below oblique load application with a maximum value of 187.57 MPa on model A and 167.45 MPa on model B. It was concluded that model B improved stress distribution on the denture compared with model A.

3D perfusion bioreactor-activated porous granules on implant fixation and early bone formation in sheep.

PubMed

Ding, Ming; Henriksen, Susan S; Martinetti, Roberta; Overgaard, Søren

2017-11-01

Early fixation of total joint arthroplasties is crucial for ensuring implant survival. An alternative bone graft material in revision surgery is needed to replace the current gold standard, allograft, seeing that the latter is associated with several disadvantages. The incubation of such a construct in a perfusion bioreactor has been shown to produce viable bone graft materials. This study aimed at producing larger amounts of viable bone graft material (hydroxyapatite 70% and β-tricalcium-phosphate 30%) in a novel perfusion bioreactor. The abilities of the bioreactor-activated graft material to induce early implant fixation were tested in a bilateral implant defect model in sheep, with allograft as the control group. Defects were bilaterally created in the distal femurs of the animals, and titanium implants were inserted. The concentric gaps around the implants were randomly filled with either allograft, granules, granules with bone marrow aspirate or bioreactor-activated graft material. Following an observation time of 6 weeks, early implant fixation and bone formation were assessed by micro-CT scanning, mechanical testing, and histomorphometry. Bone formations were seen in all groups, while no significant differences between groups were found regarding early implant fixation. The microarchitecture of the bone formed by the synthetic graft materials resembled that of allograft. Histomorphometry revealed that allograft induced significantly more bone and less fibrous tissue (p < 0.05). In conclusion, bone formation was observed in all groups, while the bioreactor-activated graft material did not reveal additional effects on early implant fixation comparable to allograft in this model. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2465-2476, 2017. © 2016 Wiley Periodicals, Inc.

Dynamic Biomechanical Examination of the Lumbar Spine with Implanted Total Disc Replacement (TDR) Utilizing a Pendulum Testing System

PubMed Central

Daniels, Alan H; Paller, David J; Koruprolu, Sarath; McDonnell, Matthew; Palumbo, Mark A; Crisco, Joseph J

2013-01-01

Study Design Biomechanical cadaver investigation Objective To examine dynamic bending stiffness and energy absorption of the lumbar spine with and without implanted Total Disc Replacement (TDR) under simulated physiologic motion. Summary of background data The pendulum testing system is capable of applying physiologic compressive loads without constraining motion of functional spinal units (FSUs). The number of cycles to equilibrium observed under pendulum testing is a measure of the energy absorbed by the FSU. Methods Five unembalmed, frozen human lumbar FSUs were tested on the pendulum system with axial compressive loads of 181N, 282N, 385N, and 488N before and after Synthes ProDisc-L TDR implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5° resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. Results In flexion/extension, the TDR constructs reached equilibrium with significantly (p<0.05) fewer cycles than the intact FSU with compressive loads of 282N, 385N and 488N. Mean dynamic bending stiffness in flexion, extension, and lateral bending increased significantly with increasing load for both the intact FSU and TDR constructs (p<0.001). In flexion, with increasing compressive loading from 181N to 488N, the bending stiffness of the intact FSUs increased from 4.0N-m/° to 5.5N-m/°, compared to 2.1N-m/° to 3.6N-m/° after TDR implantation. At each compressive load, the intact FSU was significantly more stiff than the TDR (p<0.05). Conclusion Lumbar FSUs with implanted TDR were found to be less stiff, but also absorbed more energy during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices are not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions. PMID:22869057

Biomechanical influence of crown-to-implant ratio on stress distribution over internal hexagon short implant: 3-D finite element analysis with statistical test.

PubMed

Ramos Verri, Fellippo; Santiago Junior, Joel Ferreira; de Faria Almeida, Daniel Augusto; de Oliveira, Guilherme Bérgamo Brandão; de Souza Batista, Victor Eduardo; Marques Honório, Heitor; Noritomi, Pedro Yoshito; Pellizzer, Eduardo Piza

2015-01-02

The study of short implants is relevant to the biomechanics of dental implants, and research on crown increase has implications for the daily clinic. The aim of this study was to analyze the biomechanical interactions of a singular implant-supported prosthesis of different crown heights under vertical and oblique force, using the 3-D finite element method. Six 3-D models were designed with Invesalius 3.0, Rhinoceros 3D 4.0, and Solidworks 2010 software. Each model was constructed with a mandibular segment of bone block, including an implant supporting a screwed metal-ceramic crown. The crown height was set at 10, 12.5, and 15 mm. The applied force was 200 N (axial) and 100 N (oblique). We performed an ANOVA statistical test and Tukey tests; p<0.05 was considered statistically significant. The increase of crown height did not influence the stress distribution on screw prosthetic (p>0.05) under axial load. However, crown heights of 12.5 and 15 mm caused statistically significant damage to the stress distribution of screws and to the cortical bone (p<0.001) under oblique load. High crown to implant (C/I) ratio harmed microstrain distribution on bone tissue under axial and oblique loads (p<0.001). Crown increase was a possible deleterious factor to the screws and to the different regions of bone tissue. Copyright © 2014 Elsevier Ltd. All rights reserved.

Synthesis and Characterisation of Photocrosslinked poly(ethylene glycol) diacrylate Implants for Sustained Ocular Drug Delivery.

PubMed

McAvoy, Kathryn; Jones, David; Thakur, Raghu Raj Singh

2018-01-16

To investigate the sustained ocular delivery of small and large drug molecules from photocrosslinked poly(ethylene glycol) diacrylate (PEGDA) implants with varying pore forming agents. Triamcinolone acetonide and ovalbumin loaded photocrosslinked PEGDA implants, with or without pore-forming agents, were fabricated and characterised for chemical, mechanical, swelling, network parameters, as well as drug release and biocompatibility. HPLC-based analytical methods were employed for analysis of two molecules; ELISA was used to demonstrate bioactivity of ovalbumin. Regardless of PEGDA molecular weight or pore former composition all implants loaded with triamcinolone acetonide released significantly faster than those loaded with ovalbumin. Higher molecular weight PEGDA systems (700 Da) resulted in faster drug release of triamcinolone acetonide than their 250 Da counterpart. All ovalbumin released over the 56-day time period was found to be bioactive. Increasing PEGDA molecular weight resulted in increased system swelling, decreased crosslink density (Ve), increased polymer-water interaction parameter (χ), increased average molecular weight between crosslinks (Mc) and increased mesh size (ε). SEM studies showed the porosity of implants increased with increasing PEGDA molecular weight. Biocompatibility showed both PEGDA molecular weight implants were non-toxic when exposed to retinal epithelial cells over a 7-day period. Photocrosslinked PEGDA implant based systems are capable of controlled drug release of both small and large drug molecules through adaptations in the polymer system network. We are currently continuing evaluation of these systems as potential sustained drug delivery devices.

Prosthodontic maintenance of overdentures on zirconia implants: 1-year results of a randomized controlled trial.

PubMed

Osman, Reham B; Ma, Sunyoung

2014-01-01

The purpose of this study was to determine the prosthodontic outcomes of one-piece zirconia implants and their attachment systems in edentulous participants with maxillary and mandibular overdentures after 1 year of a randomized controlled trial. Random allocation of 24 edentulous participants (age range: 45 to 86 years) into titanium (control) or zirconia (test) groups using onepiece implants and a planned unsplinted prosthodontic design was performed. Four maxillary implants (one midpalatal; three anterior crestal) and three mandibular implants (one midsymphyseal; two bilateral distal) were conventionally loaded with the overdentures. Similar attachment systems were used throughout: ball abutment-type patrices (diameter: 2.25 to 3.1 mm as part of the one-piece implants) and custommade plastic matrices (with or without metal housings depending on the patrix size). Prosthodontic outcomes were documented during the first year of the clinical trial. Following three deaths and two dropouts, there were 19 participants who were available at the 1-year recall. Of these participants, 3 had early maxillary implant failure and had to be converted to conventional maxillary complete dentures opposing mandibular implant overdentures. There were 79 maintenance events, 34 in the titanium (control) group and 45 in the zirconia (test) group. Patrix loss occurred as a result of three zirconia implant fractures (one mandibular and two crestal maxillary implants). Maintenance events were principally the replacement of matrices and overdenture fracture. Although relines and replacement overdentures also occurred, overall there were no significant differences in prosthodontic maintenance between the control and test groups. A six-field prosthodontic-success analysis table showed no statistically significant difference between the two groups; however, 50% of participants in each group were allocated to the retreatment (repair) field, which produced a low prosthodontic success rate. Removable overdentures can be used on both one-piece titanium and zirconia implants with these attachment systems, due to no difference in prosthodontic maintenance and success. Before recommending routine use of a "metal-free" overdenture treatment option in clinical practice, consideration must be given to the success of the implants themselves.

