Landes, Constantin A; Bündgen, Lukas; Laudemann, Katharina; Ghanaati, Sharam; Sader, Robert
To assess clinical, aesthetic, and quality-of-life parameters of cleft lip and palate patients' implant-supported crowns with ITI Straumann nonsubmerged and loaded after 3 months implants. In 17 bone-grafted cleft patients, 24 implants were placed nonsubmerged, loaded at 3 months to support crowns in the cleft area, and followed up at 40 months on average (± 22 months). The oral-health-related quality of life was assessed in all patients with the German Oral Health Impact Profile after implant therapy. Aesthetics were judged on photographs by dental professionals, nonprofessionals, and the patients themselves. The Implant Crown Aesthetic Index served as an objective tool. A total of 23 implants (95.8%) were loaded and in function. Clinical parameters were marginal bone loss of 1.15 ± 2.16 mm, peri-implant probing depth of 2.56 ± 0.66 mm, width of keratinized mucosa of 2.71 ± 1.1 mm, mucosal recession of 0.41 ± 0.8 mm, Periotest value of 0.18 ± 6.5, and German Oral Health Impact Profile summary score of ≤ 2. The best aesthetic outcome was assessed by the patients themselves. Soft tissues were rated worse than were implant-supported crowns. Implant-borne prosthetic rehabilitation of bone-grafted clefts with nonsubmerged ITI Straumann implants with 3 months' loading represents a reliable treatment option with high success rates in the long term. Functional aspects are comparable to those of noncleft patients. The oral-health-related quality of life of cleft patients is similar to that of noncleft patients. Aesthetics are restricted but satisfactory to patients and dental professionals. Aesthetics of peri-implant soft tissues should be improved in the future.
Karoussis, Ioannis K; Salvi, Giovanni E; Heitz-Mayfield, Lisa J A; Brägger, Urs; Hämmerle, Christoph H F; Lang, Niklaus P
The aim of this 10-year study was to compare the failure, success and complication rates between patients having lost their teeth due to periodontitis or other reasons. Fifty-three patients who received 112 hollow screw implants (HS) of the ITI Dental Implant System were divided into two groups: group A - eight patients with 21 implants having lost their teeth due to chronic periodontitis; group B - forty five patients with 91 implants without a history of periodontitis. One and 10 years after surgical placement, clinical and radiographic parameters were assessed. The incidences of peri-implantitis were noticed over the 10 years of regular supportive periodontal therapy. Success criteria at 10 years were set at: pocket probing depth (PPD)
Charters, R T
Although this system requires the use of some different impression techniques, it provides the dentist and technician a unique and simple method to restore a missing tooth with an implant-retained crown. The Straumann ITI impression coping and analog system allow the fabrication of a hybrid die for predictable results.
Zohrabian, Vahe M; Sonick, Michael; Hwang, Debby; Abrahams, James J
Dental implants restore function to near normal in partially or completely edentulous patients. A root-form implant is the most frequently used type of dental implant today. The basis for dental implants is osseointegration, in which osteoblasts grow and directly integrate with the surface of titanium posts surgically embedded into the jaw. Radiologic assessment is critical in the preoperative evaluation of the dental implant patient, as the exact height, width, and contour of the alveolar ridge must be determined. Moreover, the precise locations of the maxillary sinuses and mandibular canals, as well as their relationships to the site of implant surgery must be ascertained. As such, radiologists must be familiar with implant design and surgical placement, as well as augmentation procedures utilized in those patients with insufficient bone in the maxilla and mandible to support dental implants.
Griggs, Jason A
Systematic reviews of literature over the period between 2008 and 2017 are discussed regarding clinical evidence for the factors affecting survival and failure of dental implants. The factors addressed include publication bias, tooth location, insertion torque, collar design, implant-abutment connection design, implant length, implant width, bone augmentation, platform switching, surface roughness, implant coatings, and the use of ceramic materials in the implant body and abutment. Copyright © 2017 Elsevier Inc. All rights reserved.
Dental implant surgery Overview By Mayo Clinic Staff Dental implant surgery is a procedure that replaces tooth roots ... that look and function much like real ones. Dental implant surgery can offer a welcome alternative to dentures ...
Oshida, Yoshiki; Tuna, Elif B.; Aktören, Oya; Gençay, Koray
Among various dental materials and their successful applications, a dental implant is a good example of the integrated system of science and technology involved in multiple disciplines including surface chemistry and physics, biomechanics, from macro-scale to nano-scale manufacturing technologies and surface engineering. As many other dental materials and devices, there are crucial requirements taken upon on dental implants systems, since surface of dental implants is directly in contact with vital hard/soft tissue and is subjected to chemical as well as mechanical bio-environments. Such requirements should, at least, include biological compatibility, mechanical compatibility, and morphological compatibility to surrounding vital tissues. In this review, based on carefully selected about 500 published articles, these requirements plus MRI compatibility are firstly reviewed, followed by surface texturing methods in details. Normally dental implants are placed to lost tooth/teeth location(s) in adult patients whose skeleton and bony growth have already completed. However, there are some controversial issues for placing dental implants in growing patients. This point has been, in most of dental articles, overlooked. This review, therefore, throws a deliberate sight on this point. Concluding this review, we are proposing a novel implant system that integrates materials science and up-dated surface technology to improve dental implant systems exhibiting bio- and mechano-functionalities. PMID:20480036
Bilhan, Hakan; Kutay, Omer; Arat, Selda; Cekici, Ali; Cehreli, Murat Cavit
To explore the soft tissue, marginal bone, and prosthetic complications (if any) of Astra Tech, Brånemark, and ITI implants supporting fixed prostheses during an observation period of 2 years. The study comprised 26 patients, who received 42 Astra Tech, 36 Brånemark, and 29 ITI implants. After 3 months of healing, abutment connections were performed for Astra Tech and Brånemark implants, and fixed prostheses were delivered to the patients at 4 months. At 6-month, 1-year, and 2-year recall appointments, plaque index, periimplant inflammation index, and bleeding index scores, were recorded. The marginal bone levels were also measured at 2-year recall by means of radiographic evaluation, and prosthetic complications were recorded throughout the study. All implants survived during the 2-year observation period. The plaque index and periimplant inflammation index scores around Brånemark implants were higher than ITI and Astra Tech implants in the first year of function (P > 0.05). Marginal bone loss around ITI and Astra Tech implants was similar at 2 years (P > 0.05). The marginal bone loss around Brånemark implants was higher than Astra Tech implants (P < 0.05) but similar to ITI implants at 2-year recall appointment (P > 0.05). Fixed prostheses supported by ITI and Astra Tech implants did not experience prosthetic complications, and only 1 patient of the Brånemark group had porcelain veneer fracture. Astra Tech, Brånemark, and ITI implants supporting fixed prostheses had same survival rates (100%) in this study. ITI and Astra Tech implants had similar changes in marginal bone levels, whereas Brånemark implants had higher marginal bone loss, particularly in the first year of function.
Dol, Aleksandr V.; Ivanov, Dmitriy V.
Modern dentistry can not exist without dental implantation. This work is devoted to study of the "bone-implant" system and to optimization of dental prostheses installation. Modern non-invasive methods such as MRI an 3D-scanning as well as numerical calculations and 3D-prototyping allow to optimize all of stages of dental prosthetics. An integrated approach to the planning of implant surgery can significantly reduce the risk of complications in the first few days after treatment, and throughout the period of operation of the prosthesis.
Kasat, V.; Ladda, R.
Smoking is a prevalent behaviour in the population. The aim of this review is to bring to light the effects of smoking on dental implants. These facts will assist dental professionals when implants are planned in tobacco users. A search of “PubMed” was made with the key words “dental implant,” “nicotine,” “smoking,” “tobacco,” and “osseointegration.” Also, publications on tobacco control by the Government of India were considered. For review, only those articles published from 1988 onward in English language were selected. Smoking has its influence on general as well as oral health of an individual. Tobacco negatively affects the outcome of almost all therapeutic procedures performed in the oral cavity. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and the risk of peri-implantitis are adversely affected by smoking. To increase implant survival in smokers, various protocols have been recommended. Although osseointegrated dental implants have become the state of the art for tooth replacement, they are not without limitations or complications. In this litigious era, it is extremely important that the practitioner clearly understands and is able and willing to convey the spectrum of possible complications and their frequency to the patients. PMID:24478965
A high number of patients have one or more missing tooth and it is estimated that one in four American subjects over the age of 74 have lost all their natural teeth. Many options exist to replace missing teeth but dental implants have become one of the most used biomaterial to replace one (or more) missing tooth over the last decades. Contemporary dental implants made with titanium have been proven safe and effective in large series of patients. This review considers the main historical facts concerned with dental implants and present the different critical factors that will ensure a good osseo-integration that will ensure a stable prosthesis anchorage. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Tomsia, Antoni P; Lee, Janice S; Wegst, Ulrike G K; Saiz, Eduardo
With the advent of nanotechnology, an opportunity exists for the engineering of new dental implant materials. Metallic dental implants have been successfully used for decades, but they have shortcomings related to osseointegration and mechanical properties that do not match those of bone. Absent the development of an entirely new class of materials, faster osseointegration of currently available dental implants can be accomplished by various surface modifications. To date, there is no consensus regarding the preferred method(s) of implant surface modification, and further development will be required before the ideal implant surface can be created, let alone become available for clinical use. Current approaches can generally be categorized into three areas: ceramic coatings, surface functionalization, and patterning on the micro- to nanoscale. The distinctions among these are imprecise, as some or all of these approaches can be combined to improve in vivo implant performance. These surface improvements have resulted in durable implants with a high percentage of success and long-term function. Nanotechnology has provided another set of opportunities for the manipulation of implant surfaces in its capacity to mimic the surface topography formed by extracellular matrix components of natural tissue. The possibilities introduced by nanotechnology now permit the tailoring of implant chemistry and structure with an unprecedented degree of control. For the first time, tools are available that can be used to manipulate the physicochemical environment and monitor key cellular events at the molecular level. These new tools and capabilities will result in faster bone formation, reduced healing time, and rapid recovery to function.
Gaviria, Laura; Salcido, John Paul; Guda, Teja
Tooth loss is very a very common problem; therefore, the use of dental implants is also a common practice. Although research on dental implant designs, materials and techniques has increased in the past few years and is expected to expand in the future, there is still a lot of work involved in the use of better biomaterials, implant design, surface modification and functionalization of surfaces to improve the long-term outcomes of the treatment. This paper provides a brief history and evolution of dental implants. It also describes the types of implants that have been developed, and the parameters that are presently used in the design of dental implants. Finally, it describes the trends that are employed to improve dental implant surfaces, and current technologies used for the analysis and design of the implants. PMID:24868501
Mishra, Sunil Kumar; Kumar, Muktadar Anand; Chowdhary, Ramesh
Anodized implants with moderately rough surface were introduced around 2000. Whether these implants enhanced biologic effect to improve the environment for better osseointegration was unclear. The purpose of this article was to review the literature available on anodized surface in terms of their clinical success rate and bone response in patients till now. A broad electronic search of MEDLINE and PubMed databases was performed. A focus was made on peer-reviewed dental journals. Only articles related to anodized implants were included. Both animal and human studies were included. The initial search of articles resulted in 581 articles on anodized implants. The initial screening of titles and abstracts resulted in 112 full-text papers; 40 animal studies, 16 studies on cell adhesion and bacterial adhesion onto anodized surfaced implants, and 47 human studies were included. Nine studies, which do not fulfill the inclusion criteria, were excluded. The long-term studies on anodized surface implants do favor the surface, but in most of the studies, anodized surface is compared with that of machined surface, but not with other surfaces commercially available. Anodized surface in terms of clinical success rate in cases of compromised bone and immediately extracted sockets has shown favorable success.
An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them. PMID:19089213
An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them.
An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options.When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them.
An implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal jeopardize the clinician's efforts to accomplish satisfactory function and esthetics. For the patient, this usually involves further cost and additional procedures. The aim of this paper is to describe different methods and treatment modalities to deal with dental implant failure. The main topics for discussion include identifying the failing implant, implants replacing failed implants at the exact site, and the use of other restorative options. When an implant fails, a tailor made treatment plan should be provided to each patient according to all relevant variables. Patients should be informed regarding all possible treatment modalities following implant failure and give their consent to the most appropriate treatment option for them.
Berketa, J; James, H; Marino, V
Non-visual identification of victims utilizes DNA, fingerprint and dental comparison as primary scientific identifiers. In incidents where a victim has been incinerated, there may be loss of fingerprint detail and denaturing of DNA. Although extremely durable, tooth loss will also occur with extreme temperatures and the characteristics of recovered dental implants, if any, may be the only physical identifying data available. Currently, there are no experimental investigations to determine what changes occur to dental implants following high temperature exposure. A selection of dental implants was radiographed, utilizing purpose built apparatus to allow standard methodology. They were then heated in an INFI-TROL™ kiln to a maximum temperature of 1125°C and the radiographic procedure repeated. Image subtraction evaluation of the radiographs was recorded using Adobe(®) Photoshop(®). Both commercially pure titanium and titanium alloy dental implants survived the incineration and there was oxidation of the surface leading to minor alteration of the image. There was, however, no detectable sagging of the implants. The results of this research suggest that dental implants are still recognizable following incineration. In scenarios commonly seen by forensic odontologists, heat will destroy both teeth and conventional dental restorative materials. Implants, however, will resist these conditions and will also retain the features necessary to identify the type of implant. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Hischebeth, Gunnar T R; Randau, Thomas M; Buhr, Johanna K; Wimmer, Matthias D; Hoerauf, Achim; Molitor, Ernst; Bekeredjian-Ding, Isabelle; Gravius, Sascha
Periprosthetic joint infection (PJI) is one of the most challenging complications in orthopedic surgery. In cases of suspected periprosthetic joint infection several diagnostic methods are available. In this study we investigated the performance of the newly available Unyvero i60 implant and tissue infection (ITI) multiplex PCR System. 62 specimens from 31 patients with suspected PJI or aseptic loosening of a painful joint arthoplasty were included in this study. Besides the established diagnostic procedures we included a commercial multiplex PCR detection system for diagnosis of PJI. The PCR results obtained from analysis of sonication and synovial fluids (62 specimens) showed a sensitivity of 66.7%, a specificity of 100%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 68.4% when compared to cultural methods. Notably, cultures from sonication fluid displayed a sensitivity of 88.9%, a specificity of 61.5%, a PPV of 76.2% and a NPV of 80.0% when compared to tissue cultures. In conclusion, multiplex PCR is an additional - rapid - method for diagnosing PJI. Positive results with the PCR assay used in this study were always confirmed by subsequent matching culture positivity. However, apart from the time saved the nucleic acid amplification technique did not yield additional information than that obtained from microbiological cultures.
Kim, Tae-Il; Jang, Jun-Hyeog; Kim, Hae-Won; Knowles, Jonathan C; Ku, Young
Titanium, as an implant material, is regarded to be durable and biocompatible, which allows functional replacement of missing teeth. Successful dental implantation depends on an osseointegration phenomenon, a direct structural and functional binding reaction between bone and implant. It is well known that physicochemical characteristics of the dental implant surface, such as roughness, topography, chemistry, and electrical charge affect the biological reactions occurring at the interface of tissue and implant. Therefore, considerable efforts have been made to modify the surface of titanium implants which are based on mechanical, physical and chemical treatments. Recently, biological molecules were introduced onto the surface of implants to stimulate osteogenic cells in the early stage of implantation and consequently accelerate bone formation around implant and subsequent rapid implant stabilization. A range of extracellular matrix components, designed peptides, and growth factors have been proposed as the biological moiety. In this review, we address several issues related to the biology of dental implants and discuss biomimetic modification of the implant surface as a novel approach to obtain successful osseointegration.
Dental implant-associated infections are expected to be increasingly more common as the number of patients with implants for more than 10 years rises. There are 2 stages of peri-implant infection: early mucositis, consisting of inflammation of the peri-implant soft tissues without loss of supporting bone, and a more advanced form involving a loss of osseointegration, known as peri-implantitis. The estimated prevalence of this latter infection is 10% of 5-year implants and the main risk factor is previous periodontal disease. The etiopathogenesis of peri-implantitis is related with reservoirs of periodontal pathogens; however factors that lead to colonization of the implant surface or increased susceptibility to infection may also have an influence. Treatment should include removal of the bacterial biofilm, debridement of the exposed surface, and surgical regeneration of the peri-implant pocket.
Buser, D; Weber, H P; Bragger, U; Balsiger, C
This study examined the tissue integration of one-stage, nonsubmerged ITI implants over a period of 3 years. Fifty-four implants were placed in 38 partially edentulous patients. Following healing (at least 3 months), all 54 implants were free of peri-implant infections and revealed no detectable mobility. Radiographs showed no signs of peri-implant radiolucencies, and the implants were in favorable positions for prosthetic restoration. Following incorporation of fixed partial dentures, patients were enrolled in a hygiene recall program with 3-month intervals and were examined once a year. Based on predefined criteria, each implant was classified as successful or failing. After the 3-year observation period, 51 of 53 implants (96.2%) were considered successfully integrated. (One patient with one implant dropped out of the study.) Two implants exhibited recurrent peri-implant infections and were classified as late failures. These results indicate that one-stage ITI implants can achieve successful tissue integration on a predictable basis and that it can be maintained over a period of at least 3 years.
Vogel, Robert E
Dental implants have been considered an acceptable form of dental treatment since the early 1980s. A number of studies have been published describing impression techniques for dental implants. Many of the techniques described are so complex that they may seem daunting to the average restorative dentist. Most general practitioners do not wish to attempt to restore dental implants. This article describes a very simple, yet extremely accurate, technique for making impressions of dental implant fixtures.
Shahabouee, Mohammad; Rismanchian, Mansour; Yaghini, Jaber; Babashahi, Akram; Badrian, Hamid; Goroohi, Hossein
Background: When an implant is exposed to oral cavity, its surface gets colonized by micro-organisms. The aim of this study is to comparatively assess the microbiological parameters in sulci around the teeth and the crowns supported by dental implants. Materials and Methods: In this prospective, cross-sectional study, 34 partially edentulous patients aged between 40 and 50 years with total 50 anterior maxillary single implants with cemented crowns (depth of sulci <4 mm) and 34 similar teeth in the same jaw of the same patients were included. Excluded were the patients with compromised systemic and periodontal health and smoking habits. None of the patients had used any antimicrobial mouthwashes during at least two weeks before the study. All of the implants (ITI) were at least 6 months in place covered by definitive prostheses. Samples of gingival sulci were taken around teeth with paper cone and transported to Stuart transport medium. Samples were cultured and examined by a dark field microscope and eight laboratory tests were performed to determine the micro-organisms The data were evaluated statistically using Chi-square test (α=0.05). Results: Six anerobic bacteria found in teeth and implants sulci were Gram-positive cocci, Gram-negative cocci, Prevotella, Porphyromonas gingivalis, Bacteroid Fragilis and Fusobacterium. Gram-positive cocci and Gram-negative cocci had maximum and minimum percentage frequency in the two groups, respectively. There were no significant differences between the two groups (P value >0.05). Conclusion: The present study indicated that microflora in implant sulci is similar to the tooth sulci, when the depth of sulci is normal (<4 mm). As a result, implants’ susceptibility to inflammation is the same as teeth. PMID:22623941
Bressan, Eriberto; Sbricoli, Luca; Guazzo, Riccardo; Tocco, Ilaria; Roman, Marco; Vindigni, Vincenzo; Stellini, Edoardo; Gardin, Chiara; Ferroni, Letizia; Sivolella, Stefano; Zavan, Barbara
The structural and functional fusion of the surface of the dental implant with the surrounding bone (osseointegration) is crucial for the short and long term outcome of the device. In recent years, the enhancement of bone formation at the bone-implant interface has been achieved through the modulation of osteoblasts adhesion and spreading, induced by structural modifications of the implant surface, particularly at the nanoscale level. In this context, traditional chemical and physical processes find new applications to achieve the best dental implant technology. This review provides an overview of the most common manufacture techniques and the related cells-surface interactions and modulation. A Medline and a hand search were conducted to identify studies concerning nanostructuration of implant surface and their related biological interaction. In this paper, we stressed the importance of the modifications on dental implant surfaces at the nanometric level. Nowadays, there is still little evidence of the long-term benefits of nanofeatures, as the promising results achieved in vitro and in animals have still to be confirmed in humans. However, the increasing interest in nanotechnology is undoubted and more research is going to be published in the coming years.
Ho, Ko-Ning; Salamanca, Eisner; Lin, Hsi-Kuai
Purpose. To investigate peri-implant alveolar bone changes using periapical radiographs before and after prosthetic delivery in submerged and nonsubmerged dental implants. Methods. Digital periapical films of 60 ITI Straumann nonsubmerged dental implants and 60 Xive Dentsply submerged dental implants were taken before, immediately after, and 12 and 24 weeks after the prosthetic restoration was delivered. Results. The 60-nonsubmerged dental implant group showed mean marginal bone resorption at baseline of 0.10 ± 0.23 mm and 24 weeks later, marginal bone resorption was 0.16 ± 0.25 mm. The submerged dental implant group showed a significantly higher distal marginal bone resorption over the mesial side. Mean marginal bone resorption at baseline was 0.16 ± 0.32 on the mesial and 0.41 ± 0.56 on the distal side. Twenty-four weeks later, it was 0.69 ± 0.69 mm on the mesial and 0.99 ± 0.90 mm on the distal side. Conclusion. First, it was possible to determine that submerged implants had a higher mean marginal bone resorption and less bone-to-implant contact than nonsubmerged implants. And second, the distal side of submerged dental implants presented higher marginal bone loss than the mesial side. PMID:27999789
Henry, P J
The clinical utilization of dental implants has accelerated in recent years, and new applications continue to emerge. Concomitantly, alternative implant systems have introduced conceptually different approaches to treatment using altered protocols. The purpose of this paper is to address some of the background issues pertinent to the long-term success, survival, safety, and effectiveness of these devices. The requirements for clinical acceptance of implants are controlled initially by regulatory bodies; however, the dentist eventually must make a decision on which type of implant should be used in clinical practice. This clinical decision-making process should involve the strategy of using an evidence-based approach to ensure quality of care and reduction of liability for negligent care. This is particularly the case when treatment is undertaken in identified high-risk categories. While short- to medium-term data have been accumulated on the success rates of several implant systems, it is apparent that long-term data comparing and contrasting the various advantages and disadvantages of different systems do not exist, and adequate criteria applicable to the collective clinical experience need to be defined. Expanding areas of application are dependent on continuous improvements in implant hardware, surgical protocol development, and rationalized osteopromotive and site installation augmentation technology. Many treatment endeavors are still largely at the pilot study level of development, and long-term prospective clinical trials on large numbers of patients are required to document results adequately and to elucidate the most likely productive areas for future investigation.
Buser, D; Mericske-Stern, R; Dula, K; Lang, N P
This review article describes the scientific documentation of one-stage, non-submerged dental implants. In the past 25 years, numerous in vivo studies have demonstrated that non-submerged titanium implants achieve osseointegration as predictable as that of submerged titanium implants. This observation was confirmed in prospective clinical studies, mostly done with the ITI Dental Implant System. ITI implants have been widely documented for up to 10 years of prospective follow-up at various centers. All studies showed success rates well above 90%. In summary, the non-submerged approach is a true alternative to the original healing modality with submerged titanium implants. The non-submerged approach offers several clinical advantages: (i) the avoidance of a second surgical procedure and less chair time per patient, resulting in overall reduced treatment cost; (ii) the lack of microgap at the bone crest level, leading to less crestal bone during healing and resulting in a more favorable crown-to-implant length ratio; and (iii) a simplified prosthetic procedure, presenting an ideal basis for cemented implant restorations. Due to these significant clinical advantages, the non-submerged approach will become more important in implant dentistry in the near future, particularly in implant sites without esthetic priority.
Croitoru, Sorin Mihai; Popovici, Ion Alexandru
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.
Through following the FPPD protocol for multiple adjacent implants, and delivering final abutments, picking up the metal framework, and delivering provisionals, many benefits are gained. The benefits of following the FPPD protocol are as follows: The restorative dentist is trying-in and delivering the final abutments in one visit as opposed to removing them and placing them multiple times. This requires less chair time and time for the patient. It also reduces the mechanical stress on the abutment screw and implant body due to the elimination of multiple try-in appointments. When the metal framework is tried-in and verified for fit, the restorative dentist has the opportunity check the retention, check the margins, and make any corrections that might be needed. The abutments will be staying in the mouth when the framework is picked up. This metal try-in allows for a verification of the bite to be given to the dental lab. The delivery of provisionals manufactured by the dental laboratory offers many advantages in the FPPD technique. The patient has a form of tooth much earlier in the traditional appointment sequence. The patient can now offer feedback to the doctor and laboratory for fabrication of the permanent prosthesis with regards to shape and color. The laboratory-fabricated provisionals offer progressive loading to the implants through having a reduced occlusion yet allowing food to stimulate the implants. Overall, the FPPD technique offers shorter appointment times, more rapid delivery of fixed supported teeth, improved doctor-technician communication, and less mechanical wear on the implant parts.
Botabaev, B K
In absence of contraindications, with competent planning and complex oral mouth treatment and adequate use of surgical and orthopedic protocols, the dental implantation could be successfully implemented for esthetical and functional rehabilitation of elderly patients with different forms of adentia. Dental implantation can significantly increase the quality of life of elderly patients.
Kohli, Shivani; Bhatia, Shekhar; Kaur, Arvinder; Rathakrishnan, Tiviya
Aims: The aim of the study was to assess the awareness of the patients regarding implant-retained prosthesis as an option for tooth replacement and the knowledge about tooth replacement as a whole including source of information and attitude towards it amongst Malaysian population. Materials and Methods: Information on demographic characteristics, knowledge about implant as an option for missing tooth replacement, source of information and knowledge about other options of tooth replacement were obtained from patients visiting various dental outpatient departments of hospital and private dental clinics using nationwide self-explanatory survey. Results: Amongst the 1013 response retrieved, 27% of respondents felt moderately well informed about the dental implant treatment. Only 9% of the respondents had dental implant treatment before and 17% felt well informed about different alternatives of replacing missing teeth. The dentists were the main source of information regarding dental implant treatment modality followed by friends and electronic media. 55.6% respondents felt implant to be as good as own teeth during function whereas high cost was the major limiting factor for implant treatment. Conclusion: 56% of Malaysian population was aware of dental implant as an alternative for replacing missing teeth. Necessary efforts and measures should be made to raise the awareness of dental implant treatment in the country. PMID:26752875
Lee, Dong Won
Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effect, Science Direct, and SCOPUS databases were searched. A manual search was performed of issues of the last 15 years of the Journal of Periodontology, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Periodontal Research, Journal of Dentistry, Clinical Oral Investigations, Clinical Oral Implant Research and Clinical Implant Dentistry and Related Research. Prospective cohort studies that compared patients with periodontal disease (PD) to periodontally healthy patients and that reported data on implant loss, peri-implant bone changes or incidence of peri-implantitis were included. Case series, reviews, case reports and retrospective studies were not included. Study selection and risk of bias assessment using the Newcastle-Ottawa Scale was undertaken independently by two reviewers. Dichotomous data were expressed as risk ratios (RRs) and 95% confidence intervals (CIs). Continuous data were expressed as standardised mean differences (SMDs) and random-effects meta-analysis conducted. Fourteen studies were included with sample sizes ranging from 10-717. Meta-analysis (11 studies) showed a higher and significant risk for implant loss in patients affected by PD (RR: 1.89, 95% CI: 1.35-2.66, P = 0.0002) with no evidence of heterogeneity (v2 = 4.31, P = 0.93; I2 = 0%). Significant implant bone loss was present in patients with PD compared with periodontally healthy patients (SMD: 0.44, 95% CI: 0.19-0.69, P = 0.0006) (three studies), with no evidence of heterogeneity (v2 = 2.463, P = 0.27; I2 = 24%). Periodontally compromised patients also showed an increased risk of peri-implantitis compared with patients without PD (RR: 2.21, 95% CI: 1.42-3.43, P = 0.0004), with moderate but not significant heterogeneity (v2 = 7.35, P = 0.12; I2 = 46
Bathala, Lakshmana Rao; Sangur, Rajashekar
PURPOSE Dental implant has gained clinical success over last decade with the major drawback related to osseointegration as properties of metal (Titanium) are different from human bone. Currently implant procedures include endosseous type of dental implants with nanoscale surface characteristics. The objective of this review article is to summarize the role of nanotopography on titanium dental implant surfaces in order to improve osseointegration and various techniques that can generate nanoscale topographic features to titanium implants. MATERIALS AND METHODS A systematic electronic search of English language peer reviewed dental literature was performed for articles published between December 1987 to January 2012. Search was conducted in Medline, PubMed and Google scholar supplemented by hand searching of selected journals. 101 articles were assigned to full text analysis. Articles were selected according to inclusion and exclusion criterion. All articles were screened according to inclusion standard. 39 articles were included in the analysis. RESULTS Out of 39 studies, seven studies demonstrated that bone implant contact increases with increase in surface roughness. Five studies showed comparative evaluation of techniques producing microtopography and nanotopography. Eight studies concluded that osteoblasts preferably adhere to nano structure as compared to smooth surface. Six studies illustrated that nanotopography modify implant surface and their properties. Thirteen studies described techniques to produce nano roughness. CONCLUSION Modification of dental osseous implants at nanoscale level produced by various techniques can alter biological responses that may improve osseointegration and dental implant procedures. PMID:25558347
Esposito, M; Coulthard, P; Thomsen, P; Worthington, H V
failures. There were statistically significant differences for peri-implant bone level changes on intraoral radiographs in three comparisons in two trials. In one trial there was more bone loss only at 1 year for IMZ implants compared to Branemark (mean difference 0.60 mm; 95% CI 0.01 to 1.10) and to ITI implants (mean difference 0.50 mm; 95% CI 0.01 to 0.99). In the other trial Southern implants displayed more bone loss at 5 years than Steri-Oss implants (mean difference -0.35 mm; 95% CI -0.70 to -0.01). However this difference disappeared in the meta-analysis. More implants with rough surfaces were affected by perimplantitis (RR 0.80; 95% CI 0.67 to 0.96) meaning that turned implant surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period. Based on the available results of RCTs, there is limited evidence showing that implants with relatively smooth (turned) surfaces are less prone to loose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand, there is no evidence showing that any particular type of dental implant has superior long-term success. These findings are based on a few RCTs, often at high risk of bias, with few participants and relatively short follow-up periods. More RCTs should be conducted, with follow up of at least 5 years including a sufficient number of patients to detect a true difference if any exists. Such trials should be reported according to the CONSORT recommendations (http://www.consort-statement.org/).
Hunt, Peter R; Gartner, Judith L; Norkin, Frederic J
Many dentists are bewildered by the intricacies and complexities of dental implants. They are constantly besieged by product advertisements and can find it difficult to choose which systems to work with. Some dentists are so intimidated by the subject that they choose to avoid getting involved with implants and instead stick to traditional tooth replacement systems. By breaking implants down into 4 main components, the body, collar, connection, and restorative post, it is easier to understand the structure and function of dental implants. Each portion should be designed to achieve certain objectives. Once these structural components are understood, it is easier to compare and contrast differing implant systems.
Esposito, M; Murray-Curtis, L; Grusovin, M G; Coulthard, P; Worthington, H V
failures. There were statistically significant differences for perimplant bone level changes on intraoral radiographs in three comparisons in two trials. In one trial there was more bone loss only at 1 year for IMZ implants compared to Brånemark (mean difference 0.60 mm; 95% CI 0.01 to 1.10) and to ITI implants (mean difference 0.50 mm; 95% CI 0.01 to 0.99). In the other trial Southern implants displayed more bone loss at 5 years than Steri-Oss implants (mean difference -0.35 mm; 95% CI -0.70 to -0.01). However this difference disappeared in the meta-analysis. More implants with rough surfaces were affected by perimplantitis (RR 0.80; 95% CI 0.67 to 0.96) meaning that turned implant surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period. Based on the available results of RCTs, there is limited evidence showing that implants with relatively smooth (turned) surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand, there is no evidence showing that any particular type of dental implant has superior long-term success. These findings are based on a few RCTs, often at high risk of bias, with few participants and relatively short follow-up periods. More RCTs should be conducted, with follow up of at least 5 years including a sufficient number of patients to detect a true difference. Such trials should be reported according to the CONSORT recommendations (http://www.consort-statement.org/).
Brägger, U; Hämmerle, C; Weber, H P
Fixed reconstructions on implant abutments may be a welcome modality in the treatment of partially edentulous patients following the principles of a prophylactically oriented comprehensive care. The option to create artificial tissue integrated abutments widens the range of indications for fixed reconstructions. Risky long-span bridges as well as the preparation of intact teeth for bridge abutments may frequently be avoided. Never should the contours of the prosthesis interfere with the patient's performance of optimal plaque control. Furthermore, supportive periodontal therapy with regular maintenance visits must be provided to optimize a long-term prognosis of the dention as well as the tissue-integrated artificial abutments.
Mittal, Yuvika; Jindal, Govind; Garg, Sandeep
The use of dental implants for the rehabilitation of missing teeth has broadened the treatment options for patients and clinicians equally. As a result of advances in research in implant design, materials, and techniques, the use of dental implants has increased dramatically in the past two decades and is expected to expand further in the future. Success of dental implants depends largely on the quality and quantity of the available bone in the recipient site. This however may be compromised or unavailable due to tumor, trauma, periodontal disease, etc., which in turn necessitates the need for additional bone manipulation. This review outlines the various bone manipulation techniques that are used to achieve a predictable long-term success of dental implants. PMID:27433052
Mishra, Sunil Kumar; Chowdhary, Ramesh; Chrcanovic, Bruno Ramos; Brånemark, Per-Ingvar
Replacement of lost teeth has significant functional and psychosocial effects. The capability of osseointegrated dental implants to transmit a certain amount of sensibility is still unclear. The phenomenon of developing a certain amount of tactile sensibility through osseointegrated dental implants is called osseoperception. The aim of this article is to evaluate the available literature to find osseoperception associated with dental implants. To identify suitable literature, an electronic search was performed using Medline and PubMed database. Articles published in English and articles whose abstract is available in English were included. The articles included in the review were based on osseoperception, tactile sensation, and neurophysiological mechanoreceptors in relation to dental implants. Articles on peri-implantitis and infection-related sensitivity were not included. Review articles without the original data were excluded, although references to potentially pertinent articles were noted for further follow-up. The phenomenon of osseoperception remains a matter of debate, so the search strategy mainly focused on articles on osseoperception and tactile sensibility of dental implants. This review presents the histological, neurophysiological, and psychophysical evidence of osseoperception and also the role of mechanoreceptors in osseoperception. The literature on osseoperception in dental implants is very scarce. The initial literature search resulted in 90 articles, of which 81 articles that fulfilled the inclusion criteria were included in this systematic review. Patients restored with implant-supported prostheses reported improved tactile and motor function when compared with patients wearing complete dentures. © 2016 by the American College of Prosthodontists.
Tagliareni, Jonathan M; Clarkson, Earl
Dental implants provide completely edentulous and partial edentulous patients the function and esthetics they had with natural dentition. It is critical to understand and apply predictable surgical principles when treatment planning and surgically restoring edentulous spaces with implants. This article defines basic implant concepts that should be meticulously followed for predictable results when treating patients and restoring dental implants. Topics include biological and functional considerations, biomechanical considerations, preoperative assessments, medical history and risk assessments, oral examinations, radiographic examinations, contraindications, and general treatment planning options.
Nagarajan, Aishwarya; Perumalsamy, Rajapriya; Thyagarajan, Ramakrishnan; Namasivayam, Ambalavanan
Dental implant is a device made of alloplastic (foreign) material implanted into the jaw bone beneath the mucosal layer to support a fixed or removable dental prosthesis. Dental implants are gaining immense popularity and wide acceptance because they not only replace lost teeth but also provide permanent restorations that do not interfere with oral function or speech or compromise the self-esteem of a patient. Appropriate treatment planning for replacement of lost teeth is required and imaging plays a pivotal role to ensure a satisfactory outcome. The development of pre-surgical imaging techniques and surgical templates helps the dentist place the implants with relative ease. This article focuses on various types of imaging modalities that have a pivotal role in implant therapy.
Nagarajan, Aishwarya; Perumalsamy, Rajapriya; Thyagarajan, Ramakrishnan; Namasivayam, Ambalavanan
Dental implant is a device made of alloplastic (foreign) material implanted into the jaw bone beneath the mucosal layer to support a fixed or removable dental prosthesis. Dental implants are gaining immense popularity and wide acceptance because they not only replace lost teeth but also provide permanent restorations that do not interfere with oral function or speech or compromise the self-esteem of a patient. Appropriate treatment planning for replacement of lost teeth is required and imaging plays a pivotal role to ensure a satisfactory outcome. The development of pre-surgical imaging techniques and surgical templates helps the dentist place the implants with relative ease. This article focuses on various types of imaging modalities that have a pivotal role in implant therapy. PMID:25379354
Özdemir, Tayfun; Öksüz, Lütfiye; Gürler, Nezahat
Objectives: The aims of this study were to investigate the incidence of bacteremia, bacteriology and antibiotic susceptibility against to causative bacteria associated with dental implant installation. Study Design: 30 generally healthy patients were enrolled in this study. Blood samples were collected at baseline and at 30 minutes after dental implant installation and 24 hours after dental implant surgery. Blood samples were cultured in a BACTEC system. The isolated bacteria were identified using conventional methods. Antimicrobial sensitivity tests were performed by disc diffusion. Results: No bacteria were isolated at the baseline and 24 hours after surgery, whereas the prevalence of bacteremia at 30 minutes after dental implant installation was 23%. The isolated bacteria species were Staphylococcus epidermidis, Eubacterium spp., Corynebacterium spp. and Streptococcus viridans. The Staphylococcus epidermidis, which was isolated in three patients, was found to be resistant to penicillin which is first choice of many clinicians. Conclusion: Our findings suggest that installation of dental implants can produce bacteremia. Within the limitations of this study, it can be speculated that the resistance of antibiotics may compromise the routine prophylaxis against infective endocarditis. Therefore use of blood cultures and antibiograms may be suggested in risky patients. The outcome of the present study should be verified using a larger patient group with varying conditions. Key words: Dental implant, bacteremia, infective endocarditis, antibiotic prophylaxis. PMID:22157668
... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3630 Endosseous dental implant abutment. (a) Identification. An endosseous dental implant abutment is a premanufactured prosthetic component directly connected to the endosseous dental implant and is intended for use as an aid in...
... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3630 Endosseous dental implant abutment. (a) Identification. An endosseous dental implant abutment is a premanufactured prosthetic component directly connected to the endosseous dental implant and is intended for use as an aid in...
... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3630 Endosseous dental implant abutment. (a) Identification. An endosseous dental implant abutment is a premanufactured prosthetic component directly connected to the endosseous dental implant and is intended for use as an aid in...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endosseous dental implant abutment. 872.3630... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3630 Endosseous dental implant abutment. (a) Identification. An endosseous dental implant abutment is a premanufactured prosthetic component...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endosseous dental implant. 872.3640 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3640 Endosseous dental implant. (a) Identification. An endosseous dental implant is a device made of a material such as titanium or titanium alloy, that...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Endosseous dental implant accessories. 872.3980... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3980 Endosseous dental implant accessories. (a) Identification. Endosseous dental implant accessories are manually powered devices...
Mouth provides a congenial environment for the growth of the microorganisms as compared to any other part of the human body by exhibiting an ideal nonshedding surface. Dental plaque happens to be a diverse community of the microorganisms found on the tooth surface. Periodontal disease and the peri-implant disease are specific infections that are originating from these resident microbial species when the balance between the host and the microbial pathogenicity gets disrupted. This review discusses the biofilms in relation to the peri-implant region, factors affecting its presence, and the associated treatment to manage this complex microbial colony. Search Methodology: Electronic search of the medline was done with the search words: Implants and biofilms/dental biofilm formation/microbiology at implant abutment interface/surface free energy/roughness and implant, periimplantitis/local drug delivery and dental implant. Hand search across the journals – clinical oral implant research, implant dentistry, journal of dental research, international journal of oral implantology, journal of prosthetic dentistry, perioodntology 2000, journal of periodontology were performed. The articles included in the review comprised of in vivo studies, in vivo (animal and human) studies, abstracts, review articles. PMID:23633764
Nishimura, K; Itoh, T; Takaki, K; Hosokawa, R; Naito, T; Yokota, M
The aim of this study was to evaluate the periodontal parameters of osseointegrated dental implants. The condition of the peri-implant mucosa was assessed using periodontal parameters, i.e., of plaque index, bleeding on probing, probing pocket depth, probing attachment level and Periotest scores as well as a radiographic parameter, over a 4-year follow-up period. 32 non-submerged ITI dental implants, all placed in the mandible, were studied in 12 patients who had good oral hygiene. All patients were regularly recalled at 6-month intervals. The overall implant success rate was 100%. None of the implants showed any signs of inflammation, radiographic bone loss or any detectable mobility during the follow-up period. Methods similar to those used to evaluate the natural dentition were effectively employed to assess the clinical status of the dental implants. The diagnostic value of these parameters could not, however, be determined from this study due to the absence of any peri-implant tissue complications. The results indicated that some periodontal parameters of healthy peri-implant mucosa might be slightly different from healthy periodontal tissue.
Cutando, Antonio; Gómez-Moreno, Gerardo; Arana, Carlos; Muñoz, Fernando; Lopez-Peña, Mónica; Stephenson, Jean; Reiter, Russel J
The aim of this study was to evaluate the effect of the topical application of melatonin on osteointegration of dental implants in Beagle dogs 14 days after their insertion. In preparation for subsequent insertion of dental implants, upper and lower premolars and molars were extracted from 12 Beagle dogs. Each mandible received cylindrical screw implants of 3.25 mm in diameter and 10 mm in length. The implants were randomly assigned to the mesial and distal sites on each side of the mandible. Prior to implanting, 1.2 mg lyophylized powdered melatonin was applied to one bone hole at each side of the mandible. None was applied at the control sites. Eight histological sections per implant were obtained for histomorphometric studies. After a 2-wk treatment period, melatonin significantly increased the perimeter of bone that was in direct contact with the treated implants (P < 0.0001), bone density (P < 0.0001), new bone formation (P < 0.0001) and inter-thread bone (P < 0.05) in comparison with control implants. Topical application of melatonin may act as a biomimetic agent in the placement of endo-osseous dental implants.
Lobbezoo, F; Brouwers, J E I G; Cune, M S; Naeije, M
Bruxism (teeth grinding and clenching) is generally considered a contraindication for dental implants, although the evidence for this is usually based on clinical experience only. So far, studies to the possible cause-and-effect relationship between bruxism and implant failure do not yield consistent and specific outcomes. This is partly because of the large variation in the literature in terms of both the technical aspects and the biological aspects of the study material. Although there is still no proof for the suggestion that bruxism causes an overload of dental implants and of their suprastructures, a careful approach is recommended. There are a few practical guidelines as to minimize the chance of implant failure. Besides the recommendation to reduce or eliminate bruxism itself, these guidelines concern the number and dimensions of the implants, the design of the occlusion and articulation patterns, and the protection of the final result with a hard occlusal stabilization splint (night guard).
Penarrocha, M; Guarinos, J; Sanchis, J-M; Balaguer, J
Implantation is a common practice in the oral rehabilitation of edentulous patients, affording good results in extensive patient series. The aim was to determine the average success rate and analyze the causes of implant failure. In the present retrospective study (1994-1999) a total of 441 ITI(r) implants were performed in 114 patients (58 females (51%) and 56 males (49%) aged 44.5 years on average; range 12-82 years), with a mean follow-up of 2.3 1.3 years. Data recorded included patient age and sex, smoking habit, oral hygiene, the number, length, diameter and type of implants, their location and the prostheses fitted. After 2.3 1.3 years of follow-up, the implant success rate was 96.2%. In 7 patients a total of 15 implants failed during the osseointegration period, while in two patients a total of two implants failed following dentures placement. The failures were mainly attributed to over-drilling during the surgical procedure, or to an overloading upon tightening in the osseointegration period. No significant relation was observed between implant loss and the rest of the clinical parameters studied, with the sole exception of implant length (failure increasing with shorter lengths)(chi-square; p = 0.001).
Lee, Angie; Wang, Hom-Lay
Oral biofilm-related diseases such as periodontal and peri-implant diseases are unique infections in that they develop from the resident indigenous microflora. As more implants are nowadays being placed, clinicians may encounter more complications. Therefore, understanding the etiology is warranted to establish adequate diagnosis and provide proper treatment. This article focuses on understanding peri-implant microbiology and its roles in peri-implant diseases.
L'Homme-Langlois, Emilie; Yilmaz, Burak; Chien, Hua-Hong; McGlumphy, Edwin
A common complication in implant dentistry is unintentional implant screw loosening. The critical factor in the prevention of screw loosening is the delivery of the appropriate target torque value. Mechanical torque-limiting devices (MTLDs) are the most frequently recommended devices by the implant manufacturers to deliver the target torque value to the screw. Two types of MTLDs are available: friction-style and spring-style. Limited information is available regarding the influence of device type on the accuracy of MTLDs. The purpose of this study was to determine and compare the accuracy of spring-style and friction-style MTLDs. Five MTLDs from 6 different dental implant manufacturers (Astra Tech/Dentsply, Zimmer Dental, Biohorizons, Biomet 3i, Straumann [ITI], and Nobel Biocare) (n=5 per manufacturer) were selected to determine their accuracy in delivering target torque values preset by their manufacturers. All torque-limiting devices were new and there were 3 manufacturers for the friction-style and 3 manufacturers for the spring-style. The procedure of target torque measurement was performed 10 times for each device and a digital torque gauge (Chatillon Model DFS2-R-ND; Ametek) was used to record the measurements. Statistical analysis used nonparametric tests to determine the accuracy of the MTLDs in delivering target torque values and Bonferroni post hoc tests were used to assess pairwise comparisons. Median absolute difference between delivered torque values and target torque values of friction-style and spring-style MTLDs were not significantly different (P>.05). Accuracy of Astra Tech and Zimmer Dental friction-style torque-limiting devices were significantly different than Biohorizons torque-limiting devices (P<.05). There is no difference between the accuracy of new friction-style MTLDs and new spring-style MTLDs. All MTLDs fell within ±10% of the target torque value. Astra Tech and Zimmer Dental friction-style torque-limiting devices were significantly
...) Classification. (1) Class II (special controls). The device is classified as class II if it is a root-form endosseous dental implant. The root-form endosseous dental implant is characterized by four geometrically... II Special Controls Guidance Document: Root-Form Endosseous Dental Implants and Endosseous...
...) Classification. (1) Class II (special controls). The device is classified as class II if it is a root-form endosseous dental implant. The root-form endosseous dental implant is characterized by four geometrically... II Special Controls Guidance Document: Root-Form Endosseous Dental Implants and Endosseous...
...) Classification. (1) Class II (special controls). The device is classified as class II if it is a root-form endosseous dental implant. The root-form endosseous dental implant is characterized by four geometrically... II Special Controls Guidance Document: Root-Form Endosseous Dental Implants and Endosseous...
Siadat, Hakimeh; Alikhasi, Marzieh; Beyabanaki, Elaheh
Dental implants have become a popular treatment modality for replacing missing teeth. In this regard, the importance of restoring patients with function during the implant healing period has grown in recent decades. Esthetic concerns, especially in the anterior region of the maxilla, should also be considered until the definitive restoration is delivered. Another indication for such restorations is maintenance of the space required for esthetic and functional definitive restorations in cases where the implant site is surrounded by natural teeth. Numerous articles have described different types of interim prostheses and their fabrication techniques. This article aims to briefly discuss all types of implant-related interim prostheses by different classification including provisional timing (before implant placement, after implant placement in unloading and loading periods), materials, and techniques used for making the restorations, the type of interim prosthesis retention, and definitive restoration. Furthermore, the abutment torque for such restorations and methods for transferring the soft tissue from interim to definitive prostheses are addressed.