An Intraoperative Site-specific Bone Density Device: A Pilot Test Case.

PubMed

Arosio, Paolo; Moschioni, Monica; Banfi, Luca Maria; Di Stefano, Anilo Alessio

2015-08-01

This paper reports a case of all-on-four rehabilitation where bone density at implant sites was assessed both through preoperative computed tomographic (CT) scans and using a micromotor working as an intraoperative bone density measurement device. Implant-supported rehabilitation is a predictable treatment option for tooth replacement whose success depends on the clinician's experience, the implant characteristics and location and patient-related factors. Among the latter, bone density is a determinant for the achievement of primary implant stability and, eventually, for implant success. The ability to measure bone density at the placement site before implant insertion could be important in the clinical setting. A patient complaining of masticatory impairment was presented with a plan calling for extraction of all her compromised teeth, followed by implant rehabilitation. A week before surgery, she underwent CT examination, and the bone density on the CT scans was measured. When the implant osteotomies were created, the bone density was again measured with a micromotor endowed with an instantaneous torque-measuring system. The implant placement protocols were adapted for each implant, according to the intraoperative measurements, and the patient was rehabilitated following an all-on-four immediate loading protocol. The bone density device provided valuable information beyond that obtained from CT scans, allowing for site-specific, intraoperative assessment of bone density immediately before implant placement and an estimation of primary stability just after implant insertion. Measuring jaw-bone density could help clinicians to select implant-placement protocols and loading strategies based on site-specific bone features.

Microporous pure beta-tricalcium phosphate implants for press-fit fixation of anterior cruciate ligament grafts: strength and healing in a sheep model.

PubMed

Mayr, Hermann O; Dietrich, Markwart; Fraedrich, Franz; Hube, Robert; Nerlich, Andreas; von Eisenhart-Rothe, Rüdiger; Hein, Werner; Bernstein, Anke

2009-09-01

A sheep study was conducted to test a press-fit technique using microporous pure beta-tricalcium phosphate (beta-TCP) dowels for fixation of the anterior cruciate ligament (ACL) graft. Microporous (5 mum) cylindrical plugs of beta-TCP (diameter, 7 mm; length, 25 mm) with interconnecting pores were used. The material featured a novel configuration of structure and surface geometry. Implants were tested by use of press-fit fixation of ACL grafts with and without bone blocks in 42 sheep over a period of 24 weeks. Biomechanical, radiologic, histologic, and immunohistochemical evaluations were performed. In load-to-failure tests at 6, 12, and 24 weeks after surgery, the intra-articular graft always failed, not the fixation. Grafts showed bony fixation in the tunnel at 6 weeks and primary healing at the junction of the tunnel and joint after 24 weeks. Tricalcium phosphate was resorbed and simultaneously replaced by bone. Remodeling was still incomplete at 24 weeks. In the sheep model microporous beta-TCP implants used with press-fit fixation of ACL grafts permit early functional rehabilitation. After 6 weeks, the graft is fixed by woven bone or bony integration. Implanted microporous tricalcium phosphate is resorbed and replaced by bone. In a sheep model we showed that primary healing of ACL grafts with resorption and bony replacement of the fixating implant can be achieved by means of press-fit fixation with pure beta-TCP.

In vivo surface roughness evolution of a stressed metallic implant

NASA Astrophysics Data System (ADS)

Tan, Henry

2016-10-01

Implant-associated infection, a serious medical issue, is caused by the adhesion of bacteria to the surface of biomaterials; for this process the surface roughness is an important property. Surface nanotopography of medical implant devices can control the extent of bacterial attachment by modifying the surface morphology; to this end a model is introduced to facilitate the analysis of a nanoscale smooth surface subject to mechanical loading and in vivo corrosion. At nanometre scale rough surface promotes friction, hence reduces the mobility of the bacteria; this sessile environment expedites the biofilm growth. This manuscript derives the controlling equation for surface roughness evolution for metallic implant subject to in-plane stresses, and predicts the in vivo roughness changes within 6 h of continued mechanical loading at different stress level. This paper provides analytic tool and theoretical information for surface nanotopography of medical implant devices.

The influence of implant-abutment connection on the screw loosening and microleakage.

PubMed

Tsuruta, Katsuhiro; Ayukawa, Yasunori; Matsuzaki, Tatsuya; Kihara, Masafumi; Koyano, Kiyoshi

2018-04-09

There are some spaces between abutment and implant body which can be a reservoir of toxic substance, and they can penetrate into subgingival space from microgap at the implant-abutment interface. This penetration may cause periimplantitis which is known to be one of the most important factors associated with late failure. In the present study, three kinds of abutment connection system, external parallel connection (EP), internal parallel connection (IP), and internal conical connection (CC), were studied from the viewpoint of microleakage from the gap between the implant and the abutment and in connection with the loosening of abutment screw. We observed dye leakage from abutment screw hole to outside through microgap under the excessive compressive and tensile load and evaluated the anti-leakage characteristics of these connection systems. During the experiment, one abutment screw for EP and two screws for IP, out of seven samples in each group, were fractured. After the 2000 cycles of compressive tensile loadings, removal torque value (RTV) of abutment screw represented no statistical differences among three groups. Standard deviation was largest in the RTV of EP and smallest in that of CC. The results of microleakage of toluidine blue from implant-abutment connection indicated that microleakage generally increased as loading procedure progressed. The amount of microleakage was almost plateau at 2000 cycles in CC, but still increasing in other two groups. The value of microleakage greatly scattered in EP, but the deviation of that in CC is significantly smaller. At 500 cycles of loading, there were no significant differences in the amount of microleakage among the groups, but at 1000, 1500, and 2000 cycles of loading, the amount of microleakage in CC was significantly smaller than that in IP. Throughout the experiment, the amount of microleakage in EP was largest, but no statistical difference was indicated due to the high standard deviation. Within the limitation of the present study, CC was stable even after the loading in the RTV of abutment screw and it prevented microleakage from the microgap between the implant body and the abutment, among the three tested connections.

In vivo evaluation of the anti-infection potential of gentamicin-loaded nanotubes on titania implants

PubMed Central

Yang, Ying; Ao, Hai-yong; Yang, Sheng-bing; Wang, Yu-gang; Lin, Wen-tao; Yu, Zhi-feng; Tang, Ting-ting

2016-01-01

Titanium-based implants have been widely used in orthopedic surgery; however, failures still occur. Our in vitro study has demonstrated that gentamicin-loaded, 80 nm-diameter nanotubes possessed both antibacterial and osteogenic activities. Thus, the aim of this study was to further investigate the in vivo anti-infection effect of the titanium implants with gentamicin-loaded nanotubes. Thirty-six male Sprague Dawley rats were used to establish an implant-associated infection model. A volume of 50 μL Staphylococcus aureus suspension (1×105 CFU/mL) was injected into the medullary cavity of the left femur, and then the titanium rods without modification (Ti), titanium nanotubes without drug loading (NT), and gentamicin-loaded titanium nanotubes (NT-G) were inserted with phosphate-buffered saline-inoculated Ti rods as a blank control. X-ray images were obtained 1 day, 21 days, and 42 days after surgery; micro-computed tomography, microbiological, and histopathological analyses were used to evaluate the infections at the time of sacrifice. Radiographic signs of bone infection, including osteolysis, periosteal reaction, osteosclerosis, and damaged articular surfaces, were demonstrated in the infected Ti group and were slightly alleviated in the NT group but not observed in the NT-G group. Meanwhile, the radiographic and gross bone pathological scores of the NT-G group were significantly lower than those of the infected Ti group (P<0.01). Explant cultures revealed significantly less bacterial growth in the NT-G group than in the Ti and NT groups (P<0.01), and the NT group showed decreased live bacterial growth compared with the Ti group (P<0.01). Confocal laser scanning microscopy, scanning electron microscopy, and histopathological observations further confirmed decreased bacterial burden in the NT-G group compared with the Ti and NT groups. We concluded that the NT-G coatings can significantly prevent the development of implant-associated infections in a rat model; therefore, they may provide an effective drug-loading strategy to combat implant-associated infections in clinic. PMID:27274245

Single preoperative dose of prophylactic amoxicillin versus a 2-day postoperative course in dental implant surgery: A two-centre randomised controlled trial.