Tomsia, Antoni P.; Launey, Maximilien E.; Lee, Janice S.; Mankani, Mahesh H.; Wegst, Ulrike G.K.; Saiz, Eduardo
The combined requirements imposed by the enormous scale and overall complexity of designing new implants or complete organ regeneration are well beyond the reach of present technology in many dimensions, including nanoscale, as we do not yet have the basic knowledge required to achieve these goals. The need for a synthetic implant to address multiple physical and biological factors imposes tremendous constraints on the choice of suitable materials. There is a strong belief that nanoscale materials will produce a new generation of implant materials with high efficiency, low cost, and high volume. The nanoscale in materials processing is truly a new frontier. Metallic dental implants have been successfully used for decades but they have serious shortcomings related to their osseointegration and the fact that their mechanical properties do not match those of bone. This paper reviews recent advances in the fabrication of novel coatings and nanopatterning of dental implants. It also provides a general summary of the state of the art in dental implant science and describes possible advantages of nanotechnology for further improvements. The ultimate goal is to produce materials and therapies that will bring state-of-the-art technology to the bedside and improve quality of life and current standards of care. PMID:21464998
Tomisa, Antoni P; Launey, Maximilien E; Lee, Janice S; Mankani, Mahesh H; Wegst, Ulrike G K; Saiz, Eduardo
The requirements imposed by the enormous scale and overall complexity of designing new implants or complete organ regeneration are well beyond the reach of present technology in many dimensions, including nanoscale, as researchers do not yet have the basic knowledge required to achieve these goals. The need for a synthetic implant to address multiple physical and biologic factors imposes tremendous constraints on the choice of suitable materials. There is a strong belief that nanoscale materials will produce a new generation of implant materials with high efficiency, low cost, and high volume. The nanoscale in materials processing is truly a new frontier. Metallic dental implants have been used successfully for decades, but they have serious shortcomings related to their osseointegration and the fact that their mechanical properties do not match those of bone. This paper reviews recent advances in the fabrication of novel coatings and nanopatterning of dental implants. It also provides a general summary of the state of the art in dental implant science and describes possible advantages of nanotechnology for future improvements. The ultimate goal is to produce materials and therapies that will bring state-of-the-art technology to the bedside and improve quality of life and current standards of care.
Babu RS, Arvind; Ogle, Orrett
Tissue response represents an important feature in biocompatibility in implant procedures. This review article highlights the fundamental characteristics of tissue response after the implant procedure. This article also highlights the tissue response in compromised osseous conditions. Understanding the histologic events after dental implants in normal and abnormal bone reinforces the concept of case selection in dental implants.
Annibali, S; Cristalli, M P; Dell'Aquila, D; Bignozzi, I; La Monaca, G; Pilloni, A
Growing evidence has suggested the utility of short dental implants for oral reconstructive procedures in clinical situations of limited vertical bone height. The aim of this review was to systematically evaluate clinical studies of implants < 10 mm in length, to determine short implant-supported prosthesis success in the atrophic jaw. Implant survival, incidence of biological and biomechanical complications, and radiographic peri-implant marginal bone loss were evaluated. Screening of eligible studies, quality assessment, and data extraction were conducted by two reviewers independently. Meta-analyses were performed by the pooling of survival data by implant surface, surgical technique, implant location, type of edentulism, and prosthetic restoration. Two randomized controlled trials and 14 observational studies were selected and analyzed for data extraction. In total, 6193 short-implants were investigated from 3848 participants. The observational period was 3.2 ± 1.7 yrs (mean ± SD). The cumulative survival rate (CSR) was 99.1% (95%CI: 98.8-99.4). The biological success rate was 98.8% (95%CI: 97.8-99.8), and the biomechanical success rate was 99.9% (95%CI: 99.4-100.0). A higher CSR was reported for rough-surfaced implants. The provision of short implant-supported prostheses in patients with atrophic alveolar ridges appears to be a successful treatment option in the short term; however, more scientific evidence is needed for the long term.
Mehrali, Mehdi; Shirazi, Farid Seyed; Mehrali, Mohammad; Metselaar, Hendrik Simon Cornelis; Kadri, Nahrizul Adib Bin; Osman, Noor Azuan Abu
Functionally graded material (FGM) is a heterogeneous composite material including a number of constituents that exhibit a compositional gradient from one surface of the material to the other subsequently, resulting in a material with continuously varying properties in the thickness direction. FGMs are gaining attention for biomedical applications, especially for implants, owing to their reported superior composition. Dental implants can be functionally graded to create an optimized mechanical behavior and achieve the intended biocompatibility and osseointegration improvement. This review presents a comprehensive summary of biomaterials and manufacturing techniques researchers employ throughout the world. Generally, FGM and FGM porous biomaterials are more difficult to fabricate than uniform or homogenous biomaterials. Therefore, our discussion is intended to give the readers about successful and obstacles fabrication of FGM and porous FGM in dental implants that will bring state-of-the-art technology to the bedside and develop quality of life and present standards of care.
Becker, Stephan T; Föge, Marc; Beck-Broichsitter, Benedicta E; Gavrilova, Olga; Bolte, Hendrik; Rosenstiel, Philipp; Wiltfang, Jörg
Development, progression, and therapy of periimplantitis are nonresolved emerging problems. The aim of this pilot study was to establish a model for periimplantitis in mice to have a base for tests with immune-deficient knockout organisms to improve the knowledge about development and progression of periimplantitis and to develop further therapeutic options.In 8 mice, titanium implants were inserted in the median of the palate. Four of these implants had ligatures (periimplantitis group). After 2 weeks, the animals received a special diet enriched with sugar and flavor. After 9 weeks, micro-computed tomography (micro-CT) examinations to evaluate the periimplant tissue and histologies were performed.Dental implant insertions within the oral cavity are possible in living mice. Implants with ligatures showed significantly larger periimplant bone defects than controls. The radiologic findings were confirmed by histology. At the end of the observation period, the portion of implants lost was higher in the ligature group.This is the first publication to describe the insertion of dental implants in living mice. In addition, it is the first time that periimplant infection could be induced in that species. This model will pave the way to study knockout mice with reduced or even enhanced resistance to periimplantitis.
Wang, Guihua; Gao, Xiaoli; Lo, Edward C M
Dental implants have become a popular option for treating partially dentate or edentulous patients. Information on dental implants is widely available in the public domain and is disseminated through industries and dental practitioners at various levels/disciplines. This qualitative study aimed to evaluate the public's information acquisition and their perceptions of dental implants and the effects of these on their care-seeking and decision making. A purposive sample of 28 adults were recruited to join six focus groups. To be eligible, one must be 35-64 years of age, had never been engaged in dentally related jobs, had at least one missing tooth, and had heard about dental implant but never received dental implant or entered into any dental consultation regarding dental implants. All of the focus groups discussions were transcribed verbatim and subjected to thematic content analysis following a grounded theory approach. Participants acquired information on dental implants through various means, such as patient information boards, printed advertisements, social media, and personal connections. They expected dental implants to restore the patients' appearance, functions, and quality of life to absolute normality. They regarded dental implants as a panacea for all cases of missing teeth, overestimated their functions and longevity, and underestimated the expertise needed to carry out the clinical procedures. They were deterred from seeking dental implant treatment by the high price, invasive procedures, risks, and complications. Members of the public were exposed to information of varying quality and had some unrealistic expectations regarding dental implants. Such perceptions may shape their care-seeking behaviours and decision-making processes in one way or another. The views and experiences gathered in this qualitative study could assist clinicians to better understand the public's perspectives, facilitate constructive patient-dentist communication, and contribute
Manor, Yifat; Simon, Roy; Haim, Doron; Garfunkel, Adi; Moses, Ofer
Dental implant insertion for oral rehabilitation is a worldwide procedure for healthy and medically compromised patients. The impact of systemic disease risks on the outcome of implant therapy is unclear, since there are few if any published randomized controlled trials (RCTs). The objective of this study is to investigate the rate of complications and failures following dental implantation in medically compromised patients in order to elucidate risk factors and prevent them. A retrospective cohort study was conducted from patient files treated with dental implantation between the years 2008-2014. The study group consisted of medically complex patients while the control group consisted of healthy patients. Preoperative, intraoperative, and post operative clinical details were retrieved from patients' files. The survival rate and the success rate of the dental implants were evaluated clinically and radiographically. A total of 204 patients (1003 dental implants) were included in the research, in the study group, 93 patients with 528 dental implants and in the control group, 111 patients with 475 dental implants. No significant differences were found between the groups regarding implant failures or complications. The failure rate of dental implants among the patients was 11.8 % in the study group and 16.2 % in the control group (P = 0.04). It was found that patients with a higher number of implants (mean 6.8) had failures compared with patients with a lower number of implants (mean 4.2) regardless of their health status (P < 0.01). We found a similar rate of failure and complications of dental implantation in medically complex patients and in healthy patients. Medically complex patients can undergo dental implantation. There are similar rates of complications and failures of dental implants in medically complex patients and in healthy patients.
Jacobson, J.; And Others
A measure of dental patients' values and preferences was used to assess attitudes of 92 edentulous patients receiving implant and other dental reconstructive therapies. The implant group tended to be younger and better educated and to rate implant reconstruction as more desirable than the nonimplant denture group. (DB)
Jacobson, J.; And Others
A measure of dental patients' values and preferences was used to assess attitudes of 92 edentulous patients receiving implant and other dental reconstructive therapies. The implant group tended to be younger and better educated and to rate implant reconstruction as more desirable than the nonimplant denture group. (DB)
University of Science and Technology, Tehran, IRAN Abstract- Implantology has a widespread application in dental cases these days. Although the life...System, in Mackinny RV: Endosteal Dental Implant, Mosby Year Book, 1991  Weiss M, Titanium Fiber-Mesh Metal Implant, J. Oral Implantology , 1986...STRESS ANALYSIS ON THE BONE AROUND FIVE DIFFERENT DENTAL IMPLANTS S. M. Rajaai, S. Khorrami-mehr School of mechanical Engineering Iran
Smith, L P; Rose, T
Explantation of failed dental implants has traditionally been performed by mechanical bone removal techniques. The advent of intraoral laser surgery has seen increasing numbers of applications in oral implantology. The technique demonstrates safe and efficient explantation of a failed dental implant using Er,Cr:YSGG laser. Laser assisted explantation of dental implants is a minimally invasive technique providing an alternative to conventional mechanical explantation techniques.
Despite the recent economic downturn, the dental implant market continues to grow year on year. Many more dentists are involved in the placement restoration of dental implants and dental implants are being placed in an extended range of clinical scenarios. Dental implant therapy remains a high risk area for the inexperienced interns of civil negligence claims and General Dental Council hearings. Risk can be mitigated by:• Ensuring appropriate indemnity • Complying with the published requirements for training • Maintaining detailed and extensive clinical records • Completing the initial phases of history, examination and investigations robustly • Recording a diagnosis • Providing a bespoke written treatment plan that includes details of the need for treatment, the treatment options (the risks and benefits), the phases of treatment, the costs of treatment,the expected normal sequelae of surgery, the risks and complications of implant therapy and the requirement for future maintenance. The provision of treatment that is different in nature or extent to that agreed can result in a breach of contract as well as a claim for negligence • Engaging sufficiently with the patient to obtain consent • Providing written postoperative instructions detailing emergency arrangements, patients who are anxious or in pain may not retain oral information • Making a frank disclosure of complication or collateral damage • Considering referral at an early stage particularly if reparative surgery is required. The stress of complications or failure may impair a dentist's normally sound judgement; there may be financial pressure, or concerns regarding reputation. In some cases, dentists avoid making a frank disclosure, feel obliged to undertake complicated reparative surgery, fail to make a timely referral, fail to respond appropriately to patient's concerns and in some cases attempt to alter the clinical records.However, in the best of hands and without negligence
Assal, Patrick A
Zirconia is currently extensively used in medicine, especially in orthopedic surgery for various joint replacement appliances. Its outstanding mechanical and chemical properties have made it the "material of choice" for various types of prostheses. Its color in particular makes it a favored material to manufacture dental implants. A literature search through Medline enables one to see zirconia's potential but also to point out and identify its weaknesses. The search shows that zirconia is a biocompatible, osteoconductive material that has the ability to osseointegrate. Its strength of bonding to bone depends on the surface structure of the implant. Although interesting, the studies do not allow for the recommendation of the use of zirconia implants in daily practice. The lack of studies examining the chemical and structural composition of zirconia implants does not allow for a "gold standard" to be established in the implant manufacturing process. Randomized clinical trials (RCT) are urgently needed on surface treatments of zirconia implants intended to achieve the best possible osseointegration.
Prawoko, S. S.; Nelwan, L. C.; Odang, R. W.; Kusdhany, L. S.
The histomorphometric test is the gold standard for dental implant stability quantification; however, it is invasive, and therefore, it is inapplicable to clinical patients. Consequently, accurate and objective alternative methods are required. Resonance frequency analysis (RFA) and digital radiographic analysis are noninvasive methods with excellent objectivity and reproducibility. To analyze the correlation between the radiographic analysis of alveolar bone density around a dental implant and the resonance frequency of the dental implant. Digital radiographic images for 35 samples were obtained, and the resonance frequency of the dental implant was acquired using Osstell ISQ immediately after dental implant placement and on third-month follow-up. The alveolar bone density around the dental implant was subsequently analyzed using SIDEXIS-XG software. No significant correlation was reported between the alveolar bone density around the dental implant and the resonance frequency of the dental implant (r = -0.102 at baseline, r = 0.146 at follow-up, p > 0.05). However, the alveolar bone density and resonance frequency showed a significant difference throughout the healing period (p = 0.005 and p = 0.000, respectively). Conclusion: Digital dental radiographs and Osstell ISQ showed excellent objectivity and reproducibility in quantifying dental implant stability. Nonetheless, no significant correlation was observed between the results obtained using these two methods.
Dewi, R. S.; Odang, R. W.; Odelia, L.
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.
Clark, Danielle; Levin, Liran
Although dental implants are proven to be a predictable longterm treatment for patients, it is important to realize that not all implants that survive are necessarily successful. Successful implants are those that remain fully functional and healthy within the oral cavity. Peri-implantitis is a disease that is associated with implant failure, and is becoming rather prevalent. Assessing risk factors and stabilizing existing oral disease prior to the placement of implants will aid in preventing implant disease and failure. After implant placement, a strict follow-up regime with a dental professional should be implemented in order to monitor the implant and surrounding teeth for disease. The dental professional should continually encourage the patient to adhere to consistent homecare to prevent peri-implantitis from occurring, and in turn increase the success of their implants. Early diagnosis and elimination of inflammatory processes around the implants will improve the longterm prognosis as well.
Schwitalla, Andreas; Müller, Wolf-Dieter
The insertion of dental implants containing titanium can be associated with various complications (eg, hypersensitivity to titanium). The aim of this article is to evaluate whether there are existing studies reporting on PEEK (polyetheretherketone) as an alternative material for dental implants. A systematic literature search of PubMed until December 2010 yielded 3 articles reporting on dental implants made from PEEK. One article analyzed stress distribution in carbon fiber-reinforced PEEK (CFR-PEEK) dental implants by the 3-dimensional finite element method, demonstrating higher stress peaks due to a reduced stiffness compared to titanium. Two articles reported on investigations in mongrel dogs. The first article compared CFR-PEEK to titanium-coated CFR-PEEK implants, which were inserted into the femurs and evaluated after 4 and 8 weeks. The titanium-coated implants showed significantly higher bone-implant contact (BIC) rates. In a second study, implants of pure PEEK were inserted into the mandibles beside implants made from titanium and zirconia and evaluated after 4 months, where PEEK presented the lowest BIC. The existing articles reporting on PEEK dental implants indicate that PEEK could represent a viable alternative material for dental implants. However, further experimental studies on the chemical modulation of PEEK seem to be necessary, mainly to increase the BIC ratio and to minimize the stress distribution to the peri-implant bone.
Rizzo, Piervincenzo; Tabrizi, Aydin; Berhanu, Bruk; Ochs, Mark W.
The robustness and reliability of two nondestructive evaluation methods to assess dental prostheses stability is presented. The study aims at addressing an increasing need in the biomedical area where robust, reliable, and noninvasive methods to assess the bone-interface of dental and orthopedic implants are increasingly demanded for clinical diagnosis and direct prognosis. The methods are based on the electromechanical impedance method and on the propagation of solitary waves. Nobel Biocare® 4.3 x 13 mm implants were entrenched inside bovine rib bones that were immersed inside Normal Saline for 24 hours before test in order to avoid dehydration and simulating physiologic osmolarity of the corticocancellous bone and plasma. Afterwards the bones were immersed in a solution of nitric acid to allow material degradation, inversely simulating a bone-healing process. This process was monitored by bonding a Piezoceramic Transducer (PZT) to the abutment and measuring the electrical admittance of the PZT over time. On the other hand the bones calcium loss was calculated after immersing in acid by Atomic Absorption Spectroscopy over time for comparison. Moreover a novel transducer based on the generation and detection of highly nonlinear solitary waves was used to assess the stiffness of the abutment-implant bone. In these experiments it was found that the PZT's conductance and some of the solitary waves parameters are sensitive to the degradation of the bones and was correlated to the bone calcium loss over time.
Aljohani, Hind Ahmed; AlGhamdi, Ali Saad Thafeed
Objective In June 2008, a survey of freshly graduated dental students of King Abdulaziz University Jeddah was conducted to evaluate the extent of their exposure to oral implantology and their knowledge of some basic principles of dental implant treatment. Materials and methods Multiple-choice questionnaires were given to the fresh graduate dental students of King Abdulaziz University Jeddah to answer. Sixty-six students responded out of 86, yielding a response rate of 76.7%. Results Majority of the students (78.8%) thought that they did not have enough lectures about dental implants and all of them thought that they did not have enough training in dental implant. Most of the students were not familiar with different dental implant systems (61.1%), designs (60.6%) or sizes (74.2%). Majority of the students were lacking the knowledge about basic principles of dental implant treatment. At King Abdulaziz University, Faculty of Dentistry, implant dentistry is taught to the students in the form of implant-related lectures incorporated into their periodontic, oral surgery and prosthodontic courses with one or two lectures given on dental implant in each course. Conclusion There is an urgent need to develop a well-structured implant course that includes didactic, laboratory, preclinical and clinical components at the undergraduate curriculum of King Abdulaziz University Faculty of Dentistry. PMID:23960472
Enkling, Norbert; Hardt, Katharina; Katsoulis, Joannis; Ramseier, Christoph A; Colombo, Alessandra; Jöhren, Peter; Mericske-Stern, Regina
Dental phobia is a psychological disease and a possible contraindication for implant therapy. The study aimed to show that implant therapy in dental-phobic patients (DP, test group) after adequate psychological and dental pretreatment (PDPT) is successfully possible and results in a similar implant prognosis as in nonfearful patients (NF, control group). 15 DP with PDPT and 15 NF were treated with dental implants and were re-evaluated 2 to 4 years after denture-mounting regarding: alteration of dental anxiety (Hierarchical Anxiety Questionnaire [HAQ], Visual Analog Scale [VAS]), patient satisfaction and compliance, implant success, and peri-implant health. Statistical tests of non-inferiority DP versus NF were performed with Hodges-Lehmann estimators and respective one-sided 97.5% confidence intervals of Moses, and pairwise testings with Mann-Whitney test. The DP test group rated its anxiety significantly lower at follow- up than at baseline (PHAQ < .001). However, at follow-up, anxiety was still higher in DP than in NF (PHAQ = .046; PVAS < .001). Implant success at follow-up was 100%. Oral health was equally good in DP and NF patients. At follow-up, all patients were satisfied with implant therapy, but compliance was better for NF (100%) than for DP (73% dental checkup; 67% dental hygienist). Implant therapy can be successfully performed in DP patients with PDPT as phobia is not negatively influenced by the invasive implant therapy. However, motivation for professional maintenance programs remains challenging.
Aunmeungtong, Weerapan; Kumchai, Thongnard; Strietzel, Frank P; Reichart, Peter A; Khongkhunthian, Pathawee
Dental implant-retained overdentures have been chosen as the treatment of choice for complete mandibular removable dentures. Dental implants, such as mini dental implants, and components for retaining overdentures, are commercially available. However, comparative clinical studies comparing mini dental implants and conventional dental implants using different attachment for implant-retained overdentures have not been well documented. To compare the clinical outcomes of using two mini dental implants with Equator(®) attachments, four mini dental implants with Equator attachments, or two conventional dental implants with ball attachments, by means of a randomized clinical trial. Sixty patients received implant-retained mandibular overdentures in the interforaminal region. The patients were divided into three groups. In Groups 1 and 2, two and four mini dental implants, respectively, were placed and immediately loaded by overdentures, using Equator(®) attachments. In Group 3, conventional implants were placed. After osseointegration, the implants were loaded by overdentures, using ball attachments. The study distribution was randomized and double-blinded. Outcome measures included changes in radiological peri-implant bone level from surgery to 12 months postinsertion, prosthodontic complications and patient satisfaction. The cumulative survival rate in the three clinical groups after one year was 100%. There was no significant difference (p < 0.05) in clinical results regarding the number (two or four) of mini dental implants with Equator attachments. However, there was a significant difference in marginal bone loss and patient satisfaction between those receiving mini dental implants with Equator attachments and conventional dental implants with ball attachments. The marginal bone resorption in Group 3 was significantly higher than in Groups 1 and 2 (p < 0.05); there were no significant differences between Groups 1 and 2. There was no significant difference
Monteiro, Douglas R; Silva, Emily V F; Pellizzer, Eduardo P; Filho, Osvaldo Magro; Goiato, Marcelo C
To discuss important characteristics of the use of dental implants in posterior quadrants and the rehabilitation planning. An electronic search of English articles was conducted on MEDLINE (PubMed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations (bone quantity and density), radiographic techniques, implant selection (number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.
Zhang, Yan-ping; Liang, Na
50 cases, totally 56 horizontally impacted teeth were extracted using dental implanter to remove the alveolar bone. Another 56 horizontally impacted teeth were extracted using high speed turbine.It's concluded that is a safe and easy way using the dental implanter to remove the horizontally impacted teeth, and the reaction and the complications could be minimized.
Bilhan, Hakan; Bural, Canan; Geckili, Onur
Titanium and its alloys have been widely used for dental prosthetic devices because of their superior mechanical properties and biocompatibility. However, the incidence of titanium hypersensitivity or allergy is still unknown and the discussion about its existence is ongoing. Unexplained implant failures have also forced dental clinicians to investigate the possibility of titanium hypersensitivity or allergy. This review focuses on the potential of dental implant-related titanium hypersensitivity or allergic reactions. It includes an examination of the existing scientific literature and current knowledge. Evidence-based data and studies related to titanium hypersensitivity in dental implant patients are also discussed.
Atsuta, Ikiru; Ayukawa, Yasunori; Kondo, Ryosuke; Oshiro, Wakana; Matsuura, Yuri; Furuhashi, Akihiro; Tsukiyama, Yoshihiro; Koyano, Kiyoshi
The aim of this study was to provide an overview on the biology and soft tissue sealing around dental implants and teeth. This is a narrative review performed through scientific articles published between 1977 and 2014, indexed in MEDLINE and PubMed databases. The study selected articles that focused on epithelial sealing around dental implant or teeth with cell biology and histology of soft tissue. Implant therapy has been widely applied in dental rehabilitation for many years, with predictable long-term results. The longevity and functionality of dental implants is dependent on both osseointegration around the implant body and the establishment of a soft tissue barrier that protects the underlying hard tissue structures and the implant itself. The health and stability of the peri-implant mucosa also affects the esthetics of the implant. The healing and maintenance of the epithelial and connective tissues around implants are increasingly recognized as being fundamental to implant success. However, there has been little research into the function or formation of the soft tissue seal around dental implants, and the roles of this unique mucosal interface remain unclear. This narrative review explores the extent of the current knowledge of soft tissue barriers around implants from both a basic and clinical perspective, and aims to consolidate this knowledge and highlight the most pertinent questions relating to this area of research. Copyright © 2015 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
Lemos, Cleidiel Aparecido Araujo; Ferro-Alves, Marcio Luiz; Okamoto, Roberta; Mendonça, Marcos Rogério; Pellizzer, Eduardo Piza
The purpose of the present systematic review and meta-analysis was to compare short implants (equal or less than 8mm) versus standard implants (larger than 8mm) placed in posterior regions of maxilla and mandible, evaluating survival rates of implants, marginal bone loss, complications and prosthesis failures. This review has been registered at PROSPERO under the number CRD42015016588. Main search terms were used in combination: dental implant, short implant, short dental implants, short dental implants posterior, short dental implants maxilla, and short dental implants mandible. An electronic search for data published up until September/2015 was undertaken using the PubMed/Medline, Embase and The Cochrane Library databases. Eligibility criteria included clinical human studies, randomized controlled trials and/or prospective studies, which evaluated short implants in comparison to standard implants in the same study. The search identified 1460 references, after inclusion criteria 13 studies were assessed for eligibility. A total of 1269 patients, who had received a total of 2631 dental implants. The results showed that there was no significant difference of implants survival (P=.24; RR:1.35; CI: 0.82-2.22), marginal bone loss (P=.06; MD: -0.20; CI: -0.41 to 0.00), complications (P=.08; RR:0.54; CI: 0.27-1.09) and prosthesis failures (P=.92; RR:0.96; CI: 0.44-2.09). Short implants are considered a predictable treatment for posterior jaws. However, short implants with length less than 8 mm (4-7 mm) should be used with caution because they present greater risks to failures compared to standard implants. Short implants are frequently placed in the posterior area in order to avoid complementary surgical procedures. However, clinicians need to be aware that short implants with length less than 8mm present greater risk of failures. Copyright © 2016. Published by Elsevier Ltd.
Al Quran, Firas A M; Rashan, Bashar A; Al-Dwairi, Ziad N
The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.
Subramani, Karthikeyan; Jung, Ronald E; Molenberg, Aart; Hammerle, Christoph H F
The aim of this article was to review the current literature with regard to biofilm formation on dental implants and the influence of surface characteristics (chemistry, surface free energy, and roughness) of dental implant and abutment materials and their design features on biofilm formation and its sequelae. An electronic MEDLINE literature search was conducted of studies published between 1966 and June 2007. The following search terms were used: biofilm and dental implants, biofilm formation/plaque bacterial adhesion and implants, plaque/biofilm and surface characteristics/roughness/surface free energy of titanium dental implants, implant-abutment interface and plaque/biofilm, biofilm and supragingival/subgingival plaque microbiology, biofilm/plaque and implant infection, antibacterial/bacteriostatic titanium, titanium nanocoating/nanopatterning, antimicrobial drug/titanium implant. Both in vitro and in vivo studies were included in this review. Fifty-three articles were identified in this review process. The articles were categorized with respect to their context on biofilm formation on teeth and dental implant surfaces and with regard to the influence of surface characteristics of implant biomaterials (especially titanium) and design features of implant and abutment components on biofilm formation. The current state of literature is more descriptive, rather than providing strong data that could be analyzed through meta-analysis. Basic research articles on surface modification of titanium were also included in the review to analyze the applications of such studies on the fabrication of implant surfaces that could possibly decrease early bacterial colonization and biofilm formation. Increase in surface roughness and surface free energy facilitates biofilm formation on dental implant and abutment surfaces, although this conclusion is derived from largely descriptive literature. Surface chemistry and the design features of the implant-abutment configuration also
Zheng, Hui; Xu, Lixin; Wang, Zicheng; Li, Lianshuo; Zhang, Jieni; Zhang, Qian; Chen, Ting; Lin, Jiuxiang; Chen, Feng
Dental implants are commonly used to replace missing teeth. However, the dysbiotic polymicrobial communities of peri-implant sites are responsible for peri-implant diseases, such as peri-implant mucositis and peri-implantitis. In this study, we analyzed the microbial characteristics of oral plaque from peri-implant pockets or sulci of healthy implants (n = 10), peri-implant mucositis (n = 8) and peri-implantitis (n = 6) sites using pyrosequencing of the 16S rRNA gene. An increase in microbial diversity was observed in subgingival sites of ailing implants, compared with healthy implants. Microbial co-occurrence analysis revealed that periodontal pathogens, such as Porphyromonas gingivalis, Tannerella forsythia, and Prevotella intermedia, were clustered into modules in the peri-implant mucositis network. Putative pathogens associated with peri-implantitis were present at a moderate relative abundance in peri-implant mucositis, suggesting that peri-implant mucositis an important early transitional phase during the development of peri-implantitis. Furthermore, the relative abundance of Eubacterium was increased at peri-implantitis locations, and co-occurrence analysis revealed that Eubacterium minutum was correlated with Prevotella intermedia in peri-implantitis sites, which suggests the association of Eubacterium with peri-implantitis. This study indicates that periodontal pathogens may play important roles in the shifting of healthy implant status to peri-implant disease. PMID:26077225
Müller, Frauke; Salem, Kamel; Barbezat, Cindy; Herrmann, François R; Schimmel, Martin
Despite their unrivalled place in restorative treatment, dental implants are still scarcely used in elderly patients. The aim of this survey was therefore to identify potential barriers for accepting an implant treatment. Participants were recruited from a geriatric hospital, two long-term-care facilities and a private clinic. The final study sample comprised 92 persons, 61 women and 31 men with an average age of 81.2 ± 8.0 years. In a semi-structured interview, the participants' knowledge of implants and attitude towards a hypothetical treatment with dental implants were evaluated. Twenty-seven participants had never heard of dental implants, and another 13 participants could not describe them. The strongest apprehensions against implants were cost, lack of perceived necessity and old age. Univariate and multiple linear regression analysis identified being women, type and quality of denture, having little knowledge on implants and being hospitalised as the risk factors for refusing implants. However, old age as such was not associated with a negative attitude. The acceptance of dental implants in the elderly population might be increased by providing further information and promoting oral health in general. Regardless of the age, dental implants should be placed when patients are still in good health and live independently. © 2011 The Gerodontology Society and John Wiley & Sons A/S.
Coelho, Paulo G; Granjeiro, José M; Romanos, George E; Suzuki, Marcelo; Silva, Nelson R F; Cardaropoli, Giuseppe; Thompson, Van P; Lemons, Jack E
Among dental implant design alterations, surface modifications have been by far the most investigated topic. Regarding implant surface research, the lack of hierarchical approaches relating in vitro, in vivo, clinical trials, and ex vivo analyses has hindered biomaterials scientists with clear informed rationale guidelines for implant surface design. This manuscript provides a critical hierarchical overview of the in vitro, laboratory in vivo, clinical, and ex vivo methodologies used to investigate the performance of novel biomaterials aiming to allow dental professionals to better evaluate the past, present, and future dental implant surface research. This manuscript also contains an overview of the commercially available surface texture and chemistry modifications including novel nanotechnology-based fabrication processes. Over the last decade, surface texturing has been the most utilized parameter for increasing the host-to-implant response. Recently, dental implant surfaces utilizing reduced length scale physico/chemical features (atomic and nanometric) have shown the potential to synergistically use both texture and the inclusion of bioactive ceramic components on the surface. Although surface modifications have been shown to enhance osseointegration at early implantation times, information concerning its long-term benefit to peri-implant tissues is lacking due to the reduced number of controlled clinical trials. Given the various implants/surfaces under study, the clinician should ask, founded on the basic hierarchical approach described for the in vitro, laboratory in vivo data, as well as the results of clinical studies to effectiveness before use of any dental implant.
Cheng, Yung-Chang; Lin, Deng-Huei; Jiang, Cho-Pei
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.
Kwon, Tae-Geon; Lee, Chung-O; Park, Jin-Woo; Choi, So-Young; Rijal, Girdhari; Shin, Hong-In
Bisphosphonate-related jaw necrosis (BRONJ) associated with dental implants is a rare but continuously reported complication. To verify clinical and pathological characteristics of BRONJ around dental implants, the present study analyzed clinical, radiographic and histopathological findings of these lesions. Nineteen patients were diagnosed with osteonecrosis of the jaw associated with dental implants and treated at our institute from 2008 to 2011. The patients' medical history, demographic features, radiographic, and histopathological findings along with information on bisphosphonates (BP) administration were analyzed. The majority of BRONJ patients associated with dental implants used oral BP for osteoporosis. The patients were divided into two groups: BP initiation before (n = 16) and after (n = 3) implant surgery. Only three patients (15.8%) could be regarded as "implant surgery-triggered" BRONJ. Many patients (n = 9) showed successful osteointegration after fixture installation to an average of 35 months (11-82 months) until the development of osteonecrosis. The histological features of the lesion showed that the necrotic bone with empty lacunae was infiltrated by inflammatory cells and bacterial colonies. Viable osteocytes were also observed in some areas of the bony specimens. Three types of bone destruction pattern were observed: (i) complete necrosis of the bone around the implant (frozen type), (ii) extensive osteolysis around the implant with or without sequestra (osteolytic type), and (iii) sequestration of bone with an implant maintaining direct implant-bone contact (en block sequestration type). These findings could be existed at the same lesions depending on the degree of local bone destruction and the severity of the infection. These results and those of others suggested that already osseointegrated dental implants can also cause the osteonecrosis around the implant after BP administration. En block sequestration of bone with implant might be one of
Mendonça, Gustavo; Mendonça, Daniela B S; Aragão, Francisco J L; Cooper, Lyndon F
Current trends in clinical dental implant therapy include use of endosseous dental implant surfaces embellished with nanoscale topographies. The goal of this review is to consider the role of nanoscale topographic modification of titanium substrates for the purpose of improving osseointegration. Nanotechnology offers engineers and biologists new ways of interacting with relevant biological processes. Moreover, nanotechnology has provided means of understanding and achieving cell specific functions. The various techniques that can impart nanoscale topographic features to titanium endosseous implants are described. Existing data supporting the role of nanotopography suggest that critical steps in osseointegration can be modulated by nanoscale modification of the implant surface. Important distinctions between nanoscale and micron-scale modification of the implant surface are presently considered. The advantages and disadvantages of nanoscale modification of the dental implant surface are discussed. Finally, available data concerning the current dental implant surfaces that utilize nanotopography in clinical dentistry are described. Nanoscale modification of titanium endosseous implant surfaces can alter cellular and tissue responses that may benefit osseointegration and dental implant therapy.
Mattheos, N; Janda, M Schittek
As the application of dental implants increases worldwide, so is the number of technical and biological complications that general dental practitioners will be called to manage, while maintaining implant patients. In addition, the greater patient mobility encountered today combined with a growing trend of 'dental implant tourism' will very often result in situations where the dentist is requested to deal with complications in implants placed elsewhere and which sometimes might be of an 'exotic' system one cannot directly recognize. Such a situation can pose significant challenges to even experienced clinicians. The challenges are not only in the scientific field, but often include professional and ethical implications. This case report will discuss strategies for the management of implant complications in cases of unidentified implant systems. Critical factors in such situations would be the clinician's experience and special training, the correct radiographic technique, as well as access to the appropriate tools and devices.
Ramírez, G.; Rodil, S. E.; Arzate, H.; Muhl, S.; Olaya, J. J.
Niobium based thin films were deposited on stainless steel (SS) substrates to evaluate them as possible biocompatible surfaces that might improve the biocompatibility and extend the life time of stainless steel dental implants. Niobium nitride and niobium oxide thin films were deposited by reactive unbalanced magnetron sputtering under standard deposition conditions without substrate bias or heating. The biocompatibility of the surfaces was evaluated by testing the cellular adhesion and viability/proliferation of human cementoblasts during different culture times, up to 7 days. The response of the films was compared to the bare substrate and pieces of Ti6Al4V; the most commonly used implant material for orthopedics and osteo-synthesis applications. The physicochemical properties of the films were evaluated by different means; X-ray diffraction, Rutherford backscattering spectroscopy and contact angle measurements. The results suggested that the niobium oxide films were amorphous and of stoichiometric Nb2O5 (a-Nb2O5), while the niobium nitride films were crystalline in the FCC phase (c-NbN) and were also stoichiometric with an Nb to N ratio of one. The biological evaluation showed that the biocompatibility of the SS could be improved by any of the two films, but neither was better than the Ti6Al4V alloy. On the other hand, comparing the two films, the c-NbN seemed to be a better surface than the oxide in terms of the adhesion and proliferation of human cemetoblasts.
Dubey, Rajendra Kumar; Gupta, Deepesh Kumar; Singh, Amit Kumar
Rising population of diabetic individuals across the world has become a big concern to the society. The persistent hyperglycemia may affect each and every tissue and consequently results in morbidity and eventually mortality in diabetic patients. A direct negative response of diabetes has been observed on oral tissues with few contradictions however, little are known about effect of diabetes on dental implant treatment and the consequent results. Many studies concerned with osteointegration and prognosis of dental implant in diabetic patients have been conducted and published since 1994. These studies have been critically reviewed to understand the impact of diabetes on the success of dental implant and the factors to improve osseointegration and consequently survival of dental implant in diabetic patients. Theoretical literatures and studies in diabetic animals substantiate high failure rate of implants but most of clinical studies indicated statistically insignificant failure of dental implants even in moderately uncontrolled diabetic patients. Success of dental implant in well and fairly controlled diabetic patients with proper treatment planning, prophylactic remedies and adequate postsurgical maintenance appears as good as normal individuals. PMID:24665167
Nevins, Myron; Parma-Benfenati, Stefano; Quinti, Franco; Galletti, Prima; Sava, Cosmin; Sava, Catalin; Kim, David M
The goal of this investigation was to evaluate the efficacy of dental implants with a surface that was sandblasted with large grit and acid etched in a human model. Seven patients volunteered to allow the biopsy of a small implant in exchange for complete dental rehabilitation at no cost. All biopsy sites received soft and hard tissue reconstruction, and this report provides observation of successful bone-to-implant contact and successful prosthesis construction for the patient. The patients enthusiastically reported improved quality of life as a result of participation in this study. The surgeons’ confidence in this implant was reflected by the clinical and histologic result of the study.
Giro, Gabriela; Chambrone, Leandro; Goldstein, Abrao; Rodrigues, Jose Augusto; Zenóbio, Elton; Feres, Magda; Figueiredo, Luciene Cristina; Cassoni, Alessandra; Shibli, Jamil Awad
AIM: To assess the failure and bone-to-implant contact rate of dental implants placed on osteoporotic subjects. METHODS: Extensive examination strategies were created to classify studies for this systematic review. MEDLINE (via PubMed) and EMBASE database were examined for studies in English up to and including May 2014. The examination presented a combination of the MeSH words described as follow: “osteoporosis” or “osteopenia” or “estrogen deficiency” AND “implant” or “dental implant” or “osseointegration”. Assessment of clinical and/or histological peri-implant conditions in osteoporosis subjects treated with titanium dental implants. The examination included a combination of the MeSH terms described as follow: “osteoporosis” or “osteopenia” or “estrogen deficiency” AND “implant” or “dental implant” or “osseointegration”. RESULTS: Of 943 potentially eligible articles, 12 were included in the study. A total of 133 subjects with osteoporosis, 73 subjects diagnosed with osteopenia and 708 healthy subjects were assessed in this systematic review. In these subjects were installed 367, 205, 2981 dental implants in osteoporotic, osteopenic and healthy subjects, respectively. The failure rate of dental implant was 10.9% in osteoporotic subjects, 8.29% in osteopenic and 11.43% in healthy ones. Bone-to-implant contact obtained from retrieved implants ranged between 49.96% to 47.84%, for osteoporosis and non-osteoporotic subjects. CONCLUSION: Osteoporotic subjects presented higher rates of implant loss, however, there is a lower evidence to strengthen or refute the hypothesis that osteoporosis may have detrimental effects on bone healing. Consequently, final conclusions regarding the effect of osteoporosis in dental implant therapy cannot be made at this time. There are no randomized clinical trial accessible for evaluation and the retrospective nature of the evaluated studies shall be taken in account when interpreting this
Morra, Marco; Cassinelli, Clara; Bollati, Daniele; Cascardo, Giovanna; Bellanda, Marco
Osteoimmunology is the crosstalk between cells from the immune and skeletal systems, suggesting a role of pro-inflammatory cytokines in the stimulation of osteoclast activity. Endotoxin or bacterial challenges to inflammatory cells are directly relevant to dental implant pathologies involving bone resorption, such as osseointegration failure and peri-implantitis. While the endotoxin amount on implant devices is regulated by standards, it is unknown whether commercially available dental implants elicit different levels of adherent-endotoxin stimulated cytokines. The objective of this work is to develop a model system and evaluate endotoxin-induced expression of pro-inflammatory cytokine genes relevant to osteoclast activation on commercially available dental implants. Murine J774-A1 macrophages were cultured on Ti disks with different level of lipopolysaccharide (LPS) contamination to define the time-course of the inflammatory response to endotoxin, as evaluated by reverse transcription polymerase chain reaction analysis. The developed protocol was then used to measure adherent endotoxin on commercially available packaged and sterile dental implants in the "as-implanted" condition. Results show that tested dental implants induce variable expression of endotoxin-stimulated genes, sometimes above the level expected to promote bone resorption in vivo. Results are unaffected by the specific surface treatment; rather, they likely reflect care in cleaning and packaging protocols. In conclusion, expression of genes that enhance osteoclast activity through endotoxin stimulation of inflammatory cells is widely different on commercially available dental implants. A reappraisal of the clinical impact of adherent endotoxins on dental (and bone) implant devices is required in light of increasing knowledge on crosstalk between cells from the immune and skeletal systems.
Greenstein, Gary; Cavallaro, John
Over time, the percentage of dental implants that fail increases because of biological and technical issues. Inevitably, clinicians will dedicate more time to dealing with ailing and failing dental implants. The authors searched the literature for articles that addressed diagnostic manifestations of failed implants and reasons for their demise, as well as survival rates of dental implant reimplantations. The authors found that there is no precise cut point (besides 100 percent) with regard to the amount of bone loss in the absence of mobility that indicates an implant has failed. The decision to treat or explant an ailing implant is a judgment call by the treating clinician. Survival rates found in the literature after first and second reimplantations ranged from 71 percent to 100 percent and 50 percent to 100 percent, respectively. The 100 percent findings were based on small groups of implants, and there were scant data addressing implant survival after second reimplantations. The decision to remove an implant needs to be based on clinical assessments, radiographic evaluations or both. If the implant is deemed hopeless, there are devices that facilitate their removal. Furthermore, reimplantations can be performed successfully, but their survival rate appears to be lower than that of implants placed at sites from which they were not lost formerly. Ailing dental implants should not be condemned prematurely, because patients often respond to treatment of peri-implantitis. Many patients desire reimplantations in sites in which implants have failed. This procedure is valuable, especially if it makes possible the fabrication of an implant-supported fixed or removable prosthesis.
Abrahamsson, Kajsa H; Wennström, Jan L; Berglundh, Tord; Abrahamsson, Ingemar
The aim was to explore patients' reactions on being diagnosed with peri-implantitis, their opinions on dental implant therapy and expectations on treatment of the disease. The study subjects were patients referred to a specialist clinic for treatment of peri-implantitis. The method of grounded theory was used in collecting and analyzing data. Audiotaped, thematized open-ended interviews were conducted. The interviews were transcribed verbatim and consecutively analyzed in hierarchical coding processes that continued until saturation was met (n = 15). In the analysis, a conceptual model was generated that illuminated a process among patients. From having very high initial expectations on dental implant therapy as a permanent solution of oral/dental problems, patients realized that dental implants, such as teeth, require continuous care and that there is no guarantee for that dental implants provides a treatment alternative free from future problems. The core concept of the model "altered expectations on dental implant therapy" was composed of three main categories: "initial expectations on dental implant therapy and living with dental implants", "being referred to periodontist and become diagnosed with peri-implantitis" and "investing again in an expensive therapy with no guarantee for the future". Patients may have unrealistically high expectations on dental implant therapy. The results illuminate the importance of patient-centered communication in dentistry and that treatment decisions should be based not only on professional expertise but also on expectations, abilities, wishes and life circumstances of the individual patient. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Monteiro, Douglas R; Silva, Emily V F; Pellizzer, Eduardo P; Filho, Osvaldo Magro; Goiato, Marcelo C
AIM: To discuss important characteristics of the use of dental implants in posterior quadrants and the rehabilitation planning. METHODS: An electronic search of English articles was conducted on MEDLINE (PubMed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations (bone quantity and density), radiographic techniques, implant selection (number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning. PMID:25610852
Sun, Xiaoyan; McKenzie, Frederic D; Bawab, Sebastian; Li, Jiang; Yoon, Yongki; Huang, Jen-K
One of the most important factors affecting the outcome of dental implantation is the accurate insertion of the implant into the patient's jaw bone, which requires a high degree of anatomical accuracy. With the accuracy and stability of robots, image-guided robotics is expected to provide more reliable and successful outcomes for dental implantation. Here, we proposed the use of a robot for drilling the implant site in preparation for the insertion of the implant. An image-guided robotic system for automated dental implantation is described in this paper. Patient-specific 3D models are reconstructed from preoperative Cone-beam CT images, and implantation planning is performed with these virtual models. A two-step registration procedure is applied to transform the preoperative plan of the implant insertion into intra-operative operations of the robot with the help of a Coordinate Measurement Machine (CMM). Experiments are carried out with a phantom that is generated from the patient-specific 3D model. Fiducial Registration Error (FRE) and Target Registration Error (TRE) values are calculated to evaluate the accuracy of the registration procedure. FRE values are less than 0.30 mm. Final TRE values after the two-step registration are 1.42 ± 0.70 mm (N = 5). The registration results of an automated dental implantation system using image-guided robotics are reported in this paper. Phantom experiments show that the practice of robot in the dental implantation is feasible and the system accuracy is comparable to other similar systems for dental implantation.
Dongjoon, Yang; Sukyoung, Kim
Bone cell attachment to Ti implant surfaces is the most concerned issue in the clinical implant dentistry. Many attempts to achieve the fast and strong integration between bone and implant have been tried in many ways, such as selection of materials (for example, Ti, ZrO2), shape design of implant (for example, soft tissue level, bone level, taped or conical, etc), and surface modification of implants (for example, roughed. coated, hybrid), etc. Among them, a major consideration is the surface design of dental implants. The surface with proper structural characteristics promotes or induces the desirable responses of cells and tissues. To obtain such surface which has desirable cell and tissue response, a variety of surface modification techniques has been developed and employed for many years. In this review, the method and trend of surface modification will be introduced and explained in terms of the surface topography and chemistry of dental implants.
Ganz, Scott D
Clinicians worldwide are increasingly adopting guided surgical applications for dental implants. Clinicians are becoming more aware of the benefits of proper planning through advanced imaging modalities and interactive treatment planning applications. All aspects of the planning phase are based on sound surgical and restorative fundamentals. As an integral part of the implant team, dental laboratories have now moved from analog to the digital world, providing the necessary support to the new digital workflow.
Greenberg, Alex M
Oral and maxillofacial surgeons now have extraordinary imaging, software planning, and guide fabrication technologies at their disposal to aid in their case selection, clinical decision making, and surgical procedures for dental implant placement. Cone beam CT has opened a new era of office-based diagnostic capability and responsibility. Improved clinical experiences and evidence-based superior outcomes can be provided with confidence to patients when CT-guided dental implant surgery is used. Copyright © 2015 Elsevier Inc. All rights reserved.
Henningsen, Anders; Smeets, Ralf; Wahidi, Aria; Kluwe, Lan; Kornmann, Frank; Heiland, Max; Gerlach, Till
Immediate loading of dental implants has been proved to be feasible in partially edentulous jaws. The purpose of this retrospective investigation was to assess the feasibility of immediately loading dental implants in fully edentulous jaws. A total of 24 patients aged between 53 and 89 years received a total of 154 implants in their edentulous maxillae or mandibles. Among the implants, 45 were set in fresh extracted sockets and 109 in consolidated alveolar bones. The implants were provisionally managed with chair-side made provisional resin bridges and exposed to immediate loading. Implants were followed up for 1-8 years, including radiographic imaging. Marginal bone levels were evaluated based on radiographic imaging. A total of 148 out of the 154 implants survived over the follow-up period of 1 to 8 years, giving a survival rate of 96%. The time or region of the implantation, the pre-implant augmentation, and the length and diameter of the implants had no statistically significant influence on the survival or the success rate. The marginal bone level remained stable with only minimal loss of 0.3 mm after 60 months of loading. Within the limitations of this study, immediate loading is feasible for dental implants in edentulous jaws.
Purpose Immediate loading of dental implants has been proved to be feasible in partially edentulous jaws. The purpose of this retrospective investigation was to assess the feasibility of immediately loading dental implants in fully edentulous jaws. Methods A total of 24 patients aged between 53 and 89 years received a total of 154 implants in their edentulous maxillae or mandibles. Among the implants, 45 were set in fresh extracted sockets and 109 in consolidated alveolar bones. The implants were provisionally managed with chair-side made provisional resin bridges and exposed to immediate loading. Implants were followed up for 1–8 years, including radiographic imaging. Marginal bone levels were evaluated based on radiographic imaging. Results A total of 148 out of the 154 implants survived over the follow-up period of 1 to 8 years, giving a survival rate of 96%. The time or region of the implantation, the pre-implant augmentation, and the length and diameter of the implants had no statistically significant influence on the survival or the success rate. The marginal bone level remained stable with only minimal loss of 0.3 mm after 60 months of loading. Conclusions Within the limitations of this study, immediate loading is feasible for dental implants in edentulous jaws. PMID:27588213
Nuzzolese, E; Lusito, S; Solarino, B; Di Vella, G
Dental implants for prosthetic rehabilitation with fixed crown or mobile partial/total dentures is a very common oral treatment among the population in Italy as elsewhere. There is a great number of implant systems of different designs. However, a catalogue of radiographic images and a description of the dental implants available in Italy would be useful in order to identify the manufacturer and the type of implant encountered in forensic casework. When an unidentified body is found with one or more implants in the jaws, and no dental record is available, clues gleaned from the type of implants used could give direction to the investigation. In this study Italian implant manufactures were contacted and asked to provide specimen implants. Digital radiographs were taken of all the implants donated at 0º, 30º, and 60º horizontal rotation, combined with -20º, -10º, 0º, +10º, and +20º vertical inclination relative to the radiographic beam and the X-ray sensor. A total of 15 images per implant were taken and examined to identify consistent, unique features that would aid in implant recognition. Only those observations made from radiographs between -10º and +10º vertical inclination would ever be used for definite identification of any implant. The information from this study should be considered a survey of the commercial distribution of dental implants in Italy through their digital radiographic images. It is also a starting point for a wider geographical evaluation of different manufacturers in other countries and continents. The radiographic images provided should help both the forensic odontologist and the prosthodontist to identify pre-existing implants which they may discover from their radiographic images.