PubMed

Arduino, Paolo G; Tirone, Federico; Schiorlin, Emanuele; Esposito, Marco

2015-01-01

To evaluate the difference between a single preoperative dose versus an additional two-day postoperative course of oral amoxicillin in patients undergoing conventional dental implant placement. Two dentists in two different private practices conducted this study. One hour prior to surgery, patients had to take a single prophylactic antibiotic dose, consisting of 2 g of amoxicillin orally; after implant placement, patients were randomly allocated to two different groups: protocol A (no other antibiotic administration) and protocol B, (1 g of amoxicillin in the evening of the day of surgery and 1 g twice a day for the 2 days after). Outcome measures were prosthetic and implant failures, adverse events and early postoperative complications. Patients were followed up to 6 months after functional loading. Three hundred and sixty patients were randomised and treated (192 patients in one centre and 168 in the other). Five hundred and sixty-seven implants were placed. Protocol A was applied to 180 patients (278 implants) and protocol B also to 180 patients (289 implants). Data for 17 patients, 14 from protocol A and three from protocol B, were not available. No statistically significant differences were found for the reported outcomes. Two patients of protocol B experienced a prosthetic failure, losing four implants, while no prosthetic failures were reported for protocol A (P=0.4836; difference in proportions=-0.0110; 95% CI: -0.0412 to 0.0119). Five patients (3.0%) of protocol A lost five implants versus 5 patients (2.8%) who lost eight implants in protocol B (P=1.0000; difference in proportions=0.0020; 95% CI: -0.0384 to 0.0438). Three adverse events were observed in the total population, all occurring in protocol B (1.69%), with no statistically significant differences between the two groups (P=0.1199; difference in proportions=-0.0170; 95% CI: -0.0487 to 0.0059). However, one patient experienced a severe allergic reaction requiring therapy discontinuation and hospital admission. Early postoperative complications occurred in six patients of protocol A and in four patients of protocol B, with no statistically significant differences (P=0.5170; difference in proportions=0.0130; 95% CI: -0.0254 to 0.0568). No statistically significant differences were observed between 2 g of preoperative amoxicillin and an additional 2-day postoperative course, although adverse events were reported only in the additional 2-day postoperative group. Based on these findings, it might be sufficient to routinely administer preoperatively 2 g of amoxicillin to patients undergoing routine dental implant placement procedures rather than administering additional postoperative doses.

A prospective clinical study to evaluate the performance of zirconium dioxide dental implants in single-tooth gaps.

PubMed

Gahlert, Michael; Kniha, Heinz; Weingart, Dieter; Schild, Sabine; Gellrich, Nils-Claudius; Bormann, Kai-Hendrik

2016-12-01

Dental implants have traditionally been made from titanium or its alloys, but recently full-ceramic implants have been developed with comparable osseointegration properties and functional strength properties to titanium. These ceramic implants may have advantages in certain patients and situations, for example, where esthetic outcomes are particularly important. The objective of this investigation was to evaluate the performance of a newly developed full-ceramic ZrO 2 monotype implant design (PURE Ceramic Implant; Institut Straumann AG, Basel, Switzerland) in single-tooth gaps in the maxilla and mandible. This was a prospective, open-label, single-arm study in patients requiring implant rehabilitation in single-tooth gaps. Full-ceramic implants were placed, with provisional and final prostheses inserted after 3 and 6 months, respectively. Crestal bone level was measured at implant placement and after 6 and 12 months. Implant survival and success were evaluated after 6 and 12 months. Further evaluations are planned after 24 and 36 months. Forty-six patients were screened for potential study participation, of whom 44 (17 men and 27 women, mean age 48 ± 14 years) were recruited into the study. The majority of implants (90.9%) were placed in the maxilla. The implant survival and implant success rate after 12 months were 97.6%. A minor change of the mean bone level occurred between implant loading (final prosthesis insertion after 6 months) and 12 months (-0.14 mm) after initial bone remodeling was observed between implant placement and loading (-0.88 mm). The results indicated that monotype ceramic implants can achieve clinical outcomes comparable to published outcomes of equivalent titanium implants. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of the biomechanical behavior of short implants: The photo-elasticity method.

PubMed

Pellizzer, Eduardo Piza; de Mello, Caroline Cantieri; Santiago Junior, Joel Ferreira; de Souza Batista, Victor Eduardo; de Faria Almeida, Daniel Augusto; Verri, Fellippo Ramos

2015-10-01

The aim of this study was to analyze the stress distribution of short implants supporting single unit or splinted crowns by the photo-elasticity method. Four photo-elastic models were produced: A (3.75×7 mm); B (3.75×7 mm, 3.75×7 mm and 3.75×7 mm); C (3.75×10 mm, 3.75×7 mm and 3.75×7 mm); D (3.75×13 mm, 3.75×7 mm and 3.75×7 mm). The prostheses were made with Ni-Cr alloy. A load of 100 N in the axial and oblique directions was applied, totaling 380 applications, individually capturing their images in each model. The data were randomized and analyzed qualitatively and quantitatively by 2 examiners. The oblique loading was significantly more damaging. The increase in length was favorable for stress distribution (p<0.05). The splinting was beneficial for the transmission of stresses mainly (p<0.05). The splinting of the crowns, as well as increasing the length of the first implant and axial loading was most beneficial in the stress distribution. Short splinted implants behaved better than single unit implants. Increasing of the length of the first implant significantly improved the stress distribution in all analyzed situations. Copyright © 2015 Elsevier B.V. All rights reserved.

Temporary implant-supported prosthesis for immediate loading according to a chair-side concept: technical note and results from 37 consecutive cases.

PubMed

Ostman, Pär-Olov; Hellman, Mats; Sennerby, Lars; Wennerberg, Ann

2008-05-01

During the last years, focus has been paid to implant treatment using immediate function protocols, and different approaches to provide patients with temporary constructions have been presented. Most of these techniques involve dental technicians producing the temporary construction, for example, rebuilding existing dentures, acrylic bridges, etc. The purpose of this prospective clinical study was to evaluate the clinical outcome of a chair-side technique of a cost-effective temporary prosthesis. Fixture survival rate and risk of temporary bridge failure were analyzed. Thirty-seven partially or totally edentate patients (18 female and 19 male; mean age: 66.7 years) treated with chair-side manufactured temporary restorations (QuickBridge, BIOMET 3i, Palm Beach, Fl, USA) for immediate loading have been evaluated. The prostheses extended from two unit bridges supported by two implants to full-arch construction supported by six implants. The temporary prostheses were monitored from the day of surgery and delivery to the time of replacement with a permanent prosthetic construction 3 to 6 months later. No implants were lost during the observation time. One (3%) temporary prosthesis fractured and additional two (6%) loosened during the follow-up time. The study indicated that the tested chair-side concept for manufacturing of temporary prosthesis for immediate loading of dental implants is a viable approach.

A 3D finite element model of an implanted scapula: importance of a multiparametric validation using experimental data.

PubMed

Maurel, N; Diop, A; Grimberg, J

2005-09-01

In order to help to understand the loosening phenomenon around glenoïd prostheses, a 3D finite element model of a previously tested implanted scapula has been developed. The construction of the model was done using CT scans of the tested scapula. Different bone material properties were tested and shell elements or 8 nodes hexaedric elements were used to model the cortical bone. Surface contact elements were introduced on one hand between the bone and the lower part of the plate of the implant, and on the other, between the loading metallic ball and the upper surface of the implant. The results of the model were compared with those issued from in vitro experiments carried out on the same scapula. The evaluation of the model was done for nine cases of loading of 500 N distributed on the implant, in terms of strains (principal strains of six spots around peripheral cortex of the glenoïd) and displacement of four points positioned on the implant. The best configuration of the model presented here, fits with experiments for most of the strains (difference lower than 150microdef) but it seems to be still too stiff (mainly in the lower part). Nevertheless, we want, in this paper, to underline the importance of doing a multiparametric validation for such a model. Indeed, some models can give correct results for one case of loading but bad results for another kind of loading, some others can give good results for one kind of compared parameters (like strains for instance) but bad results for the other one (like displacements).

Circumferential bone loss around splinted and nonsplinted immediately loaded implants retaining mandibular overdentures: A randomized controlled clinical trial using cone beam computed tomography.

PubMed

Elsyad, Moustafa Abdou; Khirallah, Ahmed Samir

2016-11-01

Circumferential marginal bone around 2 splinted and nonsplinted immediately loaded implants in the edentulous mandible has not been previously investigated. The purpose of this randomized controlled clinical trial was to assess circumferential bone loss around splinted and nonsplinted immediately loaded implants retaining mandibular overdentures, using cone beam computed tomography (CBCT). Thirty participants with complete edentulism were allocated to 2 groups and received 2 implants in the canine region of the mandible. Implants were either left nonsplinted (with ball attachment [BA]) or splinted (with bar attachment [RA]). Mandibular overdentures were connected to the implants 1 week later. CBCT was used to evaluate vertical bone loss (VBL) and horizontal bone loss (HBLo) bone loss at the distal (D), buccal (B), mesial (M), and lingual (L) sites of each implant upon overdenture insertion (baseline, T0), 1 year (T1) and 3 years (T3) after insertion. Repeated measures ANOVA was used for statistical analysis (α=.05). No significant difference in the survival rate (93.3% for BA and 100% for RA) was found between groups (P=.156). VBL and HBLo increased significantly at T3 compared with T1 for both groups (P<.005). After 3 years, VBL were 1.36 ±0.57 mm and 1.0 ±0.44 mm and HBLo were 0.88 ±0.48 mm for BA and 0.77 ±0.53 mm for RA. At T1 and T3, BA had more significant VBL than RA (P<.001), while HBLo did not differ significantly between groups. For both groups, a significant difference was found in VBL and HBLo between implant sites (P<.001). The B site recorded the highest VBL, and the L site recorded the lowest VBL. The M and D sites recorded the highest HBLo, and the B and L sites recorded the lowest HBLo. Two nonsplinted immediately loaded implants retaining mandibular overdentures were associated with significantly higher vertical and horizontal circumferential bone loss than those associated with splinted implants after a follow-up of 3 years. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Retention and wear behaviors of two implant overdenture stud-type attachments at different implant angulations.

PubMed

Choi, Jae-Won; Bae, Ji-Hyeon; Jeong, Chang-Mo; Huh, Jung-Bo

2017-05-01

Implant angulation should be considered when selecting an attachment. Some in vitro studies have investigated the relationship between implant angulation and changes in the retention force of the stud attachment, but few studies have evaluated the effect of cyclic loading and repeated cycles of insertion and removal on the stud attachment. The purpose of this in vitro study was to evaluate the effects of implant angulation on the retentive characteristics of overdentures with 2 different stud attachments, an experimental system and O-rings in red and orange, after cyclic loading and repeated insertion and removal cycles. The canine region of a mandibular experimental model was fitted with 2 implant fixtures with 2 different stud attachment systems at implant angulations of 0, 15, or 30 degrees. A mastication simulator was used to simulate cyclic loading, and a universal testing machine was used to evaluate retentive force changes after repeated insertion and removal cycles. To simulate the numbers of mastication and insertion and removal cycles per annum, 400000 cyclic loadings and 1080 insertion and removal cycles were performed. Wear patterns and attachment surface deformations were evaluated by scanning electron microscopy. Data were analyzed using the Kruskal-Wallis test, Mann-Whitney U test with Bonferroni correction (α=.05/3=.017), and the paired-sample Student t test (α=.05). When retentive forces before and after testing were compared, O-ring showed significant retention loss at all implant angulations (P<.001). In contrast, the experimental system showed little retention loss in the 0- and 15-degree models (P>.05), whereas the 30-degree model showed a significant increase in retentive force (P=.001). At all implant angulations, retention loss increased significantly for the orange O-ring, followed by the red O-ring, and the experimental system (P<.001). Scanning electron microscopy analysis showed more intense wear in the matrix than the patrix (abutment that matches to matrix) and more severe wear and deformation of the O-ring rubber matrix than of the experimental zirconia ball. Upon completion of the experiment, wear and deformation were found for all attachment systems. Even when implants are not installed in parallel, the experimental system can be used without involving great loss of retention. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

[Analysis of the incidence and causes of repeated surgical interventions in patients with early complications electrotherapy - 1 center experience from the period 2012-2015].

PubMed

Piątek, Łukasz; Polewczyk, Anna; Kurzawski, Jacek; Zachura, Małgorzata; Kaczmarczyk, Małgorzata; Janion, Marianna

Due to increasing number of patients treated by cardiac implantable electronic devices we observe increasing number of complications after these procedures We analysed causes of early surgical revision of implantable devices connected with 1673 procedures of implantation (871 procedures) or exchange (802 procedures) of pacing systems (PM), cardioverter-difibrillators (ICD) and resynchronisation systems (CRT) in one local centre of electrotherapy in years 2012 to 2015. We characterised risk factors and its influence on encountered complications. In analysed period 72 reinterventions after implantations or exchanges of PM/ICD/CRT were performed. Main causes of early complications were: lead malfunction (2.5%), including the dislodgement of the leads in 1.9%, pocket hematoma (1.4%) and other abnormalities of the pocket (0.4 %), including pocket infections in 0.2%. The most important risk factors of early complications were often implantations of the leads with passive fixation and anticoagulation therapy in perioperative period. The knowledge of the early complications after implantations and exchanges of PM/ICD/CRT should improve the safety of procedures through more often used of the leads with active fixation and properly preparation of the patients requering the antithrombic therapy.

Dynamic biomechanical examination of the lumbar spine with implanted total spinal segment replacement (TSSR) utilizing a pendulum testing system.

PubMed

Daniels, Alan H; Paller, David J; Koruprolu, Sarath; Palumbo, Mark A; Crisco, Joseph J

2013-01-01

Biomechanical investigations of spinal motion preserving implants help in the understanding of their in vivo behavior. In this study, we hypothesized that the lumbar spine with implanted total spinal segment replacement (TSSR) would exhibit decreased dynamic stiffness and more rapid energy absorption compared to native functional spinal units under simulated physiologic motion when tested with the pendulum system. Five unembalmed, frozen human lumbar functional spinal units were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Flexuspine total spinal segment replacement implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°; resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. The total spinal segment replacement reached equilibrium with significantly fewer cycles to equilibrium compared to the intact functional spinal unit at all loads in flexion (p<0.011), and at loads of 385 N and 488 N in lateral bending (p<0.020). Mean bending stiffness in flexion, extension, and lateral bending increased with increasing load for both the intact functional spinal unit and total spinal segment replacement constructs (p<0.001), with no significant differences in stiffness between the intact functional spinal unit and total spinal segment replacement in any of the test modes (p>0.18). Lumbar functional spinal units with implanted total spinal segment replacement were found to have similar dynamic bending stiffness, but absorbed energy at a more rapid rate than intact functional spinal units during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices is not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions.

Dynamic Biomechanical Examination of the Lumbar Spine with Implanted Total Spinal Segment Replacement (TSSR) Utilizing a Pendulum Testing System

PubMed Central

Daniels, Alan H.; Paller, David J.; Koruprolu, Sarath; Palumbo, Mark A.; Crisco, Joseph J.