Graves, Carmen V.; Harrel, Steve K.; Rossmann, Jeffrey A.; Kerns, David; Gonzalez, Jorge A.; Kontogiorgos, Elias D.; Al-Hashimi, Ibtisam; Abraham, Celeste
Dental implants have become a widely used dental treatment approach. It is important to identify factors that can be detrimental to dental implants and the peri-implant complex. There is controversy regarding whether occlusion plays a role in the implant and peri-implant condition. The present study aims to review the scientific literature regarding this topic. Animal and human studies, and previous reviews on the topic are included and presented. There is a wide heterogeneity among study designs. Several articles demonstrated that occlusion and occlusion overload could detrimentally affect the peri-implant condition, while other articles did not support these results. More studies are needed to help understand the mechanisms by which occlusion might play a role in the peri-implant condition. PMID:27990184
Arbree, Nancy S.; Chapman, Robert J.
A survey of 52 dental schools found that dental implant techniques were taught in 34 pre- and 34 postdoctoral curricula, involving mostly prosthodontics and oral surgery departments, with periodontology departments lagging behind. Most predoctoral programs did not have research involvement. Cooperation among specialties is recommended over implant…
Arbree, Nancy S.; Chapman, Robert J.
A survey of 52 dental schools found that dental implant techniques were taught in 34 pre- and 34 postdoctoral curricula, involving mostly prosthodontics and oral surgery departments, with periodontology departments lagging behind. Most predoctoral programs did not have research involvement. Cooperation among specialties is recommended over implant…
Abraham, Celeste M
This review highlights a brief, chronological sequence of the history of dental implants. This historical perspective begins with ancient civilizations and spotlights predominant dentists and their contributions to implant development through time. The physical, chemical and biologic properties of various dental implant surfaces and coatings are discussed, and specific surface treatments include an overview of machined implants, etched implants, and sand-blasted implants. Dental implant coatings such as hydroxyapatite, fluoride, and statin usage are further reviewed. PMID:24894638
Balaguer-Martí, José-Carlos; Peñarrocha-Oltra, David; Balaguer-Martínez, José
Objective: A review is made of the immediate or immediate postoperative bleeding complications in dental implants, with a view to identifying the areas of greatest bleeding risk, the causes of bleeding, the length of the implants associated with bleeding, the most frequently implicated blood vessels, and the treatments used to resolve these complications. Material and Methods: A Medline (PubMed) and Embase search was made of articles on immediate bleeding complications in dental implants published in English up until May 2014. Inclusion criteria: studies in humans subjects with severe bleeding immediately secondary to implant placement, which reported the time until the hemorrhage, the implant lenght, the possible cause of bleeding and the treatment. Exclusion criteria: patients receiving anticoagulation treatment. Results: Fifteen articles met the inclusion criteria. The area with the largest number of bleeding complications corresponded to the mandibular canine. The cause of bleeding was lingual cortical bone perforation during implant placement, with damage to the sublingual artery. The implants associated with bleeding were those measuring 15 mm in length or more. Management focused on securing the airway (with intubation or tracheostomy if necessary), with bleeding control. Conclusions: It’s important to pay special attention when the implants are placed in the mandibular anterior zone, especially if long implants are used. The most frequently cause of bleeding was the perforation of the lingual plate. Treatment involves securing the airway, with bleeding control. Key words:Hemorrhage, complications, immediate, bleeding, dental implants. PMID:25475779
Ken, Yukawa; Tachikawa, Noriko; Kasugai, Shohei
This aim of this study was to investigate the differences between patients with and without a treatment history of dental implants by use of a questionnaire survey in order to determine the information that is required for patients undergoing dental implants. The questionnaires were given to 4512 patients who visited the Tokyo Medical and Dental University Hospital for oral implants between January 2012 and December 2014, and 2972 (66%) valid questionnaires were collected. There were 857 patients with a treatment history of dental implants and 2115 patients without. "Preservation of an adjacent tooth" was the reason that 32% of these patients chose implant therapy, and the patients without treatment history were significantly higher than the patients with one. Significantly, more patients without a treatment history of dental implants selected the after-effects of surgery and pain after surgery as their main concerns for implant therapy compared to those with a treatment history. In the question "Pain after surgery," the patients without treatment history did not know significantly lower than the patients with one. Patients without a treatment history of dental implants placed more importance on the preservation of healthy teeth. Because patients, in particular those without a treatment history of dental implants, are anxious about surgery, we should provide them with more information on treatment than we already do and explain the risks of treatment to them. To keep the credence between doctors and patients, informed consent and patient education on treatment are six important concerns. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Tawares, Mary; And Others
The study developed a profile of dental implant patients from 38 private practices to document characteristics of endosseous implant recipients of the past 10 years. Data were then analyzed using multivariate techniques to examine the relationship between these characteristics and patient-reported outcomes. Patients tended to have high incomes and…
Tawares, Mary; And Others
The study developed a profile of dental implant patients from 38 private practices to document characteristics of endosseous implant recipients of the past 10 years. Data were then analyzed using multivariate techniques to examine the relationship between these characteristics and patient-reported outcomes. Patients tended to have high incomes and…
Becker, Stephan T; Beck-Broichsitter, Benedicta E; Rossmann, Christian M; Behrens, Eleonore; Jochens, Arne; Wiltfang, Jörg
The aim of this study was to evaluate the long-term dental implant survival rates of Straumann dental implants in a university hospital environment over 12 to 23 years. A total of 388 Straumann dental implants with titanium-sprayed surfaces (TPS) were inserted in 92 patients between 1988 and 1999 in the Department of Oral and Maxillofacial Surgery of the University Hospital Schleswig-Holstein in Kiel, and they were reevaluated with standardized clinical and radiological exams. Kaplan-Meier analyses were performed for individual factors. Cox proportional hazard regression analysis was used to detect the factors influencing long-term implant failure. The long-term implant survival rate was 88.03% after an observation time of 12.2 to 23.5 years. Cox regression revealed statistically significant influences of the International Team for Implantology (ITI) implantation type (p = .00354) and tobacco smoking (p = .01264) on implant failure. A proportion 82.8% of the patients with implant losses had a medical history of periodontitis. Peri-implantitis was diagnosed in 9.7% of the remaining implants in the long-term survey. This study emphasized the long-term rehabilitation capabilities of Straumann dental implants in complex cases. The survival rates after several years constitute important information for patients, as well as for clinicians, in deciding about different concepts of tooth replacement. Patient-related and technical factors - determined before implant placement - could help to predict the risk of implant loss. © 2015 Wiley Periodicals, Inc.
Takamiya, Aline Satie; Goiato, Marcelo Coelho; Gennari Filho, Humberto
Although the long-term success of implant treatment has been well- established, failures can still occur and the smoking habit has been reported as a risk factor for implant loss. A literature review on the effects of smoking on the survival of dental implants was undertaken. Medline database was used to carry out the review with the keywords "osseointegration", "smoking" and "bone healing". The cigarette has more than 4,000 bioactive chemical components with potential toxic effects to human tissues including bone. Nicotine is the main component of the cigarette and it is frequently associated with bone healing failures. Since smoking negatively affects the osseointegration of dental implants, the main target is to quit the consumption of cigarettes. Nevertheless, the smoking habit should not be an absolute contraindication for implant treatment, but, patients should be advised that they are at a greater risk of implant failure.
Nimigean, Victor; Nimigean, Vanda R.; Sǎlǎvǎstru, Dan I.; Moraru, Simona; BuÅ£incu, Lavinia; Ivaşcu, Roxana V.; Poll, Alexandru
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.
Noronha Oliveira, M; Schunemann, W V H; Mathew, M T; Henriques, B; Magini, R S; Teughels, W; Souza, J C M
This study aimed to assess the literature available on the effects, on peri-implant tissues, of degradation products released from dental implants as a consequence of therapeutic treatment for peri-implantitis and/or of wear-corrosion of titanium. A literature review of the PubMed medline database was performed up to December 31, 2016. The following search terms were used: "titanium wear and dental implant"; "titanium corrosion and dental implant"; "bio-tribocorrosion"; "peri-implantitis"; "treatment of peri-implantitis"; "titanium particles release and dental implant"; and "titanium ion release and dental implant". The keywords were applied to the database in different combinations without limits of time period or type of work. In addition, the reference lists of relevant articles were searched for further studies. Seventy-nine relevant scientific articles on the topic were retrieved. The results showed that pro-inflammatory cytokines, infiltration of inflammatory response cells and activation of the osteoclasts activity are stimulated in peri-implant tissues in the presence of metal particles and ions. Moreover, degenerative changes were reported in macrophages and neutrophils that phagocytosed titanium microparticles, and mutations occurred in human cells cultured in medium containing titanium-based nanoparticles. Debris released from the degradation of dental implants has cytotoxic and genotoxic potential for peri-implant tissues. Thus, the amount and physicochemical properties of the degradation products determine the magnitude of the detrimental effect on peri-implant tissues. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Surapaneni, Hemchand; Yalamanchili, Pallavi Samatha; Basha, Md. Hafeez; Potluri, Sushma; Elisetti, Nirupa; Kiran Kumar, M. V.
The routine use of antibiotics in oral implant treatment seems to be widespread. The pre- or post-operative use of antibiotics in conjunction with implant surgery and its correlation with failure and success rates are poorly documented in the literature. The debate regarding overprescription of antibiotics raises the need for a critical evaluation of proper antibiotic coverage in association with implant treatment. The benefits of prophylactic antibiotics are well-recognized in dentistry. However, their routine use in the placement of endosseous dental implants remains controversial. The purpose of this review is to know the efficacy of antibiotic prophylaxis in implant dentistry. PMID:27829741
Smith, L P; Ng, M; Grubor, D; Chandu, A
This study evaluates surgical outcomes and survival rates of implants placed in a multidisciplinary implant teaching programme. A retrospective review of all implant surgery performed over a 6-year period by accredited oral and maxillofacial surgery trainees at the Royal Dental Hospital of Melbourne was undertaken. Patients were reviewed for a minimum of 6 months post-implant placement. Implant survival was defined as those implants which were not removed, were clinically integrated as assessed by torque testing and in an appropriate position to receive a subsequent prosthesis. Kaplan-Meier analysis was used to assess overall survival and univariate factors affecting survival. Multivariate analysis used Cox proportional hazards models. Over 6 years, 127 patients were treated. Follow-up data were present for 105 patients with 236 implants placed. Survival of implants at 1 and 5 years was 94 per cent and 92.8 per cent, respectively. The only univariate and multivariate factor which affected implant survival was perioperative bone grafting. All failed implants were single stage. Other factors such as patient age, smoking status, implant site, anaesthetic type, immediate or delayed placement, implant length and diameter, and medical comorbidities did not significantly affect implant survival. A satisfactory implant survival rate was found in a tertiary teaching centre. Perioperative bone grafting significantly increased the risk of implant failure.
Dhaliwal, Jagjit Singh; Albuquerque, Rubens F; Fakhry, Ali; Kaur, Sukhbir; Feine, Jocelyne S
One-piece narrow diameter implants (NDIs) have been recommended as "Single-tooth replacements in the anterior zones, single posterior, multiple-unit fixed dental prosthesis (FDP), edentulous jaws to be rehabilitated with FDP, and edentulous jaws rehabilitation with overdentures in situations with reduced mesiodistal space or reduced ridge width." (ITI consensus 2013). Since NDIs can be immediately loaded, it is important to be able to carry out stability testing. We developed and validated a customized SmartPeg for this type of implant to measure the Implant Stability Quotient (ISQ). The ISQ of mini dental implants (MDIs) was measured and compared with the stability of standard and in a rabbit model. The aim of the study is to test the feasibility of a customized SmartPeg for resonance frequency measurement of single-piece mini dental implants and to compare primary stability of a standard and the mini dental implant (3M™ESPE™ MDI) in a rabbit model after 6 weeks of healing. Eight New Zealand white rabbits were used for the study. The protocol was approved by the McGill University Animal Ethics Review Board. Sixteen 3M™ESPE™ MDI and equal number of standard implants (Ankylos® Friadent, Dentsply) were inserted into the tibia/femur of the rabbits and compared. Each rabbit randomly received two 3M™ESPE™ MDI and two Ankylos® implants in each leg. ISQ values were measured with the help of an Osstell ISQ device using custom-made SmartPegs for the MDIs and implant-specific SmartPegs™ (Osstell) for the Ankylos®. Measurements were obtained both immediately following implant placement surgery and after a 6-week healing period. Each reading was taken thrice and their average compared using Wilcoxon matched pairs signed-rank tests. The median ISQ and interquartile range (IQR) values were 53.3 (8.3) at insertion and 60.5 (5.5) at 6 weeks for the 3M™ESPE™MDI and, respectively, 58.5 (4.75) and 65.5 (9.3) for the Ankylos® implant. These values also indicate
Smeets, Ralf; Stadlinger, Bernd; Schwarz, Frank; Beck-Broichsitter, Benedicta; Jung, Ole; Precht, Clarissa; Kloss, Frank; Gröbe, Alexander; Heiland, Max
Objective. The aim of this paper is to review different surface modifications of dental implants and their effect on osseointegration. Common marketed as well as experimental surface modifications are discussed. Discussion. The major challenge for contemporary dental implantologists is to provide oral rehabilitation to patients with healthy bone conditions asking for rapid loading protocols or to patients with quantitatively or qualitatively compromised bone. These charging conditions require advances in implant surface design. The elucidation of bone healing physiology has driven investigators to engineer implant surfaces that closely mimic natural bone characteristics. This paper provides a comprehensive overview of surface modifications that beneficially alter the topography, hydrophilicity, and outer coating of dental implants in order to enhance osseointegration in healthy as well as in compromised bone. In the first part, this paper discusses dental implants that have been successfully used for a number of years focusing on sandblasting, acid-etching, and hydrophilic surface textures. Hereafter, new techniques like Discrete Crystalline Deposition, laser ablation, and surface coatings with proteins, drugs, or growth factors are presented. Conclusion. Major advancements have been made in developing novel surfaces of dental implants. These innovations set the stage for rehabilitating patients with high success and predictable survival rates even in challenging conditions. PMID:27478833
Jayaratne, Yasas S N; Anderson, Nina K; Zwahlen, Roger A
It is recommended that health-related materials for patients be written at sixth grade level or below. Many websites oriented toward patient education about dental implants are available, but the readability of these sites has not been evaluated. To assess readability of patient-oriented online information on dental implants. Websites containing patient-oriented information on dental implants were retrieved using the Google search engine. Individual and mean readability/grade levels were calculated using standardized formulas. Readability of each website was classified as easy (≤ 6th-grade level) or difficult (≥ 10th grade level). Thirty nine websites with patient-oriented information on dental implant were found. The average readability grade level of these websites was 11.65 ± 1.36. No website scored at/below the recommended 6th grade level. Thirty four of 39 websites (87.18%) were difficult to read. The number of characters, words, and sentences on these sites varied widely. All patient-oriented websites on dental implants scored above the recommended grade level, and majority of these sites were "difficult" in their readability. There is a dire need to create patient information websites on implants, which the majority can read. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Dohan Ehrenfest, David M; Vazquez, Lydia; Park, Yeong-Joon; Sammartino, Gilberto; Bernard, Jean-Pierre
Dental implants are commonly used in daily practice; however, most surgeons do not really know the characteristics of these biomedical devices they are placing in their patients. The objective of this work is to describe the chemical and morphological characteristics of 14 implant surfaces available on the market and to establish a simple and clear identification (ID) card for all of them, following the classification procedure developed in the Dohan Ehrenfest et al (2010) Codification (DEC) system. Fourteen implant surfaces were characterized: TiUnite (Nobel Biocare), Ospol (Ospol), Kohno HRPS (Sweden & Martina), Osseospeed (AstraTech), Ankylos (Dentsply Friadent), MTX (Zimmer), Promote (Camlog), BTI Interna (Biotechnology Institute), EVL Plus (SERF), Twinkon Ref (Tekka), Ossean (Intra-Lock), NanoTite (Biomet 3I), SLActive (ITI Straumann), Integra-CP/NanoTite (Bicon). Three samples of each implant were analyzed. Superficial chemical composition was analyzed using X-ray photoelectron spectroscopy/electron spectroscopy for chemical analysis, and the 100 nm in-depth profile was established using Auger electron spectroscopy. The microtopography was quantified using light interferometry. The general morphology and nanotopography were evaluated using a field emission-scanning electron microscope. Finally, the characterization code of each surface was established using the DEC system, and the main characteristics of each surface were summarized in a reader-friendly ID card. From a chemical standpoint, of the 14 different surfaces, 10 were based on a commercially pure titanium (grade 2 or 4), 3 on a titanium-aluminum alloy (grade 5 titanium), and one on a calcium phosphate core. Nine surfaces presented different forms of chemical impregnation or discontinuous coating of the titanium core, and 3 surfaces were covered with residual aluminablasting particles. Twelve surfaces presented different degrees of inorganic pollutions, and 2 presented a severe organic pollution
Koka, Sreenivas; Babu, Nivedhitha Malli Suresh; Norell, Aaron
To determine whether post-menopausal women with a history of bisphosphonate use are at greater risk for implant failure or osteonecrosis of the jaw (ONJ) than an age- and gender-matched population with no history of bisphosphonate use. A retrospective chart review and phone interview was conducted of patients seen at the Mayo Clinic who had implants placed after November 2006. Bisphosphonate users were identified by medical chart review. Dental implant survival and ONJ incidence were determined in a total of 82 post-menopausal non-bisphosphonate users and 55 post-menopausal bisphosphonate users using a phone interview. Implant failures were recorded and survival percentages were calculated for comparison. ONJ was not observed consequent to implant placement in any of the bisphosphonate users or non-users. In non-users, 163 out of 166 implants were surviving for a cumulative survival rate of 98.19%. In bisphosphonate users, 120 out of 121 implants were surviving for a cumulative survival rate of 99.17%. Dental implants placed in post-menopausal women have the same survival potential regardless of whether patients have a history of bisphosphonate use. Bisphosphonate users who undergo dental implant surgery are at low risk for osteonecrosis of the jaw and a bisphosphonate "drug holiday" is not indicated in these patients. Copyright 2010 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
The development of clinical implant dentistry was intensively affected by dental implant design improvement and innovation, which brought about new concept, even milestone-like changes of clinical protocol. The current improvements of dental implant design and their clinical importance could be highlighted as followings: 1) The implant apical design influences the implant preliminary stability in immediate implant. The apical 3-5 mm design of implant makes implant stable in immediate implant, because this part would be screwed into alveolar bone through fresh socket, the other part of implant could not be tightly screwed in the socket because of smaller implant diameter. Implant apical form, screw design, self-taping of apical part would be essential for immediate implant. 2) The enough preliminary stability of implant makes immediate prosthesis possible. When osseointegration does not occur, the implant stability comes from a mechanical anchorage, which depends on implant form, screw thread and self-taping design. 3) Implant neck design may have influence for soft tissue recession in esthetic zone. The implant with large shoulder would not be selected for the esthetic area. The platform design may be more favorable in the area. 4) The connection design between implant and abutment is thought a very important structure in implant long-term stability. Moose taper and "tube in tube" were well documented structure design in 20-year clinical practice in Peking University. 5) In last 15 years, the plenty studies showed the platform design of implant had positive influence in implant marginal bone level. Whatever in single implant restoration or multi-implant prosthesis. 6) The digital technology makes clinical work more precise and high-tech. This would be a trend in implant dentistry. New generation of chair-side digital computer-aided design/computer-aided manufacturing makes immediate prosthesis without conventional impression possible. 7) New abutment design have
Degidi, Marco; Perrotti, Vittoria; Shibli, Jamil A; Novaes, Arthur B; Piattelli, Adriano; Iezzi, Giovanna
Stability of peri-implant crestal bone plays a relevant role relative to the presence or absence of interdental papilla. Several factors can contribute to the crestal bone resorption observed around two-piece implants, such as the presence of a microgap at the level of the implant-abutment junction, the type of connection between implant and prosthetic components, the implant positioning relative to the alveolar crest, and the interimplant distance. Subcrestal positioning of dental implants has been proposed to decrease the risk of exposure of the metal of the top of the implant or of the abutment margin, and to get enough space in a vertical dimension to create a harmoniously esthetic emergence profile. The present retrospective histologic study was performed to evaluate dental implants retrieved from human jaws that had been inserted in an equicrestal or subcrestal position. A total of nine implants were evaluated: five of these had been inserted in an equicrestal position, whereas the other four had been positioned subcrestally (1 to 3 mm). In all subcrestally placed implants, preexisting and newly formed bone was found over the implant shoulder. In the equicrestal implants, crestal bone resorption (0.5 to 1.5 mm) was present around all implants. The subcrestal position of the implants resulted in bone located above the implant shoulder.
Tabrizi, Aydin; Rizzo, Piervincenzo; Ochs, Mark W.
The stability of a dental implant is a prerequisite for supporting a load-bearing prosthesis and establishment of a functional bone-implant system. Reliable and noninvasive methods able to assess the bone interface of dental and orthopedic implants (osseointegration) are increasingly demanded for clinical diagnosis and direct prognosis. In this paper, we propose the electromechanical impedance method as a novel approach for the assessment of dental implant stability. Nobel Biocare® implants with a size of 4.3 mm diameter ×13 mm length were placed inside bovine bones that were then immersed in a solution of nitric acid to allow material degradation. The degradation simulated the inverse process of bone healing. The implant-bone systems were monitored by bonding a piezoceramic transducer (PZT) to the implants’ abutment and measuring the admittance of the PZT over time. It was found that the PZT’s admittance and the statistical features associated with its analysis are sensitive to the degradation of the bones and can be correlated to the loss of calcium measured by means of the atomic absorption spectroscopy method. The present study shows promising results and may pave the road towards an innovative approach for the noninvasive monitoring of dental implant stability and integrity.
Serino, Giovanni; Turri, Alberto
Peri-implantitis is an infectious disease, which leads to loss of supporting bone around dental implants. To evaluate the extent and location of bone loss, 43 patients with peri-implantitis were examined. The bone loss was clinically measured at the time of dental surgery. Data revealed that 25% of subjects had bone loss associated with all their implants although the majority of the subjects had fewer than 50% of their implants affected by bone loss. A total number of 264 implants were examined and 131 of those had peri-implantitis associated bone loss. The pattern of bone loss at implants varied between and within subjects and location in the jaws. The highest proportion of implants with peri-implantitis was found in the upper jaw and within this group, at implants located in the incisor area of the upper jaw; the lowest was the canine area of the lower jaw. The highest proportion of implants that lost ≥ 2/3 of their bone support was found in the incisor area of the maxilla. We concluded that in the presence of peri-implant inflammation, bone quantity and characteristics may influence the progression of peri-implantitis bone loss at dental implants. We hypothesize that the ability of the bone to withstand occlusal forces will be altered as consequence of the loss of bone at the neck of the implants. To achieve an understanding of the local degradation of bone due to peri-implantitis, we need to analyze the microstructure of the bone as well the cellular biology of the peri-implant inflammation. Copyright © 2010 Elsevier Ltd. All rights reserved.
Mesa, Francisco; Muñoz, Ricardo; Noguerol, Blas; de Dios Luna, Juan; Galindo, Pablo; O'Valle, Francisco
The purpose was to determine by multivariate analysis in a large series of dental implants the variables associated with primary endosseous dental implant stability (DIS). A 10-year retrospective study was conducted of 1084 Brånemark implants placed in 316 patients. Clinical variables (age, gender, smoking habit, and periodontal status), implant diameter, implant length, and Periotest values (PTVs) were analyzed in bivariate and multivariate studies in order to determine their influence on DIS, using a cut-off PTV value of -2. The site of implant insertion showed the strongest association with primary DIS failure among the study variables. Implants in the anterior mandible had a 6.43-fold lower risk of primary DIS risk vs. those at other sites [95% confidence interval (CI) 3.28-12.61], and implants in the maxillary had a 2.70-fold higher risk of primary DIS failure vs. those in the mandible (95% CI 1.82-4). Among other variables, females had a 1.54-fold higher risk of primary DIS failure vs. males (95% CI 1.88-2.22) and implants <15 mm in length had a 1.49-fold higher risk of failure vs. longer implants (95% CI 1.09-2.04). According to these findings, primary DIS failure is more likely in females, at sites other than the anterior mandible, and with dental implants shorter than 15 mm, at least when non-threaded titanium implants are used. These data may be of value in the identification of patients at a high risk of primary DIS failure with immediate implant loading.
Jemat, A.; Ghazali, M. J.; Razali, M.; Otsuka, Y.
This review covers several basic methodologies of surface treatment and their effects on titanium (Ti) implants. The importance of each treatment and its effects will be discussed in detail in order to compare their effectiveness in promoting osseointegration. Published literature for the last 18 years was selected with the use of keywords like titanium dental implant, surface roughness, coating, and osseointegration. Significant surface roughness played an important role in providing effective surface for bone implant contact, cell proliferation, and removal torque, despite having good mechanical properties. Overall, published studies indicated that an acid etched surface-modified and a coating application on commercial pure titanium implant was most preferable in producing the good surface roughness. Thus, a combination of a good surface roughness and mechanical properties of titanium could lead to successful dental implants. PMID:26436097
Jemat, A; Ghazali, M J; Razali, M; Otsuka, Y
This review covers several basic methodologies of surface treatment and their effects on titanium (Ti) implants. The importance of each treatment and its effects will be discussed in detail in order to compare their effectiveness in promoting osseointegration. Published literature for the last 18 years was selected with the use of keywords like titanium dental implant, surface roughness, coating, and osseointegration. Significant surface roughness played an important role in providing effective surface for bone implant contact, cell proliferation, and removal torque, despite having good mechanical properties. Overall, published studies indicated that an acid etched surface-modified and a coating application on commercial pure titanium implant was most preferable in producing the good surface roughness. Thus, a combination of a good surface roughness and mechanical properties of titanium could lead to successful dental implants.
Al-Hashedi, Ashwaq Ali; Taiyeb Ali, Tara Bai; Yunus, Norsiah
Short implants have been advocated as a treatment option in many clinical situations where the use of conventional implants is limited. This review outlines the effectiveness and clinical outcomes of using short implants as a valid treatment option in the rehabilitation of edentulous atrophic alveolar ridges. Initially, an electronic search was performed on the following databases: Medline, PubMed, Embase, Cochrane Database of Systematic Reviews, and DARE using key words from January 1990 until May 2012. An additional hand search was included for the relevant articles in the following journals: International Journal of Oral and Maxillofacial Implants, Clinical Oral Implants Research, Journal of Clinical Periodontology, International Journal of Periodontics, Journal of Periodontology, and Clinical Implant Dentistry and Related Research. Any relevant papers from the journals' references were hand searched. Articles were included if they provided detailed data on implant length, reported survival rates, mentioned measures for implant failure, were in the English language, involved human subjects, and researched implants inserted in healed atrophic ridges with a follow-up period of at least 1 year after implant-prosthesis loading. Short implants demonstrated a high rate of success in the replacement of missing teeth in especially atrophic alveolar ridges. The advanced technology and improvement of the implant surfaces have encouraged the success of short implants to a comparable level to that of standard implants. However, further randomized controlled clinical trials and prospective studies with longer follow-up periods are needed.
Chrcanovic, Bruno R; Kisch, Jenö; Albrektsson, Tomas; Wennerberg, Ann
To assess the survival of dental implants placed in sites of previously failed implants and to explore the possible factors that might affect the outcome of this reimplantation procedure. Patients that had failed dental implants, which were replaced with the same implant type at the same site, were included. Descriptive statistics were used to describe the patients and implants; survival analysis was also performed. The effect of systemic, environmental, and local factors on the survival of the reoperated implants was evaluated. 175 of 10,096 implants in 98 patients were replaced by another implant at the same location (159, 14, and 2 implants at second, third, and fourth surgeries, respectively). Newly replaced implants were generally of similar diameter but of shorter length compared to the previously placed fixtures. A statistically significant greater percentage of lost implants were placed in sites with low bone quantity. There was a statistically significant difference (P = 0.032) in the survival rates between implants that were inserted for the first time (94%) and implants that replaced the ones lost (73%). There was a statistically higher failure rate of the reoperated implants for patients taking antidepressants and antithrombotic agents. Dental implants replacing failed implants had lower survival rates than the rates reported for the previous attempts of implant placement. It is suggested that a site-specific negative effect may possibly be associated with this phenomenon, as well as the intake of antidepressants and antithrombotic agents. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Mohn, Dirk; Zehnder, Matthias; Stark, Wendelin J.; Imfeld, Thomas
Background Peri-implantitis has gained significant clinical attention in recent years. This disease is an inflammatory reaction to microorganisms around dental implants. Due to the limited accessibility, non-invasive antimicrobial strategies are of high interest. An unexpected approach to implant disinfection may evolve from electrolysis. Given the electrical conductivity of titanium implants, alkalinity or active oxidants can be generated in body fluids. We investigated the use of dental titanium implants as electrodes for the local generation of disinfectants. Our hypothesis was that electrolysis can reduce viable counts of adhering bacteria, and that this reduction should be greater if active oxidative species are generated. Methodology/Principal Findings As model systems, dental implants, covered with a mono-species biofilm of Escherichia coli C43, were placed in photographic gelatin prepared with physiological saline. Implants were treated by a continuous current of 0 - 10 mA for 15 minutes. The reduction of viable counts was investigated on cathodes and anodes. In separate experiments, the local change in pH was visualized using color indicators embedded in the gelatin. Oxidative species were qualitatively detected by potassium iodide-starch paper. The in situ generated alkaline environment around cathodic implants caused a reduction of up to 2 orders of magnitude in viable E. coli counts. On anodic implants, in contrast to cathodic counterparts, oxidative species were detected. Here, a current of merely 7.5 mA caused complete kill of the bacteria. Conclusions/Significance This laboratory study shows that electrochemical treatment may provide access to a new way to decontaminate dental implants in situ. PMID:21264247
Sanon, Clarisse; Chevalier, Jérôme; Douillard, Thierry; Cattani-Lorente, Maria; Scherrer, Susanne S; Gremillard, Laurent
Based on the current lack of standards concerning zirconia dental implants, we aim at developing a protocol to validate their functionality and safety prior their clinical use. The protocol is designed to account for the specific brittle nature of ceramics and the specific behavior of zirconia in terms of phase transformation. Several types of zirconia dental implants with different surface textures (porous, alveolar, rough) were assessed. The implants were first characterized in their as-received state by Scanning Electron Microscopy (SEM), Focused Ion Beam (FIB), X-Ray Diffraction (XRD). Fracture tests following a method adapted from ISO 14801 were conducted to evaluate their initial mechanical properties. Accelerated aging was performed on the implants, and XRD monoclinic content measured directly at their surface instead of using polished samples as in ISO 13356. The implants were then characterized again after aging. Implants with an alveolar surface presented large defects. The protocol shows that such defects compromise the long-term mechanical properties. Implants with a porous surface exhibited sufficient strength but a significant sensitivity to aging. Even if associated to micro cracking clearly observed by FIB, aging did not decrease mechanical strength of the implants. As each dental implant company has its own process, all zirconia implants may behave differently, even if the starting powder is the same. Especially, surface modifications have a large influence on strength and aging resistance, which is not taken into account by the current standards. Protocols adapted from this work could be useful. Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
Mohn, Dirk; Zehnder, Matthias; Stark, Wendelin J; Imfeld, Thomas
Peri-implantitis has gained significant clinical attention in recent years. This disease is an inflammatory reaction to microorganisms around dental implants. Due to the limited accessibility, non-invasive antimicrobial strategies are of high interest. An unexpected approach to implant disinfection may evolve from electrolysis. Given the electrical conductivity of titanium implants, alkalinity or active oxidants can be generated in body fluids. We investigated the use of dental titanium implants as electrodes for the local generation of disinfectants. Our hypothesis was that electrolysis can reduce viable counts of adhering bacteria, and that this reduction should be greater if active oxidative species are generated. As model systems, dental implants, covered with a mono-species biofilm of Escherichia coli C43, were placed in photographic gelatin prepared with physiological saline. Implants were treated by a continuous current of 0-10 mA for 15 minutes. The reduction of viable counts was investigated on cathodes and anodes. In separate experiments, the local change in pH was visualized using color indicators embedded in the gelatin. Oxidative species were qualitatively detected by potassium iodide-starch paper. The in situ generated alkaline environment around cathodic implants caused a reduction of up to 2 orders of magnitude in viable E. coli counts. On anodic implants, in contrast to cathodic counterparts, oxidative species were detected. Here, a current of merely 7.5 mA caused complete kill of the bacteria. This laboratory study shows that electrochemical treatment may provide access to a new way to decontaminate dental implants in situ.
Reigosa, M.; Labarta, V.; Molinari, G.; Bernales, D.
Several types of materials are frequently used for dental prostheses in dental medicine. Different treatments with titanium are the most used. The aim of the present study was to analyze by means of cytotoxicity and cytocompatibility techniques the capacity of dental implants to integrate to the bone tissue. Cultures of UMR 106 cell line derived from an osteosarcoma were used for bioassays mainly because they show many of the properties of osteoblasts. Dental implant samples provided by B&W company were compared with others of recognized trademarks. The first ones contain ASTM titanium (8348 GR2) with acid printing. Cytotoxicity was analyzed by means of lysosome activity, using the neutral red technique and alkaline phosphatase enzyme activity. Cell variability was determined by means of the acridine ethidium-orange bromide technique. One-way ANOVA and Bonferroni and Duncan post-ANOVA tests were used for the statistical analysis. The assays did not show significant differences among the dental implants analyzed. Our findings show that the dental prostheses studied present high biocompatibility, quantified by the bioassays performed. The techniques employed revealed that they can be a useful tool for the analysis of other materials for dental medicine use.
Sakka, Salah; Baroudi, Kusai; Nassani, Mohammad Zakaria
Osseointegration is a good indication of the clinical success of titanium implants referring to the direct anchorage of such implants to the surrounding host bone. Despite the high success rate of endosseous dental implants, they do fail. A lack of primary stability, surgical trauma, and infection seem to be the most important causes of early implant failure. Early signs of infection may be an indication of a much more critical result than if the same complications occur later, because of disturbance of the primary bone healing process. Occlusal overload and periimplantitis seem to be the most important factors associated with late failure. Suboptimal implant design and improper prosthetic constructions are among those risk factors responsible for implant complications and failure. This concise review highlights the main causes associated with early and late implant failure, as thorough knowledge of this unavoidable clinical fact is essential in the field of oral implantology. © 2012 Wiley Publishing Asia Pty Ltd.
Edwards, B N; Gold, B R
Six routinely packaged commercially pure titanium dental implants (three commercial brands) were analysed using secondary ion mass spectrometry to examine the outermost surface layer. The aim of the analysis was to compare the surface purity (99.95%) of the implants with the substrate metal, common to all three brands. The use of a low primary ion current density provided a nominal protection limit of 0.01% or 100 p.p.m. All the implants examined had extremely pure surfaces. However, only one brand of implant had an ultraclean oxide surface in relation to the substrate.
Frictional heat can be generated during seating of dental implants into a drill-prepared osteotomy. This in vitro study tested the heat generated by implant seating in dense bovine mandible ramus. A thermocouple was placed approximately 0.5 mm from the rim of the osteotomy during seating of each dental implant. Four diameters of implants were tested. The average temperature increases were 0.075°C for the 5.7-mm-diameter implant, 0.97°C for the 4.7-mm-diameter implant, 1.4°C for the 3.7-mm-diameter implant, and 8.6°C for the 2.5-mm-diameter implant. The results showed that heat was indeed generated and a small temperature rise occurred, apparently by the friction of the implant surface against the fresh-cut bone surface. Bone is a poor thermal conductor. The titanium of the implant and the steel of the handpiece are much better heat conductors. Titanium may be 70 times more heat conductive than bone. The larger diameter and displacement implant may act as a heat sink to draw away any heat produced from the friction of seating the implant at the bone-implant interface. The peak temperature duration was momentary, and not measured, but this was approximately less than 1 second. Except for the 2.5-mm-diameter implants, the temperature rises and durations were found to be below those previously deemed to be detrimental, so no clinically significant osseous damage would be expected during dental implant fixture seating of standard and large-diameter-sized implants. A 2.5-mm implant may generate detrimental heat during seating in nonvital bone, but this may be clinically insignificant in vital bone. The surface area and thermal conductivity are important factors in removing generated heat transfer at the bone-implant interface. The F value as determined by analysis of variance was 69.22, and the P value was less than .0001, demonstrating significant differences between the groups considered as a whole.
Hussain, Hamza Ather; Romanos, Georgios E.
It is hypothesized that active treatment of peri-implantitis (PI) leads to re-stabilization of dental implants. The aim was to assess whether or not dental implants can re-stabilize following treatment of PI. To address the focused question, MEDLINE/PubMed and Google-Scholar databases were explored from 1977 up to and including August 2013. Any disagreements between the authors were resolved via discussion. Articles published only in English were included. Hand searching was also performed. Thirteen experimental studies were included. The treatment regimes adopted in these studies comprised of antibiotic therapy, guided bone regeneration (GBR), laser therapy, use of bone matrix proteins with membrane, conventional flap surgery and mechanical debridement. In four studies, GBR promoted new bone formation; whereas two studies showed photosensitization therapy (in combination with either mechanical debridement or GBR) to regenerate bone around peri-implant defects. Six studies reported that mechanical debridement in conjunction with antibiotic therapy promoted re-stability of dental implants. In one study, recombinant human bone matrix protein-2 with a collagen membrane helped promote re-stabilization of dental implants. New bone formation may occur to some extent around dental implants following treatment for PI; however, a “complete” re-stability may be difficult to achieve without GBR. PMID:24265901
Wright, S P; Hayden, J; Lynd, J A; Walker-Finch, K; Willett, J; Ucer, C; Speechley, S D
Objectives The aim of this paper is to identify the factors that affect the complexity of implant restoration and to explore the indices that help us to assess it. With this knowledge the growing number of clinicians restoring dental implants will have a better understanding of the available guidance and evidence base, and the differing levels of competence required.Study design A literature review was conducted. The selection of publications reporting on complexity was based on predetermined criteria and was agreed upon by the authors. After title and abstract screening 17 articles were reviewed. The articles that were utilised to form the ITI SAC tool and Cologne Risk Assessment we also included.Assessing complexity Two key guides are available: International Team for Implantology's Straight-forward Advanced Complex tool and the Cologne ABC risk score. While these guides help identify treatment complexity they do not provide a strong enough evidence base from which to solely base clinical decisions. The key patient factors are expectation, communication, the oral environment, aesthetic outcome, occlusion, soft tissue profile and the intra-arch distance, whereas the key technical factors are impression taking, type of retention, loading protocol and the need for provisional restorations. Human factors also have a significant effect on complexity, specifically, the experience and training of the clinician, team communication and the work environment.Conclusions There are many interconnecting factors that affect the complexity of dental implant restoration. Furthermore the two widely used indices for the assessment of complexity have been investigated, and although these offer a good guideline as to the level of complexity, there is a lack evidence to support their use. The development of evidence-based treatment and protocols is necessary to develop the current indices further, and these need to be expanded to include other critical areas, such as human factors. A
de-Freitas, Nayara-Ribeiro; de-Moura, Marcos-Boaventura; Veloso-Guedes, Cizelene-do-Carmo-Faleiros; Simamoto-Júnior, Paulo-César; de-Magalhães, Denildo
Background To analyze articles that studied patients submitted to diphosphonates therapy and who received dental implants before, during or after bisphosphonate (BP) treatment, compared to healthy patients, analyzing the increase of failure and loss of implants or bisphosphonate related osteonecrosis of the jaw (BRONJ) incidence. Material and Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was used in this study. The clinical question in “PICO” format was: In patients under bisphosphonate therapy, do dental implants placement, compared to healthy patients, increase the failure and loss of implants or bisphosphonate related osteonecrosis of the jaw incidence? PubMed/MEDLINE was searched for articles published up until April 15, 2015 using a combination of MeSH terms and their Entry terms. Results The search resulted in 375 articles. After selection according to the eligibility criteria, 15 studies fulfilled were included (eight retrospective, one prospective and six case series), with a total of 1339 patients analyzed, 3748 implants placed, 152 loss of implants and 78 cases of BRONJ. Conclusions Due to the lack of randomized clinical trials looking at this theme, further studies with longer follow-up are needed to elucidate the remaining questions. Thus, it is wise to be careful when planning dental implant surgery in patients undergoing bisphosphonate therapy because of the risk of developing BRONJ as well as occurring failure of implant. Moreover, complete systemic condition of the patient must be also taking into considering when such procedures are performed. Key words:Bisphosphonates, diphosphonates, dental implants, osteonecrosis. PMID:27475681
Peñarrocha-Oltra, David; Peñarrocha-Diago, Maria; Peñarrocha-Diago, Miguel
Background The guided bone regeneration (GBR) technique is highly successful for the treatment of peri-implant bone defects. The aim was to determine whether or not implants associated with GBR due to peri-implant defects show the same survival and success rates as implants placed in native bone without defects. Material and Methods Patients with a minimum of two submerged dental implants: one suffering a dehiscence or fenestration defect during placement and undergoing simultaneous guided bone regeneration (test group), versus the other entirely surrounded by bone (control group) were treated and monitored annually for three years. Complications with the healing procedure, implant survival, implant success and peri-implant marginal bone loss were assessed. Statistical analysis was performed with non-parametric tests setting an alpha value of 0.05. Results Seventy-two patients and 326 implants were included (142 test, 184 control). One hundred and twenty-five dehiscences (average height 1.92±1.11) and 18 fenestrations (average height 3.34±2.16) were treated. At 3 years post-loading, implant survival rates were 95.7% (test) and 97.3% (control) and implant success rates were 93.6% and 96.2%, respectively. Mean marginal bone loss was 0.54 (SD 0.26 mm) for the test group and 0.43 (SD 0.22 mm) for the control group. No statistically significant differences between both groups were found. Conclusions Within the limits of this study, implants with peri-implant defects treated with guided bone regeneration exhibited similar survival and success rates and peri-implant marginal bone loss to implants without those defects. Large-scale randomized controlled studies with longer follow-ups involving the assessment of esthetic parameters and hard and soft peri-implant tissue stability are needed. Key words:Guided bone regeneration, peri-implant defects, dental implants, marginal bone level, success rate, survival rate. PMID:26330931
Manor, Yifat; Chaushu, Gavriel; Lorean, Adi; Mijiritzky, Eithan
To evaluate the survival rate of dental implants replacing failed implants in grafted maxillary sinuses using the lateral approach vs nongrafted posterior maxillae. A retrospective analysis was conducted to study the survival of secondary dental implants inserted in the posterior maxilla in previously failed implant sites between the years 2000 and 2010. The study group consisted of patients who had also undergone maxillary sinus augmentation, and the control group consisted of patients in whom implants in the posterior maxilla had failed. Clinical and demographic data were analyzed using a structured form. Seventy-five patients with a total of 75 replaced implants were included in the study. The study group comprised 40 patients and the control group, 35 patients. None of the replaced implants in the study group failed, resulting in an overall survival of 100%; three replaced implants in the control group failed (92% survival). The main reason for the primary implant removal was lack of osseointegration (35 [87.5%] of 40 study group implants and 23 [65.7%] of 35 control group implants [P = .027]). The difference between the groups with regard to the timing of primary implant failure was statistically significant. The study group had more early failures of the primary implant than did the control group (77% vs 62%; P = .038). Dental implants replaced in the posterior maxilla had a high survival rate. A higher rate of survival was found in augmented maxillary sinus sites. Within the limits of the present study, it can be concluded that previous implant failures in the grafted maxillary sinus should not discourage practitioners from a second attempt.
Puttaraju, Gurkar Haraswarupa; Visveswariah, Paranjyothi Magadi
This case describes extraction of teeth in the mandibular arch, i.e., 41 42 43 44 45 51 52 53 54 55 56 57 58 (grade two mobility), followed by immediate placement of four dental implants (3i biomet), two in the 45 55 region and two dental implants in 12 21 region. A prefabricated provisional mandibular denture was immediately placed. The purpose of immediate placement was to aid the patient resume his professional duties the next day itself along with esthetic and functional comfort, psychological well-being and most importantly preserving the remaining tissue in a healthy condition. PMID:23956594
van Waas, M A J
This article is focusing on incorporation of implant overdentures into the dental curriculum. For mandibular edentulism, an implant-retained overdenture should nowadays be considered a first choice for prosthodontic care, if not the standard of care. Yet, it is not incorporated in practical teaching today. Curriculum change is always difficult. The needs of our patients specifically, and those of society generally, should be primarily drivers of innovation of the curriculum. Therefore, Dutch dental schools should make sure that graduated students are experts in analyzing edentulous patients' problems, in considering possible treatments, and in carrying out the standard of care.
Abstract-The establishment of osseointegration following dental implant placement is a major contributing factor to the clinical success and long...period. Our results showed that there was an increase in resonance frequency related to stiffness increment during osseointegration. Keywords – dental ...implant, osseointegration, resonance frequency, stability I. INTRODUCTION Dental implants are being used increasingly to provide support and retention
Shemtov-Yona, K; Rittel, D
The objective of this work is to investigate the potential state of mechanical damage in used, albeit mechanically intact, dental implants, after their retrieval from the oral cavity because of progressive bone loss (peri-implantitis). 100 retrieved dental implants were characterized with no medical record made available prior to the analysis. The implants' composition, dimensions, and surface treatments were characterized using energy dispersive X-ray analysis and scanning electron microscopy (SEM-EDX). Each implant was thoroughly examined for signs of mechanical defects and damage. The implants represent a random combination of two materials, titanium alloy (Ti-6Al-4V) and commercially pure titanium (CP-Ti), surface treatments and geometries. Two kinds of surface defects were identified: crack-like defects and full cracks that were arbitrarily divided according to their length and appearance. We found that over 60% of the implants contained both crack-like defects and full cracks. In the retrieved sample, we observed that the CP-Ti implants contained more defects and cracks than the Ti-6Al-4V ones. For the various surface roughening treatments, a general correlation with the presence of defects was observed, but without a clear differentiation between the treatments. The high incidence of embedded particles among the observed defect further strengthens the role played by the particles upon defects generation, some of which later evolve into full cracks. It was also found that the dimensions of the implant (width and length) were not correlated with the observed defects, for this specific sample. Our observations indicate that early retrieval of biologically failed implants, many of which contain early signs of mechanical failure as shown here, does actually hinder the later occurrence of implant fracture. It seems that once biological complications will be successfully overcome, such defects might grow later into full cracks as a result of cyclic mastication
Shemtov-Yona, Keren; Rittel, Daniel
With the growing use of dental implants, the incidence of implants' failures grows. Late treatment complications, after reaching full osseointegration and functionality, include mechanical failures, such as fracture of the implant and its components. Those complications are deemed severe in dentistry, albeit being usually considered as rare, and therefore seldom addressed in the clinical literature. The introduction of dental implants into clinical practice fostered a wealth of research on their biological aspects. By contrast, mechanical strength and reliability issues were seldom investigated in the open literature, so that most of the information to date remains essentially with the manufacturers. Over the years, implants have gone through major changes regarding the material, the design, and the surface characteristics aimed at improving osseointegration. Did those changes improve the implants' mechanical performance? This review article surveys the state-of-the-art literature about implants' mechanical reliability, identifying the known causes for fracture, while outlining the current knowledge-gaps. Recent results on various aspects of the mechanical integrity and failure of implants are presented and discussed next. The paper ends by a general discussion and suggestions for future research, outlining the importance of mechanical considerations for the improvement of their future performance. PMID:26583117
Shemtov-Yona, Keren; Rittel, Daniel
With the growing use of dental implants, the incidence of implants' failures grows. Late treatment complications, after reaching full osseointegration and functionality, include mechanical failures, such as fracture of the implant and its components. Those complications are deemed severe in dentistry, albeit being usually considered as rare, and therefore seldom addressed in the clinical literature. The introduction of dental implants into clinical practice fostered a wealth of research on their biological aspects. By contrast, mechanical strength and reliability issues were seldom investigated in the open literature, so that most of the information to date remains essentially with the manufacturers. Over the years, implants have gone through major changes regarding the material, the design, and the surface characteristics aimed at improving osseointegration. Did those changes improve the implants' mechanical performance? This review article surveys the state-of-the-art literature about implants' mechanical reliability, identifying the known causes for fracture, while outlining the current knowledge-gaps. Recent results on various aspects of the mechanical integrity and failure of implants are presented and discussed next. The paper ends by a general discussion and suggestions for future research, outlining the importance of mechanical considerations for the improvement of their future performance.