2013-01-01

Background Biomechanical investigations of spinal motion preserving implants help in the understanding of their in vivo behavior. In this study, we hypothesized that the lumbar spine with implanted total spinal segment replacement (TSSR) would exhibit decreased dynamic stiffness and more rapid energy absorption compared to native functional spinal units under simulated physiologic motion when tested with the pendulum system. Methods Five unembalmed, frozen human lumbar functional spinal units were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Flexuspine total spinal segment replacement implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°; resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. Results The total spinal segment replacement reached equilibrium with significantly fewer cycles to equilibrium compared to the intact functional spinal unit at all loads in flexion (p<0.011), and at loads of 385 N and 488 N in lateral bending (p<0.020). Mean bending stiffness in flexion, extension, and lateral bending increased with increasing load for both the intact functional spinal unit and total spinal segment replacement constructs (p<0.001), with no significant differences in stiffness between the intact functional spinal unit and total spinal segment replacement in any of the test modes (p>0.18). Conclusions Lumbar functional spinal units with implanted total spinal segment replacement were found to have similar dynamic bending stiffness, but absorbed energy at a more rapid rate than intact functional spinal units during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices is not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions. PMID:23451222

Influence of rhBMP-2 on Guided Bone Regeneration for Placement and Functional Loading of Dental Implants: A Radiographic and Histologic Study in Dogs.

PubMed

Ben Amara, Heithem; Lee, Jung-Won; Kim, Jung-Ju; Kang, Yun-Mi; Kang, Eun-Jung; Koo, Ki-Tae

Evidence on the outcomes of functional loading placed in recombinant human bone morphogenetic protein 2 (rhBMP-2)/acellular collagen sponge (ACS)-induced bone is lacking. The aim of this study was to verify whether guided bone regeneration (GBR) with rhBMP-2/ACS enhances regeneration of missing bone and osseointegration of dental implants subject to functional loading. Two bilateral standardized large saddle-type defects (≈10 × 10 × 6 mm) were surgically created in each mandible of seven beagle dogs 2 months after tooth extraction. Defects were immediately reconstructed randomly using rhBMP-2 (O-BMP or InFuse) soaked in ACS, deproteinized bovine bone mineral (DBBM) granules, or ACS alone as surgical control and subsequently covered with collagen membrane. Screw-type sand-blasted, acid-etched dental implants were placed 3 months later into the reconstructed defects and into adjacent bone. Osseointegration was allowed to progress for 3 months before functional loading of 3 months until sacrifice. Significantly more bone fill was radiographically observed for GBR with rhBMP-2/ACS (O-BMP: 92.5%, InFuse: 79%) in comparison to the DBBM (52%) and ACS alone groups (56.6%). Osseointegration was achieved and maintained in all experimental defects challenged by prostheses-driven functional load. The bone density ranged from 37.49% in the ACS group to 64.9% in the rhBMP-2/ACS (InFuse) group with no significance. The highest mean percentage of BIC was found in rhBMP-2/ACS (InFuse: 52.98%) with no statistical difference. Crestal bone resorption was observed around implants placed in reconstructed areas without any significant difference. GBR with rhBMP-2/ACS provided the greatest bone fill among the three treatment procedures. GBR with rhBMP-2/ACS showed efficacy for placement, osseointegration, and functional loading of titanium implants in alveolar ridge defects.

Surface modification of implants in long bone.

PubMed

Förster, Yvonne; Rentsch, Claudia; Schneiders, Wolfgang; Bernhardt, Ricardo; Simon, Jan C; Worch, Hartmut; Rammelt, Stefan

2012-01-01

Coatings of orthopedic implants are investigated to improve the osteoinductive and osteoconductive properties of the implant surfaces and thus to enhance periimplant bone formation. By applying coatings that mimic the extracellular matrix a favorable environment for osteoblasts, osteoclasts and their progenitor cells is provided to promote early and strong fixation of implants. It is known that the early bone ongrowth increases primary implant fixation and reduces the risk of implant failure. This review presents an overview of coating titanium and hydroxyapatite implants with components of the extracellular matrix like collagen type I, chondroitin sulfate and RGD peptide in different small and large animal models. The influence of these components on cells, the inflammation process, new bone formation and bone/implant contact is summarized.

Surface modification of implants in long bone

PubMed Central

Förster, Yvonne; Rentsch, Claudia; Schneiders, Wolfgang; Bernhardt, Ricardo; Simon, Jan C.; Worch, Hartmut; Rammelt, Stefan

2012-01-01

Coatings of orthopedic implants are investigated to improve the osteoinductive and osteoconductive properties of the implant surfaces and thus to enhance periimplant bone formation. By applying coatings that mimic the extracellular matrix a favorable environment for osteoblasts, osteoclasts and their progenitor cells is provided to promote early and strong fixation of implants. It is known that the early bone ongrowth increases primary implant fixation and reduces the risk of implant failure. This review presents an overview of coating titanium and hydroxyapatite implants with components of the extracellular matrix like collagen type I, chondroitin sulfate and RGD peptide in different small and large animal models. The influence of these components on cells, the inflammation process, new bone formation and bone/implant contact is summarized. PMID:23507866

Evaluation of the Alteration of Occlusal Distribution in Unilateral Free-End and Intermediate Missing Cases.

PubMed

Kon, Kazuhiro; Shiota, Makoto; Sakuyama, Aoi; Ozeki, Maho; Kozuma, Wataru; Kawakami, Sawako; Kasugai, Shohei

2017-02-01

The present study aimed to evaluate the effect of implant prostheses on the occlusal force and area as well as the distribution of occlusal loading in unilateral free-end and intermediate missing cases. Fourteen healthy subjects (7 free-end missing cases in the first and second molars and 7 intermediate missing cases in the first molar region) were included. Six months after the implant prosthesis was placed, an occlusal evaluation was performed with or without the implant superstructure by using Dental Prescale film and an occluder device. In free-end missing cases, the total occlusal force and area, implant-side occlusal force and area, and implant-side occlusal force and area of the residual natural teeth were significantly affected by the implant prostheses. In intermediate missing cases, the implant-side occlusal force of the residual natural teeth was significantly affected by the implant prostheses. In free-end missing cases, the proportions of implant-side occlusal force, non-implant-side occlusal force, and implant-side occlusal force of the residual natural teeth relative to the total occlusal force were significantly affected by the implant prostheses. In the intermediate missing cases, the proportion of the implant-side occlusal force of the residual natural teeth relative to the total occlusal force was significantly affected by the implant prostheses. The proportion of the occlusal area was also significantly affected. In free-end missing cases, implant prostheses significantly increased the occlusal force and area, which resulted in the proper occlusal distribution. In intermediate missing cases, an implant prosthesis may only improve the same-side occlusal loading of the natural teeth.

Flexible non-fusion scoliosis correction systems reduce intervertebral rotation less than rigid implants and allow growth of the spine: a finite element analysis of different features of orthobiom™

PubMed Central

Zander, T.; Burra, N. K.; Bergmann, G.