Ojeda, J; Martínez-Reina, J; García-Aznar, J M; Domínguez, J; Doblaré, M
Crestal bone loss can result in the failure of dental implants and can be caused, by among other factors, the development of non-physiological mechanical conditions. Bone remodelling (BR) is the physiological process through which bone adapts itself to the mechanical environment. A previously published mathematical model of BR is used in this work to study the homogenized structural evolution of peri-implant bone. This model is used to study the influence of the diameter and length of a dental implant of pure titanium on its long-term stability. The temporal evolution of porosity and microstructural damage of the peri-implant bone are the variables analysed in this study. The results show that damage and porosity increase as the implant length decreases and, more pronouncedly, as its diameter decreases. The increase in damage and porosity levels is localized, as many other studies confirm, at the implant neck due to the stress concentration that is created in that area. The main conclusion of this study is that in implants with a diameter equal to or greater than 3 mm the damage is under control and there is no mechanical failure of the peri-implant bone in the long term.
Hsu, Jui-Ting; Shen, Yen-Wen; Kuo, Chih-Wei; Wang, Ruei-Teng; Fuh, Lih-Jyh; Huang, Heng-Li
This study investigated the effects of three three-dimensional (3D) bone-to-implant contact (BIC) parameters-potential BIC area (pBICA), BIC area (BICA), and 3D BIC percentage (3D BIC%; defined as BICA divided by pBICA)-in relation to the implant diameter on primary implant stability, as well as their correlations were also evaluated. Dental implants with diameters of 3.75, 4, 5, and 6 mm and artificial bone specimens were scanned by microcomputed tomography to construct 3D models for calculating pBICA, BICA, and 3D BIC%. Indexes of the primary implant stability including the insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ) were measured after implants with various diameters were placed into bone specimens. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were all performed as statistical and correlation analyses. The implant diameter significantly influenced pBICA and BICA, but not 3D BIC%. ITV and PTV were more sensitive to implant diameter than was ISQ. The coefficients of determination were high (>0.92) for the correlations between pBICA (or BICA) and indexes of the primary implant stability. This study revealed how the implant diameter and the three-dimensional (3D) BIC influence the primary stabilities of dental implant. ITV and PTV were more sensitively influenced by the implant diameter than ISQ. The pBICA and BICA seem to be more important than 3D BIC % for using wider implant in treatment plan, since those two parameters are highly predictive of variations in the primary stability of dental implant. Copyright © 2017. Published by Elsevier B.V.
Zitzmann, Nicola U; Arnold, Dario; Ball, Judith; Brusco, Daniel; Triaca, Albino; Verna, Carlalberta
Single-tooth implants in the maxillary anterior region have the highest risk of esthetic complications from infrapositioning due to continuing maxillary growth and the eruption of adjacent teeth. Although the placement of anterior single-tooth implants should normally be postponed, particularly girls and young women with a hyperdivergent growth pattern, if an infraposition of an implant is present, then thorough examination and strategic planning are required. According to the severity, the strategic treatment options are as follows: simple retention; adjustment or replacement of the implant restoration, possibly including adjacent teeth; surgical implant repositioning by segmental osteotomy combined with osseodistraction; or submergence or removal of the implant. With the patient presented, an interdisciplinary approach that combined orthodontic alignment, surgical segmental osteotomy, distraction osteogenesis, and restorative features offered the opportunity to realign the adjacent teeth into the arch and to harmonize the gingival contour by means of continuous soft tissue enlargement and adaptation.
Li, Bo-Han; Byun, Soo-Hwan; Kim, Soung-Min; Lee, Jong-Ho
The incidence of peri-implantitis, marginal bone loss, implant success, and survival rates of 52 dental implants placed through the skin paddle and 23 implants through the neighboring gingiva were investigated. Mixed linear model was adopted to analyze the influence of radiation and skin paddle on marginal bone loss and peri-implantitis. The incidence of peri-implantitis in implants placed through the skin flaps was higher (32.7%) than that of implants placed through the oral mucosa (8.7%). According to the mixed linear analysis, no significant difference in the amount of marginal bone loss was observed between the 2 groups: implants placed through the skin graft had marginal bone loss of 0.39 ± 0.14 mm at 1 year and 0.50 ± 0.23 mm at 5 years, and implants placed through the oral mucosa had marginal bone loss of 0.32 ± 0.12 mm and 0.52 ± 0.21 mm at the same time intervals. The 1-year and 2- to 5-year cumulative survival rates of the implants placed through the skin were 100% and 98%, respectively, and those of implants placed through the oral mucosa were both 95.65%. The 1-year and 2- to 5-year cumulative success rates of the implants placed through the skin were 92.30% and 79.38%, respectively, and those of implants placed through the oral mucosa were 91.30% and 82.59%, respectively. Implants can be successfully placed and maintained in lining defects covered with a skin paddle; hence, this treatment modality may be considered reasonable and reliable for the functional and aesthetic rehabilitation of patients with oromaxillofacial reconstructions. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Kasraei, Shahin; Torkzaban, Parviz; Shams, Bahar; Hosseinipanah, Seyed Mohammad; Farhadian, Maryam
The aim of the present study was to evaluate the success rate of failed implants re-implanted after surface treatment with CO2 laser. Despite the widespread use of dental implants, there are many incidents of failures. It is believed that lasers can be applied to decontaminate the implant surface without damaging the implant. Ten dental implants that had failed for various reasons other than fracture or surface abrasion were subjected to CO2 laser surface treatment and randomly placed in the maxillae of dogs. Three failed implants were also placed as the negative controls after irrigation with saline solution without laser surface treatment. The stability of the implants was evaluated by the use of the Periotest values (PTVs) on the first day after surgery and at 1, 3, and 6 months post-operatively. The mean PTVs of treated implants increased at the first month interval, indicating a decrease in implant stability due to inflammation followed by healing of the tissue. At 3 and 6 months, the mean PTVs decreased compared to the 1-month interval (P < 0.05), indicating improved implant stability. The mean PTVs increased in the negative control group compared to baseline (P < 0.05). Independent t-test showed that the mean PTVs of treated implants were significantly lower than control group at 3 and 6 months after implant placement (P < 0.05). Based on the PTVs, re-implantation of failed implants in Jack Russell Terrier dogs after CO2 laser surface debridement is associated with a high success rate in terms of implant stability.
Cohen, Omer; Gabay, Eran; Machtei, Eli E
The aim of this study was to evaluate the effect of water irrigation on heat dissipation kinetics following abutment preparation of 1-piece dental implants. UNO 1-piece dental implants were mounted on Plexiglas apparatus clamping the implant at the collar. T-type thermocouple was attached to the first thread of the implant and recorded thermal changes at 100 millisecond intervals. Implants were prepared using highspeed dental turbine at 400,000 RPM with a coarse diamond bur. Once temperature reached 47 degrees C, abutment preparation was discontinued. Thirty implants were divided into 2 groups. Group A: Passive cooling without water irrigation. Group B: Cooling with turbine's water spray adjacent to the implant (30 mL/min). The following parameters were measured: T47 (time from peak temperature to 47 degrees C), T50%, T75% (time until the temperature amplitude decayed by 50% and 75%, respectively), dTemp50%/dt decay, and dTemp75%/dt decay (cooling rate measured at 50% and 75% of amplitude decay, respectively). Water spray irrigation significantly reduced T47 (1.37+/-0.29 seconds vs 19.97+/-3.06 seconds, P<0.0001), T50% (3.04+/-0.34 seconds vs 27.37+/-2.56 seconds, P<0.0001), and T75% (5.71+/-0.57 seconds vs 57.61+/-5.47 seconds, P<0.0001). Water spray irrigation also increased cooling capacity ninefold: dTemp50%/dt decay (4.14+/-0.61 degrees C/s vs 0.48+/-0.06 degrees C/s, P<0.0001), and dTemp50%/dt decay (1.70+/-0.29 degrees C/s vs 0.19+/-0.03 degrees C/s, P<0.0001). The continuous use of water spray adjacent to the abutment following the cessation of implant preparation might prove beneficial for rapid cooling of the implant.
Chrcanovic, Bruno Ramos; Albrektsson, Tomas; Wennerberg, Ann
The purpose of the present review was to test the null hypothesis of no difference in the implant failure rate, marginal bone loss, and postoperative infection for patients being rehabilitated by tilted or by axially placed dental implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational. The estimates of an intervention were expressed in risk ratio (RR) and mean difference (MD) in millimetres. The search strategy resulted in 44 publications. A total of 5029 dental implants were tilted (82 failures; 1.63%), and 5732 implants were axially placed (104 failures; 1.81%). The difference between the procedures did not significantly affect the implant failure rates (P=0.40), with a RR of 1.14 (95% CI 0.84-1.56). A statistically significant difference was found for implant failures when studies evaluating implants inserted in maxillae only were pooled (RR 1.70, 95% CI 1.05-2.74; P=0.03), the same not happening for the mandible (RR 0.77, 95% CI 0.39-1.52; P=0.45). There were no apparent significant effects of tilted dental implants on the occurrence of marginal bone loss (MD 0.03, 95% CI -0.03 to 0.08; P=0.32). Due to lack of satisfactory information, meta-analysis for the outcome 'postoperative infection' was not performed. It is suggested that the differences in angulation of dental implants might not affect the implant survival or the marginal bone loss. The reliability and validity of the data collected and the potential for biases and confounding factors are some of the shortcomings of the present study. The question whether tilted implants are more at risk for failure than axially placed implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine
The oral cavity provides an ideal and unique environment for study of biological processes involving metallic dental aids. Dental materials within the mouth interact continually with physiological fluids. Oral tissues are exposed to a veritable bombardment of both chemical and physical stimuli as well as the metabolism of many species of bacteria; yet, for the most part, oral tissues remain healthy. The pH of saliva varies from 5.2 to 7.8. Teeth, restorations, or any prosthesis including dental implants in the oral cavity have to function in one of the most inhospitable environments in the human body. They are subject to larger temperature and pH variations than most other parts of the body. Corrosion, the graded degradation of materials by electrochemical attack, is of concern particularly when dental implants are placed in the hostile electrolytic environment provided by the human mouth. Allergic reactions may occur from the presence of ions produced from the corrosion of implants. The present article describes various manifestations of allergic reactions due to implant material in the oral cavity. PMID:23990733
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Endosseous dental implant. 872.3640 Section 872.3640 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... for prosthetic devices, such as artificial teeth, in order to restore a patient's chewing function....
Machtei, Eli E; Oettinger-Barak, Orit; Horwitz, Jacob
The relationship of dental implants with neighboring teeth will affect both occlusal relationship and distribution of forces; thus, the purpose of this study was to examine implants' axial relationship with adjacent and opposing teeth/implants. Data of dental implants patients was retrieved. Panoramic X rays were digitized. Computer-based software was used to measure the angular relationship between the implants and adjacent/opposing teeth and implants. Data was further sorted by the mode of placement and implants position. 50 patients (219 implants) were included. Mean angle to adjacent tooth/implant was 178.71° ± 9.18° (range 129.7°-206°). Implants were more parallel to adjacent teeth (180.99° ± 1.06°) than to adjacent implants (176.32° ± 0.54°; P = .0001). Mean angular relationship to opposite tooth was 167.88° ± 8.92° (range 137.7°-179.8°). Implants that were placed freehand or with positional guide had similar intra-arch relationship (178.22° and 178.81°, respectively) and similar inter-arch angulations (164.46° and 167.74°). Molars had greater deviation of the angular relationship (175.54°) compared to premolars (181.62°) and incisors (180.55°, P = .0001). Implants placed in the maxilla had smaller axial deviation compared to implants in the mandible (180.41° ± 0.64 vs 177.14° ± 1.02; P = .0081). Good axial relationship may be obtained in most implants placed by an experienced clinician, even when placed freehand. The mandibular posterior region is more prone to axial deviation and as such requires special attention.
Calvo-Guirado, José Luis; Gómez-Moreno, Gerardo; Barone, Antonio; Cutando, Antonio; Alcaraz-Baños, Miguel; Chiva, Fernando; López-Marí, Laura; Guardia, Javier
The aim of this study was to evaluate the effect of the topical application of melatonin mixed with collagenized porcine bone to accelerate the osteointegration on the rough discrete calcium deposit (DCD) surface implants in Beagle dogs 3 months after their insertion. In preparation for subsequent insertion of dental implants, lower premolars and molars were extracted from 12 Beagle dogs. Each mandible received three parallel wall implants with discrete calcium deposit (DCD) surface of 4 mm in diameter and 10 mm in length. The implants were randomly assigned to the distal sites on each side of the mandible in three groups: group I implants alone, group II implants with melatonin and group III implants with melatonin and porcine bone. Prior to implanting, 5 mg lyophylized powdered melatonin was applied to one bone hole at each side of the mandible. None was applied at the control sites. Ten histological sections per implant were obtained for histomorphometric studies. After a 4-wk treatment period, melatonin significantly increased the perimeter of bone that was in direct contact with the treated implants (P < 0.0001), bone density (P < 0.0001), new bone formation (P < 0.0001) in comparison with control implants. Topical application of melatonin on DCD surface may act as a biomimetic agent in the placement of endo-osseous dental implants and enhance the osteointegration. Melatonin combined with porcine bone on DCD implants reveals more bone to implant contact at 12 wk (84.5 +/- 1.5%) compared with melatonin treated (75.1 +/- 1.4%) and nonmelatonin treated surface implants (64 +/- 1.4%).
Rodríguez Gutiérrez, Carlos; Rodríguez Gómez, Enrique
Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. It is caused by loose otoconia from the utricle which, in certain positions, displaced the cupula of the posterior semicircular canal. BPPV most often is a result of aging. It also can occur after a blow to the head. Less common causes include a prolonged positioning on the back (supine) during some surgical procedures. Additionally one can include in this ethiopathogenesis the positioning required during the maxillary dental implant surgery with bone regeneration related to a forced head positioning and inner ear trauma induced by dental turbine noise working in the maxillary bone. Two cases of patients who suffered BPPV after undergoing maxillary dental implant with bone regeneration procedures are reported. Diagnosis and treatment are also described.
Parrish, Lawrence; Hunter, Richard; Kimmes, Nici; Wilcox, Charles; Nunn, Martha; Miyamoto, Takanari
The purpose of this report is to describe the dental implant education that predoctoral students receive and to characterize the patient population receiving implants at Creighton University School of Dentistry (CDS). CDS has no postdoctoral residency programs. Therefore, clinical management of diagnosis, treatment planning, surgical aspects, restoration, complications, and maintenance of dental implants requires significant involvement by predoctoral dental students. CDS implant education involves radiology diagnostic assets of the General Dentistry Department (including the use of Cone Beam Computed Tomography), as well as faculty and equipment from the Departments of Oral and Maxillofacial Surgery, Periodontics, and Prosthodontics, with a majority of students satisfied with their didactic preparation for their clinical experiences. Focusing on a three-year window from August 2007 to August 2010 and using electronic health records, this study found that a total of 242 implants were placed, out of which six failed within one year of placement and had to be removed. The average age of the population of 153 patients was found to be 53.3 years, with a range of eighteen to eighty-nine. Treatment outcomes compared very favorably with those published in the literature.
Shemtov-Yona, K; Rittel, D; Dorogoy, A
This paper investigates the influence of surface preparation treatments of dental implants on their potential (mechanical) fatigue failure, with emphasis on grit-blasting. The investigation includes limited fatigue testing of implants, showing the relationship between fatigue life and surface damage condition. Those observations are corroborated by a detailed failure analysis of retrieved fracture dental implants. In both cases, the negative effect of embedded alumina particles related to the grit-blasting process is identified. The study also comprises a numerical simulation part of the grit blasting process that reveals, for a given implant material and particle size, the existence of a velocity threshold, below which the rough surface is obtained without damage, and beyond which the creation of significant surface damage will severely reduce the fatigue life, thus increasing fracture probability. The main outcome of this work is that the overall performance of dental implants comprises, in addition to the biological considerations, mechanical reliability aspects. Fatigue fracture is a central issue, and this study shows that uncontrolled surface roughening grit-blasting treatments can induce significant surface damage which accelerate fatigue fracture under certain conditions, even if those treatments are beneficial to the osseointegration process. Copyright © 2014 Elsevier Ltd. All rights reserved.
Joób-Fancsaly, Arpád; Divinyi, Tamás; Karacs, Albert; Koncz, Szilvia; Pető, Gábor; Sulyok, Lili
Clinical and radiological evaluations were conducted in patients with high energy Nd : glass laser-treated dental implants. These patients underwent dental implantation surgery between 1997 and 2006. Strict success criteria were used for the examination and analysis of implants. Based on clinical and radiological evaluation, success and survival rates of laser surface treated dental implants were similar to those of sandblasted, acid-etched surface implants frequently reported in the literature. Specific surface morphology and high degree of purity of laser surface treated dental implants ensure excellent osseointegration and a good clinical performance also on the long-term.
Barros, Raquel R M; Degidi, Marco; Novaes, Arthur B; Piattelli, Adriano; Shibli, Jamil A; Iezzi, Giovanna
The role of osteocytes in bone structure and function remains partially unresolved. Their participation in mechanotransduction, i.e., the conversion of a physical stimulus into a cellular response, has been hypothesized. The present study was an evaluation of the osteocyte density in the peri-implant bone of immediately loaded and submerged dental implants. Fourteen male patients were included in the study; all of them were partially edentulous and needed a posterior mandibular restoration. Implants were inserted in these areas; half of the sample was loaded immediately (included in a fixed provisional prosthesis on the same day as implant surgery), whereas the other half was left to heal submerged. Fourteen implants (seven immediately loaded and seven unloaded) were retrieved with a trephine after a healing period of 8 weeks. The specimens were treated to obtain thin ground sections, and histomorphometry was used to evaluate the osteocyte index in the peri-implant bone. A higher and statistically significant number of osteocytes was found in the peri-implant bone around immediately loaded implants (P = 0.0081). A correlation between the percentage of bone-implant contact and osteocyte density was found for immediately loaded implants (P = 0.0480) but not for submerged implants (P = 0.2667). The higher number of osteocytes in the peri-implant bone around immediately loaded implants could be related to the functional adaptation required by the loading stimulus, which also explains the hypothesized involvement of the osteocytes in the maintenance of the bone matrix.
Engelke, Wilfried; Stahr, Stefanie; Schwarzwäller, Wolfgang
This study aims to assess the effect of satellite implants on the primary stability of dental implants placed in fresh extraction sites in vitro. 34 titanium screw implants (3.75 mm x 10 mm; Bego, Bremen, Germany) were inserted in premolar- and molar-fresh extraction sites in domestic pig mandibles. Periotest (PT) values were assessed before and after insertion of one vestibular and one lingual 1.7-mm bone screw (Mondeal, Tuttlingen, Germany) as a satellite implant was connected to the implants with a 0.6-mm microplate welded to the implant abutment. The average PT values were 2.9 without satellite implants, -1.0 with one satellite implant, and -2.5 with two satellite implants during horizontal testing, and 3.0, 1.4, and 0.4, respectively, for vertical testing. Satellite implants increase the horizontal stability of implants in fresh extraction sites. Differences for horizontal PT assessment were significant on a 0.01 level of confidence. Implants in extraction sites may be loaded immediately, if vertical stabilization is provided by cortical bone and if horizontal PT values show sufficient stability after satellite implant insertion.
Bourauel, Christoph; Aitlahrach, Maria; Heinemann, Friedhelm; Hasan, Istabrak
In recent years, mini and short dental implants have become increasingly popular as treatment alternatives for patients in whom the bone is unsuitable for a standard implant. As yet, no detailed scientific analysis of the mechanical and biomechanical impact of the reduced diameter and length of these implants has been published. We analysed 21 commercially available implants (13 mini, eight short) with respect to material behaviour and load transfer to the alveolar bone, using finite element (FE) analysis. Following μCT scanning and geometry reconstruction, FE models of mini implants and short implants were inserted into idealised bone segments. Mini implants were analysed in the anterior mandibular jaw region at a force of 150 N under immediate loading, using a contact analysis in the FE software package Marc Mentat 2007. Short implants were inserted in posterior bone segments and analysed in the osseointegrated state at an occlusal force of 300 N. Von Mises stresses (up to 1150 MPa) in mini implants partly exceeded the ultimate strength. Implant diameter and geometry had a pronounced effect on stresses in the cortical plate (up to 266 MPa). Strains in spongy bone and stresses in cortical bone around short implants were markedly increased compared to those in standard implants. An increased risk of bone damage or implant failure may be assumed in critical clinical situations.
Levin, Liran; Zigdon, Hadar; Coelho, Paulo G; Suzuki, Marcelo; Machtei, Eli E
This preliminary investigation aimed to evaluate the potential of contaminated implants to reosseointegrate into pristine sites and, in addition, to assess the potential of osseointegration of new implants in peri-implantitis sockets in a canine model. All mandibular premolars were bilaterally extracted from two mongrel dogs. Following 12 weeks of healing, two dental implants were inserted on each hemiarch. Forty-five days following implant placement, a silk ligature secured with cyanoacrylate was placed around the implants' cervical region in order to induce peri-implantitis. After another 45 days from ligature placement, the implants were mechanically removed using counter rotation with a ratchet and were reimplanted without any decontamination (neither rinsing nor chemical or mechanical cleaning) in adjacent pristine zones. In sites where implants were removed, new, wider-diameter implants were placed in the infected sockets. Forty-five days following reimplantation surgery, the dogs were sacrificed; nondecalcified specimens were processed and toluidine blue stained for morphologic and morphometric (bone-to-implant contact [BIC]) assessment under an optical microscope. In dog 1 all the implants (both in the pristine and in the infected sites) survived and osseointegrated while in dog 2, six out of eight implants failed to osseointegrate and exfoliated. Overall, the mean BIC of all implants was 51.08% (SD 20.54). The mean BIC for the infected implants placed into pristine sites was 51.48% ± 26.29% (SD) and the mean BIC for the new implants in peri-implantitis socket was 50.58% ± 14.27% (SD). Within the limitations of this preliminary investigation, especially the small number of animals, osseointegration seems to be achievable both in infected sites and around contaminated implant surfaces. © 2011 Wiley Periodicals, Inc.
Kihara, Hidemichi; Sun, Jie; Sakai, Maiko; Nagai, Shigemi; Da Silva, John
The aim of this study was to investigate the extent and forms of predoctoral implant dentistry instruction in North American dental schools and to identify future directions and challenges. The survey collected data on curriculum content, departmental oversight, techniques, and materials, as well as current problems to be solved. The 30-question survey was sent in 2012 to the dean or administrator in charge of the predoctoral curriculum of all 73 dental schools in the U.S. and Canada at the time; four reminders were sent. Forty-seven schools responded, for a response rate of 64%. Of the 47 responding schools, 46 (98%) offered didactic instruction (mean of 17 hours); 87% had a laboratory component (mean of 14.46 hours); and 57% had a clinical requirement. In the responding schools, students had an average of 1.85 implant restorative cases and 0.61 surgical cases. Forty-two of the schools (89%) had implemented observation of implant surgery and/or assisting with implant surgery in their curricula. Major challenges reported in implementing a comprehensive predoctoral implant curriculum included expense of implant systems to the schools and to patients, shortage of predoctoral cases, and lack of curriculum time and trained faculty. These results show that implant education for predoctoral dental students continues to expand, with a trend towards more preclinical exercises and clinical experiences and fewer didactic courses.
Funato, Akiyoshi; Ogawa, Takahiro
Ultraviolet (UV) light treatment of titanium, or photofunctionalization, has been shown to enhance its osteoconductivity in animal and in vitro studies, but its clinical performance has yet to be reported. This clinical case series sought to examine the effect of photofunctionalization on implant success, healing time, osseointegration speed, and peri-implant marginal bone level changes at 1 year after restoration. Four partially edentulous patients were included in the study. Seven implants with identical microroughened surfaces were photofunctionalized with UV light for 15 minutes. Osseointegration speed was calculated by measuring the increase in implant stability quotient (ISQ) per month. Marginal bone levels were evaluated radiographically at crown placement and at 1 year. All implants placed into fresh extraction sockets, vertically augmented bone, simultaneously augmented sinuses, or the site of a failing implant remained functional and healthy at 1 year, even with an earlier loading protocol (2.1 to 4.5 months). ISQs of 48 to 75 at implant placement had increased to 68 to 81 at loading. In particular, implants with low primary stability (initial ISQ < 70) showed large increases in ISQ. The speed of osseointegration of photofunctionalized implants was considerably greater than that of as-received implants documented in the literature. Mean marginal bone levels were -0.35 ± 0.71 mm at crown placement and had significantly increased to 0.16 ± 0.53 mm at 1 year, with coronal gains in marginal bone level that surpassed the implant platform. No implants showed marginal bone loss. Within the limits of this study, photofunctionalization expedited and enhanced osseointegration of commercial dental implants in various clinically challenging/compromised bone conditions. Photofunctionalization resulted in preservation--and often a gain--of marginal bone level, and long-term large-scale clinical validation is warranted.
Yoon, Da-Le; Kim, Yong-Gun; Cho, Jin-Hyun; Lee, Jae-Mok; Lee, Sang-Kyu
This study was designed to evaluate the teeth and dental implants during dental maintenance therapy over 3 years in different conditions after periodontal and dental prosthetic treatment. 166 patients received maintenance therapy. 59 patients were treated with 2% minocycline-HCl ointment as local drug delivery (LDD) (L group) and 107 patients were treated without LDD (NL group). Clinical data was collected in maintenance period for evaluation. Patients were classified into groups depending on the application of LDD with maintenance therapy, the type of dental treatment before maintenance period (Pre-Tx), the frequency (F-MT), and regularity (R-MT) of maintenance therapy. The numbers of lost teeth (N-teeth, P=.003) and newly placed dental implants (N-implants, P=.022) are significantly different according to Pre-Tx. F-MT among patients who received surgical dental treatment before maintenance period showed statistical differences in N-teeth (P=.041), but not in N-implants (P=.564). All of the patients in L group showed high F-MT (F-MT1). In NL group, there were no statistical differences in N-teeth or N-implants according to F-MT or R-MT. In F-MT1 group, application of LDD made N-teeth significantly different from both Pre-Tx groups while no significant difference could be found in N-implant. Independent t-test and one-way ANOVA were selected for statistical analysis. The regular maintenance therapy and LDD can be effective for teeth during maintenance period. It is not only pharmacological efficacy in decreasing bacterial species that makes LDD a useful adjunct. Application of LDD also motivates patients to take adequate check-ups in the aspects of both frequency and regularity.
PURPOSE This study was designed to evaluate the teeth and dental implants during dental maintenance therapy over 3 years in different conditions after periodontal and dental prosthetic treatment. MATERIALS AND METHODS 166 patients received maintenance therapy. 59 patients were treated with 2% minocycline-HCl ointment as local drug delivery (LDD) (L group) and 107 patients were treated without LDD (NL group). Clinical data was collected in maintenance period for evaluation. Patients were classified into groups depending on the application of LDD with maintenance therapy, the type of dental treatment before maintenance period (Pre-Tx), the frequency (F-MT), and regularity (R-MT) of maintenance therapy. RESULTS The numbers of lost teeth (N-teeth, P=.003) and newly placed dental implants (N-implants, P=.022) are significantly different according to Pre-Tx. F-MT among patients who received surgical dental treatment before maintenance period showed statistical differences in N-teeth (P=.041), but not in N-implants (P=.564). All of the patients in L group showed high F-MT (F-MT1). In NL group, there were no statistical differences in N-teeth or N-implants according to F-MT or R-MT. In F-MT1 group, application of LDD made N-teeth significantly different from both Pre-Tx groups while no significant difference could be found in N-implant. Independent t-test and one-way ANOVA were selected for statistical analysis. CONCLUSION The regular maintenance therapy and LDD can be effective for teeth during maintenance period. It is not only pharmacological efficacy in decreasing bacterial species that makes LDD a useful adjunct. Application of LDD also motivates patients to take adequate check-ups in the aspects of both frequency and regularity. PMID:28680555
Stanford, Clark M; Schneider, Galen B
Achieving a long-term stable implant interface is a significant clinical issue when there is insufficient cortical bone stabilisation at implant placement. Clinical outcomes studies suggest that the higher risk implants are those placed in compromised cortical bone (thin, porous, etc.) in anatomical sites with minimal existing trabecular bone (characterised as type IV bone). In establishing and maintaining an implant interface in such an environment, one needs to consider the impact of masticatory forces, the response of bone to these forces and the impact of age on the adaptive capacity of bone. These forces, in turn, have the potential to create localised changes in interfacial stiffness through viscoelastic changes at the interface. Changes in bone as a function of age (e.g. localised hypermineralised osteopetrosis and localised areas of osteopenia) will alter the communication between osteocytes and osteoblasts creating the potential for differences in response of osteoblastic cells in the older population. A key to understanding the biomechanical and functional behaviour of implants in the older population is to control the anticipated modelling and remodelling behaviour through implant design that takes into account how tissues respond to the mechanically active environment.
Mahshid, Minoo; Saboury, Aboulfazl; Fayaz, Ali; Sadr, Seyed Jalil; Lampert, Friedrich; Mir, Maziar
Background Mechanical torque devices (MTDs) are one of the most commonly recommended devices used to deliver optimal torque to the screw of dental implants. Recently, high variability has been reported about the accuracy of spring-style mechanical torque devices (S-S MTDs). Joint stability and survival rate of fixed implant supported prosthesis depends on the accuracy of these devices. Currently, there is limited information on the steam sterilization influence on the accuracy of MTDs. The purpose of this study was to assess the effect of steam sterilization on the accuracy (±10% of the target torque) of spring-style mechanical torque devices for dental implants. Materials and methods Fifteen new S-S MTDs and their appropriate drivers from three different manufacturers (Nobel Biocare, Straumann [ITI], and Biomet 3i [3i]) were selected. Peak torque of devices (5 in each subgroup) was measured before and after autoclaving using a Tohnichi torque gauge. Descriptive statistical analysis was used and a repeated-measures ANOVA with type of device as a between-subject comparison was performed to assess the difference in accuracy among the three groups of spring-style mechanical torque devices after sterilization. A Bonferroni post hoc test was used to assess pairwise comparisons. Results Before steam sterilization, all the tested devices stayed within 10% of their target values. After 100 sterilization cycles, results didn’t show any significant difference between raw and absolute error values in the Nobel Biocare and ITI devices; however the results demonstrated an increase of error values in the 3i group (P < 0.05). Raw error values increased with a predictable pattern in 3i devices and showed more than a 10% difference from target torque values (maximum difference of 14% from target torque was seen in 17% of peak torque measurements). Conclusion Within the limitation of this study, steam sterilization did not affect the accuracy (±10% of the target torque) of the
Olmedo, Daniel G; Tasat, Déborah R; Duffó, Gustavo; Guglielmotti, Maria B; Cabrini, Rómulo L
Pure titanium or titanium alloys, and to a lesser extent, zirconium, are metals that are often used in direct contact with host tissues. These metallic biomaterials are highly reactive, and on exposure to fluid media or air, quickly develop a layer of titanium dioxide (TiO2) or zirconium dioxide (ZrO2). This layer of dioxide forms a boundary at the interface between the biological medium and the metal structure, determining the degree of biocompatibility and the biological response of the implant. Corrosion is the deterioration a metal undergoes as a result of the surrounding medium (electrochemical attack), which causes the release of ions into the microenvironment. No metal or alloy is entirely inert in vivo. Corrosion phenomena at the interlace are particularly important in the evolution of both dental and orthopedic implants and one of the possible causes of implant failure after initial success. This paper comprises a review of literature and presents results of our laboratory experiments related to the study of corrosion, with special emphasis on dental implants. In situ degradation of a metallic implant is undesirable because it alters the structural integrity of the implant. The issue of corrosion is not limited to a local problem because the particles pmduced as a result could migrate to distant sites, whose evolution would require further studies.
Ichim, Paul I; Hu, Xiaozhi; Bazen, Jennifer J; Yi, Wei
In this work, we use FEA to test the hypothesis that a low-modulus coating of a cylindrical zirconia dental implant would reduce the stresses in the peri-implant bone and we use design optimization and the rule of mixture to estimate the elastic modulus and the porosity of the coating that provides optimal stress shielding. We show that a low-modulus coating of a dental implant significantly reduces the maximum stresses in the peri-implant bone without affecting the average stresses thus creating a potentially favorable biomechanical environment. Our results suggest that a resilient coating is capable of reducing the maximum compressive and tensile stresses in the peri-implant bone by up to 50% and the average stresses in the peri-implant bone by up to 15%. We further show that a transitional gradient between the high-modulus core and the low-modulus coating is not necessary and for a considered zirconia/HA composite the optimal thickness of the coating is 100 µ with its optimal elastic at the lowest value considered of 45 GPa.
Dental implants are placed endosseously, and the bone is the ultimate bearer of the occlusal load. Patients are not uniform in the maximum bite force they can generate. The occlusal biting load in the posterior jaw is usually about three times of that found in the anterior. It is possible for supporting implants to be overloaded by the patients' biting force, resulting in bone loss and failure of the fixture. Bite force measurement may be an important parameter when planning dental implant treatment. Some patients can generate extreme biting loads that may cause a luxation of the fixture and subsequent loss of osseointegration. A patient with low biting force may be able to have a successful long-term outcome even with poor anatomical bone qualities. Patients with a high bite force capability may have an increased risk for late component fracture or implant failure. There is no correlation of any bite force value that would indicate any overload of a given implant in a given osseous site. Nonetheless, after bite force measurement, a qualitative judgement may be made by the clinician for the selection of an implant diameter and length and prosthetic design.
Prasad, Soni; Bansal, Naveen
The aims of this study were to assess 1) differences in perceptions of dental implant training between dental students who received didactic training alone (control group) and those who received didactic plus simulation training (test group); 2) differences in response between students with and without clinical experience in implant dentistry; and 3) the interaction effect of simulation training and clinical experience on students' satisfaction. A survey was distributed to the control group in 2014 and to the test group in 2015; both groups were at the same U.S. dental school. Data were collected on confidence levels with various implant restorative procedures along with overall satisfaction and number of implant restorations performed by each student. The response rate was 78.7% in the control group and 81.3% in the test group. In the control group, 85.7% of students reported being satisfied with implant training compared to 90.8% of students in the test group. The interaction effect of simulation training and clinical experience on overall student satisfaction was OR=1.5 at 95% CI: 0.8, 3.0. The students who had clinical experience with implant restorative procedures had significantly greater satisfaction than those who did not (OR=4.8, 95% CI: 2.1, 11.1, p<0.01). This study found that both the simulation and clinical experience affected these students' confidence and satisfaction levels with implant education: they were almost five times more satisfied with implant training when clinical experience in implant restorative procedures was a part of their implant education.
Da Silva, John D.; Kazimiroff, Julie; Papas, Athena; Curro, Frederick A.; Thompson, Van P.; Vena, Donald A.; Wu, Hongyu; Collie, Damon; Craig, Ronald G.
implants, 20 (2.2 percent) had restorations replaced or judged as needing to be replaced. The majority of P-Is and patients were satisfied with the esthetic outcomes for both the implant and restoration. Conclusions These results suggest that implant survival and success rates in general dental practices may be lower than those reported in studies conducted in academic or specialty settings. Practical Implications The results of this study, generated in the private general practice setting, add to the evidence base to facilitate implant treatment planning. PMID:24982276
Chrcanovic, Bruno Ramos; Albrektsson, Tomas; Wennerberg, Ann
To test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL) and postoperative infection in patients who received platform-switched implants or platform-matched implants, against the alternative hypothesis of a difference. Main search terms used in combination: dental implant, oral implant, platform switch, switched platform, platform mismatch, and dental implant-abutment design. An electronic search without time or language restrictions was undertaken in December/2014 in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register plus hand-searching. Eligibility criteria included clinical human studies, either randomized or not. Twenty-eight publications were included, with a total of 1216 platform-switched implants (16 failures; 1.32%) and 1157 platform-matched implants (13 failures; 1.12%). There was less MBL loss at implants with platform-switching than at implants with platform-matching (mean difference -0.29, 95% CI -0.38 to -0.19; P<0.00001). An increase of the mean difference of MBL between the procedures was observed with the increase in the follow-up time (P=0.001) and with the increase of the mismatch between the implant platform and the abutment (P=0.001). Due to lack of satisfactory information, meta-analyses for the outcomes 'implant failure' and 'postoperative infection' were not performed. The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them with short follow-up periods. The question whether platform-matched implants are more at risk for failure and loose more marginal bone than platform-switched implants has received increasing attention in the last years. As the philosophies of treatment alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures, forming a basis for optimum treatment. Copyright © 2014 Elsevier Ltd
Hosoki, Maki; Nishigawa, Keisuke; Miyamoto, Youji; Ohe, Go; Matsuka, Yoshizo
Titanium has been considered to be a non-allergenic material. However, several studies have reported cases of metal allergy caused by titanium-containing materials. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. He exhibited allergic symptoms (eczema) after orthopedic surgery. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. After removal of dental implants, the eczema disappeared completely. Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. Most of the usage of titanium is in the form of titanium dioxide. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population. In general, allergic risk of titanium material is smaller than that of other metal materials. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Insua, Angel; Monje, Alberto; Wang, Hom-Lay; Miron, Richard J
Despite the growing number of publications in the field of implant dentistry, there are limited studies to date investigating the biology and metabolism of bone healing around dental implants and their implications in peri-implant marginal bone loss. The aim of this review article is to provide a thorough understanding of the biological events taking place during osseointegration and the subsequent early and late phases of bone remodeling around dental implants. An update on the coupling mechanism occurring during bone resorption-bone remodeling is provided, focused on the relevance of the osteocytes, bone lining cells and immune cells during bone maintenance. An electronic and manual literature search was conducted by three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles up to September 2016 with no language restriction. Local bone metabolism is subject to signals from systemic calcium-phosphate homeostasis and bone remodeling. Three areas of interest were reviewed due to recent reported compromises in bone healing including the putative effects of (1) cholesterol, (2) hyperlipidemia, and (3) low vitamin D intake. Moreover, the prominent influence of osteocytes and immune cells is discussed as being key regulators during dental implant osseointegration and maintenance. These cells are of crucial importance in the presence of biofilm accumulation and their associated byproducts that leads to hard and soft tissue breakdown; the so called peri-implantitis. Factors that could negatively impact osteoclastogenesis or osteal macrophage activation should be monitored in future research including implant placement/torque protocols, bone characteristics, as well as meticulous maintenance programs to favor osseointegration and future long-term stability and success of dental implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res
Cheng, Y M
Periodontal prosthesis refers to multidisciplinary efforts to stop disease progression, correct deformities created by dental diseases, and establish a therapeutic occlusion to restore the form and function of the masticatory system. These efforts are critical for the long-term prognosis and maintenance of the guarded teeth and the overall prosthesis. This article presents a functionally and esthetically challenging case, which illustrates a multidisciplinary approach--specifically implantology and orthodontics--and how they impact on each other during treatment. The role and importance of dental implants and orthodontics in setting up a case is illustrated in this article.
Liu, Huinan; Jiang, Wenping; Malshe, Ajay
A novel hybrid coating process, combining NanoSpray® (built on electrostatic spray coating) technology with microwave sintering process, was developed for synthesizing hydroxyapatite- (HA-) based nanostructured coating with favorable properties for dental and orthopedic implants. Specifically, HA nanoparticles were deposited on commercially pure titanium substrates using NanoSpray technique to produce the HA coating, which was then sintered in a microwave furnace under controlled conditions. The study showed that the use of NanoSpray followed by microwave sintering results in nanoscale HA coating for dental/orthopedic application.
Casap, Nardy; Nadel, Sahar; Tarazi, Eyal; Weiss, Ervin I
This study evaluated the benefits of a virtual reality navigation system for teaching the surgical stage of dental implantation to final-year dental students. The study aimed to assess the students' performance in dental implantation assignments by comparing freehand protocols with virtual reality navigation. Forty final-year dentistry students without previous experience in dental implantation surgery were given an implantation assignment comprising 3 tasks. Marking, drilling, and widening of implant holes were executed by a freehand protocol on the 2 mandibular sides by 1 group and by virtual reality navigation on 1 side and contralaterally with the freehand protocol by the other group. Subjective and objective assessments of the students' performance were graded. Marking with the navigation system was more accurate than with the standard protocol. The 2 groups performed similarly in the 2-mm drilling on the 2 mandibular sides. Widening of the 2 mesial holes to 3 mm was significantly better with the second execution in the standard protocol group, but not in the navigation group. The navigation group's second-site freehand drilling of the molar was significantly worse than the first. The execution of all assignments was significantly faster in the freehand group than in the navigation group (60.75 vs 77.25 minutes, P = .02). Self-assessment only partly matched the objective measurements and was more realistic in the standard protocol group. Despite the improved performance with the navigation system, the added value of training in dental implantation surgery with virtual reality navigation was minimal. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Harirforoush, R; Arzanpour, S; Chehroudi, B
Dental implants are ideally placed in an orientation that allows vertical transfer of occlusal forces along their long axis. Nevertheless, optimal situations for implant placement are seldom encountered resulting in implants placement in angulated positions, which may affect their long-term success. The resonance frequency (RF) is an objective tool used to monitor stability of the implant tissue integration; however, little is known of the effect of the implant orientation in bone on the RF and its potential significance. The purpose of this research was to determine the relation between the dental implant orientation and the corresponding RF of implant. Three-dimensional (3D) modelling software was used to construct a 3D model of a pig mandible from computed tomography (CT) images. The RF of the implant was analysed using finite element (FE) modal analysis in software ANSYS (v.12). In addition, a cubical model was also developed in MIMICS to investigate the parameters affecting the relationship between RF and implant orientation in a simplified environment. The orientation angle was increased from 0 to 10 degrees in 1 degree increments and the resulting RF was analysed using correlation analysis and one-way ANOVA. Our analysis illustrated that the RF fluctuation following altering implant orientation was strongly correlated (r=0.97) with the contacting cortical to cancellous bone ratio (CCBR) at the implant interface. The most extreme RF change (from 9.81kHz to 10.07kHz) occurred when the implant was moved 0.5mm in positive z-direction, which resulted in the maximum change of CCBR from 52.9 to 54.8. Copyright © 2014. Published by Elsevier Ltd.
Greenstein, Gary; Cavallaro, John
Whether or not keratinized tissue is needed around dental implants to maintain peri-implant health is a controversial subject. To clarify this issue a search was conducted for clinical trials that appraised the significance ofkeratinized gingiva (KG) around teeth and dental implants. A critical assessment of the data revealed that the literature is replete with studies that contradict one another with respect to the need for KG as it relates to survivability of implants, gingival response to plaque, inflammation, probing depths, recession, and loss of bone. When groups of patients with and without KG were compared with respect to various clinical parameters, a statistically significant better result in the presence of KG could be interpreted to indicate that having KG is advantageous. However, quantitative differences between groups with and without KG were usually very small. Overall, the data was interpreted to indicate that some patients may need augmentation of keratinized tissue to maintain peri-implant health. Ultimately, the decision to augment KG is a judgment call that needs to be made by the treating clinician, because there are not enough data to facilitate development of definitive guidelines relevant to this subject. Apparently, the need for KG is patient specific, and at present there is no method to reliably predict who would benefit from tissue augmentation.
Mendoza-Arnau, Amparo; Vallecillo-Capilla, Manuel-Francisco; Cabrerizo-Vílchez, Miguel-Ángel
Background To characterize the surface topography of several dental implants for commercial use. Material and Methods Dental implants analyzed were Certain (Biomet 3i), Tissue Level (Straumann), Interna (BTI), MG-InHex (MozoGrau), SPI (Alphabio) and Hikelt (Bioner). Surface topography was ascertained using a confocal microscope with white light. Roughness parameters obtained were: Ra, Rq, Rv, Rp, Rt, Rsk and Rku. The results were analysed using single-factor ANOVA and Student-Neuman-Keuls(p<0.05) tests. Results Certain and Hikelt obtained the highest Ra and Rq scores, followed by Tissue Level. Interna and SPI obtained lower scores, and MG-InHex obtained the lowest score. Rv scores followed the same trend. Certain obtained the highest Rp score, followed by SPI and Hikelt, then Interna and Tissue Level. MG-InHex obtained the lowest scores. Certain obtained the highest Rt score, followed by Interna and Hikelt, then SPI and Tissue Level. The lowest scores were for MG-InHex. Rsk was negative (punctured surface) in the MG-InHex, SPI and Tissue Level systems, and positive (pointed surface) in the other systems. Rku was higher than 3 (Leptokurtic) in Tissue Level, Interna, MG-InHex and SPI, and lower than 3 (Platykurtic) in Certain and Hikelt. Conclusions The type of implant determines surface topography, and there are differences in the roughness parameters of the various makes of implants for clinical use. Key words:Implants for clinical use, topography, confocal microscopy. PMID:27475680
Gooty, Jagadish Reddy; Palakuru, Sunil Kumar; Guntakalla, Vikram Reddy; Nera, Mahipal
Dental implants made of titanium for replacement of missing teeth are widely used because of ease of technical procedure and high success rate, but are not free of complications and may fail. Fracturing of the prosthetic screw continues to be a problem in restorative practice and great challenge to remove the fractured screw conservatively. This case report describes and demonstrates the technique of using an ultrasonic scaler in the removal of the fracture screw fragment as a noninvasive method without damaging the hex of implants. PMID:24963261
Dewan, Karun; Bishop, Karl
Cherubism is a rare non-neoplastic, fibro-osseous hereditary disorder characterized by bilateral expansion of the maxilla and mandible producing a characteristic facial appearance. It can affect the facial and dental growth of the individual and often results in gross aesthetic and functional deficiencies. The teeth may also be displaced or submerged and these problems can often compromise successful restorative rehabilitation. This paper describes the restorative management of an adult patient with Cherubism involving a fixed implant retained mandibular restoration. The care utilized 3D planning software and implant insertion guides to facilitate an early loading protocol and the use of optimum bone quality/volume areas.
... reclassify this preamendments class III device into class II. FDA believes that this new information is... dental implant, a preamendments class III device, into class II (special controls). On its own initiative, based on new information, FDA is proposing to revise the classification of blade-form endosseous...
Gellrich, Nils-Claudius; Rahlf, Björn; Zimmerer, Rüdiger; Pott, Philipp-Cornelius; Rana, Majeed
Every endosseous dental implant is dependent on an adequate amount and quality of peri-implant hard and soft tissues and their fully functional interaction. The dental implant could fail in cases of insufficient bone and soft tissues or due to a violation of the soft to hard tissues to implant shoulder interface with arising of a secondary bone loss. To overcome this biological weak-spot, we designed a new implant that allows for multi vector endosseous anchorage around the individual underlying bone, which has to be scanned by computed tomography (CT) or Cone beam CT (CBCT) technique to allow for planning the implant. We developed a workflow to digitally engineer this customized implant made up of two planning steps. First, the implant posts are designed by prosthodontic-driven backward planning, and a wireframe-style framework is designed on the individual bony surface of the recipient site. Next, the two pieces are digitally fused and manufactured as a single piece implant using the SLM technique (selective laser melting) and titanium-alloy-powder. Preoperative FEM-stress-test of the individual implant is possible before it is inserted sterile in an out-patient procedure. Unlike any other historical or current dental implant protocol, our newly developed "individual patient solutions dental" follows the principle of a fully functional and rigid osteosynthesis technology and offers a quick solution for an implant-borne dental rehabilitation in difficult conditions of soft and hard tissues.
De Maeztu, M A; Braceras, I; Álava, J I; Recio, C; Piñera, M; Gay-Escoda, C
This clinical study evaluated a new surface treatment of ion implantation with CO ions which has previously been subjected to extensive study in animal models. The aim of this work was to assess its effect in humans. Experimental mini-implants were used; half of their longitudinal surface was machined and the other half was treated with CO ion implantation. The study was conducted in healthy volunteer patients who required prosthetic treatment with dental implants, and in accordance with the corresponding ethics committees. Coinciding with the insertion of commercial implants for oral restoration, one or two mini-implants were placed in the upper maxillary tuberosity or in the retromolar trigone of the mandible. The mini-implants were removed with a trephine jointly with a small volume of surrounding bone after a 3-month period. Two evaluation methods were used and both showed a greater degree of bone integration in the mini-implant section that underwent CO ion implantation treatment in comparison with the non-treated surface: 62.9% vs. 57.9%, and 54.8% vs. 46.2%. In addition, no adverse reactions were observed in the surface treatment with CO ion implantation. These results confirm the positive benefits in humans, based on the findings obtained from previous animal experiments.