2007-01-01

The orthobiom™ non-fusion scoliosis correction system consists of two longitudinal rods, polyaxial pedicle screws, mobile and fixed connectors and a cross-connector. The mobile connectors can move along and around the rod, thus allowing length adaptation during growth. The aim of this study was to determine the effects of different features of this novel implant on intervertebral rotations, to calculate the movement of the mobile connectors along the rods for different loading cases and to compare the results with those of a rigid implant construct. A finite element analysis was performed using six versions (M1–M6) of a three-dimensional, nonlinear model of a spine ranging from T3 to L2. The models were loaded with pure moments of 7.5 N m in the three main anatomical planes. First, the validated intact model (M1) was studied. Then, the orthobiom™ implant system was inserted, bridging the segments between T4 and L1 (M2). The effect of pedicle screws only in every second vertebrae was investigated (M3). For comparison, three connection variations of screws and rods were investigated: (1) an implant with rigid screws and mobile connectors (M4), (2) an implant with non-locking polyaxial screws and fixed connectors (M5) and (3) a completely rigid implant construct (M6). For flexion, extension and lateral bending, intervertebral rotation was reduced at all implant levels due to the implants. A rigid implant construct (M6) and an implant with non-locking polyaxial screws and fixed connectors (M5) led to the strongest reduction of intervertebral rotation. The orthobiom™ non-fusion implant system (M2, M3) allowed much more intervertebral rotation than a rigid implant (M6). Differences in intervertebral rotations were small when polyaxial screws were placed at every second level only (M3) instead of at every level (M2). For axial rotation, intervertebral rotation was strongly reduced by a rigid implant construct (M6) and by an implant with rigid screws and mobile connectors (M4). For rotation, an implant with non-locking polyaxial screws (M2, M3, M5) led to nearly the same intervertebral rotations as in an intact spine without an implant (M1). The predicted maximum translation of the mobile connectors along the rod was 4.2 mm for extension, 3.1 mm for lateral bending, 1.6 mm for flexion and 0.8 mm for axial rotation. The movement of the connectors was highest for those closest to the ends of the rods. With rigid screws, the maximum translation was significantly reduced. This study, conducted under a load-controlled loading protocol, showed that intervertebral rotation was reduced much less by the non-fusion orthobiom™ system than by a rigid implant. The mobile connectors moved considerably along the rod when the spine was bent. It can be expected that the connectors also move along the rod as the adolescent grows, possibly leaving the discs intact until the patient is fully grown. PMID:17712575

In vivo tissue distribution and efficacy studies for cyclosporin A loaded nano-decorated subconjunctival implants.

PubMed

Yavuz, Burçin; Bozdağ Pehlivan, Sibel; Kaffashi, Abbas; Çalamak, Semih; Ulubayram, Kezban; Palaska, Erhan; Çakmak, Hasan Basri; Ünlü, Nurşen

2016-11-01

Biodegradable implants are promising drug delivery systems for sustained release ocular drug delivery with the benefits such as minimum systemic side effects, constant drug concentration at the target site and getting cleared without surgical removal. Dry eye syndrome (DES) is a common disease characterized with the changes in ocular epithelia surface and results in inflammatory reaction that might lead to blindness. Cyclosporin A (CsA) is a cyclic peptide that is frequently employed for the treatment of DES and it needs to be applied several times a day in tear drops form. The aim of this study was to evaluate in vivo behavior and efficacy of the developed nano-decorated subconjunctival implant systems for sustained release CsA delivery. Biodegradable Poly-ɛ-caprolactone (PCL) implant or micro-fiber implants containing CsA loaded poly-lactide-co-glycolide (85:15) (PLGA) or PCL nanoparticles were prepared in order to achieve sustained release. Two of the formulations PCL-PLGA-NP-F and PCL-PCL-NP-I were selected for in vivo evaluation based on their in vitro characteristics determined in our previous study. In this study, formulations were implanted to Swiss Albino mice with induced dry eye syndrome to investigate the ocular distribution of CsA following subconjunctival implantation and to evaluate the efficacy. Tissue distribution study indicated that CsA was present in ocular tissues such as cornea, sclera and lens even 90 days after the application and blood CsA levels were found lower than ocular tissues. Efficacy studies also showed that application of CsA-loaded fiber implant formulation resulted in faster recovery based on their staining scores.

In vitro and in vivo evaluation of novel implantation technology in hydrogel contact lenses for controlled drug delivery.

PubMed

Maulvi, Furqan A; Lakdawala, Dhara H; Shaikh, Anjum A; Desai, Ankita R; Choksi, Harsh H; Vaidya, Rutvi J; Ranch, Ketan M; Koli, Akshay R; Vyas, Bhavin A; Shah, Dinesh O

2016-03-28

Glaucoma is commonly treated using eye drops, which is highly inefficient due to rapid clearance (low residence time) from ocular surface. Contact lenses are ideally suited for controlled drug delivery to cornea, but incorporation of any drug loaded particulate system (formulation) affect the optical and physical property of contact lenses. The objective of the present work was to implant timolol maleate (TM) loaded ethyl cellulose nanoparticle-laden ring in hydrogel contact lenses that could provide controlled drug delivery at therapeutic rates without compromising critical lens properties. TM-implant lenses were developed, by dispersing TM encapsulated ethyl cellulose nanoparticles in acrylate hydrogel (fabricated as ring implant) and implanted the same in hydrogel contact lenses (sandwich system). The TM-ethyl cellulose nanoparticles were prepared by double emulsion method at different ratios of TM to ethyl cellulose. The X-ray diffraction studies revealed the transformation of TM to amorphous state. In vitro release kinetic data showed sustained drug release within the therapeutic window for 168h (NP 1:3 batch) with 150μg loading. Cytotoxicity and ocular irritation study demonstrated the safety of TM-implant contact lenses. In vivo pharmacokinetic studies in rabbit tear fluid showed significant increase in mean residence time (MRT) and area under curve (AUC), with TM-implant contact lenses in comparison to eye drop therapy. In vivo pharmacodynamic data in rabbit model showed sustained reduction in intra ocular pressure for 192h. The study demonstrated the promising potential of implantation technology to treat glaucoma using contact lenses, and could serve as a platform for other ocular diseases. Copyright © 2016 Elsevier B.V. All rights reserved.

Modelling dental implant extraction by pullout and torque procedures.

PubMed

Rittel, D; Dorogoy, A; Shemtov-Yona, K

2017-07-01

Dental implants extraction, achieved either by applying torque or pullout force, is used to estimate the bone-implant interfacial strength. A detailed description of the mechanical and physical aspects of the extraction process in the literature is still missing. This paper presents 3D nonlinear dynamic finite element simulations of a commercial implant extraction process from the mandible bone. Emphasis is put on the typical load-displacement and torque-angle relationships for various types of cortical and trabecular bone strengths. The simulations also study of the influence of the osseointegration level on those relationships. This is done by simulating implant extraction right after insertion when interfacial frictional contact exists between the implant and bone, and long after insertion, assuming that the implant is fully bonded to the bone. The model does not include a separate representation and model of the interfacial layer for which available data is limited. The obtained relationships show that the higher the strength of the trabecular bone the higher the peak extraction force, while for application of torque, it is the cortical bone which might dictate the peak torque value. Information on the relative strength contrast of the cortical and trabecular components, as well as the progressive nature of the damage evolution, can be revealed from the obtained relations. It is shown that full osseointegration might multiply the peak and average load values by a factor 3-12 although the calculated work of extraction varies only by a factor of 1.5. From a quantitative point of view, it is suggested that, as an alternative to reporting peak load or torque values, an average value derived from the extraction work be used to better characterize the bone-implant interfacial strength. Copyright © 2017 Elsevier Ltd. All rights reserved.

Anterior cement augmentation of adjacent levels after vertebral body replacement leads to superior stability of the corpectomy cage under cyclic loading-a biomechanical investigation.

PubMed

Oberkircher, Ludwig; Krüger, Antonio; Hörth, Dominik; Hack, Juliana; Ruchholtz, Steffen; Fleege, Christoph; Rauschmann, Michael; Arabmotlagh, Mohammad

2018-03-01

In the operative treatment of osteoporotic vertebral body fractures, a dorsal stabilization in combination with a corpectomy of the fractured vertebral body might be necessary with respect to the fracture morphology, whereby the osteoporotic bone quality may possibly increase the risk of implant failure. To achieve better stability, it is recommended to use cement-augmented screws for dorsal instrumentation. Besides careful end plate preparation, cement augmentation of the adjacent end plates has also been reported to lead to less reduction loss. The aim of the study was to evaluate biomechanically under cyclic loading whether an additional cement augmentation of the adjacent end plates leads to improved stability of the inserted cage. Methodical cadaver study. Fourteen fresh frozen human thoracic spines with proven osteoporosis were used (T2-T7). After removal of the soft tissues, the spine was embedded in Technovit (Kulzer, Germany). Subsequently, a corpectomy of T5 was performed, leaving the dorsal ligamentary structures intact. After randomization with respect to bone quality, two groups were generated: Dorsal instrumentation (cemented pedicle screws, Medtronic, Minneapolis, MN, USA)+cage implantation (CAPRI Corpectomy Cage, K2M, Leesburg, VA, USA) without additional cementation of the adjacent endplates (Group A) and dorsal instrumentation+cage implantation with additional cement augmentation of the adjacent end plates (Group B). The subsequent axial and cyclic loading was performed at a frequency of 1 Hz, starting at 400 N and increasing the load within 200 N after every 500 cycles up to a maximum of 2,200 N. Load failure was determined when the cages sintered macroscopically into the end plates (implant failure) or when the maximum load was reached. One specimen in Group B could not be clamped appropriately into the test bench for axial loading because of a pronounced scoliotic misalignment and had to be excluded. The mean strength for implant failure was 1,000 N±258.2 N in Group A (no cement augmentation of the adjacent end plates, n=7); on average, 1,622.1±637.6 cycles were achieved. In Group B (cement augmentation of the adjacent end plates, n=6), the mean force at the end of loading was 1,766.7 N±320.4 N; an average of 3,572±920.6 cycles was achieved. Three specimens reached a load of 2,000 N. The differences between the two groups were significant (p=.006 and p=.0047) regarding load failure and number of cycles. Additional cement augmentation of the adjacent end plates during implantation of a vertebral body replacement in osteoporotic bone resulted in a significant increased stability of the cage in the axial cyclic loading test. Copyright © 2017 Elsevier Inc. All rights reserved.

Antimicrobial and bone-forming activity of a copper coated implant in a rabbit model.

PubMed

Prinz, Cornelia; Elhensheri, Mohamed; Rychly, Joachim; Neumann, Hans-Georg

2017-08-01

Current strategies in implant technology are directed to generate bioactive implants that are capable to activate the regenerative potential of the surrounding tissue. On the other hand, implant-related infections are a common problem in orthopaedic trauma patients. To meet both challenges, i.e. to generate a bone implant with regenerative and antimicrobial characteristics, we tested the use of copper coated nails for surgical fixation in a rabbit model. Copper acetate was galvanically deposited with a copper load of 1 µg/mm 2 onto a porous oxide layer of Ti6Al4V nails, which were used for the fixation of a tibia fracture, inoculated with bacteria. After implantation of the nail the concentration of copper ions did not increase in blood which indicates that copper released from the implant was locally restricted to the fracture site. After four weeks, analyses of the extracted implants revealed a distinct antimicrobial effect of copper, because copper completely prevented both a weak adhesion and firm attachment of biofilm-forming bacteria on the titanium implant. To evaluate fracture healing, radiographic examination demonstrated an increased callus index in animals with copper coated nails. This result indicates a stimulated bone formation by releasing copper ions. We conclude that the use of implants with a defined load of copper ions enables both prevention of bacterial infection and the stimulation of regenerative processes.

Immediate vs non-immediate loading post-extractive implants: a comparative study of implant stability quotient (ISQ)

PubMed Central

MILILLO, L.; FIANDACA, C.; GIANNOULIS, F.; OTTRIA, L.; LUCCHESE, A.; SILVESTRE, F.; PETRUZZI, M.

2016-01-01

SUMMARY Purpose This study aims to evaluate differences in implant stability between post-extractive implants vs immediately placed post-extractive implants by resonance frequency analysis (RFA). Materials and methods Patients were grouped into two different categories. In Group A 10 patients had an immediate post-extractive implant, then a provisional, acrylic resin crown was placed (immediate loading). In Group B (control group) 10 patients only had an immediate post-extractive implant. Both upper and lower premolars were chosen as post-extractive sites. Implant Stability Quotient (ISQ) was measured thanks to RFA measurements (Osstell®). Five intervals were considered: immediately after surgery (T0) and every four weeks, until five months after implant placement (T1, T2, T3, T4,T5). A statistical analysis by means of Student’s T-test (significance set at p<0.05) for independent sample was carried out in order to compare Groups A and B. Results The ISQ value between the two groups showed a statistically significant difference (p<0.02) at T1. No statistically significant difference in ISQ was assessed at T0, T2, T3, T4 and T5. Conclusions After clinical assessment it is possible to confirm that provisional and immediate prosthetic surgery in post-extraction sites with cone-shaped implants, platform-switching abutment and bioactive surface can facilitate osseointegration, reducing healing time. PMID:28042440

[The primary stability between manual and robot assisted implantation of hip prostheses: A biomechanical study on synthetic femurs].

PubMed

Decking, J; Gerber, A; Kränzlein, J; Meurer, A; Böhm, B; Plitz, W

2004-01-01

We investigated the initial stability of cementless stems implanted with robotic milling and conventional manual broaching. Proximally porous structured stems (G2, ESKA-Implants, Luebeck, Germany) were implanted into synthetic femora. In one group, the femoral cavity was prepared by a CT-based robot (CASPAR, URS-Ortho, Germany) with a high-speed milling head. In the other group, femora were rasped manually with broaches. The broaches had 1 mm proximal press-fit, the robotic cavities 1.5 mm. The implants were exposed to 15 000 loading cycles with 1 000 +/- 500 N. The direction of forces on the implant head were chosen to simulate stair climbing. Internal rotation and translation (caudal, dorsal and lateral) of the implants were measured by linear transducers. The robotic group showed significantly less reversible motion regarding translation in caudal, dorsal and lateral directions. The standard deviations of implant motions were smaller in the robotic group. Using robotic preparation of the femur, initial stability was higher and more consistent than with manual broaching, but differences in undersizing of the cavities created in the femur in relation to the implant may have contributed to these differences for the most part. In-vitro-loading experiments focusing on femoral cavities with varying press-fits are recommended before the introduction of new implants or operating procedures.

One-year results of maxillary overdentures supported by 2 titanium-zirconium implants - implant survival rates and radiographic outcomes.

PubMed

Zembic, Anja; Tahmaseb, Ali; Jung, Ronald E; Wismeijer, Daniel

2017-07-01

To assess implant survival rates and peri-implant bone loss of 2 titanium-zirconium implants supporting maxillary overdentures at 1 year of loading. Twenty maxillary edentulous patients (5 women and 15 men) being dissatisfied with their complete dentures were included. In total, 40 diameter-reduced titanium-zirconium implants were placed in the anterior maxilla. Local guided bone regeneration (GBR) was allowed if the treatment did not compromise implant stability. Following 3 to 5 months of healing, implant-supported overdentures were inserted on two ball anchors. Implants and overdentures were assessed at 1, 2, 4, and 8 weeks after implant insertion and 2, 4, and 12 months after insertion of overdentures (baseline). Standardized radiographs were taken at implant loading and 1 year. Implant survival rates and bone loss were the primary outcomes. Nineteen patients (1 dropout) with 38 implants were evaluated at a mean follow-up of 1.1 years (range 1.0-1.7 years). One implant failed resulting in an implant survival rate of 97.3%. There was a significant peri-implant bone loss of the implants at 1 year of function (mean, 0.7 mm, SD = 1.1 mm; median: 0.48 mm, IQR = 0.56 mm). There was a high 1-year implant survival rate for edentulous patients receiving 2 maxillary implants and ball anchors as overdenture support. However, several implants exhibited an increased amount of bone loss of more than 2 mm. Overdentures supported by 2 maxillary implants should thus be used with caution as minimally invasive treatment for specific patients encountering problems with their upper dentures until more long-term data is available. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of nano-hydroxyapatite on bone morphogenetic protein-2-induced hard tissue formation and dentin resorption on a dentin surface

NASA Astrophysics Data System (ADS)

Tamagawa, Hiroki; Tenkumo, Taichi; Sugaya, Tsutomu; Kawanami, Masamitsu

2012-12-01

AimThe purpose of this study was to evaluate the effects of the addition of nano-hydroxyapatite to a collagen membrane-carrier of recombinant human bone morphogenetic protein-2 (rhBMP-2) on hard tissue formation and dentin resorption on dentin surfaces in vivo. Materials and methodsNano-hydroxyapatite collagen composite (nHAC) membranes or collagen (C) membranes were each immersed in either 100 or 400 μg/ml rhBMP-2 and placed on dentin chips that were implanted into rat thigh muscle. The implants were analyzed at 2 or 4 weeks after surgery by histological observation and histomorphometric analysis. ResultsThe percentage of the hard tissue formed by each nHAC group was significantly higher than that formed by any of the C groups, except for that formed by the group loaded with 400 μg/ml rhBMP-2 at 4 weeks after implantation. No significant differences were observed in the percentage of dentin resorption between the nHAC groups and C groups at any stage or at any rhBMP-2 concentration. ConclusionThese findings showed that addition of nano-hydroxyapatite to a collagen membrane accelerated the formation of hard tissue induced by a low dose of rhBMP-2 on dentin surfaces at an early stage after implantation into rat thigh muscle, without increasing dentin resorption.