Gajendrareddy, Praveenkumar; Elangovan, Satheesh; Rampa, Sankeerth; Allareddy, Veeratrishul; Lee, Min Kyeong; Nalliah, Romesh P; Allareddy, Veerasathpurush
Clinical trials serve as the empirical basis for clinical decision making. The objective of the current study is to provide an overview of clinical trials examining dental implant outcomes. All registered studies on Dental Implants were selected for analysis. The clinicaltrials.gov
Pieralli, S; Kohal, R J; Jung, R E; Vach, K; Spies, B C
To determine the survival rate and marginal bone loss (MBL) of zirconia dental implants restored with single crowns or fixed dental prostheses. An electronic search was conducted up to November 2015 (without any restriction regarding the publication time) through the databases MEDLINE (PubMed), Cochrane Library, and EMBASE to identify randomized controlled clinical trials and prospective clinical trials including >15 patients. Primary outcomes were survival rate and MBL. Furthermore, the influence of several covariates on MBL was evaluated. Qualitative assessment and statistical analyses were performed. This review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews. With the applied search strategy, 4,196 titles could be identified. After a screening procedure, 2 randomized controlled clinical trials and 7 prospective clinical trials remained for analyses. In these trials, a total of 326 patients received 398 implants. The follow-up ranged from 12 to 60 mo. Implant loss was mostly reported within the first year, especially within the healing period. Thereafter, nearly constant survival curves could be observed. Therefore, separate meta-analyses were performed for the first and subsequent years, resulting in an implant survival rate of 95.6% (95% confidence interval: 93.3% to 97.9%) after 12 mo and, thereafter, an expected decrease of 0.05% per year (0.25% after 5 y). Additionally, a meta-analysis was conducted for the mean MBL after 12 mo, resulting in 0.79 mm (95% confidence interval: 0.73 to 0.86 mm). Implant bulk material and design, restoration type, and the application of minor augmentation procedures during surgery, as well as the modes of temporization and loading, had no statistically significant influence on MBL. The short-term cumulative survival rates and the MBL of zirconia implants in the presented systematic review are promising. However, additional data are still
Mathieu, Vincent; Vayron, Romain; Richard, Gilles; Lambert, Grégory; Naili, Salah; Meningaud, Jean-Paul; Haiat, Guillaume
Dental implants are now widely used for the replacement of missing teeth in fully or partially edentulous patients and for cranial reconstructions. However, risks of failure, which may have dramatic consequences, are still experienced and remain difficult to anticipate. The stability of biomaterials inserted in bone tissue depends on multiscale phenomena of biomechanical (bone-implant interlocking) and of biological (mechanotransduction) natures. The objective of this review is to provide an overview of the biomechanical behavior of the bone-dental implant interface as a function of its environment by considering in silico, ex vivo and in vivo studies including animal models as well as clinical studies. The biomechanical determinants of osseointegration phenomena are related to bone remodeling in the vicinity of the implants (adaptation of the bone structure to accommodate the presence of a biomaterial). Aspects related to the description of the interface and to its space-time multiscale nature will first be reviewed. Then, the various approaches used in the literature to measure implant stability and the bone-implant interface properties in vitro and in vivo will be described. Quantitative ultrasound methods are promising because they are cheap, non invasive and because of their lower spatial resolution around the implant compared to other biomechanical approaches.
Sundell, Gustav; Dahlin, Christer; Andersson, Martin; Thuvander, Mattias
Osseointegration of dental implants occurs on a hierarchy of length scales down to the atomic level. A deeper understanding of the complex processes that take place at the surface of an implant on the smallest scale is of interest for the development of improved biomaterials. To date, transmission electron microscopy (TEM) has been utilized for examination of the bone-implant interface, providing details on the nanometer level. In this study we show that TEM imaging can be complemented with atom probe tomography (APT) to reveal the chemical composition of a Ti-based dental implant in a human jaw on the atomic level of resolution. As the atom probe technique has equal sensitivity for all elements, it allows for 3 dimensional characterizations of osseointegrated interfaces with unprecedented resolution. The APT reconstructions reveal a Ca-enriched zone in the immediate vicinity of the implant surface. A surface oxide of some 5nm thickness was measured on the titanium implant, with a sub-stoichiometric composition with respect to TiO2. Minor incorporation of Ca into the thin oxide film was also evident. We conclude that the APT technique is capable of revealing chemical information from the bone-implant interface in 3D with unprecedented resolution, thus providing important insights into the mechanisms behind osseointegration.
Friedrich, Reinhard E; Todorovic, Manuel; Heiland, Max; Scheuer, Hanna A; Krüll, Andreas
A fundamental improvement of restorative dentistry is the compensation of missing teeth by insertion of artificial dental roots allowing retention of dental prosthesis. The function of dental implants conserves a permanent perforation of the mucosa and upholds a non-physiological contact of bone with foreign material and oral micro-organisms. Occasionally head and neck cancer patients are scheduled to receive radiotherapy but are wearing dental implants. An earlier study had shown that the distribution of x-rays is noteworthily changed when dental implants are present in the irradiation field. New implants of smaller size are currently being designed that allow sufficient retention for dental prosthesis. The aim of this consecutive study was to calculate alterations in the irradiated bone caused by a foreign body, representing an implant of reduced size and physical qualities equivalent to titanium, using a stochastic (Monte Carlo) simulation. A clinical linear accelerator was simulated using BEAM/EGS4. The calculations showed that the presence of a dimension-reduced implant results in remarkable differences of the dose distribution all around the implant. Titanium dental implants of reduced size located in the field of irradiation were capable of causing significant radiation scattering. Similar to standard implants, the risk for dose enhancement was notably important for the bone in direct contact with the implant. All therapists involved in the therapy of cancer patients undergoing head and neck radiotherapy should consider the impact of dental implants on the radiation beam as a catalyst of osteoradionecrosis.
Schiegnitz, E; Al-Nawas, B; Kämmerer, P W; Grötz, K A
The aim of this comprehensive literature review is to provide recommendations and guidelines for dental implant therapy in patients with a history of radiation in the head and neck region. For the first time, a meta-analysis comparing the implant survival in irradiated and non-irradiated patients was performed. An extensive electronic search in the electronic databases of the National Library of Medicine was conducted for articles published between January 1990 and January 2013 to identify literature presenting survival data on the topic of dental implants in patients receiving radiotherapy for head and neck cancer. Review and meta-analysis were performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses statement. For meta-analysis, only studies with a mean follow-up of at least 5 years were included. After screening 529 abstracts from the electronic database, we included 31 studies in qualitative and 8 in quantitative synthesis. The mean implant survival rate of all examined studies was 83 % (range, 34-100 %). Meta-analysis of the current literature (2007-2013) revealed no statistically significant difference in implant survival between non-irradiated native bone and irradiated native bone (odds ratio [OR], 1.44; confidence interval [CI], 0.67-3.1). In contrast, meta-analysis of the literature of the years 1990-2006 showed a significant difference in implant survival between non-irradiated and irradiated patients ([OR], 2.12; [CI], 1.69-2.65) with a higher implant survival in the non-irradiated bone. Meta-analysis of the implant survival regarding bone origin indicated a statistically significant higher implant survival in the irradiated native bone compared to the irradiated grafted bone ([OR], 1.82; [CI], 1.14-2.90). Within the limits of this meta-analytic approach to the literature, this study describes for the first time a comparable implant survival in non-irradiated and irradiated native bone in the current literature. Grafted
Javed, Fawad; Romanos, Georgios E
We speculated that the long-term survival of narrow or conventional diameter (<5 mm) implants is higher than that of wide-diameter implants (≥ 5 mm) when placed in posterior atrophic maxillae. The aim of this paper was to systematically review indexed literature regarding the influence of implant diameter on long-term survival of dental implants placed in posterior maxilla. The addressed focused question was "Does implant diameter influence long-term survival of dental implants placed in posterior maxilla?" Databases were searched from 1986 till June 2014 using the following MeSH terms: "dental implants," "dental implant-abutment design," "maxilla," and "survival." Review articles, case reports, letters to the editor, unpublished data, and studies published in languages other than English were excluded. Reference list of potentially relevant original and review studies was hand-searched. The initial search yielded 51 studies. Scrutiny of the titles and abstracts reduced the number of clinical studies included in the present review to 19. Mean age of the patients ranged between 37 and 60 years. Cylindrical and tapered implants were used in 12 and 3 studies, respectively. In all studies, threaded, rough-surfaced dental implants with diameters ranging between 3.0 and 5.5 mm were used. In all studies, follow-up periods and cumulative survival rates ranged between 5 and 15 years and 80.5 and 100 %, respectively. The role of implant diameter on long-term survival of dental implants placed in posterior maxilla is secondary. A well-designed surgical protocol, achievement of sufficient primary stability at the time of implant placement, and pre- and postsurgical oral hygiene maintenance visits are critical factors that influence the long-term survival of dental implants placed in posterior atrophic maxilla.
Dhaliwal, Jagjit S; Albuquerque, Rubens F; Murshed, Monzur; Feine, Jocelyne S
Mini dental implants (MDIs) are becoming increasingly popular for rehabilitation of edentulous patients because of their several advantages. However, there is a lack of evidence on the osseointegration potential of the MDIs. The objective of the study was to histomorphometrically evaluate and compare bone apposition on the surface of MDIs and standard implants in a rabbit model. Nine New Zealand white rabbits were used for the study to meet statistical criteria for adequate power. Total 18 3M(™)ESPE(™) MDIs and 18 standard implants (Ankylos(®) Friadent, Dentsply) were inserted randomly into the tibia of rabbits (four implants per rabbit); animals were sacrificed after a 6-week healing period. The specimens were retrieved en bloc and preserved in 10% formaldehyde solution. Specimens were prepared for embedding in a light cure acrylic resin (Technovit 9100). The most central sagittal histological sections (30-40 μm thick) were obtained using a Leica SP 1600 saw microtome. After staining, the Leica DM2000 microscope was used, the images were captured using Olympus DP72 camera and associated software. Bone implant contact (BIC) was measured using Infinity Analyze software. All implants were osseointegrated. Histologic measures show mineralized bone matrix in intimate contact with the implant surface in both groups. The median BIC was 57.5% (IQR 9.0) in the MDI group and 55.0% (IQR 4.5) in the control group (P > 0.05, Mann-Whitney test). There were no statistical differences in osseointegration at 6 weeks between MDIs and standard implants in rabbit tibias. Based on these results, it is concluded that osseointegration of MDIs is similar to that of standard implants.
Ossi, Zannar; Abdou, Wael; Reuben, Robert L; Ibbetson, Richard J
There is considerable interest in using acoustic emission (AE) and ultrasound to assess the quality of implant-bone interfaces and to monitor for micro-damage leading to loosening. However, remarkably little work has been done on the transmission of ultrasonic waves though the physical and biological structures involved. The aim of this in vitro study is to assess any differences in transmission between various dental materials and bovine rib bones with various degrees of hydration. Two types of tests have been carried out using pencil lead breaks as a standard AE source. The first set of tests was configured to assess the surface propagation of AE on various synthetic materials compared with fresh bovine rib bone. The second is a set of transmission tests on fresh, dried and hydrated bones each fitted with dental implants with various degrees of fixity, which includes components due to bone and interface transmission. The results indicate that transmission through glass ionomer cement is closest to the bone. This would suggest that complete osseointegration could potentially be simulated using such cement. The transmission of AE energy through bone was found to be dependent on its degree of hydration. It was also found that perfusing samples of fresh bone with water led to an increase in transmitted energy, but this appeared to affect transmission across the interface more than transmission through the bone. These findings have implications not only for implant interface inspection but also for passive AE monitoring of implants.
Wang, Chao; Wang, Lizhen; Liu, Xiaoyu; Fan, Yubo
Dental implants may alter the mechanical environment in the jawbone, thereby causing remodelling and adaptation of the surrounding trabecular bone tissues. To improve the efficacy of dental implant systems, it is necessary to consider the effect of bone remodelling on the performance of the prosthetic systems. In this study, finite element simulations were implemented to predict the evolution of microarchitecture around four implant systems using a previously developed model that combines both adaptive and microdamage-based mechano-sensory mechanisms in bone remodelling process. Changes in the trabecular architecture around dental implants were mainly focused. The simulation results indicate that the orientational and ladder-like architecture around the implants predicted herein is in good agreement with those observed in animal experiments and clinical observations. The proposed algorithms were shown to be effective in simulating the remodelling process of trabecular architecture around dental implant systems. In addition, the architectural features around four typical dental implant systems in alveolar bone were evaluated comparatively.
Palmer, R M
Patients have high expectations of dental implants in terms of appearance, function and longevity. It is essential that these expectations are realistically managed and that treatment of the highest standard is provided. This involves very careful evaluation, including clinical and radiographic, and presentation of the pros and cons of treatment alternatives. Provision of a successful implant restoration requires many skills including a surgical procedure to place the implant in the best possible position and prosthodontic techniques to provide an aesthetic restoration in occlusal harmony with the rest of the dentition. Recognition of risk factors and long-term maintenance requirements are equally important. Clinicians involved in these treatments must obtain adequate training and develop skills through treatment of straightforward cases using well established protocols before embarking on more demanding cases.
Kulakov, O B; Doktorov, A A; D'iakova, S V; Denisov-Nikol'skiĭ, Iu I; Grötz, K A
In an experiment performed on pigs, methods of light and scanning electron microscopy were used to study the interaction of zirconium and titanium dental implants with bone 6 months following their insertion. Distinct features of integration of both implant types with bone structures were detected. Sites of direct contact of bone structures with metal were found to undergo constant remodeling according to biochemical and metabolic conditions in each zone of an implant surface. Statistically the degree of interactive properties of zirconium implants significantly exceeded similar parameter for titanium screws. Along the perimeter of the zones of bone contact with zirconium implants greater numbers of forming and formed bone areas were revealed as compared to the zones of bone contact with titanium implants, where erosion lacunae were more numerous. The complex of research methods used in this study have not revealed distinct changes in the structure of osteocytes, located in immediate proximity to the metal surface in comparison with more distant sites in the bone.
Esquivel-Upshaw, Josephine F.; Mehler, Alex; Clark, Arthur E.; Neal, Dan; Anusavice, Kenneth J.
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
Esquivel-Upshaw, Josephine F; Mehler, Alex; Clark, Arthur E; Neal, Dan; Anusavice, Kenneth J
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, 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. 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 1-3 years. Fractures were observed, their locations recorded, and images compared with baseline photographs of occlusal contacts. No significant relationship existed 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. Because of the absence of a periodontal ligament, this clinical study demonstrates that there is a need to evaluate occlusion differently with implant-supported prostheses than with natural tooth supported prostheses. Implant supported prostheses should have minimal occlusion and lighter contacts than those supported by natural dentition
Dingsdag, Simon; Nelson, Stephen; Coleman, Nicholas V.
Background Previously, we demonstrated that bacteria reside in apparently healed alveolar bone, using culture and Sanger sequencing techniques. Bacteria in apparently healed alveolar bone may have a role in peri-implantitis and dental implant failure. Objective To compare bacterial communities associated with apical periodontitis, those colonising a failed implant and alveolar bone with reference biofilm samples from healthy teeth. Methods and results The study consisted of 196 samples collected from 40 patients undergoing routine dental implant insertion or rehabilitation. The bacterial 16S ribosomal DNA sequences were amplified. Samples yielding sufficient polymerase chain reaction product for further molecular analyses were subjected to terminal restriction fragment length polymorphism (T-RFLP; 31 samples) and next generation DNA sequencing (454 GS FLX Titanium; 8 samples). T-RFLP analysis revealed that the bacterial communities in diseased tissues were more similar to each other (p<0.049) than those from the healthy reference samples. Next generation sequencing detected 13 bacterial phyla and 373 putative bacterial species, revealing an increased abundance of Gram-negative [Prevotella, Fusobacterium (p<0.004), Treponema, Veillonellaceae, TG5 (Synergistetes)] bacteria and a decreased abundance of Gram-positive [(Actinomyces, Corynebacterium (p<0.008)] bacteria in the diseased tissue samples (n=5) relative to reference supragingival healthy samples (n=3). Conclusion Increased abundances of Prevotella, Fusobacterium and TG5 (Synergistetes) were associated with apical periodontitis and a failed implant. A larger sample set is needed to confirm these trends and to better define the processes of bacterial pathogenesis in implant failure and apical periodontitis. The application of combined culture-based, microscopic and molecular technique-based approaches is suggested for future studies. PMID:27834171
Turkyilmaz, Ilser; Tözüm, Tolga F
The aim of this study was to present the 30-year outcomes of 28 implants supporting mandibular screw-retained fixed dental prostheses (FDPs). Dental charts of the 4 patients were carefully reviewed, and it was noticed that they received 28 implants and 5 screw-retained FDPs in 1983 and 1984. The chief concerns raised by these patients were poor retention of their complete dentures and decreased masticatory function at the time of treatment planning. Each dental care they received was recorded in the last 30 years. Implant survival, radiographic, and prosthodontic examinations were performed. No implants were lost after 30 years, giving the implant a survival rate of 100%. The average marginal bone level was 2.6 ± 0.5 mm at the last recall appointment. Of the 5 FDPs delivered, 1 needed replacement, indicating a prosthesis survival rate of 80%. The patients needed 21 repairs such as replacement of denture teeth/gold screws and hard relining, and 19 adjustments such as occlusal adjustments and acrylic resin contouring, over 30 years. This clinical report shows that machined-surface dental implants can successfully support screw-retained fixed dental prostheses for over 30 years, making dental implants an important dental treatment alternative compared to the traditional prosthetic treatment methods.
Kranjcic, Josip; Mikus, Anja; Mehulic, Ketij; Vojvodic, Denis
The use of inserted dental implants is growing every day in order to improve retention and stability of complete removable dental prostheses (RDPs), especially in the mandible. Therefore, the aim of this study was to examine the knowledge and awareness of dental implants among elderly people wearing complete RDPs. This study, based on answers from a questionnaire designed for the purpose of this study, included 301 participants wearing complete RDPs from elderly care homes with average age of 74 years. The awareness of dental implants was statistically significantly (p < 0.05) affected by the participants' age, residence size, and their level of education. Younger participants (x¯ = 70 years) had heard about dental implants (56.5%; p < 0.05) and believed in the possibility of retaining complete RPDs using dental implants (56.1%; p < 0.05). Among participants living in places with populations of 10,000 or fewer residents, more had not heard about dental implants (59.4%; p < 0.05). Among participants who had completed college/university or high school, there were a higher number of participants who had heard about dental implants (82.4%; p < 0.05). Although more than half of the participants had heard of dental implants, this did not mean they were well informed about the implant insertion procedure and the costs for such a treatment. In conclusion, awareness of dental implants in studied participants was insufficient. The results reinforce the need for better education and the provision of proper information to elderly people about dental implants and implant treatment options. © 2014 by the American College of Prosthodontists.
Balkin, B E; Steflik, D E; Naval, F
The clinical and histological results of two cases demonstrating retrieved Sendax mini-dental implants in two different patients is the focus of this report. The mini-dental implants were inserted using the auto-advance technique and loaded immediately. The implants were retrieved at 4 months following insertion and at 5 months following insertion and were prepared and reviewed histologically. Clinically, the implants had no mobility, with no apparent exudate or bleeding upon probing, prior to removal. At the time explant procedures were performed, the mini-dental implants had provided immediate support for prostheses during the integration of traditional root-form endosteal implants. Upon explantation, the mini-dental implants were in a state of health and functioning in their intended purpose. Histologically, the bone appeared to be integrated to the surface of the implant at the light microscope level, and the bone appeared to be relatively mature and healthy in the areas observed, more so than one would expect in this amount of time from insertion of mini-dental implants with immediate loading. A discussion of the purposes and technique used for insertion and removal of these mini-dental implants is discussed. This is the first human histological report on the auto-advance technique with immediate loading of mini-dental implants, demonstrating feasibility in ongoing applications.
Geringer, Jean; Demanget, Nicolas; Pellier, Julie
Surface treatments of dental implants aim at promoting osseointegration, i.e. the anchorage of the metallic part. Titanium-, grade II-V, based material is used as a bulk material for dental implants. For promoting the anchorage of this metallic biomaterial in human jaw, some strategies have been applied for improving the surface state, i.e. roughness, topography and coatings. A case study, experimental study, is described with the method of acid etching on titanium grade 4, CpTi. The main goal is to find the right proportion in a mixture of two acids in order to obtain the best surface state. Finally, a pure theoretical prediction is quite impossible and some experimental investigations are necessary to improve the surface state. The described acid etching is compared with some other acid etching treatments and some coatings available on dental implants. Thus, the discussion is focused on the tribocorrosion behaviour of titanium-based materials. The purpose of the coating is that the lifetime under tribocorrosion is limited. Moreover, the surgery related to the implantation has a huge impact on the stability of dental implants. Thus, the performance of dental implants depends on factors related to surgery (implantation) that are difficult to predict from the biomaterial characteristics. From the tribocorrosion point of view, i.e. during the mastication step, the titanium material is submitted to some deleterious factors that cause the performance of dental implants to decrease.
Babík, Ondrej; Czán, Andrej; Holubják, Jozef; Kameník, Roman; Pilc, Jozef
One of the most best-known characteristic and important requirement of dental implant is made of biomaterials ability to create correct interaction between implant and human body. The most implemented material in manufacturing of dental implants is titanium of different grades of pureness. Since most of the implant surface is in direct contact with bone tissue, shape and integrity of said surface has great influence on the successful osseointegration. Among other characteristics of titanium that predetermine ideal biomaterial, it shows a high mechanical strength making precise machining miniature Increasingly difficult. The article is focused on evaluation of the resulting quality, integrity and characteristics of dental implants surface after machining.
Hong, Jaan; Kurt, Seta; Thor, Andreas
Surface modifications of dental implants have gained attention during several years and the thrombotic response from blood components with these materials has become more important during recent years. The aims of this study were to evaluate the thrombogenic response of whole blood, in contact with clinically used dental surfaces, Sandblasted Large grit Acid etched titanium (SLA) and Sandblasted Large grit Acid etched, and chemically modified titanium with hydrophilic properties (SLActive). An in vitro slide chamber model, furnished with heparin, was used in which whole blood came in contact with slides of the test surfaces. After incubation (60-minute rotation at 22 rpm in a 37°C water bath), blood was mixed with ethylenediaminetetraacetic acid (EDTA) or citrate, further centrifuged at +4°C. Finally, plasma was collected pending analysis. Whole blood in contact with surfaces resulted in significantly higher binding of platelets to the hydrophilic surface, accompanied by a significant increase of contact activation of the coagulation cascade. In addition, the platelet activation showed a similar pattern with a significant elevated release of β-TG from platelet granule. The conclusion that can be drawn from the results in our study is that the hydrophilic modification seems to augment the thrombogenic properties of titanium with implications for healing into bone of, that is titanium dental implants. © 2011 Wiley Periodicals, Inc.
Kirsten, A; Hausmann, A; Weber, M; Fischer, J; Fischer, H
The healing time of zirconia implants may be reduced by the use of bioactive glass coatings. Unfortunately, existing glasses are either bioactive like Bioglass 45S5 but thermally incompatible with the zirconia substrate, or they are thermally compatible but exhibit only a very low level of bioactivity. In this study, we hypothesized that a tailored substitution of alkaline earth metals and alkaline metals in 45S5 can lead to a glass composition that is both bioactive and thermally compatible with zirconia implants. A novel glass composition was analyzed using x-ray fluorescence spectroscopy, dilatometry, differential scanning calorimetry, and heating microscopy to investigate its chemical, physical, and thermal properties. Bioactivity was tested in vitro using simulated body fluid (SBF). Smooth and microstructured glass coatings were applied using a tailored spray technique with subsequent thermal treatment. Coating adhesion was tested on implants that were inserted in bovine ribs. The cytocompatibility of the coating was analyzed using L929 mouse fibroblasts. The coefficient of thermal expansion of the novel glass was shown to be slightly lower (11.58 · 10(-6) K(-1)) than that of the zirconia (11.67 · 10(-6) K(-1)). After storage in SBF, the glass showed reaction layers almost identical to the bioactive glass gold standard, 45S5. A process window between 800 °C and 910 °C was found to result in densely sintered and amorphous coatings. Microstructured glass coatings on zirconia implants survived a minimum insertion torque of 60 Ncm in the in vitro experiment on bovine ribs. Proliferation and cytotoxicity of the glass coatings was comparable with the controls. The novel glass composition showed a strong adhesion to the zirconia substrate and a significant bioactive behavior in the SBF in vitro experiments. Therefore, it holds great potential to significantly reduce the healing time of zirconia dental implants. © International & American Associations for Dental
Kuroshima, Shinichiro; Nakano, Takayoshi; Ishimoto, Takuya; Sasaki, Muneteru; Inoue, Maaya; Yasutake, Munenori; Sawase, Takashi
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.
Vanegas-Acosta, J C; Garzón-Alvarado, D A; Lancellotti, V
Cell behavior and tissue formation are influenced by a static electric field (EF). Several protocols for EF exposure are aimed at increasing the rate of tissue recovery and reducing the healing times in wounds. However, the underlying mechanisms of the EF action on cells and tissues are still a matter of research. In this work we introduce a mathematical model for electrically stimulated osteogenesis at the bone-dental implant interface. The model describes the influence of the EF in the most critical biological processes leading to bone formation at the bone-dental implant interface. The numerical solution is able to reproduce the distribution of spatial-temporal patterns describing the influence of EF during blood clotting, osteogenic cell migration, granulation tissue formation, displacements of the fibrillar matrix, and formation of new bone. In addition, the model describes the EF-mediated cell behavior and tissue formation which lead to an increased osteogenesis in both smooth and rough implant surfaces. Since numerical results compare favorably with experimental evidence, the model can be used to predict the outcome of using electrostimulation in other types of wounds and tissues. Copyright © 2013 Elsevier B.V. All rights reserved.
Yokoyama, Ken'ichi; Ichikawa, Tetsuo; Murakami, Hiroki; Miyamoto, Youji; Asaoka, Kenzo
Titanium and its alloy are increasingly attracting attention for use as biomaterials. However, delayed fracture of titanium dental implants has been reported, and factors affecting the acceleration of corrosion and fatigue have to be determined. The fractured surface of a retrieved titanium screw and metallurgical structures of a dental implant system were analyzed. The outer surface of the retrieved screw had a structure different from that of the as-received screw. It was confirmed that a shear crack initiated at the root of the thread and propagated into the inner section of the screw. Gas chromatography revealed that the retrieved screw had absorbed a higher amount of hydrogen than the as-received sample. The grain structure of a titanium screw, immersed in a solution known to induce hydrogen absorption, showed features similar to those of the retrieved screw. It was concluded that titanium in a biological environment absorbs hydrogen and this may be the reason for delayed fracture of a titanium implant.
Malik, Rajvir; Garg, Rachna; Suresh, D K; Chandna, Shalu
The purpose of this article is to illustrate the relationship of bone quality and the prognosis of dental implant. Reported success rates for dental implants are high. Thus, an implant-supported restoration offers a predictable treatment for tooth replacement. Nevertheless, failures that mandate immediate implant removal do occur. A case involving a 40-year-old male patient who had a missing mandibular left first molar is reported. A mucoperiosteal flap was made using interdental and crevicular incisions. The osteotomy was performed starting with the pilot drill, then the depth of the osteotomy was assessed using the shoulder depth gauge. The site was gradually enlarged using reamers with progressively increasing diameters. The implant (Bicon's Nano Tite™) was then placed. However, three months later at the second stage surgery, the implant was found to be clinically mobile. The surgical site selected in this case had fine trabeculated bone with thin cortical plates (D4 bone) that apparently contributed to the failure of dental implant. Implant therapy has become common practice and will continue to increase in popularity. This also implies that dental professionals will have to learn more how to deal with implant failure and related complications. Why an implant does not integrate could have a multifactorial etiology. The type and quality of bone available to support a dental implant are very important, so attention should be directed to all the factors responsible for the success or failure of a dental implant. In cases involving D4 bone, one must consider other treatment modalities for replacement of a missing tooth or use caution in the placement of the implants, especially in the high-load-bearing molar areas.
Sezin, M.; Croharé, L.; Ibañez, J.C.
Objective: To determine and compare the micro topographic characteristics of dental implants submitted to different surface treatments, using scanning electron microscopy (SEM). Materials and Methods: Implants were divided into 7 groups of 3 specimens each, according to the surface treatment used: group 1: Osseotite, BIOMET 3i; group 2: SLA surface, Institut Straumann AG; group 3: Oxalife surface, Tree-Oss implant; group 4: B&W implant surface; group 5: Q-implant surface; group 6: ML implant surface; group 7: RBM surface, Rosterdent implant. The surfaces were examined under SEM (Carl Zeiss FE-SEM-SIGMA). Image Proplus software was used to determine the number and mean diameter of pores per area unit (mm). The data obtained were analyzed with the Mann-Whitney test. A confocal laser microscope (LEXT-OLS4100 Olympus) was used to conduct the comparative study of surface roughness (Ra). Data were analyzed using Tukey's HSD test. Results: The largest average pore diameter calculated in microns was found in group 5 (3.45 µm+/-1.91) while the smallest in group 7 (1.47µm+/-1.29). Significant differences were observed among each one of the groups studied (p<0.05). The largest number of pores/mm2 was found in group 2 (229343) and the smallest number in group 4 (10937). Group 2 showed significant differences regarding the other groups (p<0.05). The greatest roughness (Ra) was observed in group 2 (0.975µm+/-0.115) and the smallest in group 4 (0.304µm+/-0.063). Group 2 was significantly different from the other groups (p<0.05). Conclusion: The micro topography observed in the different groups presented dissimilar and specific features, depending on the chemical treatment used for the surfaces.. PMID:27335615
Quintero, David G; Winger, Julia N; Khashaba, Rania; Borke, James L
Advanced glycation endproducts (AGEs) are a diverse group of molecular adducts formed in environments high in reducing sugars that accumulate with aging and in diabetes. This study tests the hypothesis that AGEs inhibit the stabile osseointegration of dental implants through tissue interactions that interfere with bone turnover and compromise the biomechanical properties at the bone-implant interface. Maxillary first molars were extracted from 32 rats and allowed to heal for 4 weeks. Titanium implants (1 mm x 3 mm) were placed in the healed sockets of 2 groups of 16 rats consisting of 8 rats injected 3 times/wk for 1 month with AGE (prepared from glucose and lysine) and 8 rats injected with vehicle as a control. AGE injections continued for an additional 14 or 28 days before sacrifice. X-ray images, blood, and tissues were collected to examine bone/implant contact ratio, serum pyridinoline ([PYD] a collagen breakdown marker), osteocalcin ([OSC] a bone formation marker), and for immunohistochemistry with antibodies to AGE and the bone turnover-marker protein matrix metalloproteinase1. Compared with the AGE-treated groups, the controls showed significantly higher bone/implant contact at both 14- and 28-day time points. PYD (P < .05) and OSC (trend) levels from controls showed decreases at 28 days when compared with AGE-treated groups. Immunohistochemistry with AGE-specific and bone turnover marker antibodies showed stronger staining associated with the implant/tissue interface in AGE-treated rats. Our studies indicate an association between AGE and inhibition of bone turnover, suggesting that the formation of AGE in high glycemic conditions, such as diabetes, may contribute to a slower rate of osseointegration that negatively affects implant stability.
Rittel, D; Dorogoy, A; Shemtov-Yona, K
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.
Ramakrishnaiah, Ravikumar; Al Kheraif, Abdulaziz Abdullah; Mohammad, Ashfaq; Divakar, Darshan Devang; Kotha, Sunil Babu; Celur, Sree Lalita; Hashem, Mohamed I; Vallittu, Pekka K; Rehman, Ihtesham Ur
The current study was aimed to fabricate customized root form dental implant using additive manufacturing technique for the replacement of missing teeth. The root form dental implant was designed using Geomagic™ and Magics™, the designed implant was directly manufactured by layering technique using ARCAM A2™ electron beam melting system by employing medical grade Ti-6Al-4V alloy powder. Furthermore, the fabricated implant was characterized in terms of certain clinically important parameters such as surface microstructure, surface topography, chemical purity and internal porosity. Results confirmed that, fabrication of customized dental implants using additive rapid manufacturing technology offers an attractive method to produce extremely pure form of customized titanium dental implants, the rough and porous surface texture obtained is expected to provide better initial implant stabilization and superior osseointegration.
Bencharit, Sompop; Byrd, Warren C; Altarawneh, Sandra; Hosseini, Bashir; Leong, Austin; Reside, Glenn; Morelli, Thiago; Offenbacher, Steven
Porous tantalum trabecular metal has recently been incorporated in titanium dental implants as a new form of implant surface enhancement. However, there is little information on the applications of this material in implant dentistry. The purpose of this article is to summarize the contemporary concept on the applications of porous tantalum trabecular metal in implant dentistry. We therefore review the current literature on the basic science and clinical uses of this material. Porous tantalum metal is used to improve the contact between osseous structure and dental implants and therefore presumably facilitate osseointegration. Success of porous tantalum metal in orthopedic implants led to the incorporation of porous tantalum metal in the design of root-form endosseous titanium implants. The porous tantalum three-dimensional enhancement of titanium dental implant surface allows for combining bone ongrowth together with bone ingrowth, or osseoincorporation. While little is known about the biological aspect of the porous tantalum in the oral cavity, there seems to be several possible advantages of this implant design. This article reviews the biological aspects of porous tantalum-enhanced titanium dental implants, in particular the effects of anatomical consideration and oral environment to implant designs. We propose here possible clinical situations and applications for this type of dental implant. Advantages and disadvantages of the implants as well as needed future clinical studies are discussed. © 2013 Wiley Periodicals, Inc.
Shugaa-Addin, Bassam; Al-Shamiri, Hashem-Motahir; Al-Maweri, Sadeq; Tarakji, Bassel
To explore the current literature of the survival of dental implants in irradiated head and neck cancer patients considering the role of implant location, bone augmentation, dose of radiation and timing of implant placement. Pubmed search was conducted to identify articles published between January 2000 and December 2014 and presenting data of dental implant survival with radiotherapy in head and neck cancer patients. Studies on animal subjects and craniofacial implants were excluded. 18 articles out of 27 were eligible for inclusion in this systematic review. 12 out of 18 studies reported favorable outcome of dental implants and radiotherapy with survival rates between 74.4% and 97%. Seven out of ten studies comparing the survival rates according to site of implant placement reported that implants were found to osseointegrate with greater success in the irradiated mandible than irradiated maxilla. 5 studies which compared implant survival in irradiated native bone versus irradiated grafted bone reported that irradiated grafted bone showed a significantly reduced dental implant survival rate in comparison to irradiated native bone. 6 out of 18studies in which radiation doses exceeded 70 Gy reported lower survival rates of dental implants in comparison to the studies in which radiation doses were ≤70Gy. Higher survival rates were reported in 2 studies in which implants placement was before radiotherapy in comparison to the remaining 16 studies in which implants placement was after radiotherapy. Dental implants may be affected by radiotherapy especially when they are placed in maxilla, in grafted bone, or after radiation, however, they remain a functional option for rehabilitation of head and cancer patients. More Prospective cohort studies and randomized controlled trails are still needed to draw more evidence based conclusions. Dental implants, implant survival, radiotherapy, head and neck cancer.
ANNIBALI, S.; RIPARI, M.; LA MONACA, G.; TONOLI, F.; CRISTALLI, M.P.
SUMMARY There are many detailed articles regarding accidents and local complications in dental implantation. Comparison of the data they report is not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery and complications are all the pathological conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for complications prevention and treatment are also described. PMID:23285333
Lin, Mu-Han; Li, Jinsheng; Price, Robert A., Jr.; Wang, Lu; Lee, Chung-Chi; Ma, C.-M.
This work aims to investigate the dosimetric impact of dental implants on volumetric modulated arc therapy (VMAT) for head-and-neck patients and to evaluate the effectiveness of using the material's electron-density ratio for the correction. An in-house Monte Carlo (MC) code was utilized for the dose calculation to account for the scattering and attenuation caused by the high-Z implant material. Three different dental implant materials were studied in this work: titanium, Degubond®4 and gold. The dose perturbations caused by the dental implant materials were first investigated in a water phantom with a 1 cm3 insert. The per cent depth dose distributions of a 3 × 3 cm2 photon field were compared with the insert material as water and the three selected dental implant materials. To evaluate the impact of the dental implant on VMAT patient dose calculation, four head-and-neck cases were selected. For each case, the VMAT plan was designed based on the artifact-corrected patient geometry using a treatment planning system (TPS) that was typically utilized for routine patient treatment. The plans were re-calculated using the MC code for five situations: uncorrected geometry, artifact-corrected geometry and artifact-corrected geometry with one of the three different implant materials. The isodose distributions and the dose-volume histograms were cross-compared with each other. To evaluate the effectiveness of using the material's electron-density ratio for dental implant correction, the implant region was set as water with the material's electron-density ratio and the calculated dose was compared with the MC simulation with the real material. The main effect of the dental implant was the severe attenuation in the downstream. The 1 cm3 dental implant can lower the downstream dose by 10% (Ti) to 51% (Au) for a 3 × 3 cm2 field. The TPS failed to account for the dose perturbation if the dental implant material was not precisely defined. For the VMAT patient dose calculation
Sakaguchi, R L; Borgersen, S E
Clinical studies indicate that loosening or fracture of dental implant prostheses occurs in 5% to 45% of cases during the first year. The nature of loosening or displacement of prosthetic components is complex, since it involves cycling fatigue, oral fluids, and varied chewing patterns and loads. A finite element contact analysis method was used to study the load-transfer mechanism between prosthetic components caused by torque application to the threaded fasteners used for assembly. Screw elongation is achieved while allowing for elastic recovery of the screw to produce a clamping force on the fastened elements. Clamping forces were additive along the axis of the prosthetic components. When the gold retaining screw is fastened into the abutment screw, clamping force on the implant is increased at the expense of decreasing the clamping force at the abutment screw-abutment interface by 50%. Maximum tensile stresses in the screws after preload were less than 55% of the yield stress.
Zheng, R C; Park, Y K; Cho, J J; Kim, S K; Heo, S J; Koak, J Y; Lee, J H
During the maintenance of bone marrow-derived mesenchymal stem cells (BMMSCs), suspended cells are discarded normally. We noted the osteogenic potential of these cells to be like that of anchorage-dependent BMMSCs. Therefore, we characterized suspended BMMSCs from rabbit bone marrow by bioengineering and applied the suspended BMMSCs to double-canaled dental implants inserted into rabbits. After primary isolation of BMMSCs, we collected the suspended cells during primary culture on the third day. The cells were transferred and maintained on an extracellular-matrix-coated culture plate. The cells were characterized and compared with BMMSCs by colony-forming-unit fibroblast (CFU-f) and cell proliferation assay, fluorescence-activated cell sorter (FACS), in vitro multipotency, and reverse transcription polymerase chain reaction (RT-PCR). We also analyzed the osteogenic potential of cells mixed with hydroxyapatite/tricalcium phosphate (HA/TCP) and transplanted into immunocompromised mice. We compared the viability and proliferation of the suspended BMMSCs and BMMSCs on the titanium implant surface and observed cell morphology. Then, the cells mixed with HA/TCP were applied to the double-canaled implants during installation into rabbit tibia. Four weeks later, we analyzed bone formation inside the canal by histomorphometry. The suspended cells showed higher CFU-f on the extracellular matrix (ECM)-coated culture plate and similar results of proliferation capacity compared with BMMSCs. The cells also showed osteogenic, adipogenic, and chondrogenic ability. The suspended cells showed levels of attachment survival and proliferation on the surfaces of titanium implant discs to be higher than or similar to those of BMMSCs. The suspended cells as well as BMMSCs showed stronger bone formation ability in both upper and lower canals of the implants compared with controls on double-canaled implants inserted into rabbit tibia. In this study, we showed that suspended cells after
Sysoliatin, S P; Sysoliatin, P G; Palkina, M O; Solop, M V
The long-term results of dental implant placement in patients with the history of odontogenic maxillary sinusitis are assessed in retrospective study. Maxillary sinusotomy and endoscopic surgery procedures are compared in regard to complications risks after subsequent sinus lift and dental implantation, the latter proving to be method of choice in such cases.
Tsarev, V N; Nikolaeva, E N; Ippolitov, E V; Tsareva, T V
The study included 32 patients with complications which have developed 3 months to 14 years after dental implants placement. ELISA method was used to assess cytokines content in various sites of tooth alignment in patients with Herpesviridae and periodontopathogenics bacteria associated periimplantitis. The results prove the necessity for Herpesviridae and selected bacteria monitoring after dental implantation.
Fedoretz, M; Fedoretz, T
With the initiation of the concept of osseointegration, the use of dental implants has become a predictable and frequently used addition to comprehensive planning and treatment of edentulous patients. Implantology poses challenges for the dental laboratory not present in any other existing specialty. Single-stage implant surgery represents such an innovation.
Balabanian, Cláudia A C A; Coutinho-Netto, Joaquim; Lamano-Carvalho, Teresa L; Lacerda, Suzie A; Brentegani, Luiz G
The present study investigated the biocompatibility of a biopolymer based on vegetable latex extracted from the Hevea brasiliensis rubber tree, implanted into the bony alveolar cavity after dental extraction in rats. A granule of latex (area = 0.25 +/- 0.04 mm(2)) was implanted inside the alveolus immediately after extraction of the upper right incisor, and the animals were sacrificed 7, 21 and 42 days after the procedure. The hemi-maxillas were decalcified and processed for embedding in paraffin to obtain semi-serial longitudinal sections 5 mum thick, and then stained with hematoxylin-eosin. The latex granule was observed in the cervical third of the alveolus without any foreign body reaction, or persistence of the initial acute inflammatory reaction. Bone repair in the areas adjacent to the material was quantified, and a decrease was noted in the thickness of the fibrous capsule surrounding the implants from 92.8 +/- 9.3 microm on day 7 to 9.4 +/- 1.8 microm on day 42 (ANOVA, P = 0.01). The quantitative data confirmed acceleration of bone formation (statistically significant at 5%) in parallel with a decrease of connective tissue in the areas around the implants. These results show that the tested material is biologically compatible, and progressively integrated into the alveolar bone, simultaneously accelerating bone formation and playing an important role in the healing process.
Goiato, M C; dos Santos, D M; Santiago, J F; Moreno, A; Pellizzer, E P
Bone quality and quantity are important factors with regard to the survival rate of dental implants. The aim of this study was to conduct a systematic review of dental implants inserted in low-density bone and to determine the survival rate of dental implants with surface treatments over time. A systematic review of the literature was undertaken by two independent individuals; the Medline/PubMed database was searched for the period July 1975 to March 2013. Relevant reports on bone quality and osseointegration of dental implants were selected. The search retrieved 1018 references, and after inclusion and exclusion criteria were applied, 19 studies were selected for review. A total of 3937 patients, who had received a total of 12,465 dental implants, were analyzed. The survival rates of dental implants according to the bone density were: type I, 97.6%; type II, 96.2%; type III, 96.5%; and type IV, 88.8%. The survival rate of treated surface implants inserted in low-density bone was higher (97.1%) than that of machined surface implants (91.6%). Surface-treated dental implants inserted in low-density bone have a high survival rate and may be indicated for oral rehabilitation. However, more randomized studies are required to better evaluate this issue. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Bencharit, Sompop; Byrd, Warren C.; Altarawneh, Sandra; Hosseini, Bashir; Leong, Austin; Reside, Glenn; Morelli, Thiago; Offenbacher, Steven
Statement of Problem Porous tantalum trabecular metal has recently been incorporated in titanium dental implants as a new form of implant surface enhancement. However, there is little information on the applications of this material in implant dentistry. Methods We, therefore review the current literature on the basic science and clinical uses of this material. Results Porous tantalum metal is used to improve the contact between osseous structure and dental implants; and therefore presumably facilitate osseointegration. Success of porous tantalum metal in orthopedic implants led to the incorporation of porous tantalum metal in the design of root-from endosseous titanium implants. The porous tantalum three-dimensional enhancement of titanium dental implant surface allows for combining bone ongrowth together with bone ingrowth, or osseoincorporation. While little is known about the biological aspect of the porous tantalum in the oral cavity, there seems to be several possible advantages of this implant design. This article reviews the biological aspects of porous tantalum enhanced titanium dental implants, in particular the effects of anatomical consideration and oral environment to implant designs. Conclusions We propose here possible clinical situations and applications for this type of dental implant. Advantages and disadvantages of the implants as well as needed future clinical studies are discussed. PMID:23527899
Elias, Carlos Nelson; Rocha, Felipe Assis; Nascimento, Ana Lucia; Coelho, Paulo Guilherme
The primary stability of dental implants has been investigated before, but a study of the influence of implant shape, size and surface morphology (machined, acid etched or anodized), surgical technique (press-fit or undersized) and substrate (natural or simulated bone) on the primary stability of dental implants has not been reported. The present work intends to fill this gap. In this work, six different dental implants were inserted into and removed from synthetic and natural bone while measuring the torque. A total of 255 dental implants with three shapes, four sizes and three surface topographies were inserted into pig rib, PTFE and polyurethane. The implant sites were prepared using straight and tapered drills. The primary stability was estimated from the maximum insertion torque. Comparisons between samples were based on the maximum insertion torque (MIT), the maximum removal torque (MRT) and the torque ratio (TR=MRT/MIT). The insertion torque into pig ribs showed larger dispersion. All parameters (shape, size and surface morphology of the implant, surgical technique and substrate type) were found to have a significant influence on primary stability. The insertion of a tapered implant requires a higher torque than the insertion of a straight implant. Surface treatments improve the primary stability. The influence of the surgical technique is smaller than that of implant size and shape. The highest insertion torque was that of anodized tapered implants inserted into undersized sites. Finally, the primary stability of dental implants is highly dependent on implant design, surgical technique and substrate type. Copyright © 2012 Elsevier Ltd. All rights reserved.
Becker, William; Hujoel, Philippe; Becker, Burton E; Wohrle, Peter
To evaluate aged partially and fully edentulous patients who received dental implants and were maintained over time. Further, to determine how the partially and edentulous ageing populations (65 and above) with dental implants maintain bone levels, proper oral hygiene, and perceive benefits of dental implants. Since 1995, patients receiving dental implants have been prospectively entered into an Access-based computerized program (Triton Tacking System). Patient demographics (age, sex), bone quality, quantity, implant location, and type of surgery have been continuously entered into the database. The database was queried for patients receiving implants (first stage) between 66 and 93 years of age. Thirty-one patients were within this age group. Twenty-five patients returned to the clinic for periodontal and dental implant evaluation. The Periodontal Index was used to evaluate selected teeth in terms of probing depth, bleeding on probing, plaque accumulation, and mobility. Using NIH Image J, radiographs taken at second stage and last examination were measured for changes in interproximal bone levels. Once identified, each patient anomalously filled out an abbreviated quality of health life form. Due to small sample size, descriptive statistics were used to compare clinical findings. Fifteen males ranging from 78 to 84 (mean age 84 years) years and 16 females from 66 to 93 (mean age 83 years) (age range 66-93) were contacted by phone or mail and asked to return to our office for a re-examination. For this group, the first dental implants were placed in 1996 (n = initial two implants) and continuously recorded through 2013 (n = last seven implants). Thirty-one patients received a total of 84 implants. Two patients were edentulous, and the remaining were partially edentulous. Four implants were lost. Between implant placement and 6- to 7-year interval, 13 patients with 40 implants had a cumulative survival rate of 94.6%. Of the original group (n = 33), three
Al-Juboori, Mohammed Jasim
The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement. PMID:25678816
Al-Juboori, Mohammed Jasim
The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement.
Kola, Mohammed Zaheer; Shah, Altaf H; Khalil, Hesham S; Rabah, Ahmed Mahmoud; Harby, Nehad Mohammed H; Sabra, Seham Ali; Raghav, Deepti
Dental implants have been used in a variety of different forms for many years. Since the mid-20th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants. PMID:25838757
Kola, Mohammed Zaheer; Shah, Altaf H; Khalil, Hesham S; Rabah, Ahmed Mahmoud; Harby, Nehad Mohammed H; Sabra, Seham Ali; Raghav, Deepti
Dental implants have been used in a variety of different forms for many years. Since the mid-20(th) century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.
The aim of this study is to evaluate the satisfaction of patients with posterior implants in relation to the clinical success criteria and surface electromyography (sEMG) findings of the masseter and temporalis muscles. Total 42 subjects were investigated. Twenty one subjects with posterior dental implants were interviewed using a questionnaire and the clinical success criteria were determined based on The International Congress of Oral Implantologists. The myofunction of the masticatory muscles were assessed using sEMG (21 subjects) and compared to the control group of subjects without implants (21 subjects). Out of 21 subjects, all were satisfied with the aesthetics of their implant. Twenty of them (95.2%) were satisfied with its function and stability. As for clinical criteria, 100% (50) of the implants were successful with no pain, mobility or exudates. sEMG findings showed that patients have significantly lower (p<0.01) basal or resting median power frequency but with muscle burst. During chewing, control subjects showed faster chewing action. There was no difference in reaction and recovery time of clenching for both groups. In conclusion, the satisfaction of implant patients was high, and which was in relation to the successful clinical success criteria and sEMG findings. PMID:26465146
Nicholson, Dawn; Blodgett, Kris; Braga, Charles; Finkbeiner, Larry; Fourrier, Jeanne; George, John; Gregg, Robert; Honigman, Allen; Houser, Bruce; Lamas, William; Lehrman, Neal; Linden, Eric; McCarthy, Delwin; McCawley, Tom; McCormick, Randy; Marcus, Ed; Noraian, Kirk; Rubelman, Peter; Salama, Maurice; Saunders, Steven; Seamons, Brandon; Thein, David; Toms, Michael; Vassos, George; Harris, David M.
A large percentage of dental implants experience complications, most commonly, infection leading to peri-implantitis and peri-mucositis, inflammatory disease involving pathogen contamination. It presents with radiographic findings of crestal bone loss. At this time there appears to be no compelling evidence for an effective intervention. The LANAP protocol is a FDA cleared surgical protocol that produces new attachment and bone regeneration when applied to periodontally infected natural teeth. The LANAP protocol and laser dosimetry have been modified to treat ailing and failing implants. Twenty-one clinicians who have been trained to perform the LANAP protocol and the LAPIPTM protocol have volunteered 26 LAPIP case reports. The time from implant to intervention ranges from 3 months to 16 years. Post-LAPIP radiographs range from 2-48 months. Ten cases were excluded for technical reasons. All 16 remaining cases provide radiographic evidence of increase in crestal bone mass around the implant and, when reported, probe depth reductions. All treating clinicians report control of the infection, reversal of bone loss and rescue of the incumbent implant. Although the success/failure rate cannot be judged from these data, any successes in this area deserve reporting and further study.
Park, Shin-Young; Kim, Kyoung-Hwa; Shin, Seung-Yun; Koo, Ki-Tae; Lee, Yong-Moo; Chung, Chong-Pyoung; Seol, Yang-Jo
This study evaluated decontamination methods using a dental water jet and dental floss on microthreaded implants for regenerative periimplantitis therapy. In 6 beagle dogs, experimental periimplantitis was induced, and decontamination procedures, including manual saline irrigation (control group), saline irrigation using a dental water jet (group 1) and saline irrigation using a dental water jet with dental flossing (group 2), were performed. After in situ decontamination procedures, some of the implant fixtures (n = 4 per group) were retrieved for analysis by SEM, whereas other fixtures (n = 4 per group) underwent regenerative therapy. After 3 months of healing, the animals were killed. The SEM examination indicated that decontamination of the implant surfaces was the most effective in group 2, with no changes in implant surface morphology. The histological examination also revealed that group 2 achieved significantly greater amounts of newly formed bone (6.75 ± 2.19 mm; P = 0.018), reosseointegration (1.88 ± 1.79 mm; P = 0.038), and vertical bone fill (26.69 ± 18.42%; P = 0.039). Decontamination using a dental water jet and dental floss on microthreaded implants showed positive mechanical debridement effects and positive bone regeneration effects.
Kang, Jeong-Kyung; Lee, Ki; Lee, Yong-Sang; Park, Pil-Kyoo
PURPOSE The aim of this retrospective study is to analyze the relationship between local factors and survival rate of dental implant which had been installed and restored in Seoul Veterans Hospital dental center for past 10 years. And when the relationship is found out, it could be helpful to predict the prognosis of dental implants. MATERIALS AND METHODS A retrospective study of patients receiving root-shaped screw-type dental implants placed from January 2000 to December 2009 was conducted. 6385 implants were placed in 3755 patients. The following data were collected from the dental records and radiographs: patient's age, gender, implant type and surface, length, diameter, location of implant placement, bone quality, prosthesis type. The correlations between these data and survival rate were analyzed. Statistical analysis was performed with the use of Kaplan-Meier analysis, Chi-square test and odds ratio. RESULTS In all, 6385 implants were placed in 3755 patients (3120 male, 635 female; mean age 65 ± 10.58 years). 108 implants failed and the cumulative survival rate was 96.33%. There were significant differences in age, implant type and surface, length, location and prosthesis type (P<.05). No significant differences were found in relation to the following factors: gender, diameter and bone quality (P>.05). CONCLUSION Related factors such as age, implant type, length, location and prosthesis type had a significant effect on the implant survival. PMID:22259704
Elias, Carlos Nelson; Oshida, Yoshiki; Lima, José Henrique Cavalcanti; Muller, Carlos Alberto
The biological properties of titanium depend on its surface oxide film. Several mechanical and chemical treatments have been used to modify the surface morphology and properties of titanium dental implants. One possible method of improving dental implant biocompatibility is to increase surface roughness and decrease the contact angle. In the present work, the biological properties of dental implants were investigated through in vivo and in vitro tests. The effects of surface roughness, contact angle and surface morphology on titanium dental implant removal torque were investigated. Machined dental implants and discs made with commercially pure titanium ASTM grade 4 were submitted to sandblasting treatments, acid etching and anodizing. The sample surface morphologies were characterized by SEM, the surface roughness parameters were quantified using a laser non-contact profilometer, and a contact angle measurement was taken. Dental implants were placed in the tibia of rabbits and removed 12 weeks after the surgery. It was found that: (i) acid etching homogenized the surface roughness parameters; (ii) the anodized surface presented the smallest contact angle; (iii) the in vivo test suggested that, in similar conditions, the surface treatment had a beneficial effect on the implant biocompatibility measured through removal torque; and (iv) the anodized dental implant presented the highest removal torque.
Kirsten, A.; Hausmann, A.; Weber, M.; Fischer, J.
The healing time of zirconia implants may be reduced by the use of bioactive glass coatings. Unfortunately, existing glasses are either bioactive like Bioglass 45S5 but thermally incompatible with the zirconia substrate, or they are thermally compatible but exhibit only a very low level of bioactivity. In this study, we hypothesized that a tailored substitution of alkaline earth metals and alkaline metals in 45S5 can lead to a glass composition that is both bioactive and thermally compatible with zirconia implants. A novel glass composition was analyzed using x-ray fluorescence spectroscopy, dilatometry, differential scanning calorimetry, and heating microscopy to investigate its chemical, physical, and thermal properties. Bioactivity was tested in vitro using simulated body fluid (SBF). Smooth and microstructured glass coatings were applied using a tailored spray technique with subsequent thermal treatment. Coating adhesion was tested on implants that were inserted in bovine ribs. The cytocompatibility of the coating was analyzed using L929 mouse fibroblasts. The coefficient of thermal expansion of the novel glass was shown to be slightly lower (11.58·10–6 K–1) than that of the zirconia (11.67·10–6 K–1). After storage in SBF, the glass showed reaction layers almost identical to the bioactive glass gold standard, 45S5. A process window between 800 °C and 910 °C was found to result in densely sintered and amorphous coatings. Microstructured glass coatings on zirconia implants survived a minimum insertion torque of 60 Ncm in the in vitro experiment on bovine ribs. Proliferation and cytotoxicity of the glass coatings was comparable with the controls. The novel glass composition showed a strong adhesion to the zirconia substrate and a significant bioactive behavior in the SBF in vitro experiments. Therefore, it holds great potential to significantly reduce the healing time of zirconia dental implants. PMID:25421839
Schwitalla, Andreas Dominik; Zimmermann, Tycho; Spintig, Tobias; Abou-Emara, Mohamed; Lackmann, Justus; Müller, Wolf-Dieter; Houshmand, Alireza
Frequent reports attest to the various advantages of tapered implant/abutment interfaces (IAIs) compared to other types of interfaces. For this reason, a conical IAI was designed as part of the development of a PEEK (polyetheretherketone)-based dental implant. This IAI is equipped with an apically displaced anti-rotation lock with minimal space requirements in the form of an internal spline. The objective of this study was the determination of the average insertion torque (IT) at failure of this design, so as to determine its suitability for immediate loading, which requires a minimum IT of 32Ncm. 10 implants each made of unfilled PEEK, carbon fiber reinforced ("CFR") PEEK (> 50vol% continuous axially parallel fibers) as well as of titanium were produced and tested in a torque test bench. The average IT values at failure of the unfilled PEEK implants were measured at 22.6 ± 0.5Ncm and were significantly higher than those of the CFR-Implants (20.2 ± 2.5Ncm). The average IT values at failure of the titanium specimens were significantly higher (92.6 ± 2.3Ncm) than those of the two PEEK variants. PEEK- and CFR-PEEK-implants in the present form cannot adequately withstand the insertion force needed to achieve primary stability for immediate loading. Nevertheless, the achievable torque resilience of the two PEEK-variants may be sufficient for a two-stage implantation procedure. To improve the torque resistance of the PEEK implant material the development of a new manufacturing procedure is necessary which reinforces the PEEK base with continuous multi-directional carbon fibers as opposed to the axially parallel fibers of the tested PEEK compound. Copyright © 2017 Elsevier Ltd. All rights reserved.
Schwitalla, Andreas Dominik; Zimmermann, Tycho; Spintig, Tobias; Kallage, Ilona; Müller, Wolf-Dieter
The increasing use of PEEK (poly-ether-ether-ketone) as a substitute for metal implant components has led to the suggestion that it could also be used as an alternative to titanium in the field of dental implants. A major requirement for dental implant materials is their resistance to cyclic loading due to mastication. A special fatigue test was designed to evaluate the elastic behavior and long-term form stability of cylindrically shaped PEEK specimens of 4, 5 and 6mm in diameter, using 11 different PEEK materials of various grades: unfilled, filled with titanium dioxide or barium sulfate powder, reinforced with short carbon fibers or short glass fibers, and reinforced with continuous carbon fibers. The samples were exposed to cyclic loads of up to 2000N. The elastic limits ranged between 46.57±6.44MPa for short carbon fiber reinforced specimens of 6mm diameter and 107.62±8.23MPa for samples of a different short carbon fiber reinforced PEEK compound of 4mm diameter. The elastic limits of the two PEEK grades containing continuous carbon fibers could not be observed because they exceeded the limits of the test specification. The elastic moduli ranged between 2.06±0.18GPa for barium sulfate powder filled PEEK-specimens of 6 mm diameter and 57.53±14.3GPa for continuous carbon fibers reinforced PEEK-specimens of 4 mm diameter. In terms of the elastic limit all the PEEK materials in consideration were able to resist the pressure caused by maximum masticatory forces.
Esfahrood, Zeinab Rezaei; Ahmadi, Loghman; Karami, Elahe; Asghari, Shima
The purpose of this study was to perform a literature review of short implants in the posterior maxilla and to assess the influence of different factors on implant success rate. A comprehensive search was conducted to retrieve articles published from 2004 to 2015 using short dental implants with lengths less than 10 mm in the posterior maxilla with at least one year of follow-up. Twenty-four of 253 papers were selected, reviewed, and produced the following results. (1) The initial survival rate of short implants in the posterior maxilla was not related to implant width, surface, or design; however, the cumulative success rate of rough-surface short implants was higher than that of machined-surface implants especially in performance of edentulous dental implants of length <7 mm. (2) While bone augmentation can be used for rehabilitation of the atrophic posterior maxilla, short dental implants may be an alternative approach with fewer biological complications. (3) The increased crown-to-implant (C/I) ratio and occlusal table (OT) values in short dental implants with favorable occlusal loading do not seem to cause peri-implant bone loss. Higher C/I ratio does not produce any negative influence on implant success. (4) Some approaches that decrease the stress in posterior short implants use an implant designed to increase bone-implant contact surface area, providing the patient with a mutually protected or canine guidance occlusion and splinting implants together with no cantilever load. The survival rate of short implants in the posterior edentulous maxilla is high, and applying short implants under strict clinical protocols seems to be a safe and predictable technique.
The purpose of this study was to perform a literature review of short implants in the posterior maxilla and to assess the influence of different factors on implant success rate. A comprehensive search was conducted to retrieve articles published from 2004 to 2015 using short dental implants with lengths less than 10 mm in the posterior maxilla with at least one year of follow-up. Twenty-four of 253 papers were selected, reviewed, and produced the following results. (1) The initial survival rate of short implants in the posterior maxilla was not related to implant width, surface, or design; however, the cumulative success rate of rough-surface short implants was higher than that of machined-surface implants especially in performance of edentulous dental implants of length <7 mm. (2) While bone augmentation can be used for rehabilitation of the atrophic posterior maxilla, short dental implants may be an alternative approach with fewer biological complications. (3) The increased crown-to-implant (C/I) ratio and occlusal table (OT) values in short dental implants with favorable occlusal loading do not seem to cause peri-implant bone loss. Higher C/I ratio does not produce any negative influence on implant success. (4) Some approaches that decrease the stress in posterior short implants use an implant designed to increase bone-implant contact surface area, providing the patient with a mutually protected or canine guidance occlusion and splinting implants together with no cantilever load. The survival rate of short implants in the posterior edentulous maxilla is high, and applying short implants under strict clinical protocols seems to be a safe and predictable technique. PMID:28462189
Brandt, Jan; Lauer, Hans-Christoph; Peter, Thorsten; Brandt, Silvia
A digital process is presented for an implant-supported single-tooth and a 3-unit fixed dental prosthesis (FDP) with customized abutments and monolithic prosthetic zirconia restorations. The digital impression on the implant level was made with a TRIOS intraoral scanner (3Shape). This process included the fabrication of an implant cast with the fused deposition modeling technique and a 3-dimensional printing process with integrated implant analogs. The process enabled the FDPs to be designed with CAD/CAM on the cast before patient contact. Designing a printed implant cast expands the use of the digital workflow in the dental field.
Ahmed, Hameeda Bashir; Crespi, Roberto; Romanos, Georgios E.
A secure implant primary (mechanical) stability is positively associated with a successful implant integration and long-term successful clinical outcome. Therefore, it is essential to assess the initial stability at different time-points to ensure a successful osseointegration. The present study critically reviews the factors that may play a role in achieving a successful initial stability in dental implants. Databases were searched from 1983 up to and including October 2013 using different combinations of various keywords. Bone quality and quantity, implant geometry, and surgical technique adopted may significantly influence primary stability and overall success rate of dental implants. PMID:24381734
Torabinejad, Mahmoud; Goodacre, Charles J
Clinicians are confronted with difficult choices regarding whether a tooth with pulpal and/or periapical disease should be saved through endodontic treatment or be extracted and replaced with an implant. The authors examined publications (research, literature reviews and systematic reviews) related to the factors affecting decision making for patients who have oral diseases or traumatic injuries. The factors to be considered included patient-related issues (systemic and oral health, as well as comfort and treatment perceptions), tooth- and periodontium-related factors (pulpal and periodontal conditions, color characteristics of the teeth, quantity and quality of bone, and soft-tissue anatomy) and treatment-related factors (the potential for procedural complications, required adjunctive procedures and treatment outcomes). On the basis of survival rates, it appears that more than 95 percent of dental implants and teeth that have undergone endodontic treatment remain functional over time. Clinicians need to consider carefully several factors before choosing whether to perform endodontic therapy or extract a tooth and place an implant. The result should be high levels of comfort, function, longevity and esthetics for patients.
Imre, Ildikó; Tóth, Zsuzsanna
During dental rehabilitation of a patient with ICD, an upper telescope retained overdenture with acrylic baseplate and lower cantilever bridges were constructed. In the consultation following the anamnesis and the clinical examination, the cardiologist did not believe antibiotic profilaxis to be necessary, adding that it is advisable to avoid the use of ultrasonic depurator and electrocauter. Nowadays after saving the life the improving of patient's better quality of life is an important aspect. The risk of ICD-implantation is minimal however, not negligible, the patient can pursue a way of life free of limitation. According to the latest trends, the number of ICD-implantations will increase exponentially in the near future, due to the aging of the population, the simplification and safeness of implantation and the increase of patients who can be treated with the device. In case of arritmia or putative dysfunction, the latest ICD-s are able to send emergency alert to the arritmia centre with the help of an outer transmitter. Probably the system will completely change the follow-up of patients with ICD within the next few years, clinical researches of its efficiency are going on at present.
Koh, Jung-Woo; Yang, Jae-Ho; Han, Jung-Suk; Lee, Jai-Bong; Kim, Sung-Hun
Macroscopic and especially microscopic properties of implant surfaces play a major role in the osseous healing of dental implants. Dental implants with modified surfaces have shown stronger osseointegration than implants which are only turned (machined). Advanced surface modification techniques such as anodic oxidation and Ca-P application have been developed to achieve faster and stronger bonding between the host bone and the implant. The purpose of this study was to investigate the effect of surface treatment of titanium dental implant on implant stability after insertion using the rabbit tibia model. THREE TEST GROUPS WERE PREPARED: sandblasted, large-grit and acid-etched (SLA) implants, anodic oxidized implants, and anodized implants with Ca-P immersion. The turned implants served as control. Twenty rabbits received 80 implants in the tibia. Resonance frequencies were measured at the time of implant insertion, 2 weeks and 4 weeks of healing. Removal torque values (RTV) were measured 2 and 4 weeks after insertion. The implant stability quotient (ISQ) values of implants for resonance frequency analysis (RFA) increased significantly (P < .05) during 2 weeks of healing period although there were no significant differences among the test and control groups (P > .05). The test and control implants also showed significantly higher ISQ values during 4 weeks of healing period (P < .05). No significant differences, however, were found among all the groups. All the groups showed no significant differences in ISQ values between 2 and 4 weeks after implant insertion (P > .05). The SLA, anodized and Ca-P immersed implants showed higher RTVs at 2 and 4 weeks of healing than the machined one (P < .05). However, there was no significant difference among the experimental groups. The surface-modified implants appear to provide superior implant stability to the turned one. Under the limitation of this study, however, we suggest that neither anodic oxidation nor Ca-P immersion
Badran, Zahi; Struillou, Xavier; Hughes, Francis J; Soueidan, Assem; Hoornaert, Alain; Ide, Mark
For decades titanium has been the preferred material for dental implant fabrication, with mechanical and biological performance resulting in high clinical success rates. Tshese have been further enhanced by incremental development of surface modifications aimed at improving speed and degree of osseointegration and resulting in enhanced clinical treatment options and outcomes. However, increasing demand for metal-free dental restorations has also led to the development of ceramic-based dental implants such as zirconia. In orthopaedics, alternative biomaterials have been used for implant applications such as polyetheretherketone or silicon nitride. The latter is potentially of particular interest for oral use as it has been shown to have antibacterial properties. In this paper we aim to shed light on this particular biomaterial as a future promising candidate for dental implantology applications, addressing basic specifications required for any dental implant material.
Antalainen, Anna-Kaisa; Helminen, Mika; Forss, Helena; Sándor, George K; Wolff, Jan
The National Institute for Health and Welfare in Finland (THL) has maintained the Finnish Dental Implant Register since April 1994. The aim of this study was to use the Dental Implant Register to assess the influence of patient characteristics and background factors on dental implant removals in Finland from 1994 to 2012. THL granted permission to access the Finnish Dental lmplant Register (1994 to 2012) and assess the following factors: total implant placements, total implant removals, time from implant placement to removal, implant types, implant lengths, placed and failed implants by jaw and tooth type, and patient sex and age. A total of 198,538 dental implants (51 different types) were placed between 1994 and 2012. A total of 3,318 (1.7%) of the placed implants were removed during the observation period. A total of 1,856 (1.8%) of the placed implants were removed from the maxilla and 1,462 (1.5%) from the mandible (P < .001). A slight difference in the sex distribution concerning implant failures (3.1% in men vs 2.3% in women) was observed. The median removal time was 247 days postoperatively (range 0 to 11,383 days), and one-third of the implants were removed within the first 142 days. Most of the placed implants were 10 mm or longer (93.3%) with 12 mm being the most commonly used length (23.9%). Shorter implants (8 mm or less) were removed more often (2.5% removal rate) than 9 mm or longer implants (1.5% removal rate). The IMZ Implant system demonstrated the highest overall removal rates (8.5%), while Brånemark Nobel Direct (0.6%) demonstrated the lowest removal rates. Of the most commonly placed implant types (together comprising 60.9% of all implants placed), the Straumann (1.2%) and the Astra Implant (1.2%) systems demonstrated equally low removal rates. The overall dental implant removal rates in Finland are low. Only slight differences in gender and implant position were observed.
Esposito, Marco; Coulthard, Paul; Thomsen, Peter; Worthington, Helen V
We tested the hypothesis of no difference in implant failures between various dental implant types. We searched for all randomised clinical trials comparing different implant types/systems with a follow up of at least one year on four databases. Screening of eligible trials, quality assessment and data extraction were conducted in duplicate. Thirty-one trials were identified. Twelve trials, reporting results of 512 patients, were included. No significant differences were observed for implant failures. There were minor statistically significant differences for peri-implant bone level changes. Turned surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period.
Edher, Faraj; Nguyen, Caroline T
Dental implants can be essential in the rehabilitation of various cancer defects, but their ideal placement can be complicated by the limited dimensions of the available host bone. Surgical interventions developed to increase the amount of bone are not all predictable or successful and can sometimes be contraindicated. Short dental implants have been suggested as an alternative option in sites where longer implants are not possible. Whether they provide a successful treatment option is unclear. The purpose of this study was to review the literature on short dental implants and assess whether they are a viable definitive treatment option for rehabilitating cancer patients with deficient bone. A scoping review of the literature was performed, including a search of established periodontal textbooks for articles on short dental implants combined with a search of PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. A search for all literature published before June 2016 was based on the following keywords: ['dental implants' OR 'dental implantation, endosseous' OR 'dental prosthesis, implant supported'] AND [short]. The minimum acceptable implant length has been considered to be 6 mm. The survival rates of short implants varied between 74% and 96% at 5 years, depending on factors such as the quality of the patient's bone, primary stability of the implant, clinician's learning curve, and implant surface. Short implants can achieve results similar to those of longer implants in augmented bone and offer a treatment alternative that could reduce the need for invasive surgery and associated morbidity and be safer and more economical. Short dental implants (6 mm to 8 mm) can be used successfully to support single or multiple fixed reconstructions or overdentures in atrophic maxillae and mandibles. The use of short dental implants lessens the need for advanced and complicated surgical bone augmentation procedures, which reduces complications
Vajdovich, István; Orosz, Mihály
According to the literature short dental implants have often been used for the replacement of teeth in the daily praxis. The implantation of short dental implants raise a lot of questions. The autors's aim is to collect the most important experiences of current literature on the mentioned theme to oral implantologists. In the article 33 reviews and clinical studies have been overviewed. The analysis of the different studies suggest that the use of short implants--taking into account of indications and contraindications--decreases the incidence of complications and the patient's discomfort as well as the cost of treatment. The use of short dental implants is proposed as an alternative method in the daily dental praxis.
Kulshrestha, Shatavari; Khan, Shakir; Meena, Ramovatar; Singh, Braj R; Khan, Asad U
Oral biofilms play a crucial role in the development of dental caries and other periodontal diseases. Streptococcus mutans is one of the primary etiological agents in dental caries. Implant systems are regularly employed to replace missing teeth. Oral biofilms accumulate on these implants and are the chief cause of dental implant failure. In the present study, the potential of graphene/zinc oxide nanocomposite (GZNC) against the cariogenic properties of Streptococcus mutans was explored and the anti-biofilm behaviour of artificial acrylic teeth surfaces coated with GZNC was examined. Acrylic teeth are a good choice for implants as they are low cost, have low density and can resist fracture. Microscopic studies and anti-biofilm assays showed a significant reduction in biofilm in the presence GZNC. GZNC was also found to be nontoxic against HEK-293 (human embryonic kidney cell line). The results indicate the potential of GZNC as an effective coating agent for dental implants by efficiently inhibiting S. mutans biofilms.
Bordin, Dimorvan; Cavalcanti, Indira M G; Jardim Pimentel, Marcele; Fortulan, Carlos A; Sotto-Maior, Bruno S; Del Bel Cury, Altair A; da Silva, Wander José
Friction coefficient (FC) was quantified between titanium-titanium (Ti-Ti) and titanium-zirconia (Ti-Zr), materials commonly used as abutment and implants, in the presence of a multispecies biofilm (Bf) or salivary pellicle (Pel). Furthermore, FC was used as a parameter to evaluate the biomechanical behavior of a single implant-supported restoration. Interface between Ti-Ti and Ti-Zr without Pel or Bf was used as control (Ctrl). FC was recorded using tribometer and analyzed by two-way Anova and Tukey test (p<0.05). Data were transposed to a finite element model of a dental implant-supported restoration. Models were obtained varying abutment material (Ti and Zr) and FCs recorded (Bf, Pel, and Ctrl). Maximum and shear stress were calculated for bone and equivalent von Misses for prosthetic components. Data were analyzed using two-way ANOVA (p<0.05) and percentage of contribution for each condition (material and FC) was calculated. FC significant differences were observed between Ti-Ti and Ti-Zr for Ctrl and Bf groups, with lower values for Ti-Zr (p<0.05). Within each material group, Ti-Ti differed between all treatments (p<0.05) and for Ti-Zr, only Pel showed higher values compared with Ctrl and Bf (p<0.05). FC contributed to 89.83% (p<0.05) of the stress in the screw, decreasing the stress when the FC was lower. FC resulted in an increase of 59.78% of maximum stress in cortical bone (p=0.05). It can be concluded that the shift of the FC due to the presence of Pel or Bf is able to jeopardize the biomechanical behavior of a single implant-supported restoration.
Bllaca, Florian; Toci, Ervin
BACKGROUND: Iliac bone grafts are used to augment alveolar ridges followed by subsequent dental implants in completely edentulous patients. In Albania the information about these issues is scarce. AIM: To describe the procedure of iliac bone grafts augmentation of alveolar ridges and evaluate the survival rate of dental implants in completely edentulous patients in Albania. SUBJECTS AND METHODS: Seven totally edentulous patients (three males, average age 45.9 years) presenting at Durrës Regional Hospital during 2008-2015 and seeking a solution to their problem through implantation procedures were included in the study. Patients were thoroughly examined, evaluated and the best augmentation procedure, using iliac crest bone grafts, and dental implantation technique was chosen. The number of dental implants placed was recorded and their survival rate was calculated. RESULTS: The most common intervention site was maxillae (in 71.4% of cases). Dental implants were installed six months after augmentation, all fixed on the very stable augmented alveolar ridge. On average between 20%-30% of bone grafts, volume was resorbed. Of 37 implants settled, 36 of them or 97.3% survived. CONCLUSION: Iliac bone grafts are a suitable augmentation source of bone in a patient suffering from complete edentulism in Albania. The survival rate of dental implants is very satisfactory. PMID:28028420
Rathi, Nakul; Scherer, Michael D; McGlumphy, Edwin
This clinical report describes a technique to stabilize a computer-aided dental implant surgical guide to existing implants. A patient requested conversion of her existing mandibular implant-assisted overdenture into a fixed complete denture. The surgical procedure was planned virtually, and the two existing dental implants were integrated into the surgical plan as a means to fixate the surgical guide. The implants were placed, and the patient's prosthesis was converted into an interim fixed complete denture.
Compton, Sharon M; Clark, Danielle; Chan, Stephanie; Kuc, Iris; Wubie, Berhanu A; Levin, Liran
The objectives of this study were to evaluate implant survival and success in the elderly population and to assess indicators and risk factors for success or failure of dental implants in older adults (aged 60 years and older). This historical prospective study was developed from a cohort of patients born prior to 1950 who received dental implants in a single private dental office. Implant survival and marginal bone levels were recorded and analyzed with regard to different patient- and implant-related factors. The study examined 245 patient charts and 1,256 implants from one dental clinic. The mean age at the time of implant placement was 62.18 ± 8.6 years. Smoking was reported by 9.4% of the cohort studied. The overall survival rate of the implants was 92.9%; 7.1% of the implants had failed. Marginal bone loss depicted by exposed threads was evident in 23.3% of the implants. Presenting with generalized periodontal disease and/or severe periodontal disease negatively influenced the survival probability of the implant. Implants placed in areas where bone augmentation was performed prior to or during implant surgery did not have the same longevity compared with those that did not have augmentation prior to implantation. The overall findings concluded that implants can be successfully placed in older adults. A variety of factors are involved in the long-term success of the implant, and special consideration should be taken prior to placing implants in older adults to limit the influence of those risk factors.
Henningsen, Anders; Smeets, Ralf; Köppen, Kai; Sehner, Susanne; Kornmann, Frank; Gröbe, Alexander; Heiland, Max; Gerlach, Till
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.
La Malfa Ribolla, Emma; Rizzo, Piervincenzo; Gulizzi, Vincenzo
The achievement and the maintenance of dental implant stability are prerequisites for the long-term success of the osseointegration process. Since implant stability occurs at different stages, it is clinically required to monitor an implant over time, i.e. between the surgery and the placement of the artificial tooth. In this framework, non-invasive tests able to assess the degree of osseointegration are necessary. In this paper, the electromechanical impedance (EMI) method is proposed to monitor the stability of dental implants. A 3D finite element model of a piezoceramic transducer (PZT) bonded to a dental implant placed into the bone was created, considering the presence of a bone-implant interface subjected to Young's modulus change. The numerical model was validated experimentally by testing bovine bone samples. The EMI response of a PZT, bonded to the abutment screwed to implants inserted to the bone, was measured. To simulate the osseointegration process a pulp canal sealer was used to secure the implant to the bone. It was found that the PZT's admittance is sensitive to the stiffness variation of the bone-implant interface. The results show that EMIbased method is able (i) to evaluate the material properties around the implant, and (ii) to promote a novel non-invasive monitoring of dental implant surgical procedure.
Wilk, Brian L
Over the course of the past two to three decades, intraoral digital impression systems have gained acceptance due to high accuracy and ease of use as they have been incorporated into the fabrication of dental implant restorations. The use of intraoral digital impressions enables the clinician to produce accurate restorations without the unpleasant aspects of traditional impression materials and techniques. This article discusses the various types of digital impression systems and their accuracy compared to traditional impression techniques. The cost, time, and patient satisfaction components of both techniques will also be reviewed.
Colletti, Giacomo; Felisati, Giovanni; Biglioli, Federico; Tintinelli, Roberto; Valassina, Davide
A fungus ball is one of the fungal diseases that can affect the paranasal sinuses. It requires surgical treatment. Because there is only one previously reported case of dental implant placement after treatment of a maxillary sinus fungus ball, the authors here report on a case of a maxillary sinus fungus ball with bone erosion that was treated surgically with a combined endoscopic endonasal and endoral (Caldwell-Luc) approach. One year later, a graft from the ilium was obtained and a sinus elevation was performed to allow the placement of dental implants. Three months later, the dental implants were placed, and they were all osseointegrated at the 9-month follow-up.
Hindy, Ahmed; Farahmand, Farzam; Tabatabaei, Fahimeh Sadat
There are numerous functions for laser in modern implant dentistry including surface treatment, surface coating, and implant manufacturing. As laser application may potentially improve osseointegration of dental implants, we systematically reviewed the literature for in vitro biological responses to laser-modified or processed titanium dental implants. The literature was searched in PubMed, ISI Web, and Scopus, using keywords "titanium dental implants," "laser," "biocompatibility," and their synonyms. After screening the 136 references obtained, 28 articles met the inclusion criteria. We found that Nd:YAG laser was the most commonly used lasers in the treatment or processing of titanium dental implants. Most of the experiments used cell attachment and cell proliferation to investigate bioresponses of the implants. The most commonly used cells in these assays were osteoblast-like cells. Only one study was conducted in stem cells. These in vitro studies reported higher biocompatibility in laser-modified titanium implants. It seems that laser radiation plays a vital role in cell response to dental implants; however, it is necessary to accomplish more studies using different laser types and parameters on various cells to offer a more conclusive result.
Wang, Chao; Zhang, Weiping; Ajmera, Deepal Haresh; Zhang, Yun; Fan, Yubo; Ji, Ping
Dental implants have to be placed with the long axis in different angulations due to the change in bone morphology. The objective of this study was to investigate the different bone remodeling response induced by the tilted dental implants and to assess whether it could lead to bone loss and implant failure. In this study, bone remodeling due to palato-labially inclined dental implants placed in the anterior maxillary incisor region was simulated. CT-based finite element models of a maxillary bone with dental implants were created herein. Five dental implants were placed at [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text], respectively. The remodeling progression was recorded and compared. Model [Formula: see text] (palatal side) shows the highest bone density values, but the inclined implant at [Formula: see text] (labial side) leads to significant bone loss. From a biomechanical perspective, it is speculated that a palatally inclined implant is more likely to enhance the bone density in the maxillary anterior region, but labial inclination of implant could jeopardize its stability.
Prasant, M C; Thukral, Rishi; Kumar, Sachin; Sadrani, Sannishth M; Baxi, Harsh; Shah, Aditi
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
Gosau, Martin; Viale-Bouroncle, Sandra; Eickhoff, Hannah; Prateeptongkum, Esthera; Reck, Anja; Götz, W; Klingelhöffer, Christoph; Müller, Steffen; Morsczeck, Christian
Dental stem cells in combination with implant materials may become an alternative to autologous bone transplants. For tissue engineering different types of soft and rigid implant materials are available, but little is known about the viability and the osteogenic differentiation of dental stem cells on these different types of materials. According to previous studies we proposed that rigid bone substitute materials are superior to soft materials for dental tissue engineering. We evaluated the proliferation, the induction of apoptosis and the osteogenic differentiation of dental stem/progenitor cells on a synthetic bone-like material and on an allograft product. The soft materials silicone and polyacrylamide (PA) were used for comparison. Precursor cells from the dental follicle (DFCs) and progenitor cells from the dental apical papilla of retained third molar tooth (dNC-PCs) were applied as dental stem cells in our study. Both dental cell types attached and grew on rigid bone substitute materials, but they did not grow on soft materials. Moreover, rigid bone substitute materials only sustained the osteogenic differentiation of dental stem cells, although the allograft product induced apoptosis in both dental cell types. Remarkably, PA, silicone and the synthetic bone substitute material did not induce the apoptosis in dental cells. Our work supports the hypothesis that bone substitute materials are suitable for dental stem cell tissue engineering. Furthermore, we also suggest that the induction of apoptosis by bone substitute materials may not impair the proliferation and the differentiation of dental stem cells.
Fernández-Solís, José; Marín-Fernández, Ana-Belén; Valencia-Laseca, Alfredo; Monsalve-Iglesias, Fernando
Dental implant surgery is continuously expanding. In fact, every day more and more surgeons are choosing dental implants for allowing great results in the field of oral rehabilitation. However, these procedures are not exempt from complications. This report presents the case of a 66 years old man underwent implant surgery by a specialized dentist. No problems were reported during implant placement. Despite this, three months later, it was displaced into the sublingual space at the time of uncovering. Against this backdrop, the patient was referred to an expert maxillofacial surgeon. Next day, the implant was removed using an intraoral approach to reach the sublingual space. According with our knowledge, there are no cases reported in the literature that describe this complication. Key words:Dental implant, sublingual space, bone atrophy, complications of oral surgery. PMID:27703616
Ikbal, M.; Odang, R. W.; Indrasari, M.; Dewi, R. S.
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.
Background The occurrence of pyogenic granuloma in association to dental implants is rare and only five cases have been reported in the literature. Material and Methods Patients charts were analyzed to select patients who had been diagnosed for pyogenic granuloma and its association with dental implants had been evaluated. The clinical status of the dental implants and the prosthesis had also been assessed. Results Clinical and histopathological diagnosis of pyogenic granuloma had been reached for soft mass growth in association with dental implants in 10 patients. Histological analysis of all samples was performed to obtain a firm diagnosis of finding against pyogenic granuloma lesions. Accumulation of dental plaque due to poor oral hygiene and improper design of the prosthesis had been related to the occurrence of pyogenic granuoloma. This lesion showed no predilection to specific surface type and had no significant association with marginal bone loss. Conclusions Pyogenic granuloma should be included in the differential diagnosis of soft mass growth around dental implants. Key words:Reactive lesion, soft mass, pyogenic granuloma, dental implant, titanium. PMID:26535087
Kashi, Ajay; Saha, Subrata
The clinical use of evidence-based medicine has been regarded as one of the most significant medical advancements of the last century. As the costs of medical care escalate, clinical decisions have to be made prudently and with a high degree of efficacy. One of the most expensive treatments in dentistry includes the use of dental implants to rehabilitate partial and fully edentulous patients. Due to the high costs of treatments and the ever increasing varieties of dental implants becoming available, the clinician is often faced with a challenging situation to decide the best prostheses for their patients. Furthermore, navigating through the vast database of literature pertaining to dental implants and their related research can be very time consuming and challenging to a dental surgeon before they can make appropriate clinical decisions. Similar to other orthopedic implants, dental implants need to be evaluated for their long-term efficacy in vivo before they are clinically acceptable. In order to help clinician(s) make patient oriented decisions, evidence-based techniques are becoming increasingly popular. This can be a very useful tool in translating research findings into clinical practice, thus narrowing the gap between research and clinical dentistry. This article discusses ways in which evidence-based techniques can help dental surgeons analyze and make informed clinical decisions about dental implant treatments.
Busscher, H J; Rinastiti, M; Siswomihardjo, W; van der Mei, H C
Biomaterials for the restoration of oral function are prone to biofilm formation, affecting oral health. Oral bacteria adhere to hydrophobic and hydrophilic surfaces, but due to fluctuating shear, little biofilm accumulates on hydrophobic surfaces in vivo. More biofilm accumulates on rough than on smooth surfaces. Oral biofilms mostly consist of multiple bacterial strains, but Candida species are found on acrylic dentures. Biofilms on gold and amalgam in vivo are thick and fully covering, but barely viable. Biofilms on ceramics are thin and highly viable. Biofilms on composites and glass-ionomer cements cause surface deterioration, which enhances biofilm formation again. Residual monomer release from composites influences biofilm growth in vitro, but effects in vivo are less pronounced, probably due to the large volume of saliva into which compounds are released and its continuous refreshment. Similarly, conflicting results have been reported on effects of fluoride release from glass-ionomer cements. Finally, biomaterial-associated infection of implants and devices elsewhere in the body is compared with oral biofilm formation. Biomaterial modifications to discourage biofilm formation on implants and devices are critically discussed for possible applications in dentistry. It is concluded that, for dental applications, antimicrobial coatings killing bacteria upon contact are more promising than antimicrobial-releasing coatings.
Cortada, M; Giner, L; Costa, S; Gil, F J; Rodríguez, D; Planell, J A
The corrosion of five materials for implant suprastructures (cast-titanium, machined-titanium, gold alloy, silver-palladium alloy and chromium-nickel alloy), was investigated in vitro, the materials being galvanically coupled to a titanium implant. Various electrochemical parameters E(CORR), i(CORR) Evans diagrams, polarization resistance and Tafel slopes) were analyzed. The microstructure of the different dental materials was observed before and after corrosion processes by optical and electron microscopy. Besides, the metallic ions released in the saliva environment were quantified during the corrosion process by means of inductively coupled plasma-mass spectrometry technique (ICP-MS). The cast and machined titanium had the most passive current density at a given potential and chromium-nickel alloy had the most active critical current density values. The high gold content alloys have excellent resistance corrosion, although this decreases when the gold content is lower in the alloy. The palladium alloy had a low critical current density due to the presence of gallium in this composition but a selective dissolution of copper-rich phases was observed through energy dispersive X-ray analysis.
Christman, Adam; Schrader, Stuart; John, Vanchit; Zunt, Susan; Maupome, Gerardo; Prakasam, Sivaraman
Complications during and after dental implant placement can be a hindrance to successful treatment. Checklists are emerging as useful tools in error reduction in various fields. The authors selected a Delphi panel to explore the appropriate clinical practices involved in implant placement, with the objective of formulating a safety checklist that would aid in reducing errors. The authors administered a Delphi method survey to an expert panel of 24 board-certified periodontists to determine if consensus existed regarding the critical steps involved in implant placement. They defined consensus as 90 percent agreement among participants. Using the Delphi data, the authors designed a safety checklist for implant placement. The panelists generated 20 consensus statements regarding essential steps in implant placement. The authors divided the statements into preoperative, intraoperative and postoperative phases. To determine the rationale for consensus decisions, the authors conducted a thematic qualitative analysis of responses to all open-ended questionnaire items, asking panel members how or why a particular procedure was performed. The panelists reached a consensus regarding the steps they considered critical in implant placement. Further research is needed to assess the acceptance and effectiveness of this type of checklist in a clinical setting. Practical Implications. The authors developed a checklist that may be useful in reducing errors in placement of dental implants. If effective, this checklist ultimately will aid in minimizing risk and increasing implant success rates, especially for inexperienced practitioners, dental students, surgical residents and dental implant trainees (that is, dentists undergoing training to place implants through continuing education courses).
Ogata, Yorimasa; Nakayama, Yohei; Tatsumi, Junichi; Kubota, Takehiko; Sato, Shuichi; Nishida, Tetsuya; Takeuchi, Yasuo; Onitsuka, Tokuya; Sakagami, Ryuji; Nozaki, Takenori; Murakami, Shinya; Matsubara, Naritoshi; Tanaka, Maki; Yoshino, Toshiaki; Ota, Junya; Nakagawa, Taneaki; Ishihara, Yuichi; Ito, Taichi; Saito, Atsushi; Yamaki, Keiko; Matsuzaki, Etsuko; Hidaka, Toshirou; Sasaki, Daisuke; Yaegashi, Takashi; Yasuda, Tadashi; Shibutani, Toshiaki; Noguchi, Kazuyuki; Araki, Hisao; Ikumi, Noriharu; Aoyama, Yukihiko; Kogai, Hideki; Nemoto, Kenji; Deguchi, Shinji; Takiguchi, Takashi; Yamamoto, Matsuo; Inokuchi, Keita; Ito, Takatoshi; Kado, Takashi; Furuichi, Yasushi; Kanazashi, Mikimoto; Gomi, Kazuhiro; Takagi, Yukie; Kubokawa, Keita; Yoshinari, Nobuo; Hasegawa, Yoshiaki; Hirose, Tetsushi; Sase, Toshinaga; Arita, Hirokazu; Kodama, Toshiro; Shin, Kitetsu; Izumi, Yuichi; Yoshie, Hiromasa
We investigated the prevalences and risk factors for peri-implant diseases in Japanese adult dental patients attending a follow-up visit at dental hospitals or clinics as part of their maintenance program. This cross-sectional multicenter study enrolled patients with dental implants who attended regular check-ups as part of a periodontal maintenance program during the period from October 2012 through September 2013. Patients with implants with at least 3 years of loading time were included in the study. The condition of peri-implant tissue was examined and classified into the following categories: healthy, peri-implant mucositis, and peri-implantitis. Patients were also evaluated for implant risk factors. A total of 267 patients (110 men, 157 women; mean age: 62.5 ± 10.7 years) were analyzed. The prevalence of patient-based peri-implant mucositis was 33.3% (n = 89), and the prevalence of peri-implantitis was 9.7% (n = 26). Poor oral hygiene and a history of periodontitis were strong risk factors for peri-implant disease. The present prevalences were lower than those previously reported. The quality of periodontal therapy before and after implant installation and patient compliance and motivation, as indicated by plaque control level, appear to be important in maintaining peri-implant tissue health.
Strietzel, Frank Peter; Reichart, Peter A; Kale, Abhijit; Kulkarni, Milind; Wegner, Brigitte; Küchler, Ingeborg
This systematic literature review was performed to investigate if smoking interferes with the prognosis of implants with and without accompanying augmentation procedures compared with non-smokers. A systematic electronic and handsearch (articles published between 1989 and 2005; English and German language; search terms "dental or oral implants and smoking"; "dental or oral implants and tobacco") was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review. Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces. Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.
Zhong, Weijian; Chen, Binke; Liang, Xin; Ma, Guowu
The exposing of dental implant into the maxillary sinus combined with membrane perforation might increase risks of implant failure and sinus complications. The purpose of this study was to investigate the effects of the dental implant penetration into the maxillary sinus cavity in different depths on osseointegration and sinus health in a dog model. Sixteen titanium implants were placed in the bilateral maxillary molar areas of eight adult mongrel dogs, which were randomly divided into four groups according to the different penetrating extents of implants into the sinus cavities (group A: 0 mm; group B: 1 mm; group C: 2 mm; group D: 3 mm). The block biopsies were harvested five months after surgery and evaluated by radiographic observation and histological analysis. No signs of inflammatory reactions were observed in any maxillary sinus of the eight dogs. The tips of the implants with penetrating depth of 1 mm and 2 mm were found to be fully covered with newly formed membrane and partially with new bone. The tips of the implants with penetrating depth over 3 mm were exposed in the sinus cavity and showed no membrane or bone coverage. No significant differences were found among groups regarding implant stability, bone-to-implant contact (BIC) and bone area in the implant threads (BA). Despite the protrusion extents, penetration of dental implant into the maxillary sinus with membrane perforation does not compromise the sinus health and the implant osseointegration in canine.
Al-Sabbagh, Mohanad; Okeson, Jeffrey P; Bertoli, Elizangela; Medynski, Denielle C; Khalaf, Mohd W
Nerve trauma caused by dental implant placement is associated with altered sensation and chronic pain. Complete or partial loss of sensation is often reported by patients who have experienced nerve trauma during implant surgery. Some patients report persistent pain and neurosurgery disturbance long after the normal healing time has passed. In addition, neuropathic pain is reported after implant surgery. Practitioners who place dental implants must be familiar with the differential diagnosis, prevention, and management of neuropathic pain. This article provides insights into the prevention and management of neurosensory deficits and chronic persistent neuropathic pain and considerations for patient referral.
Al-Sabbagh, Mohanad; Okeson, Jeffrey P; Khalaf, Mohd W; Bhavsar, Ishita
Many studies have documented the successful outcomes of dental implants, but have also reported the association of sensory disturbances with the surgical implant procedure. Postsurgical pain is a normal response to tissue injury, and usually resolves after the tissue heals. However, some patients who receive dental implants experience persistent pain even after normal healing. This article describes the basic anatomy and pathophysiology associated with nerve injury. The incidence and diagnosis of these problems, in addition to factors that result in the development of chronic persistent neuropathic pain and sensory disturbances associated with surgical implant placement, are discussed.
Siadat, Hakimeh; Hashemzadeh, Shervin; Geramy, Allahyar; Bassir, Seyed Hossein; Alikhasi, Marzieh
There are some anatomical restrictions in which implants are not possible to be inserted in their conventional configuration. Offset placement of implants in relation to the prosthetic unit could be a treatment solution. The aim of this study was to evaluate the effect of the offset placement of implant-supported prosthesis on the stress distribution around a dental implant using 3D finite element analysis. 3D finite element models of implant placement in the position of a mandibular molar with 4 configurations (0, 0.5, 1, 1.5 mm offset) were created in order to investigate resultant stress/strain distribution. A vertical load of 100 N was applied on the center of the crown of the models. The least stress in peri-implant tissue was found in in-line configuration (0 mm offset). Stress concentration in the peri-implant tissue increased by increasing the amount of offset placement. Maximum stress concentration in all models was detected at the neck of the implant. It can be concluded that the offset placement of a single dental implant does not offer biomechanical advantages regarding reducing stress concentration over the in-line implant configuration. It is suggested that the amount of offset should be as minimum as possible.
Sanromán, F; Montolio, J; Llorens, M P
Mandibular incisors were taken out in 13 adult dogs. Twenty days after the extraction, two implants either of titanium or hydroxylapatite were placed in a second operation. The clinical, pathological and radiological results suggest that metallic implants produce fibrous tissue around the implant. In most cases, fibrous tissue does not ossify and this facilitates the formation of a malunion and the mobilization of the implant. However, the results with hydroxylapatite implants appear to be satisfactory due to the formation of an osseous tissue mandibular bone. This tissue prevents the mobilization of the implant allowing support to a dental prostheses.
Gleiznys, Alvydas; Skirbutis, Gediminas; Harb, Ali; Barzdziukaite, Ingrida; Grinyte, Ieva
BACKGROUND. Mini dental implants (MDI) and small diameter implants (SDI) have been extensively used as temporary or orthodontic anchorage; however there have been studies that proved their availability as a mean for long term prosthodontics. Our aim was to review the indications, advantages of MDI and SDI, and their long-term survival. METHODS. Computerized searches were conducted for clinical studies between year 2000 and 2011 that involved either implants with 3.3 mm diameter or less, used in prosthodontics; or provided a follow up of MDI or SDI duration of at least 4 months following implant placement including survival rate data. All studies about implants used in orthodontics were excluded. The range of available MDI and SDI has been found in cataloges of the companies: 3M ESPE IMTEC, Bicon Dental, Zimmer, Implant Direct, Intra lock, Hiossen, Simpler Implant, KAT Implants, OCO Biomedical, American Dental Implant. RESULTS. 41 studies meeting the above criteria were selected, 22 out of them reviewed survival rates of MDI and SDI. The follow up duration varried from 4 months to 8 years with survival rates between 91.17 and 100%. Nevertheless, the companies showed a big variety of MDI and SDI provided in the market for long term prostheses. CONCLUSIONS. Implants with small diameters can be used successfully in a variety of clinical situations. Less surgical time, less postoperative pain, ability of direct loading after surgery with no harm to bone and cost effectiveness are the advantages. The reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. MDI and SDI show high survival rates, but special cautions for bone quality and good oral hygiene should be maintained.