Magnetic attachment for implant overdentures: influence of contact relationship with the denture base on stability and bending strain.

PubMed

Yang, Tsung-Chieh; Maeda, Yoshinobu; Gonda, Tomoya; Wada, Masahiro

2013-01-01

This study evaluated how the contact height between the magnetic attachment and denture base influences stability and bending strain. An implant modified with strain gauges and a magnetic attachment mounted in an acrylic resin block were used to characterize systems with varying degrees or heights of contact with the abutment. Bending strain under lateral loading increased significantly as the contact height decreased. In the no contact and resilient contact groups, magnetic assemblies separated at reduced bending strain in all loading conditions. The contact height of the magnetic attachment influenced the stability and the amount of bending strain on the implant.

Clinical evaluation of the stability of implants placed at different supracrestal levels.

PubMed

Gultekin, B Alper; Sirali, Ali; Gultekin, Pinar; Ersanli, Selim

2016-01-01

The aim of this study was to evaluate the stability during healing and before loading of implants placed at two different supracrestal levels according to their collar texture. This retrospective study included patients who received posterior implants with the same macro design. Implants with a machined collar were placed 0.3 mm above the crestal bone (M group), while those with a laser-microtextured collar were placed 1 mm above the crestal bone (L group). All implants healed in a single stage with healing abutments. Implant stability quotient (ISQ) values were determined using resonance frequency analysis immediately after implant placement during surgery and after 1, 4, 8, and 12 weeks after surgery. Other evaluated factors for stability included the implant diameter and length and the site of placement (maxilla or mandible). In total, 103 implants (47 L, 56 M) were evaluated. The median ISQ values at baseline and 1 week after placement were significantly higher for the M group than for the L group (p=0.006 and p=0.031, respectively). There were no differences at the subsequent observation points. The ISQ value was higher for wide-diameter than regular diameter (p=0.001) and mandibular implants than maxillary implants (p=0.001 at 0-8. weeks; p=0.012 at 12 weeks) at all observation points. When diameter data were neglected, the implant length did not influence the ISQ value at all observation points. Our results suggest that submerging implant more inside bone may only influence primary stability. Moreover, the implant diameter and site of placement influence primary and secondary stability before loading, whereas the implant length does not when its diameter is not accounted for.

The influence of micro and macro-geometry in term of bone-implant interface in two implant systems: an histomorphometrical study

PubMed Central

ROCCI, A.; CALCATERRA, R.; DI GIROLAMO, M.; ROCCI, M.; ROCCI, C.; BAGGI, L.

2015-01-01

SUMMARY Objective Many factors could affect the osseous healing of implants such as surface topography of biomaterial, the status of the bone/implant site, implant loading conditions, surgical technique and implant design. The aim of this study was to analyze the BIC of 2 different implants systems characterized by different micro and macrogeometry, that were placed in the posterior maxillary and mandibular jaws of humans, clinically unloaded and retrieved for histomorphometric analyses after 12 weeks. Material and method The patients were divided in two groups (Group I and II); group I was composed by 4 patients that each received in the posterior areas of mandible one type A implant [GTB-Plan1Health Amaro (UD) Italy] one type B implant (OsseoSpeed Astra Tech, Dentsply Molndal, Sweden). Group II was composed by 3 patients that each received in the posterior areas of jawsbone one type A implant [GTB-Plan1Health Amaro (UD) Italy] one type B implant (OsseoSpeed Astra Tech, Dentsply Molndal, Sweden). After 12 weeks of healing all the implants of both groups were harvested with the peri-implant bone tissues. Osseointegration process was evaluated throughout measurements of BIC. Results No statistical significance differences were found among the mean percentage of BIC of Group I – type A were 66,51% versus 49,96% in Group I – type B, as well as among the mean percentage of BIC of Group II – type A were 43.7% versus 60.02% in Group II – type B. Conclusions Our results highlight that the mean percentage of BIC after 12 weeks from the implants placement without functional loading is not influenced by the composition of the implant surface. PMID:28042421

The influence of micro and macro-geometry in term of bone-implant interface in two implant systems: an histomorphometrical study.

PubMed

Rocci, A; Calcaterra, R; DI Girolamo, M; Rocci, M; Rocci, C; Baggi, L

2015-01-01

Many factors could affect the osseous healing of implants such as surface topography of biomaterial, the status of the bone/implant site, implant loading conditions, surgical technique and implant design. The aim of this study was to analyze the BIC of 2 different implants systems characterized by different micro and macrogeometry, that were placed in the posterior maxillary and mandibular jaws of humans, clinically unloaded and retrieved for histomorphometric analyses after 12 weeks. The patients were divided in two groups (Group I and II); group I was composed by 4 patients that each received in the posterior areas of mandible one type A implant [GTB-Plan1Health Amaro (UD) Italy] one type B implant (OsseoSpeed Astra Tech, Dentsply Molndal, Sweden). Group II was composed by 3 patients that each received in the posterior areas of jawsbone one type A implant [GTB-Plan1Health Amaro (UD) Italy] one type B implant (OsseoSpeed Astra Tech, Dentsply Molndal, Sweden). After 12 weeks of healing all the implants of both groups were harvested with the peri-implant bone tissues. Osseointegration process was evaluated throughout measurements of BIC. No statistical significance differences were found among the mean percentage of BIC of Group I - type A were 66,51% versus 49,96% in Group I - type B, as well as among the mean percentage of BIC of Group II - type A were 43.7% versus 60.02% in Group II - type B. Our results highlight that the mean percentage of BIC after 12 weeks from the implants placement without functional loading is not influenced by the composition of the implant surface.

Histomorphometry and bone mechanical property evolution around different implant systems at early healing stages: an experimental study in dogs.

PubMed

Jimbo, Ryo; Anchieta, Rodolfo; Baldassarri, Marta; Granato, Rodrigo; Marin, Charles; Teixeira, Hellen S; Tovar, Nick; Vandeweghe, Stefan; Janal, Malvin N; Coelho, Paulo G

2013-12-01

Commercial implants differ at macro-, micro-, and nanolevels, which makes it difficult to distinguish their effect on osseointegration. The aim of this study was to evaluate the early integration of 5 commercially available implants (Astra OsseoSpeed, Straumann SLA, Intra-Lock Blossom Ossean, Nobel Active, and OsseoFix) by histomorphometry and nanoindentation. Implants were installed in the tibiae of 18 beagle dogs. Samples were retrieved at 1, 3, and 6 weeks (n = 6 for each time point) and were histologically and nanomechanically evaluated. The results presented that both time (P < 0.01) and implant system and time interaction (P < 0.02) significantly affected the bone-to-implant contact (BIC). At 1 week, the different groups presented statistically different outcomes. No significant changes in BIC were noted thereafter. There were no significant differences in rank elastic modulus (E) or in rank hardness (H) for time (E: P > 0.80; H: P > 0.75) or implant system (E: P > 0.90; H: P > 0.85). The effect of different implant designs on osseointegration was evident especially at early stages of bone healing.

Single-Stage Ear Reconstruction and Hearing Restoration Using Polyethylene Implant and Implantable Hearing Devices.

PubMed

Hempel, John Martin

2015-12-01

The use of porous polyethylene in reconstructive surgery of the auricle is becoming increasingly accepted. This is a single-stage procedure providing pleasing cosmetic rehabilitation. Further advantages are the possibility of early implantation and the lack of complications caused by harvesting costal cartilage. Additional hearing restoration using middle ear implants allows functional rehabilitation at an early stage. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.