Carr, A B; Gerard, D A; Larsen, P E
In an effort to better understand the supporting anatomy for unloaded endosseous dental implants, this study focused on the histomorphometric analysis of 3 different types of implants placed into non-human primate jaws and allowed to heal for 6 months. This report describes data from 24 screw-type dental implants placed in edentulated (2 months healing time) posterior arches of 4 adult female baboons. Three different implants were placed and allowed to heal for 6 months prior to processing for evaluation: commercially pure titanium (n = 8), titanium alloy (n = 8), and titanium plasma-sprayed (n = 8). Circumferential bone-implant interface sampling from 6 regions along the entire length of each implant was obtained for evaluation of percent bone-implant contact (%BIC) and percent bone area (%BA), within 3 mm of the implant. Data were collected (reliability of 1.6% for both parameters) and analyzed by an observer blinded to implant material using IMAGE analysis software for differences between jaws, implant biomaterials, and jaw/biomaterial (analysis of variance, pairwise comparison using least squares method with Bonferroni adjustment). The results indicated that the overall mean %BIC was 55.8 and mean %BA was 48.1. Maxillary and mandibular differences for both parameters were statistically significantly different: %BIC in maxilla 50.8, in mandible 60.8; %BA in maxilla 43.6, in mandible 52.6 (both significant at the P < .05 level). The biomaterial analyses revealed no significant differences between the different implants for %BIC or %BA. The trend observed--that mandibular values were greater than maxillary values for the overall jaw comparisons--was found to be consistent at the jaw/biomaterial level, although the small sample size limited statistical power. These data, along with data from a previous 3-month study, provide insight into baseline supporting anatomy for dental implants.
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Vasco, Marco Antonio Amorim; Hecke, Mildred Ballin; Bezzon, Osvaldo Luiz
There are difficulties for dental implant use in posterior mandible when there is little bone height for implant placement. Among the treatment alternatives available, there is no direct comparison between short implants and conventional implants placed with lateralization of the inferior alveolar nerve. The present study aimed to comparatively evaluate the risk of peri-implant bone loss of the above treatments. With this aim, computed tomography scans of mandibles were processed, and implants and prosthetic components were reverse engineered for reconstruction of three-dimensional models to simulate the biomechanical behavior of 3-element fixed partial dentures supported by 2 osseointegrated implants, using simulations with the finite element method. The models of implants were based on MK III implants (Nobel Biocare) of 5- and 4-mm diameter by 7-mm length, representing short implants, and 4- and 3.75-mm diameter by 15-mm length, representing implants used in lateralization of the inferior alveolar nerve. All models were simulated with prestress concerning the stresses generated by the torque of the screw. Axial and oblique occlusal loads at 45% were simulated, resulting in 8 different simulations. The results showed that the risk for bone loss in osseointegrated implants is greater for treatments with short implants.
Magrin, Gabriel Leonardo; Sigua-Rodriguez, Eder Alberto; Goulart, Douglas Rangel; Asprino, Luciana
The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement.
Magrin, Gabriel Leonardo; Sigua-Rodriguez, Eder Alberto; Goulart, Douglas Rangel; Asprino, Luciana
The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement. PMID:26966469
Godoy-Gallardo, Maria; Manzanares-Céspedes, Maria Cristina; Sevilla, Pablo; Nart, José; Manzanares, Norberto; Manero, José M; Gil, Francisco Javier; Boyd, Steven K; Rodríguez, Daniel
The aim of this study was to evaluate the in vivo effect of antibacterial modified dental implants in the first stages of peri-implantitis. Thirty dental implants were inserted in the mandibular premolar sites of 5 beagle dogs. Sites were randomly assigned to Ti (untreated implants, 10units), Ti_Ag (silver electrodeposition treatment, 10units), and Ti_TSP (silanization treatment, 10units). Coated implants were characterized by scanning electron microscopy, interferometry and X-ray photoelectron spectroscopy. Two months after implant insertion, experimental peri-implantitis was initiated by ligature placement. Ligatures were removed 2months later, and plaque formation was allowed for 2 additional months. Clinical and radiographic analyses were performed during the study. Implant-tissue samples were prepared for micro computed tomography, backscattered scanning electron microscopy, histomorphometric and histological analyses and ion release measurements. X-ray, SEM and histology images showed that vertical bone resorption in treated implants was lower than in the control group (P<0.05). This effect is likely due to the capacity of the treatments to reduce bacteria colonization on the implant surface. Histological analysis suggested an increase of peri-implant bone formation on silanized implants. However, the short post-ligature period was not enough to detect differences in clinical parameters among implant groups. Within the limits of this study, antibacterial surface treatments have a positive effect against bone resorption induced by peri-implantitis. Copyright © 2016 Elsevier B.V. All rights reserved.
Jacobsen, Hans-Christian; Wahnschaff, Falko; Trenkle, Thomas; Sieg, Peter; Hakim, Samer G
Bony reconstruction of jaw defects using the free fibular flap and dental rehabilitation mostly requires insertion of dental implants within the transferred fibula bone. The aim of this paper was to discuss results of the implant stability with data on the possible benefit for the patient's quality of life after such treatment. For clinical outcome of implants, we evaluated 26 patients with a total number of 94 dental implants after a follow-up period of 12 to 132 months. A group of 38 patients who underwent mandibular reconstruction with free fibular flap could be included in the life-quality study. Evaluation included 23 patients with and 15 patients without implant-borne restoration. The quality of life was assessed using the standard QLQ C-30 questionnaire and the H&N35 module of the European Organisation for Research and Treatment of Cancer (EORTC). Of implants, 94.7 % were stable at the time of investigation and could be used for prosthesis. Patients with dental implants reported improvement of life quality along with better scores in most function and symptom scales; however, only values for global health status (QL2), absence of dyspnea (DY) and absence of feeding tube (HNFE) were significantly better than in the control group. Dental implant insertion in fibula grafts along with implant-borne restoration is a proven concept and might lead to improved quality of life following ablative surgery of the jaw. The effect on the quality of life is not as predictable as on the implant stability. Patients with bony defects of the jaw require bony reconstruction. This allows further masticatory rehabilitation using dental implants and might lead to improved quality of life.
Bankoğlu Güngör, Merve; Aydın, Cemal; Yılmaz, Handan; Gül, Esma Başak
Due to the possible aesthetic problems of titanium implants, the developments in ceramic implant materials are increasing. Natural tooth colored ceramic implants may be an alternative to overcome aesthetic problems. The purpose of this article is to give information about the basic properties of dental zirconia implants and present 3 cases treated with two-piece zirconia implants. Two-piece zirconia dental implants, 4.0 mm diameter and 11.5 mm in length, were inserted into maxillary incisor region. They were left for 6 months to osseointegrate. Panoramic and periapical radiographs were obtained and examined for bone-implant osseointegration. During the follow-up period the patients were satisfied with their prosthesis and no complication was observed.
Murphy, M; Walczak, M S; Thomas, A G; Silikas, N; Berner, S; Lindsay, R
Targeting understanding enhanced osseointegration kinetics, the goal of this study was to characterize the surface morphology and composition of Ti and TiZr dental implant substrates subjected to one of two surface treatments developed by Straumann. These two treatments are typically known as SLA and SLActive, with the latter resulting in more rapid osseointegration. A range of techniques was applied to characterize four different substrate/surface treatment combinations (TiSLA, TiSLActive, TiZrSLA, and TiZrSLActive). Contact angle measurements established their hydrophilic/hydrophobic nature. Surface morphology was probed with scanning electron microscopy. X-ray diffraction, Raman μ-spectroscopy, and X-ray photoelectron spectroscopy were used to elucidate the composition of the near-surface region. Consistent with previous work, surface morphology was found to differ only at the nanoscale, with both SLActive substrates displaying nano-protrusions. Spectroscopic data indicate that all substrates exhibit surface films of titanium oxide displaying near TiO2 stoichiometry. Raman μ-spectroscopy reveals that amorphous TiO2 is most likely the only phase present on TiSLA, whilst rutile-TiO2 is also evidenced on TiSLActive, TiZrSLA, and TiZrSLActive. For TiZr alloy substrates, there is no evidence of discrete phases of oxidized Zr. X-ray photoelectron spectra demonstrate that all samples are terminated by adventitious carbon, with it being somewhat thicker (∼1nm) on TiSLA and TiZrSLA. Given previous in vivo studies, acquired data suggest that both nanoscale protrusions, and a thinner layer of adventitious carbon contribute to the more rapid osseointegration of SLActive dental implants. Composition of the surface oxide layer is apparently less important in determining osseointegration kinetics. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
Butterworth, C J; Baxter, A M; Shaw, M J; Bradnock, G
To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. Anonymous postal questionnaire in the United Kingdom. Consultants in restorative dentistry. Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2-150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.
Seckinger, R J; Weintraub, A M; Berthold, P; Weintraub, G S
Over the past 20 years the incorporation of implant dentistry into academia has been documented in some detail for North American dental schools but has not been pursued on an international level. In June of 1993, we surveyed 51 dental schools outside of the United States affiliated with the University of Pennsylvania School of Dental Medicine's Office of International Relations concerning their teaching involvement with implant dentistry. Results from the 44 (86 percent) responding schools suggest that implant dentistry is being incorporated into predoctoral curriculums. Industrialized countries were more inclined to provide implant education. Insufficient time and the thought that the predoctoral level was not the place for implant dentistry were cited as some of the reasons for not incorporating implant dentistry into the curriculum. Oral surgery, prosthodontics, and periodontics departments developed and administered the implant curriculum. Formats varied among schools with respect to allotted time, curricular placement, laboratory experience, and clinical participation. Didactic material most frequently presented included a historical overview, diagnosis and treatment planning, classification of dental implants, and surgical and prosthetic concepts. Clinical involvement varied from actual implant placement to observation of prosthodontic procedures. Results were categorized based on the TOEFL (Test of English as a Foreign Language) classification of countries in six regions.
Berketa, J; James, H; Marino, V
Minimal dimensional changes in free standing dental implants when incinerated in a kiln to a temperature of 1125°C have been reported previously. However, in the same study colour changes were observed between commercially pure titanium and titanium alloy type of implants, with speculation that this change may be a useful distinguishing tool in cases requiring forensic identification. The present study was instigated to determine what changes occur following cremation to bone-supported dental implants placed within mandibles of sheep. A selection of dental implants was photographed and radiographed. They were then surgically placed in sheep mandibles and the entire sheep heads cremated in a commercial cremator. There was detachment of the dental implants from the mandible, which could have implications for scene recovery. Following retrieval and re-irradiating of the implants, image subtraction evaluation of the radiographs was recorded using Adobe(®) Photoshop.(®) As with the previous study there was slight oxidation of the implant surfaces leading to minor alteration of the images. There was, however, no gold crust colour change in the commercially pure titanium. Photography within the retrieved implants revealed the batch number within the Straumann™ implant was still visible, which could significantly add weight to the identification of deceased persons.
Chahine, Gilbert; Koike, Mari; Okabe, Toru; Smith, Pauline; Kovacevic, Radovan
This paper addresses the production of customized Ti-6Al-4V ELI dental implants via electron beam melting (EBM). The melting of Ti-6Al-4V ELI powder produces implants with great biocompatibility, fi ne mechanical performance, and a high bone ingrowth potential. The EBM technology is used to produce one-component dental implants that mimic the exact shape of the patient’s tooth, replacing the traditional, three-component, “screw-like” standardized dental implants currently used. The new generation of implants provides the possibility of simplifying pre-insertion procedures leading to faster healing time, and the potential of better and stronger osseointegration, specifi cally through incorporating lattice structure design.
Basquill, P J; Steflik, D E; Brennan, W A; Horner, J; Van Dyke, T E
The effect that diagnostic radiation may have on peri-implant supporting alveolar tissues is not well understood. Fifty-four (54) titanium dental implants were inserted into the posterior mandible of nine micropigs. At implant placement surgery, 18 implants were exposed to either 2 (diagnostic) or 10 (excessive) doses of diagnostic radiation; the remaining 36 implants served as controls. Fourteen weeks after implant placement, standardized clinical radiographs were taken, pigs were euthanized, and implants with supporting alveolar tissues were prepared and examined by light and scanning electron microscopy (SEM). Ninety-seven sections were evaluated by SEM for morphometric and morphologic analyses. The mean percent of implant length in contact with bone was 47% for the controls and 53% for the implants receiving radiation. Five implants were lost during the initial healing phase and four implants were clinically mobile at time of euthanasia, giving a success rate of 83% (45/54). Correlative light microscopy of peri-implant supporting tissues revealed no distinct differences between the microvasculature of controls versus implants exposed to radiation. Standardized clinical radiographs revealed crestal saucerization in both control and radiated implants. This study revealed no statistically significant difference for the percent of implant length in contact with alveolar bone for controls or implants exposed to 2 or 10 doses of diagnostic radiation at implant placement time.
Gennaro, Paolo; Chisci, Glauco; Gabriele, Guido; Iannetti, Giorgio
Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant.
Rahimov, Chingiz R.; Farzaliyev, Ismayil M.; Fathi, Hamid Reza; Davudov, Mahammad M.; Aliyev, Anar; Hasanov, Emin
Routine reconstruction of subtotal defects of the mandible and orthopedic rehabilitation supported by dental implants is achieved by means of detailed planning and lasts over a year. This article shows the outcomes of single-stage surgical treatment and immediate orthopedic rehabilitation performed with the help of preoperative virtual computer simulation. 3D investigation of pathological and donor sites, virtual simulation of tumor resection, positioning of the dental implants into fibula, virtual flap bending and transfer, virtual bending of fixing reconstruction plates, and fabrication of navigation templates and bridge prosthesis supported by dental implants were done preoperatively. The surgery included tumor resection, insertion of dental implants into fibula, elevation of fibula osteocutaneous free flap, rigid fixation within recipient site, and immediate loading by bridge orthopedic device. On 10-month follow-up, functional and esthetic results were asses as reasonable. Radiography showed dental implants to be integrated and positioned appropriately. We found that successful rehabilitation of the patients with extensive defects of the jaws could be achieved by ablative tumor resection, dental implants insertion prior to flap elevation guided by navigation templates, further osteotomy, modeling of the flap based on navigation template, flap transfer, and rigid fixation within recipient site by prebended plates, with application of prefabricated prosthesis. PMID:27162568
Shafer, D M; Rogerson, K; Norton, L; Bennett, J
Successful osseointegration of titanium dental implants is decreased in areas of poor bone volume and density. Low amperage direct current (LADC) has been shown to perturb bone cells, which in turn promotes bone growth. The purpose of this experiment was to evaluate the effect of LADC on the osseointegration of endosseous titanium dental implants. Two implant sites were prepared in the body of the mandible of five rabbits by an extraoral approach. An LADC-stimulated 3.75 x 7 mm-titanium implant was placed in one site and an identical control implant was inserted on the contralateral side. A sterilized silicone-encased power pack producing 7.5 +/- 0.2 uA and 1.35 +/- 0.01 V was placed in a submandibular pouch. The active cathode lead was attached to the LADC implant and the anode was placed in the mandible 5 mm distal to the implant. Nonactive leads were similarly connected to the control implant. Twenty-eight days after placement, the implants were removed using a torque wrench, and the bone surrounding the implants was examined both microscopically and radiographically. The average force to initial rotation was 1,320 +/- 880 g/cm for the LADC-stimulated implants and 1,290 +/- 238 g/cm for the control implants. This was significantly different by t test (P = .94). Light microscopic evaluation demonstrated a mixture of compact and woven bone and fibrous tissue adjacent to both groups of implants. Histomorphometric analysis demonstrated an average percent of bone in relation to the total tissue adjacent to the control implants of 33.5 +/- 15.4 and 40.2 +/- 4.8 for the LADC-stimulated implants (not significantly different, t test, P = .39). CONCLUSION. It was concluded that LADC as used in this study does not positively affect the healing of bone. Its ability to enhance bone growth around titanium dental implants needs further investigation.
Barias, Pamela A; Lee, Damian J; Yuan, Judy Chia-Chun; Sukotjo, Cortino; Campbell, Stephen D; Knoernschild, Kent L
The purposes of this retrospective clinical review were to: (1) describe the demographics of implant patients, types of implant treatment and implant-supported prostheses in an Advanced Education in Prosthodontic Program, (2) evaluate the survival rate of dental implants placed by prosthodontic residents from 2006 to 2008, and (3) analyze the relationship between resident year of training and implant survival rate. All patients who received dental implants placed by prosthodontic residents from January 2006 to October of 2008 in the Advanced Prosthodontic Program at the University of Illinois at Chicago College of Dentistry were selected for this study. Age, gender, implant diameter, length, implant locations, surgical and restorative detail, and year of prosthodontic residency training were collected and analyzed. Life-table and Kaplan-Meier survival analyses were performed based on implants overall, locations, year of training, and use of a computer-generated surgical guide. A Logrank statistic was performed between implant survival and year of prosthodontic residency training, location, and use of computer-generated surgical guide (α= 0.05). Three hundred and six implants were placed, and of these, seven failed. Life-table and Kaplan-Meier analyses computed a cumulative survival rate (CSR) of 97% for overall implants and implants placed with a computer-generated surgical guide. No statistical difference was found in implant survival rates as a function of year of training (P= 0.85). Dental implants placed by prosthodontic residents had a CSR comparable to previously published studies by other specialties. The year of prosthodontic residency training and implant failure rate did not have any significant relationship. © 2012 by the American College of Prosthodontists.
Jimbo, R; Tovar, N; Anchieta, R B; Machado, L S; Marin, C; Teixeira, H S; Coelho, P G
This study investigated the effect of undersized preparations with two different implant macrogeometries. There were four experimental groups: group 1, conical implant with an undersized osteotomy of 3.2mm; group 2, conical implant with an undersized osteotomy of 3.5mm; group 3, cylindrical implant with an undersized osteotomy of 3.2mm; group 4, cylindrical implant with an undersized osteotomy of 3.5mm. Implants were placed in one side of the sheep mandible (n=6). After 3 weeks, the same procedure was conducted on the other side; 3 weeks later, euthanasia was performed. All implants were 4mm×10mm. Insertion torque was recorded for all implants during implantation. Retrieved samples were subjected to histological sectioning and histomorphometry. Implants of groups 1 and 2 presented significantly higher insertion torque than those of groups 3 and 4 (P<0.001). No differences in bone-to-implant contact or bone area fraction occupied were observed between the groups at 3 weeks (P>0.24, and P>0.25, respectively), whereas significant differences were observed at 6 weeks between groups 1 and 2, and between groups 3 and 4 (P<0.01). Undersized drilling affected the biological establishment of bone formation around both dental implant macrogeometries.
Background. The information available about osseointegration and the bone to implant interaction of zirconia implants with various surface modifications is still far from sufficient. Objective. The purpose of this systematic review and meta-analysis was to evaluate and compare zirconia dental implants with different surface topographies, with a focus on bone to implant contact and removal torque. Methods. The systematic review of the extracted publications was performed to compare the bone to implant contact (BIC) with removal torque (RT) values of titanium dental implants and machined and surfaced modified zirconia implants. Results. A total of fifteen articles on BIC and RT values were included in the quantitative analysis. No significant difference in the BIC values was observed between titanium and machined zirconia implants (p = 0.373; 95% CI: −0.166 to 0.443). However, a significantly better BIC values were observed for acid etched zirconia implants compared with those of titanium implants (p = 0.032; 95% CI: 0.068 to 1.461). Unmodified zirconia implants showed favorable BIC values compared to modified-surface zirconia implants (p = 0.021; 95% CI: −0.973 to −0.080). Conclusion. Acid etched zirconia implants may serve as a possible substitute for successful osseointegration. PMID:28299337
Hafezeqoran, Ali; Koodaryan, Roodabeh
Background. The information available about osseointegration and the bone to implant interaction of zirconia implants with various surface modifications is still far from sufficient. Objective. The purpose of this systematic review and meta-analysis was to evaluate and compare zirconia dental implants with different surface topographies, with a focus on bone to implant contact and removal torque. Methods. The systematic review of the extracted publications was performed to compare the bone to implant contact (BIC) with removal torque (RT) values of titanium dental implants and machined and surfaced modified zirconia implants. Results. A total of fifteen articles on BIC and RT values were included in the quantitative analysis. No significant difference in the BIC values was observed between titanium and machined zirconia implants (p = 0.373; 95% CI: -0.166 to 0.443). However, a significantly better BIC values were observed for acid etched zirconia implants compared with those of titanium implants (p = 0.032; 95% CI: 0.068 to 1.461). Unmodified zirconia implants showed favorable BIC values compared to modified-surface zirconia implants (p = 0.021; 95% CI: -0.973 to -0.080). Conclusion. Acid etched zirconia implants may serve as a possible substitute for successful osseointegration.
Wiest, Wolfram; Zabler, Simon; Rack, Alexander; Fella, Christian; Balles, Andreas; Nelson, Katja; Schmelzeisen, Rainer; Hanke, Randolf
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.
Ata-Ali, Javier; Ata-Ali, Fadi; Di-Benedetto, Nicolas; Bagán, Leticia; Bagán, José-Vicente
A systematic review is made to determine whether human immunodeficiency virus (HIV) infection has an impact upon dental implant osseointegration. A PubMed (MEDLINE) literature search was made of articles published up until 14 April 2014. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS) and levels of evidence (based on the University of Oxford's Center for Evidence Based Medicine criteria). The combinations of search terms resulted in a list of 132 titles. Nine studies finally met the inclusion criteria and were selected for inclusion in the systematic review. A total of 173 dental implants were placed in 80 patients (135 implants in 56 HIV-positive subjects and 38 implants in 24 HIV-negative patients), and a single loss of dental implant osseointegration was recorded in an HIV-positive patient. Our results suggest that dental implant placement in HIV-positive patients does not increase the dental implant failure rate. Prophylactic antibiotic treatment, the administration of highly active antiretroviral therapy, and control of the CD4+ T lymphocyte counts appear to be the main influencing factors in this respect. Given the few studies included in our systematic review, further prospective studies involving larger sample sizes and longer durations of follow-up are required in order to confirm the results obtained.
Schwitalla, Andreas Dominik; Spintig, Tobias; Kallage, Ilona; Müller, Wolf-Dieter
Due to its mechanical properties, the biocompatible high-performance material PEEK (polyetheretherketone) and PEEK-based compounds may represent viable alternatives to titanium in the field of dental implantology. Therefore we performed static pressure tests with 11 PEEK materials (two unfilled grades, two grades filled with titanium-dioxide-powder, two grades filled with barium-sulfate-powder, two grades reinforced with short carbon fibers, one grade reinforced with glass fibers and two grades reinforced with continuous carbon fibers) in the form of cylindrical specimens with a diameter of 4, 5 and 6mm. The specimens had a height to diameter ratio of 2:1 and were therefore 8, 10 and 12mm high. The parameters elastic modulus, elastic limit and pressure strength were evaluated. The elastic moduli ranged between 2.65±0.03GPa for specimens of a titanium-dioxide-filled grade and 106.71±14.83GPa for specimens reinforced with continuous carbon fibers. The elastic limits ranged between 808.1±42.44N for specimens of a barium-sulfate-filled grade and 7256.4±519.86N for specimens reinforced with continuous carbon fibers. The lowest pressure strength of 122.77MPa was observed for specimens of an unfilled grade, whereas the highest pressure strength of 712.67±66.02MPa could be evaluated for specimens containing continuous carbon fibers. Regarding the maximum bite force of a first molar, all tested materials seem to be suitable for the use as dental implants.
Cordeiro, Jairo M; Beline, Thamara; Ribeiro, Ana Lúcia R; Rangel, Elidiane C; da Cruz, Nilson C; Landers, Richard; Faverani, Leonardo P; Vaz, Luís Geraldo; Fais, Laiza M G; Vicente, Fabio B; Grandini, Carlos R; Mathew, Mathew T; Sukotjo, Cortino; Barão, Valentim A R
The aim of this study was to develop binary and ternary titanium (Ti) alloys containing zirconium (Zr) and niobium (Nb) and to characterize them in terms of microstructural, mechanical, chemical, electrochemical, and biological properties. The experimental alloys - (in wt%) Ti-5Zr, Ti-10Zr, Ti-35Nb-5Zr, and Ti-35Nb-10Zr - were fabricated from pure metals. Commercially pure titanium (cpTi) and Ti-6Al-4V were used as controls. Microstructural analysis was performed by means of X-ray diffraction and scanning electron microscopy. Vickers microhardness, elastic modulus, dispersive energy spectroscopy, X-ray excited photoelectron spectroscopy, atomic force microscopy, surface roughness, and surface free energy were evaluated. The electrochemical behavior analysis was conducted in a body fluid solution (pH 7.4). The albumin adsorption was measured by the bicinchoninic acid method. Data were evaluated through one-way ANOVA and the Tukey test (α=0.05). The alloying elements proved to modify the alloy microstructure and to enhance the mechanical properties, improving the hardness and decreasing the elastic modulus of the binary and ternary alloys, respectively. Ti-Zr alloys displayed greater electrochemical stability relative to that of controls, presenting higher polarization resistance and lower capacitance. The experimental alloys were not detrimental to albumin adsorption. The experimental alloys are suitable options for dental implant manufacturing, particularly the binary system, which showed a better combination of mechanical and electrochemical properties without the presence of toxic elements. Copyright © 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
Lee, Daehyun; Sohn, Byungjin; Kim, Kyoung Hwa; Kim, Sungtae; Koo, Ki-Tae; Kim, Tae-Il; Seol, Yang-Jo; Lee, Yong-Moo; Rhyu, In-Chul; Ku, Young
There have been previous studies on the relationship between periodontitis and peri-implantitis, but limited information is available on how periodontitis affects osseointegration and wound healing of newly placed dental implants adjacent to natural teeth. The objective of the present experiment is to evaluate healing around dental implants adjacent to teeth with untreated experimental periodontitis. The study included six male beagle dogs. Scaling and plaque control procedures were performed on three dogs (control group). In the other three dogs (experimental group), retraction cords and ligature wires were placed subgingivally around all premolars and the first molars. Induced experimental periodontitis was confirmed after 3 months. Each control or experimental group was divided into two subgroups depending on the timing of implant placement (immediate/delayed). Twelve dental implants (two implants for each dog) were placed immediately, and the other 12 dental implants (two implants for each dog) were placed 2 months after extraction. The animals were sacrificed 2 months after implant placement. Histologic and histometric analyses were performed. Four implants (three from the immediate placement group and one from the delayed placement group) failed in the experimental group. There were significant differences in the percentage of bone-to-implant contact and marginal bone volume density between the control and experimental groups. Both parameters were significantly lower in the experimental group than in the control group (P <0.05). There was a tendency toward more marginal bone loss in the experimental group than the control group. Immediate placement of implants is associated with a higher failure rate compared with delayed placement. Untreated experimental periodontitis was correlated with compromised osseointegration in the implants with delayed placement.
Ribeiro, Rodrigo; Melo, Rayanne; Tortamano Neto, Pedro; Vajgel, André
Background. Genetic polymorphisms in certain cytokines and chemokines have been investigated to understand why some individuals display implant flaws despite having few risk factors at the time of implant. Purpose. To investigate the association of genetic polymorphisms in interleukin- (IL-) 10 [-1082 region (A/G)] and RANKL [-438 region (A/G)] with the failure of dental implants. Materials and Methods. This study included 90 partially edentulous male and female patients who were rehabilitated with a total of 245 Straumann dental implants. An implant was considered a failure if any of the following occurred: mobility, persistent subjective complaint, recurrent peri-implant infection with suppuration, continuous radiolucency around the implant, probing depth ≥ 5 mm, and bleeding on probing. Buccal mucosal cells were collected for analysis of RANKL438 and IL-10. Results. The implant success rate in this population was 34.4%. The mutant allele (G) in RANKL had an incidence of 52.3% and mutant allele (A) in IL-10 was observed in 37.8%. No statistically significant difference was detected between the failure of the implant and the genotypes and allelic frequencies. Conclusion. No association was detected between the genetic polymorphisms of RANKL (-438) and IL-10 (-1082) and the failure of dental implants in the population studied. PMID:28348592
Metzler, Philipp; von Wilmowsky, Cornelius; Stadlinger, Bernd; Zemann, Wolfgang; Schlegel, Karl Andreas; Rosiwal, Stephan; Rupprecht, Stephan
Promising biomaterial characteristics of diamond-coatings in biomedicine have been described in the literature. However, there is a lack of knowledge about implant osseointegration of this surface modification compared to the currently used sandblasted acid-etched Ti-Al6-V4 implants. The aim of this study was to investigate the osseointegration of microwave plasma-chemical-vapour deposition (MWP-CVD) diamond-coated Ti-Al6-V4 dental implants after healing periods of 2 and 5 months. Twenty-four MWP-CVD diamond-coated and 24 un-coated dental titanium-alloy implants (Ankylos(®)) were placed in the frontal skull of eight adult domestic pigs. To evaluate the effects of the nano-structured surfaces on bone formation, a histomorphometric analysis was performed after 2 and 5 months of implant healing. Histomorphometry analysed the bone-to-implant contact (BIC). No significant difference in BIC for the diamond-coated implants in comparison to reference implants could be observed for both healing periods. Scanning electron microscopy revealed an adequate interface between the bone and the diamond surface. No delamination or particle-dissociation due to shearing forces could be detected. In this study, diamond-coated dental titanium-alloy implants and sandblasted acid-etched implants showed a comparable degree of osseointegration.
Guo, M; Liu, L; Zhang, J; Liu, M
ABSTRACT Objective: In the last decade, dental implants have emerged as a crucial modality and serve as an individual form of therapy for dental failure. However, disparities in host responses have led to peri-implantitis and implant failure. The pathological mechanisms driving peri-implantitis remain largely unknown. In this study, we evaluated the role of oxidative stress and advanced glycation end products (AGEs) in the progression of peri-implantitis and dental implants failure, compared with chronic periodontal disease. Subjects and Methods: Three patient groups (peri-implantitis, chronic periodontal disease and control), each with 10 subjects (7M/3F) and average age ranging from 40–60 years were selected for analysis. Salivary oxidative stress and tissue AGE levels were analysed by probing for reactive oxygen species (ROS) and Maillard reaction-related fluorescence, respectively. Results: We observed significant increase (> 2-fold) in oxidative stress and AGE levels in patients with peri-implantitis and chronic periodontal disease compared to controls, with chronic periodontal disease having the highest levels. In addition, we observed a strong positive correlation (r = 0.94) between oxidative stress and AGE levels in the patients. Conclusion: We propose that increased AGE levels and oxidative stress, although not the only pathway, are significant mediators in the pathogenesis of peri-implantitis. Altering them may potentially be used in combination with other modalities to manage peri-implantitis. PMID:26624598
Eser, Atilim; Tonuk, Ergin; Akca, Kivanc; Dard, Michel M; Cehreli, Murat Cavit
The objective of this study was to predict time-dependent bone remodeling around tissue- and bone-level dental implants used in patients with reduced bone width. The remodeling of bone around titanium tissue-level, and titanium and titanium-zirconium alloy bone-level implants was studied under 100 N oblique load for one month by implementing the Stanford theory into three-dimensional finite element models. Maximum principal stress, minimum principal stress, and strain energy density in peri-implant bone and displacement in x- and y- axes of the implant were evaluated. Maximum and minimum principal stresses around tissue-level implant were higher than bone-level implants and both bone-level implants experienced comparable stresses. Total strain energy density in bone around titanium implants slightly decreased during the first two weeks of loading followed by a recovery, and the titanium-zirconium implant showed minor changes in the axial plane. Total strain energy density changes in the loading and contralateral sides were higher in tissue-level implant than other implants in the cortical bone at the horizontal plane. The displacement values of the implants were almost constant over time. Tissue-level implants were associated with higher stresses than bone-level implants. The time-dependent biomechanical outcome of titanium-zirconium alloy bone-level implant was comparable to the titanium implant. Copyright © 2013 Elsevier Ltd. All rights reserved.
Miyahara, Takayuki; Dahlin, Christer; Galli, Silvia; Parsafar, Shima; Koizumi, Hiroyasu; Kasugai, Shohei
Dental implant-supported reconstructions demonstrate significantly less physiological flexibility for loading and traumatic forces compared with a normal dentition because of their rigid integration with the adjacent bone. Ethylene vinyl acetate (EVA) material has become widely accepted as a mouthguard material; however, many studies indicate the necessity of improving the impact absorption ability by considering the design and developing new materials. The aim of this study was to compare the shock-absorbing ability of a novel dual component material comprising EVA and porous rubber with that of EVA alone. Three groups of samples were tested: Group 1 = EVA (thickness, 4 mm), Group 2 = type 1 material (2-mm thick porous rubber sheet sandwiched between two sheets of 1-mm thick EVA sheets), and Group 3 = type 2 material (1-mm thick porous rubber sheet sandwiched between EVA sheets with 1 and 2-mm thickness, respectively). Shock absorption was determined by means of a hammer impact testing device equipped with strain gauge, accelerator, and load cell. The value of shock-absorbing ability of group 2 (40.6 ± 12.5%) was significantly higher than those of group 1 (15.6 ± 2.1%) and group 3 (21.2 ± 9.2%). The material with thicker rubber sheet showed significantly higher shock-absorbing ability compared with that of the material with thinner rubber sheet. The novel dual material was superior to conventional EVA material in shock-absorbing ability depending on the thickness of porous rubber, and it may be potentially effective as mouthguard material, in particular, for patients wearing implant-supported constructions. © 2012 John Wiley & Sons A/S.
Yao, Jie; Li, Ming; Tang, Hua; Wang, Peng-Lai; Zhao, Yu-Xiao; McGrath, Colman; Mattheos, Nikos
While research in terms of patient-centered care in implant therapy is growing, few studies have investigated patients' initial perceptions prior to consultation with the implant dentist. The aim of this cross-sectional study was to capture patients' initial information level, perceptions, as well as expectations from the implant therapy. A 34-item questionnaire was developed to investigate patients' preoperative information, perceptions and expectations from treatment with Dental Implants. The study was conducted in three locations (Hong Kong, SiChuan and JiangSu) during 2014-2015 with 277 patients. The main information source about implant therapy was the dentist or hygienist for less than half of the patients (n = 113, 42%). About 62.8% of participants considered that they were in general informed about implants, but only 17.7% felt confident with the information they had. More than 30% of the sample appeared to maintain dangerous misperceptions about Dental Implants: "Dental Implants require less care than natural teeth"; "Treatment with Dental Implants is appropriate for all patients with missing teeth"; "Dental Implants last longer than natural teeth"; and "Treatments with Dental Implants have no risks or complications." Patients were divided when asked whether "Dental Implants are as functional as natural teeth" (agreement frequency = 52.7%). Expectations from treatment outcome were commonly high, while there was a significant correlation between the overall mean of perception scores and outcome expectation scores (r = 0.32, P < 0.001). Overall, younger subjects (<45 years) and those with higher education level (bachelor and postgraduate) tended to present more realistic perceptions and lower outcome expectations. The majority of patients in this study presented relatively realistic perceptions. However, an alarming portion of the sample presented with inaccurate perceptions and unrealistic expectations, which the dental team would need to diagnose
Chen, Hui; Liu, Nizhou; Xu, Xinchen; Qu, Xinhua; Lu, Eryi
Background There are conflicting reports as to the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. We undertook a meta-analysis to evaluate the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. Methods A comprehensive research on MEDLINE and EMBASE, up to January 2013, was conducted to identify potential studies. References of relevant studies were also searched. Screening, data extraction and quality assessment were conducted independently and in duplicate. A random-effects meta-analysis was used to pool estimates of relative risks (RRs) with 95% confidence intervals (CIs). Results A total of 51 studies were identified in this meta-analysis, with more than 40,000 dental implants placed under risk-threatening conditions. The pooled RRs showed a direct association between smoking (n = 33; RR = 1.92; 95% CI, 1.67–2.21) and radiotherapy (n = 16; RR = 2.28; 95% CI, 1.49–3.51) and the risk of dental implant failure, whereas no inverse impact of diabetes (n = 5; RR = 0.90; 95% CI, 0.62–1.32) on the risk of dental implant failure was found. The influence of osteoporosis on the risk of dental implant failure was direct but not significant (n = 4; RR = 1.09; 95% CI, 0.79–1.52). The subgroup analysis indicated no influence of study design, geographical location, length of follow-up, sample size, or mean age of recruited patients. Conclusions Smoking and radiotherapy were associated with an increased risk of dental implant failure. The relationship between diabetes and osteoporosis and the risk of implant failure warrant further study. PMID:23940794
Chrcanovic, B R; Kisch, J; Albrektsson, T; Wennerberg, A
Recent studies have suggested that the insertion of dental implants in patients being diagnosed with bruxism negatively affected the implant failure rates. The aim of the present study was to investigate the association between the bruxism and the risk of dental implant failure. This retrospective study is based on 2670 patients who received 10 096 implants at one specialist clinic. Implant- and patient-related data were collected. Descriptive statistics were used to describe the patients and implants. Multilevel mixed effects parametric survival analysis was used to test the association between bruxism and risk of implant failure adjusting for several potential confounders. Criteria from a recent international consensus (Lobbezoo et al., J Oral Rehabil, 40, 2013, 2) and from the International Classification of Sleep Disorders (International classification of sleep disorders, revised: diagnostic and coding manual, American Academy of Sleep Medicine, Chicago, 2014) were used to define and diagnose the condition. The number of implants with information available for all variables totalled 3549, placed in 994 patients, with 179 implants reported as failures. The implant failure rates were 13·0% (24/185) for bruxers and 4·6% (155/3364) for non-bruxers (P < 0·001). The statistical model showed that bruxism was a statistically significantly risk factor to implant failure (HR 3·396; 95% CI 1·314, 8·777; P = 0·012), as well as implant length, implant diameter, implant surface, bone quantity D in relation to quantity A, bone quality 4 in relation to quality 1 (Lekholm and Zarb classification), smoking and the intake of proton pump inhibitors. It is suggested that the bruxism may be associated with an increased risk of dental implant failure. © 2016 John Wiley & Sons Ltd.
AUNMEUNGTONG, W.; KHONGKHUNTHIAN, P.; RUNGSIYAKULL, P.
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
Salvi, Giovanni E; Bosshardt, Dieter D; Lang, Niklaus P; Abrahamsson, Ingemar; Berglundh, Tord; Lindhe, Jan; Ivanovski, Saso; Donos, Nikos
The objective of the present review was to summarize the evidence available on the temporal sequence of hard and soft tissue healing around titanium dental implants in animal models and in humans. A search was undertaken to find animal and human studies reporting on the temporal dynamics of hard and soft tissue integration of titanium dental implants. Moreover, the influence of implant surface roughness and chemistry on the molecular mechanisms associated with osseointegration was also investigated. The findings indicated that the integration of titanium dental implants into hard and soft tissue represents the result of a complex cascade of biological events initiated by the surgical intervention. Implant placement into alveolar bone induces a cascade of healing events starting with clot formation and continuing with the maturation of bone in contact with the implant surface. From a genetic point of view, osseointegration is associated with a decrease in inflammation and an increase in osteogenesis-, angiogenesis- and neurogenesis-associated gene expression during the early stages of wound healing. The attachment and maturation of the soft tissue complex (i.e. epithelium and connective tissue) to implants becomes established 6-8 weeks following surgery. Based on the findings of the present review it can be concluded that improved understanding of the mechanisms associated with osseointegration will provide leads and targets for strategies aimed at enhancing the clinical performance of titanium dental implants.
Vivan Cardoso, Marcio; Vandamme, Katleen; Chaudhari, Amol; De Rycker, Judith; Van Meerbeek, Bart; Naert, Ignace; Duyck, Joke
The purpose of this study was to compare the clinical performance of two dental implant types possessing a different macro-design in the in vivo pig model. Titanium Aadva(TM) implants (GC, Tokyo, Japan) were compared with OsseoSpeed(TM) implants (Astra, Mölndal, Sweden), with the Aadva implant displaying significant larger inter-thread dimensions than the OsseoSpeed implant. Implants were installed in the parietal bone of 12 domestic pigs and left for healing for either 1 or 3 months. Implant osseointegration was evaluated by quantitative histology (bone volume relative to the tissue volume [BV/TV]; bone-to-implant contact [BIC]) for distinct implant regions (collar, body, total implant length) with specific implant thread features. The Wilcoxon-Mann-Whitney nonparametric test with α = 0.05 was performed. An inferior amount of bone enveloping the Aadva implant compared with the OsseoSpeed implant was observed, in particular at the implant body part with its considerable inter-thread gaps (p < .05). Concomitantly, the Aadva macro-design negatively affected the amount of bone in direct contact with the implant for this specific implant part (p < .05), and resulted in an overall impaired implant osseointegration at the initial healing stage (total implant length; 1-month healing; p < .05). Although the Aadva implant displayed a clinically acceptable level of osseointegration, the findings demonstrate that implant macro-design features can impact the dynamics of implant osseointegration. Consideration of specific implant macro-design features should be made relative to the biological and mechanical microenvironment. © 2013 Wiley Periodicals, Inc.
Chrcanovic, Bruno Ramos; Albrektsson, Tomas; Wennerberg, Ann
The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus nonirradiated patients against the alternative hypothesis of a difference. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed that there was a tendency of lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies. © 2015 Wiley Periodicals, Inc.
Popa, Marcela; Hussien, Mohamed D; Cirstea, Alexandra; Grigore, Raluca; Lazar, Veronica; Bezirtzoglou, Eugenia; Chifiriuc, Mariana Carmen; Sakizlian, Monica; Stavropoulou, Elisavet; Bertesteanu, Serban
At present, the use of dental implants is a very common practice as tooth loss is a frequent problem and can occur as a result of disease or trauma. An implant is usually made of biocompatible materials that do not cause rejection reactions and allow the implant union with the respective bone. To achieve this goal, the implant surface may have different structures and coatings, generally used to increase the adherence of the implant to the bone and to decrease the risk of the periimplantar inflammatory reactions. This review gives some insights of the metal based materials used for dental implants, their limits, improvement strategies as well as the pathophysiology, diagnosis, treatment and prevention of periimplantary diseases.
Yeo, In-Sung; Han, Jung-Suk; Yang, Jae-Ho
The aim of this study was to investigate the early bone response to the titanium dental implants with different surface characteristics using the rabbit tibia model. Calcium metaphosphate coated, anodic oxidized, hydroxyapatite particle-blasted, and turned (control) surfaces were compared. Surface topography was evaluated by field emission scanning electron microscope and optical interferometer. Eighteen rabbits received 72 implants in the tibia. Resonance frequency was analyzed every week for 6 weeks. Removal torque values were measured 2 and 6 weeks after placement. The implant-bone interfaces were directly observed by light microscope and bone-to-implant contact ratios were measured 2 and 6 weeks after insertion. All the surface-modified implants showed superior initial bone responses to the control. No significant differences were found among the surface-modified groups. Data suggest that various surface modification methods can provide favorable bone responses for early functioning and healing of dental implants.
Madi, Marwa; Zakaria, Osama; Ichinose, Shizuko; Kasugai, Shohei
The aim of this study was to compare the effect of ligature-induced periimplantitis on dental implants with and without hydroxyapatite (HA) coat. Thirty-two dental implants (3.3 mm wide, 13 mm long) with 4 surface treatments (8 implant/group) (M: machined, SA: sandblasted acid etched, S: sputter HA coat and P: plasma-sprayed HA coat) were inserted into canine mandibles. After 12 weeks, oral hygiene procedures were stopped and silk ligatures were placed around the implant abutments to allow plaque accumulation for the following 16 weeks. Implants with the surrounding tissues were retrieved and prepared for histological examination. Bone-to-implant contact (BIC) and implant surfaces were examined using scanning electron microscopy and energy dispersive x-ray spectroscopy. Histological observation revealed marginal bone loss and large inflammatory cell infiltrates in the periimplant soft tissue. Sputter HA implants showed the largest BIC (98.1%) and machined implant showed the smallest values (70.4%). After 28 weeks, thin sputter HA coat was almost completely dissolved, whereas plasma-sprayed HA coat showed complete thickness preservation. Thin sputter HA-coated implants showed more bone implant contact and less marginal bone loss than thick HA-coated implants under periimplantitis condition.
Ata-Ali, Fadi; Di-Benedetto, Nicolas; Bagán, Leticia; Bagán, José-Vicente
Background A systematic review is made to determine whether human immunodeficiency virus (HIV) infection has an impact upon dental implant osseointegration. Material and Methods A PubMed (MEDLINE) literature search was made of articles published up until 14 April 2014. The systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The quality of the studies included in the review was assessed using the Methodological Index for Nonrandomized Studies (MINORS) and levels of evidence (based on the University of Oxford’s Center for Evidence Based Medicine criteria). Results The combinations of search terms resulted in a list of 132 titles. Nine studies finally met the inclusion criteria and were selected for inclusion in the systematic review. A total of 173 dental implants were placed in 80 patients (135 implants in 56 HIV-positive subjects and 38 implants in 24 HIV-negative patients), and a single loss of dental implant osseointegration was recorded in an HIV-positive patient. Conclusions Our results suggest that dental implant placement in HIV-positive patients does not increase the dental implant failure rate. Prophylactic antibiotic treatment, the administration of highly active antiretroviral therapy, and control of the CD4+ T lymphocyte counts appear to be the main influencing factors in this respect. Given the few studies included in our systematic review, further prospective studies involving larger sample sizes and longer durations of follow-up are required in order to confirm the results obtained. Key words: Dental implants, implant failure, HIV positive, systematic review, AIDS, HAART. PMID:25662560
Topçu, Ali Orkun; Yamalik, Nermin; Güncü, Güliz N; Tözüm, Tolga F; El, Hakan; Uysal, Serdar; Hersek, Nur
The present study aimed at evaluating both the implant site-related and patient-based factors with the potential to affect the extent of patients' satisfaction and also their perceptions regarding dental implant treatment. Potential differences between the esthetic evaluations of dental patients and dental specialists were also considered. Implant-supported fixed prosthesis (n = 164) in 264 anterior esthetic implant sites were included. Patients' satisfaction, esthetic considerations, and perceptions toward dental implants, were evaluated by both Oral Health Impact Profile-14 (OHIP-14) questionnaire and visual analog scale. Pink Esthetic Score/White Esthetic Score were used for the professional esthetic evaluations of dental specialists. Overall patient satisfaction was high (87.42 ± 11.86). Compared with implant supported single-tooth restorations, patients with implant-supported bridges had lower OHIP scores (P = 0.001) and were relatively less satisfied with particular aspects of dental implant treatment (eg, cleanability, phonetics, surgical discomfort, and pretreatment information). Generally, type of prosthesis, history of soft/hard tissue augmentation, and reason for tooth loss had a clear impact on the extent of patients' satisfaction, esthetic considerations regarding treatment outcome, and their perceptions toward dental implant treatment (P < 0.05). Fixed implant-supported restorations generally provide with high levels of satisfaction and oral health-related quality of life.
Monje, Alberto; Suarez, Fernando; Galindo-Moreno, Pablo; García-Nogales, Agustín; Fu, Jia-Hui; Wang, Hom-Lay
This systematic review aimed to evaluate the effect of implant length on peri-implant marginal bone loss (MBL) and its associated influencing factors. An electronic search of the PubMed and MEDLINE databases for relevant studies published in English from November 2006 to July 2012 was performed by one examiner (AM). Selected studies were randomized clinical trials, human experimental clinical trials or prospective studies (e.g., cohort as well as case series) with a clear aim of investigating marginal bone loss of short dental implants (<10 mm) supporting fixed prostheses. A random-effect meta-regression model was used to determine the relationship between the effect size mean MBL and the covariate "implant length." Additionally, a subgroup analysis, by means of a random-effect one-way ANOVA model, comparing mean MBL values at different levels of each factor ("type of connection" and "type of prostheses") was also performed. The meta-regression of mean MBL on the moderator "implant length" was found to be insignificant (P = 0.633). Therefore, it could not be concluded that implant length had an effect on peri-implant MBL. In addition, standardized differences in mean MBL on the subgroups short (<10 mm) and standard (≥ 10 mm) implants, as determined by the meta-analysis (random-effect model), were found to be statistically insignificant (P = 0.222). Within limitations of the present systematic review, it could be concluded that short dental implants (<10 mm) had similar peri-implant MBL as standard implants (≥ 10 mm) for implant-supported fixed prostheses. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Gómez-de Diego, Rafael; Mang-de la Rosa, María del Rocío; Romero-Pérez, María J.; Cutando-Soriano, Antonio
The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words “implant” AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication. Key words:Dental implants, medically compromised patient, systemic diseases. PMID:24608222
Zitzmann, N U; Krastl, G; Weiger, R; Kühl, S; Sendi, P
For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient's perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs.
Zitzmann, N.U.; Krastl, G.; Weiger, R.; Kühl, S.; Sendi, P.
For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient’s perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs. PMID:24158338
Rammelsberg, Peter; Bernhart, Gunda; Lorenzo Bermejo, Justo; Schmitter, Marc; Schwarz, Stefanie
Objective of this study was to evaluate the incidence of complications in dental implants and abutment teeth used for combined tooth-implant- and solely implant-supported double crown-retained removable dental prostheses (RDPs). Patients were selected from a prospective clinical study. Seventy-three RDPs retained by 234 implants and 107 abutment teeth were placed in 39 men and 22 women with a mean age of 65 years. Forty-five RDPs were located in the maxilla and 28 in the mandible. Thirty-four RDPs were solely implant-supported and 39 were combined tooth-implant-supported. Kaplan-Meier analysis was used to estimate success defined as survival without severe abutment-related complications, and Cox regression was used to isolate the most relevant prognostic risk factors. After a median observation period of 2.7 years for the RDPs, six implants failed and eleven implants were diagnosed with peri-implantitis. Four abutment teeth were extracted, and three abutment teeth showed severe complications requiring extended interventions. For both abutment teeth and implants, Kaplan-Meier analyses revealed a 5-year probability of success of 85% for solely implant-supported RDPs and 92% for combined tooth-implant-supported RDPs. Multiple Cox regression identified RDP location (P = 0.01), age (P = 0.01), and gender (P = 0.04) as prognostic risk factors for severe implant-related complications. Solely implant-supported RPDs showed a poorer prognosis, but the risk difference did not reach statistical significance. Preliminary data suggest that the combination of teeth and implants to support double crown-retained RDPs may result in a prognostic advantage. The present findings should be validated in independent studies. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Surmenko, Elena L.; Tuchin, Valery V.; Sokolova, Tatiana N.; Seryanov, Yury V.
The surface of rejected dental implants was studied. It was clarified that the implant rejection happened in a case of incomplete osteointegration of implants, incomplete proliferation of a bone tissue in holes. In a turn, osteointegration depends on uniformity of deposition of a titanium-hydroxyapatite (Ti/HA) coating and the impurities composition of used materials. The excess of exterior elements imported at technological processes also influences on adhesion.
Tatullo, Marco; Marrelli, Massimo; Mastrangelo, Filiberto; Gherlone, Enrico
Background: Dental implant failure can recognize several causes and many of them are quite preventable with the right knowledge of some clinical critical factors. Aim of this paper is to investigate about the histological aspects related to dental implants failure in such cases related to cement excess, how such histological picture can increase the risk of bacterial infections and how the different type of cement can interact with osteoblasts in-vitro. Methods: We randomly selected 5 patients with a diagnosis of dental implant failure requiring to be surgically removed: in all patients was observed an excess of dental cement around the failed implants. Histological investigations were performed of the perimplant bone. Cell culture of purchased human Osteoblasts was performed in order to evaluate cell proliferation and cell morphology at 3 time points among 3 cement types and a control surface. Results: Dental cement has been related to a pathognomonic histological picture with a foreign body reaction and many areas with black particles inside macrophage cells. Finally, cell culture on different dental cements resulted in a lower osteoblasts survival rate. Conclusions: It is appropriate that the dentist puts a small amount of dental cement in the prosthetic crown, so to avoid the clinical alterations related to the excess of cement. PMID:28529868
The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias.
Procacci, Pasquale; De Santis, Daniele; Bertossi, Dario; Albanese, Massimo; Plotegher, Cristina; Zanette, Giovanni; Pardo, Alessia; Nocini, Pier Francesco
This case report describes an extraordinary case of the spontaneous transmaxillary-transnasal discharge of a dental implant, which occurred during a sneeze. The patient was complained of symptoms of acute sinusitis. She underwent a computed tomography scan that revealed a dental implant dislocated in the maxillary sinus. Medical treatment based on antibiotics and mucolytics was administered to the patient in order to prepare her for endoscopic endonasal surgery. The implant was spontaneously discharged two days after during a sneeze. Mucociliary clearance in combination with a local osteolytic inflammatory process and mucolytics therapy are the likely causes of this unusual discharge. PMID:27574611
The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias. PMID:27269668
Procacci, Pasquale; De Santis, Daniele; Bertossi, Dario; Albanese, Massimo; Plotegher, Cristina; Zanette, Giovanni; Pardo, Alessia; Nocini, Pier Francesco
This case report describes an extraordinary case of the spontaneous transmaxillary-transnasal discharge of a dental implant, which occurred during a sneeze. The patient was complained of symptoms of acute sinusitis. She underwent a computed tomography scan that revealed a dental implant dislocated in the maxillary sinus. Medical treatment based on antibiotics and mucolytics was administered to the patient in order to prepare her for endoscopic endonasal surgery. The implant was spontaneously discharged two days after during a sneeze. Mucociliary clearance in combination with a local osteolytic inflammatory process and mucolytics therapy are the likely causes of this unusual discharge.
The case report of a woman with severe osteoporosis who was treated with dental implants is presented. Polyarthritis was diagnosed in 1955, and a corticosteroid medication treatment was started in 1960. During the years, the patient has undergone multiple joint surgeries. Dental implants were inserted in the maxilla in 1987 and in the mandible in 1988. Due to a compression of the spine, the patient lost 12 cm in body height between 1991 and 1993; a spontaneous femur fracture was diagnosed in December 1992. However, the arch bone has been stable; the 6- and 5-year follow-up results of the maxillary and mandibular implants, respectively, are presented.
Stanford, Clark M; Wagner, Wilfried; Rodriguez Y Baena, Ruggero; Norton, Michael; McGlumphy, Edwin; Schmidt, Joseph
Evaluations of multicenter clinical trials are needed to determine the effectiveness of care in routine implant therapy in clinical practice. Ninety-two clinicians in 75 clinics in 13 countries recruited five subjects per clinic who were in need of a minimum of two dental implants to restore a partially edentulous quadrant and were followed for a minimum of 1 year after loading. A centralized Internet-based case report form was developed to coordinate data recording. Data entry was done by each clinic, with follow-up source verification. The study recruited 549 subjects in 101 clinics with 1,893 implants placed. Three hundred forty subjects completed the 1-year recall (gender distribution of 56% female, 44% male; mean age of 57 years with a range of 18 to 84 years). In all, 1,246 dental implants were followed; a majority of subjects had two to four implants. Twenty-eight percent of subjects received osseous grafting prior to or coincident with implant placement. In the maxilla, 779 (63%) implants were placed, 256 in the anterior and 523 in the posterior; in the mandible, 467 implants were placed, 85 in the anterior and 382 in the posterior arch. The median edentulous period prior to implant placement was 24 months (range, 0 to 480 months); 46% of all patients received implants within 12 months of tooth loss. At 1 year after prosthesis insertion, 15 subjects had lost a total of 17 implants, for a cumulative implant survival rate of 98.6%. Chi-square and Fisher exact tests indicated a higher risk of implant loss at sites with advanced resorption and for wider-diameter implants (5-mm tapered body). There was no statistical relationship with implant loss relative to implant length or anatomic location within the oral cavity. The outcomes support the need for ongoing involvement of clinicians in routine practice assessments of patient-based outcomes of implant therapy.
Kirstein, Karol; Dobrzyński, Maciej; Kosior, Piotr; Chrószcz, Aleksander; Dudek, Krzysztof; Fita, Katarzyna; Parulska, Olga; Rybak, Zbigniew; Skalec, Aleksandra; Szklarz, Magdalena; Janeczek, Maciej
The excessive temperature fluctuations during dental implant site preparation may affect the process of bone-implant osseointegration. In the presented studies, we aimed to assess the quality of cooling during the use of 3 different dental implant systems (BEGO®, NEO BIOTECH®, and BIOMET 3i®). The swine rib was chosen as a study model. The preparation of dental implant site was performed with the use of 3 different speeds of rotation (800, 1,200, and 1,500 rpm) and three types of cooling: with saline solution at room temperature, with saline solution cooled down to 3°C, and without cooling. A statistically significant difference in temperature fluctuations was observed between BEGO and NEO BIOTECH dental systems when cooling with saline solution at 3°C was used (22.3°C versus 21.8°C). In case of all three evaluated dental implant systems, the highest temperature fluctuations occurred when pilot drills were used for implant site preparation. The critical temperature, defined in the available literature, was exceeded only in case of pilot drills (of all 3 systems) used at rotation speed of 1,500 rpm without cooling.
Kirstein, Karol; Dobrzyński, Maciej; Kosior, Piotr; Chrószcz, Aleksander; Dudek, Krzysztof; Fita, Katarzyna; Parulska, Olga; Rybak, Zbigniew; Skalec, Aleksandra; Szklarz, Magdalena; Janeczek, Maciej
The excessive temperature fluctuations during dental implant site preparation may affect the process of bone-implant osseointegration. In the presented studies, we aimed to assess the quality of cooling during the use of 3 different dental implant systems (BEGO®, NEO BIOTECH®, and BIOMET 3i®). The swine rib was chosen as a study model. The preparation of dental implant site was performed with the use of 3 different speeds of rotation (800, 1,200, and 1,500 rpm) and three types of cooling: with saline solution at room temperature, with saline solution cooled down to 3°C, and without cooling. A statistically significant difference in temperature fluctuations was observed between BEGO and NEO BIOTECH dental systems when cooling with saline solution at 3°C was used (22.3°C versus 21.8°C). In case of all three evaluated dental implant systems, the highest temperature fluctuations occurred when pilot drills were used for implant site preparation. The critical temperature, defined in the available literature, was exceeded only in case of pilot drills (of all 3 systems) used at rotation speed of 1,500 rpm without cooling. PMID:27110558
Wiest, Wolfram; Zabler, Simon; Rack, Alexander; Fella, Christian; Balles, Andreas; Nelson, Katja; Schmelzeisen, Rainer; Hanke, Randolf
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. PMID:26524314
The aim of this study was to analyze the influence of smoking habits and other possibly relevant factors on dental implant survival. The study population included all patients who underwent dental implants between the years 1999 and 2008 at a large military dental clinic and were examined in the periodic medical examination center. Correlation between implant characteristics and patients’ smoking habits, as mentioned in the questionnaire answered by patients in the periodic examination, was performed. Besides standard statistical methods, multiple linear regression models were constructed for estimation of the relative influence of some factors on implant survival rate. The long-term results of the implant treatment were good. The study refers to 7,680 implants. 7,359 (95.8%) survived and 321 (4.2%) did not survive. Concerning smoking habits, in a uni-variable analysis, factors found to have an association with implant survival were the smoking status of the patients (smoking/no smoking), the amount of smoking, passive smoking, and the time elapsed in ex-smokers from the time they ceased smoking to the time of implantation. In a multi-variable analysis, factors found to have an association with implant survival were smoking status (smoking/no smoking) and amounts of smoking as expressed in pack years. PMID:25237600
Greenstein, Gary; Carpentieri, Joseph; Cavallaro, John
The aim of this investigation was to evaluate the potential causes, clinical significance, and treatment of open contacts between dental implant restorations and adjacent natural teeth. The authors searched the dental literature for clinical trials in humans that addressed the incidence of open contacts that develop after implant restorations are placed next to teeth. The authors found 5 studies in which the investigators addressed the incidence of open contacts after implant restorations are inserted next to teeth. Results from these studies indicated that an interproximal gap developed 34% to 66% of the time after an implant restoration was inserted next to a natural tooth. This event occurred as early as 3 months after prosthetic rehabilitation, usually on the mesial aspect of a restoration. The occurrence of an interproximal separation next to an implant restoration was greater than anticipated. It appears that force vectors cause tooth movement and an implant functions like an ankylosed tooth. Clinicians should inform patients of the potential to develop interproximal gaps adjacent to implant restorations, which may require repair or replacement of implant crowns or rehabilitation of adjacent teeth. Furthermore, steps should be taken to check the continuity of the arch periodically. If the clinician detects an open contact, it is prudent to monitor for signs or symptoms of pathosis so that prosthetic repair of the gap can be initiated, if needed. These problems could add to treatment costs and decrease overall patient satisfaction related to implant treatment. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.
The American Academy of Periodontology has developed the following parameter on the placement and management of dental implants. Dental implants are a recognized form of tooth replacement and as such should be presented as an alternative for the replacement of missing teeth. A comprehensive treatment plan should be developed in consultation with all parties involved. Patients should be informed about all therapeutic alternatives, including non-replacement, potential complications, expected results, and their responsibility in treatment. The patient should also be informed that, to insure implant health, close monitoring and professional care by the dental team and good personal home care are imperative. Appropriate educational materials are an essential part of gaining informed consent. Given this information, patients should then be able to make informed decisions regarding their implant therapy.
Alzahrani, Ahmed S.; Abed, Hassan H.
Diabetes mellitus (DM) is considered one of the major chronic diseases in the world. Long-term hyperglycemia considerably affects the body tissues, and consequently, can lead to morbidity and mortality. Moreover, many oral complications have been observed with DM but little consideration in relation to the placement of dental implants has been investigated. Dental research has analyzed the relation of dental implants and bone osseointegration in diabetic patients. Theoretically, an impaired immune system and delayed wound healing of these patients might decrease the success rate of implant placement; however, with noticeable advances in evidence-based dentistry and statistically significant results, successful implant treatment could be achieved significantly in well-controlled diabetic patients. PMID:27761554
Hasan, Istabrak; Rahimi, Alireza; Keilig, Ludger; Brinkmann, Kai-Thomas; Bourauel, Christoph
This study aimed to predict the distribution of bone trabeculae, as a density change per unit time, around a dental implant based on applying a selected mathematical remodelling model. The apparent bone density change as a function of the mechanical stimulus was the base of the applied remodelling model that describes disuse and overload bone resorption. The simulation was tested in a finite element model of a screw-shaped dental implant in an idealised bone segment. The sensitivity of the simulation to different mechanical parameters was investigated; these included element edge length, boundary conditions, as well as direction and magnitude of the implant loads. The alteration in the mechanical parameters had a significant influence on density distribution and model stability, in particular at the cortical bone region. The remodelling model could succeed to achieve trabeculae-like structure around osseointegrated dental implants. The validation of this model to a real clinical case is required.
Bourauel, Christoph; Mundt, Torsten; Heinemann, Friedhelm
This paper was aimed to review the studies published about short dental implants. In the focus were the works that investigated the effect of biting forces of the rate of marginal bone resorption around short implants and their survival rates. Bone deformation defined by strain was obviously higher around short implants than the conventional ones. The clinical outcomes of 6 mm short implants after 2 years showed a survival rate of 94% to 95% and lower survival rate (<80%) for 7 mm short implants after 3 to 6 years for single crown restorations. The short implants used for supporting fixed partial prostheses had a survival rate of 98.9%. Short implants can be considered as a good alternative implant therapy to support single crown or partial fixed restorations. PMID:23738085
Huang, James I-Sheng; Yu, Hui-Chieh; Chang, Yu-Chao
Trigeminocardiac reflex (TCR) is a clinical phenomenon that manifests as s sudden onset of hemodynamic perturbations. TCR has been reported in cranio-maxillofacial surgery resulting in severe medical risks. Monitoring the hemodynamic changes during cranio-maxillofacial surgery can provide important information to ensure the continuous evaluation of patient's physical conditions. This prospective observational study was conducted to determine the hemodynamic alterations related to the possibly of occurrence of TCR in patients during dental implant surgery. One hundred and thirty-five patients (69 males and 66 females) received dental implant placement were enrolled in this study. The hemodynamic changes were evaluated by monitoring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse oximetry (SpO2). The above data were collected before, during, and after dental implant surgery. The data demonstrated that the minimal values of HR, SBP, and DBP as well as MABP decreased significantly during operation comparing with the corresponding values before operation (p < 0.0001). In addition, HR and SBP decreased significantly in post-operation stage comparing with the corresponding values in pre-operation stage (p < 0.0001). Comparing to dental implant placement in the mandible, patients received dental implant placement in the maxilla had more risks to confront with MABP reduction (OR = 3.98; 95% confidence interval: 1.12-13.2). A significant HR and BP reduction possibly due to TCR can occur during dental implant surgery. Therefore, the dentists should monitor the hemodynamic changes during dental implant surgery to prevent the possible occurrence of medical risks related to TCR. Copyright © 2017. Published by Elsevier B.V.
Khouly, Ismael; Veitz-Keenan, Analia
The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched with no language or date restrictions. Two reviewers independently selected studies. Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants that reported the outcome of implant success or failure at least four months after initial loading were considered. Data were extracted independently by two reviewers and study risk of bias assessed. Results were expressed using fixed-effect models as there were either fewer than four studies or we used Peto odds ratios (ORs) for dichotomous data when there were zero cells in either the treatment or control or both arms and the number of trials was small. Eighteen trials involving 650 patients were included. Five studies were considered to be at low risk of bias, 11 at high risk and two of unclear risk. Four trials (102 patients) evaluated short implants (5 to 8.5 mm long) as an alternative to sinus lift in bone with residual height between 4 and 9 mm. One year after loading there was insufficient evidence to claim differences between the two procedures for prosthesis failure (OR (Peto) 0.37, 95% confidence interval (CI) 0.05 to 2.68; three trials) or implant failure (OR (Peto) 0.44, 95% CI 0.10 to 1.99; four trials). There was however an increase in complications at treated sites when undertaking the sinus lift (OR (Peto) 4.77, 95% CI 1.79 to 12.71, P value = 0.002; four trials).Fourteen trials (548 patients) compared different sinus lift techniques. Only three comparisons included more than one trial. These were bone graft versus no bone graft, autogenous bone versus bone substitute, bone graft with or without platelet-rich plasma (PRP). There was insufficient evidence to claim a benefit for any of these techniques for the primary outcomes of prosthesis and implant failure.The other
Capodiferro, S; Favia, G; Scivetti, M; De Frenza, G; Grassi, R
Background Osseointegrated endosseous implants are widely used for the rehabilitation of completely and partially edentulous patients, being the final prosthodontic treatment more predictable and the failures extremely infrequent. A case of fracture of an endosseous dental implant, replacing the maxillary first molar, occurring in a middle-age woman, 5 years after placement is reported. Materials and methods The difficult management of this rare complication of implant dentistry together with the following rehabilitation is described. Additionally, the authors performed an accurate analysis of the removed fractured implant both by the stereomicroscope and by the confocal laser scanning microscope. Results and discussion The fractured impant showed the typical signs of a fatigue-induced fracture in the coronal portion of the implant together with numerous micro-fractures in the apical one. Three dimensional imaging performed by confocal laser scanning microscope led easily to a diagnosis of "fatigue fracture" of the implant. The biomechanical mechanism of implant fractures when overstress of the implant components due to bending overload is discussed. Conclusion When a fatigue-induced fracture of an dental implant occurs in presence of bending overload, the whole implant suffers a deformation that is confirmed by the alterations (micro-fractures) of the implant observable also in the osseointegrated portion that is easily appraisable by the use of stereomicroscope and confocal laser scanning microscope without preparation of the sample. PMID:16792797
Özçakır Tomruk, Ceyda; Şençift, Kemal
PURPOSE The purpose of this study was to evaluate the patients' knowledge on dental implants in a Turkish subpopulation. MATERIALS AND METHODS Five hundred twenty seven Turkish adults referred to Yeditepe University Faculty of Dentistry, Istanbul, Turkey, were presented with a questionnaire including 20 questions regarding the level of information and awareness about the dental implants. The data were collected and statistical analyses were performed with Chi square test to compare the descriptive data. RESULTS Among 527 subjects, 54% were female and 46% were male with a mean age of 42.2 years. The rate of patients' implant awareness was 27.7%. When the patients were questioned about the treatment options for rehabilitation of tooth missing, 60.9% of patients were informed about fixed partial denture, followed by conventional complete denture (32.5%) and removable partial denture (24.9%). Six percent reported that they were very well informed about the dental implants whereas 48.2% were poorly informed. The information sources of the implants were from the dentist (44.5%), printed media (31.6%) and friends and acquaintances (17.3%), respectively. Sixteen percent of the population believed that their implants would last forever. CONCLUSION The dentists should give more detailed information to the patients about dental implants and tooth-supported fixed partial dentures in the future. PMID:24843399
Bortoluzzi, Marcelo Carlos; Manfro, Rafael; Fabris, Vinícius; Cecconello, Rodrigo; Derech, Estevo D’Agostini
Objectives: The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (<4 mm) in the posterior maxillae. Materials and Methods: A series of consecutive patients who sought dental implant rehabilitation were included in this study. The sinus lift cases were selected and divided into two groups based on the maxillary alveolar height, ≥4 mm of radiographically measurable bone height (Group 1) and < 4 mm of bone height (Group 2). Results: A total of 13 implants were installed in Group 1, whereas 8 implants were installed in Group 2. The success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation, at 100% for Group 1 (bone height ≥ 4 mm) and 87.5% for Group 2 (bone height with < 4 mm). Besides the differences between the percentages of success, statistical differences were not reached when the groups were compared (Fisher's exact test, P = 0.38). Conclusions: Despite the limitations of this study, including its low number of participants, the results indicate that simultaneous surgery for sinus lifting, grafting and dental implants in posterior maxillae with very low bone heights (<4 mm) can be performed safely, although with lower success rates than found in patients with higher residual bone heights (>4 mm). PMID:24987595
Bortoluzzi, Marcelo Carlos; Manfro, Rafael; Fabris, Vinícius; Cecconello, Rodrigo; Derech, Estevo D'Agostini
The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (<4 mm) in the posterior maxillae. A series of consecutive patients who sought dental implant rehabilitation were included in this study. The sinus lift cases were selected and divided into two groups based on the maxillary alveolar height, ≥4 mm of radiographically measurable bone height (Group 1) and < 4 mm of bone height (Group 2). A total of 13 implants were installed in Group 1, whereas 8 implants were installed in Group 2. The success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation, at 100% for Group 1 (bone height ≥ 4 mm) and 87.5% for Group 2 (bone height with < 4 mm). Besides the differences between the percentages of success, statistical differences were not reached when the groups were compared (Fisher's exact test, P = 0.38). Despite the limitations of this study, including its low number of participants, the results indicate that simultaneous surgery for sinus lifting, grafting and dental implants in posterior maxillae with very low bone heights (<4 mm) can be performed safely, although with lower success rates than found in patients with higher residual bone heights (>4 mm).
Wu, Xixi; Al-Abedalla, Khadijeh; Abi-Nader, Samer; Daniel, Nach G; Nicolau, Belinda; Tamimi, Faleh
Proton pump inhibitors (PPIs) have a negative impact on bone accrual. Because osseointegration is influenced by bone metabolism, this study investigates the association between PPIs and the risk of osseointegrated implant failure. This retrospective cohort study included a total of 1,773 osseointegrated dental implants in 799 patients (133 implants in 58 PPIs users and 1,640 in 741 non-users) who were treated at the East Coast Oral Surgery Clinic in Moncton, Canada, from January 2007 to September 2015. Kaplan-Meier estimator was used to describe the hazard function of dental implant failure by PPIs usage. Multilevel mixed effects parametric survival analyses were used to test the association between PPIs exposure and risk of implant failure adjusting for potential confounders. The failure rates were 6.8% for people using PPIs compared to 3.2% for non-users. Subjects using PPIs had a higher risk of dental implant failure (HR = 2.73; 95% CI = 1.10-6.78) compared to those who did not use the drugs. The findings suggest that treatment with PPIs may be associated with an increased risk of osseointegrated dental implant failure.
Tsarev, V N; Nikolaeva, E N; Ippolitov, E V; Tsareva, T V
Determination of cytokine content in various areas of dentition in patients with peri-implantitis associated with parodontopathogenic bacteria species of I and II order. 32 patients with complications that developed in 3 months to 14 years after installation of intraosteal dental implants were examined. Content of cytokines in various areas of dentition was determined by using solid phase enzyme immunoassay in patients with developed peri-implantitis associated with parodontopathogenic bacteria species of I and II order. Multiplex polymerase chain reaction was used for determination of parodontopathogenic bacteria marker DNA. Marker DNA of I order parodontopathogenic bacteria - Aggregatibacter (Actinobacillus) actinomycetemcomitans, Tannerella forsythia (Bacteroides forsythus), Porphyromonas gingivalis in peri-implantation tissues during implant rejection was detected with 34.4 - 75% frequency while II order (Prevotella intermedia, Treponema denticola, Parvimonas micros (Peptostreptococcus micros), Fusobacterium nucleatum/periodonticum etc.) - with significantly lower frequency. Total concentration of IL- 1beta, IL-4, IL-6, IL-8, TNFalpha, IL- 17A and INFgamma in contents of pathological pocket in the area of implants and the levels of each of them were significantly higher than in the contents of parodontal pockets, areas with stable implants and gingival fluid from areas with healthy teeth. Total interleukin content in the contents of pathological pockets in the area of rejected implants was significantly higher than in other studied areas. In the exudate of parodontal pockets of the preserved teeth it was 2.4 times lower, in the area of stable implants - 4.6 times lower, and in the areas with healthy teeth - 4.8 times lower than with rejected implants (p<0.05). The results of the study conducted allow to make a conclusion regard- ing reasonability of monitoring during dental implantation of parodontopathogenic microorganism strains and local cytokine response of
Chen, X; Zhou, X C; Liu, S; Wu, R F; Aparicio, C; Wu, J Y
This study aimed to evaluate the in vivo osseointegration of implants with hydrophobic antimicrobial GL13K-peptide coating in rabbit femoral condyles by micro-CT and histological analysis. Six male Japanese Rabbits (4 months old and weighing 2.5 kg each) were included in this study. Twelve implants (3.75 mm wide, 7 mm long) were randomly distributed in two groups, with six implants in the experimental group coated with GL13K peptide and six implants in the control group without surface coating. Each implant in the test and the control group was randomly implanted in the left or right side of femoral condyles. On one side randomly-selected of the femur, each rabbit received a drill that was left without implant as control for the natural healing of bone. After 3 weeks of healing radiographic evaluation of the implant sites was taken. After 6 weeks of healing, rabbits were sacrificed for evaluation of the short-term osseointegration of the dental implants using digital radiography, micro-CT and histology analysis. To perform evaluation of osseointegration, implant location and group was double blinded for surgeon and histology/radiology researcher. Two rabbits died of wound infection in sites with non-coated implants 2 weeks after surgery. Thus, at least four rabbits per group survived after 6 weeks of healing. The wounds healed without suppuration and inflammation. No implant was loose after 6 weeks of healing. Radiography observations showed good osseointegration after 3 and 6 weeks postoperatively, which proved that the tissues followed a natural healing process. Micro-CT reconstruction and analysis showed that there was no statistically significant difference (P > 0.05) in volume of bone around the implant between implants coated with GL13K peptide and implants without coating. Histomorphometric analysis also showed that the mineralized bone area was no statistically different (P > 0.05) between implants coated with GL13K peptide and
Lee, Woo-Taek; Koak, Jai-Young; Lim, Young-Jun; Kim, Seong-Kyun; Kwon, Ho-Beom; Kim, Myung-Joo
The poly-ether-ether-ketone (PEEK) polymer is of great interest as an alternative to titanium in orthopedics because of its biocompatibility and low elastic modulus. This study evaluated the fatigue limits of PEEK and the effects of the low elastic modulus PEEK in relation to existing dental implants. Compressive loading tests were performed with glass fiber-reinforced PEEK (GFR-PEEK), carbon fiber-reinforced PEEK (CFR-PEEK), and titanium rods. Among these tests, GFR-PEEK fatigue tests were performed according to ISO 14801. For the finite element analysis, three-dimensional models of dental implants and bone were constructed. The implants in the test groups were coated with a 0.5-mm thick and 5-mm long PEEK layer on the upper intrabony area. The strain energy densities (SED) were calculated, and the bone resorption was predicted. The fatigue limits of GFR-PEEK were 310 N and were higher than the static compressive strength of GFR-PEEK. The bone around PEEK-coated implants showed higher levels of SED than the bone in direct contact with the implants, and the wider diameter and stiffer implants showed lower levels of SED. The compressive strength of the GFR-PEEK and CFR-PEEK implants ranged within the bite force of the anterior and posterior dentitions, respectively, and the PEEK implants showed adequate fatigue limits for replacing the anterior teeth. Dental implants with PEEK coatings and PEEK implants may reduce stress shielding effects. Dental implant application of PEEK polymer-fatigue limit and stress shielding. Copyright © 2012 Wiley Periodicals, Inc.
Huang, Wei; Wu, Yiqun; Zou, Duohong; Zhang, Zhiyong; Zhang, Chenping; Sun, Jian; Xu, Bin; Zhang, Zhiyuan
Defects of the maxilla due to tumor extirpation can create accordingly high levels of psychological and physical trauma for patients and their families. However, the reconstruction of maxillary defects remains very challenging. Today, using autogenous bone grafts and dental implants is an effective method to restore maxillary defects. The purpose of this study was to evaluate the long-term clinical outcomes of maxillary rehabilitation with dental implants after tumor resection. Patient satisfaction after maxillary reconstruction was also assessed with regard to function and comfort. Over a 6-year period (2000-2005), 24 patients with maxillary tumors underwent resection with either immediate (n = 18) or delayed reconstruction or underwent prosthetic rehabilitation (n = 6).The patients received 88 implants in total, including 9 zygomatic and 79 conventional implants, for maxillary rehabilitation of the defective areas. Autogenous bone grafts were successful in all patients, although partial loss of the graft was observed in one patient who received an iliac graft. Patient follow-up was started at the point of the prosthetic loading of implants. The median treatment time was 99.1 months (range:18-137 months). One patient died after 18 months of follow-up due to tumor recurrence, and two patients were lost to follow-up after 3 years of observation. Ten conventional dental implants were removed due to peri-implantitis. Six patients chose implant-supported obturators. The cumulative survival and success rates of the implants were 88.6 and 86.3%, respectively. This study demonstrated that the rehabilitation of maxillary defects following tumor resection using implant-supported fixed prostheses with autogenous bone grafts or prosthetic rehabilitation is successful and is associated with high patient satisfaction. Oral function can be restored using dental implants for patients with maxillary defects. © 2012 Wiley Periodicals, Inc.
Shadid, Rola Muhammed; Sadaqah, Nasrin Rushdi; Othman, Sahar Abdo
Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs) conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability. PMID:25126094
Bhatavadekar, Neel B
Although dental implants have seen tremendous clinical success over the past few decades, there are some worrying reports in literature describing squamous cell carcinoma (SCC) in close association with dental implants. This article also provides a critical assessment of the published literature relating to the presence of carcinoma in association with dental implants, analyzing the previously published and hypothesized carcinogenic responses to an implant, to try and come to a conclusion regarding the plausibility and clinical risk for cancer formation in association with dental implants. An unusual case of an SCC noted in close proximity to a dental implant is also presented. A systematic search was conducted using Medline (PubMed), Cochrane Database, and Google Scholar with the search terms "cancer," "squamous cell carcinoma," "dental implant," "SCC," "peri-implantitis," "oral cancer," and "implantology" and using multiple combinations using Boolean operators "or" and "and." The search was not limited to dental literature; orthopedic and biomedical literature was also included. The results were then hand screened to pick out the relevant articles. In total, 14 previous published reports were found, where 24 dental implants were reported to be associated with SCC. Not all the reported patients had a history of cancer, but contributory factors such as smoking were found. An analysis of the biological plausibility of previously proposed carcinogenic mechanisms, such as corrosion, metallic ion release, and particulate debris, did not support the etiologic role for dental implants in cancer development, and the standardized incidence ratio was found to be extremely low (0.00017). Peri-implantitis should be assessed cautiously in patients receiving implants who have a previous history of cancer. Dental implants are a safe treatment modality based on the published data, and any change in surgical protocol is not mandated.
Šćepanović, Miodrag; Todorović, Aleksandar; Marković, Aleksa; Patrnogić, Vesna; Miličić, Biljana; Moufti, Adel M; Mišić, Tijana
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.
Schwitalla, A D; Abou-Emara, M; Spintig, T; Lackmann, J; Müller, W D
Dental implants are mostly fabricated of titanium. Potential problems associated with these implants are discussed in the literature, for example, overloading of the jawbone during mastication due to the significant difference in the elastic moduli of titanium (110 GPa) and bone (≈1-30 GPa). Therefore poly-ether-ether-ketone (PEEK) could represent an alternative biomaterial (elastic modulus 3-4 GPa). Endolign(®) represents an implantable carbon fiber reinforced (CFR)-PEEK including parallel oriented endless carbon fibers. According to the manufacturer it has an elastic modulus of 150 GPa. PEEK compounds filled with powders show an elastic modulus around 4 GPa. The aim of the present finite element analysis was to point out the differences in the biomechanical behavior of a dental implant of Endolign(®) and a commercial powder-filled PEEK. Titanium served as control. These three materials were used for a platform-switched dental implant-abutment assembly, whereas Type 1 completely consisted of titanium, Type 2 of a powder-filled PEEK and Type 3 of Endolign(®). A force of 100 N was applied vertically and of 30° to the implant axis. All types showed a minimum safety factor regarding the yield strength of cortical bone. However, within the limits of this study the Type 2 implant showed higher stresses within the adjacent cortical bone than Type 1 and Type 3. These implant assemblies showed similar stress distributions. Endless carbon fibers give PEEK a high stability. Further investigations are necessary to evaluate whether there is a distinct amount of endless carbon fibers causing an optimal stress distribution behavior of CFR-PEEK. Copyright © 2014 Elsevier Ltd. All rights reserved.
Meulen, Peter van der; Linden, Wynand van der; Eeden, Ronnie van
For more than 25 years, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used in implant restorative dentistry. Today this technology offers a means of milling titanium frameworks that fit dental implants accurately. This report presents a restoratively driven protocol employing advanced implant restorative and surgical techniques. Treatment of a patient with advanced periodontitis with extensive loss of hard and soft tissues is presented. After extraction of the patient's remaining hopeless teeth, dental implants were placed, along with interim, fixed-margin abutments and abutment protection caps. Two days later, acrylic resin fixed-interim prostheses restored the patient's esthetics and partial masticatory function. After implant osseointegration, maxillary, and mandibular frameworks for definitive prostheses were milled from Ti alloy, using one specific CAD/CAM technology. The benefits of this technology are also discussed. © 2012 by the American College of Prosthodontists.
Shokri, Mehran; Daraeighadikolaei, Arash
Background. There is no doubt that the success of the dental implants depends on the stability. The aim of this work was to measure the stability of dental implants prior to loading the implants, using a resonance frequency analysis (RFA) by Osstell mentor device. Methods. Ten healthy and nonsmoker patients over 40 years of age with at least six months of complete or partial edentulous mouth received screw-type dental implants by a 1-stage procedure. RFA measurements were obtained at surgery and 1, 2, 3, 4, 5, 7, and 11 weeks after the implant surgery. Results. Among fifteen implants, the lowest mean stability measurement was for the 4th week after surgery in all bone types. At placement, the mean ISQ obtained with the magnetic device was 77.2 with 95% confidence interval (CI) = 2.49, and then it decreased until the 4th week to 72.13 (95% CI = 2.88), and at the last measurement, the mean implant stability significantly (P value <0.05) increased and recorded higher values to 75.6 (95% CI = 1.88), at the 11th week. Conclusions. The results may be indicative of a period of time when loading might be disadvantageous prior to the 4th week following implant placement. These suggestions need to be further assessed through future studies. PMID:23737790
A 44-year-old woman had sustained facial lacerations, loss of several teeth, alveolar bone fracture, and severe vertical bone resorption in conjunction with a shattered alveolar bone and marked loss of intraoral function and facial disfigurement in a car accident. She underwent 9 surgical procedures by plastic surgeons to treat the facial lesions, including hold facial scar formation reduction surgery, reduction of fractures of the nasal and cheek bones, and bone transplants. To restore intraoral function and improve facial appearance, plastic surgeons transplanted a rib into the maxillary sinus while dental surgeons simultaneously inserted 5 dental implants. Eleven months after the dental implant surgery, a complete upper denture and a mandibular gingival ceramometal-casting crown were fitted. After insertion of the final prosthodontics, regular follow-up examinations were performed to check dental occlusion, oral hygiene, and the condition of the gingival tissue. In the years since the upper dental implants were fitted, there have been no bone resorption and no functional problems. Transplantation of rib bones is an effective method for maxillary reconstruction and remains effective even after the insertion of dental implants. The patient is extremely satisfied with the results. A means of maintaining oral health over the long term, and of motivating the patient to maintain oral health, should be established.
Momota, Y; Kani, K; Takano, H; Azuma, M
This is a rare case report of a cerebellopontine angle (CPA) mass mimicking lingual nerve injury after a dental implant placement. Lingual nerve injury is a common complication following dental implant placement. CPA masses are likely to cause symptomatic trigeminal neuralgia, and thus can mimic and be easily confused with oral diseases. We experienced a case of CPA mass mimicking lingual nerve injury after dental implant placement. The patient was a 57-year-old Japanese female who complained of glossalgia. She underwent dental implant placement in the mandible before visiting our clinic. Panoramic x-ray radiography revealed no abnormalities; the salivary flow rate by gum test was 7.0 ml/10 min. She was diagnosed with lingual nerve injury and secondary burning mouth syndrome. Vitamin B12 and oral moisturizer did not provide relief; furthermore, numbness in the lower lip emerged. A Semmes Weinstein test demonstrated elevation of her sensitivity threshold. Finally, magnetic resonance imaging revealed a 20-mm diameter mass in the CPA. The patient is now being followed under conservative management. Our experience underscores the importance of including CPA mass in the differential diagnosis of dental diseases. © 2015 Australian Dental Association.
Gómez-de Diego, Rafael; Mang-de la Rosa, María del Rocío; Romero-Pérez, María-Jesús; Cutando-Soriano, Antonio; López-Valverde-Centeno, Antonio
The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words "implant" AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication.
Alkhodary, Mohamed Ahmed; Abdelraheim, Abdelraheim Emad Eldin; Elsantawy, Abd Elaleem Hassan; Al Dahman, Yousef Hamad; Al-Mershed, Mohammed
Objectives It takes a lot of training on patients for both undergraduate to develop clinical sense as regards to the placement of dental implants in the jaw bones, also, the models provided by the dental implant companies for training are usually made of strengthened synthetic foams, which are far from the composition, and tactile sense provided by natural bone during drilling for clinical placement of dental implants. Methodology This is an in-vitro experimental study which utilized bovine femur bone, where the shaft of the femur provided the surface compact layer, and the head provided the cancellous bone layer, to provide a training model similar to jaw bones macroscopic anatomy. Both the compact and cancellous bone samples were characterized using mechanical compressive testing. Results The elastic moduli of the cancellous and cortical femur bone were comparable to those of the human mandible, and the prepared training model provided a more lifelike condition during the drilling and placement of dental implants. Conclusion The composite bone model developed simulated the macroscopic anatomy of the jaw bones having a surface layer of compact bone, and a core of cancellous bone, and provided a better and a more natural hands-on experience for placement of dental implants as compared to plastic models made of polyurethane. PMID:26309434
Tonetti, M S
Permucosal osseointegrated dental implants are a highly effective and predictable treatment modality for edentulism. This review discusses some controversial aspects of the definitions for success and failure of root-form dental implants. The discussion will focus on the underlying pathologies that, if untreated, may lead to loss of the implanted device. Few clinical syndromes are described based on human pathological material and clinical presentation. The theoretical chronological relationship between implant loss and the incidence of pathology of the soft- and hard-tissue seal around implants is also discussed. The review also examines the finding that implant failures are not randomly distributed in the treated populations and that implant loss clusters in specific high-risk groups and individuals. Known risk indicators, and possible risk factors, are discussed, taking into account the patient, the reconstruction, the implant, and implant site-specific factors. Particular emphasis is placed on the need for better determination of whether periodontal patients are at higher risk for implant failures as a consequence of their increased susceptibility to infectious, inflammatory-response-driven tissue breakdown.
Sprecher, C M; Gahlert, M; Röhling, S; Kniha, H; Gueorguiev, B; Milz, S
Two different imaging techniques used to determine bone tissue response to dental implants were compared. Dental implants were implanted into the maxillae of 18 pigs, which were sacrificed after 4, 8 and 12 weeks. Implants with surrounding bone tissue were retrieved for methyl methacrylate histology and contact radiography. On identical sections peri-implant bone density and bone implant contact (BIC) ratio were assessed with two different imaging methods. Evaluation of Giemsa eosin stained and contact radiographed sections showed direct osseous integration for all implants and both methods showed a strong correlation with correlation coefficient r = 0.930 (P < 0.0001) for peri-implant bone density and r = 0.817 (P < 0.0001) for bone implant contact ratio. While the two imaging methods showed moderate differences for peri-implant bone density there were significant differences between the BIC values determined. In general, contact radiography tends to underestimate BIC for approximately 4.5 % (P = 0.00003).
Holländer, Jens; Lorenz, Jonas; Stübinger, Stefan; Hölscher, Werner; Heidemann, Detlef; Ghanaati, Shahram; Sader, Robert
In recent years, dental implants made from zirconia have been further developed and are considered a reliable treatment method for replacing missing teeth. The aim of this study was to analyze dental implants made from zirconia regarding their clinical performance compared with natural teeth (control). One hundred six zirconia implants in 38 adults were analyzed in a clinical study after 1 year of loading. The plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), probing attachment level (PAL), and creeping or recession (CR/REC) of the gingiva were detected and compared with natural control teeth (CT). Furthermore, the papilla index (PAP), Periotest values (PTV), microbial colonization of the implant/dental sulcus fluid, and patient satisfaction were assessed. The survival rate was 100%. No statistical significance was observed between implants and teeth regarding BOP, PPD, and PAL. A statistical significance was detected regarding PI and CR/REC with significantly less plaque accumulation and recession in the study group. Mean PAP was 1.76 ± 0.55, whereas the mean PTV was -1.31 ± 2.24 (range from -5 to +6). A non-statistically significant higher colonization of periodontitis/peri-implantitis bacteria was observed in the implant group. The questionnaire showed that the majority of the patients were satisfied with the overall treatment. One-piece zirconia dental implants exhibited similar clinical results (BOP, PPD, and PAL) compared with natural teeth in regard to adhesion of plaque (PI) and creeping attachment (CR/REC); zirconia implants performed even better. The favorable results for PAL and CR/REC reflect the comparable low affinity of zirconia for plaque adhesion. Patient satisfaction indicated a high level of acceptance for zirconia implants. However, a long-term follow-up is needed to support these findings.
Morais, Pedro; Queirós, Sandro; Moreira, António H. J.; Ferreira, Adriano; Ferreira, Ernesto; Duque, Duarte; Rodrigues, Nuno F.; Vilaça, João. L.
Dental implant recognition in patients without available records is a time-consuming and not straightforward task. The traditional method is a complete user-dependent process, where the expert compares a 2D X-ray image of the dental implant with a generic database. Due to the high number of implants available and the similarity between them, automatic/semi-automatic frameworks to aide implant model detection are essential. In this study, a novel computer-aided framework for dental implant recognition is suggested. The proposed method relies on image processing concepts, namely: (i) a segmentation strategy for semi-automatic implant delineation; and (ii) a machine learning approach for implant model recognition. Although the segmentation technique is the main focus of the current study, preliminary details of the machine learning approach are also reported. Two different scenarios are used to validate the framework: (1) comparison of the semi-automatic contours against implant's manual contours of 125 X-ray images; and (2) classification of 11 known implants using a large reference database of 601 implants. Regarding experiment 1, 0.97±0.01, 2.24±0.85 pixels and 11.12±6 pixels of dice metric, mean absolute distance and Hausdorff distance were obtained, respectively. In experiment 2, 91% of the implants were successfully recognized while reducing the reference database to 5% of its original size. Overall, the segmentation technique achieved accurate implant contours. Although the preliminary classification results prove the concept of the current work, more features and an extended database should be used in a future work.
de Avila, Erica Dorigatti; de Molon, Rafael Scaf; Vergani, Carlos Eduardo; de Assis Mollo, Francisco; Salih, Vehid
The aim of this review was to investigate the relationship between biofilm and peri-implant disease, with an emphasis on the types of implant abutment surfaces. Individuals with periodontal disease typically have a large amount of pathogenic microorganisms in the periodontal pocket. If the individuals lose their teeth, these microorganisms remain viable inside the mouth and can directly influence peri-implant microbiota. Metal implants offer a suitable solution, but similarly, these remaining bacteria can adhere on abutment implant surfaces, induce peri-implantitis causing potential destruction of the alveolar bone near to the implant threads and cause the subsequent loss of the implant. Studies have demonstrated differences in biofilm formation on dental materials and these variations can be associated with both physical and chemical characteristics of the surfaces. In the case of partially edentulous patients affected by periodontal disease, the ideal type of implant abutments utilized should be one that adheres the least or negligible amounts of periodontopathogenic bacteria. Therefore, it is of clinically relevance to know how the bacteria behave on different types of surfaces in order to develop new materials and/or new types of treatment surfaces, which will reduce or inhibit adhesion of pathogenic microorganisms, and, thus, restrict the use of the abutments with indication propensity for bacterial adhesion. PMID:28788641
de Avila, Erica Dorigatti; de Molon, Rafael Scaf; Vergani, Carlos Eduardo; de Assis Mollo, Francisco; Salih, Vehid
The aim of this review was to investigate the relationship between biofilm and peri-implant disease, with an emphasis on the types of implant abutment surfaces. Individuals with periodontal disease typically have a large amount of pathogenic microorganisms in the periodontal pocket. If the individuals lose their teeth, these microorganisms remain viable inside the mouth and can directly influence peri-implant microbiota. Metal implants offer a suitable solution, but similarly, these remaining bacteria can adhere on abutment implant surfaces, induce peri-implantitis causing potential destruction of the alveolar bone near to the implant threads and cause the subsequent loss of the implant. Studies have demonstrated differences in biofilm formation on dental materials and these variations can be associated with both physical and chemical characteristics of the surfaces. In the case of partially edentulous patients affected by periodontal disease, the ideal type of implant abutments utilized should be one that adheres the least or negligible amounts of periodontopathogenic bacteria. Therefore, it is of clinically relevance to know how the bacteria behave on different types of surfaces in order to develop new materials and/or new types of treatment surfaces, which will reduce or inhibit adhesion of pathogenic microorganisms, and, thus, restrict the use of the abutments with indication propensity for bacterial adhesion.
Kuo, Hsien-Nan; Mei, Hsiang-I; Liu, Tung-Kuan; Liu, Tse-Ying; Lo, Lun-Jou; Lin, Chun-Li
This study constructs a standard in vitro laser treatment platform with dental implant thread surface on bacterial adhesion for peri-implantitis at different tooth positions. The standard clinical adult tooth jaw model was scanned to construct the digital model with 6 mm bone loss depth on behalf of serious peri-implantitis at the incisor, first premolar, and first molar. A cylindrical suite connected to the implant and each tooth root in the jaw model was designed as one experimental unit set to allow the suite to be replaced for individual bacterial adhesion. The digital peri-implantitis and suite models were exported to fulfill the physical model using ABS material in a 3D printer. A 3 mm diameter specimen implant on bacterial adhesion against Escherichia coli was performed for gram-negative bacteria. An Er:YAG laser, working with a chisel type glass tip, was moved from the buccal across the implant thread to the lingual for about 30 seconds per sample to verify the in vitro laser treatment platform. The result showed that the sterilization rate can reach 99.3% and the jaw model was not damaged after laser irradiation testing. This study concluded that using integrated image processing, reverse engineering, CAD system, and a 3D printer to construct a peri-implantitis model replacing the implant on bacterial adhesion and acceptable sterilization rate proved the feasibility of the proposed laser treatment platform.
Mei, Hsiang-I; Liu, Tse-Ying; Lo, Lun-Jou
This study constructs a standard in vitro laser treatment platform with dental implant thread surface on bacterial adhesion for peri-implantitis at different tooth positions. The standard clinical adult tooth jaw model was scanned to construct the digital model with 6 mm bone loss depth on behalf of serious peri-implantitis at the incisor, first premolar, and first molar. A cylindrical suite connected to the implant and each tooth root in the jaw model was designed as one experimental unit set to allow the suite to be replaced for individual bacterial adhesion. The digital peri-implantitis and suite models were exported to fulfill the physical model using ABS material in a 3D printer. A 3 mm diameter specimen implant on bacterial adhesion against Escherichia coli was performed for gram-negative bacteria. An Er:YAG laser, working with a chisel type glass tip, was moved from the buccal across the implant thread to the lingual for about 30 seconds per sample to verify the in vitro laser treatment platform. The result showed that the sterilization rate can reach 99.3% and the jaw model was not damaged after laser irradiation testing. This study concluded that using integrated image processing, reverse engineering, CAD system, and a 3D printer to construct a peri-implantitis model replacing the implant on bacterial adhesion and acceptable sterilization rate proved the feasibility of the proposed laser treatment platform. PMID:28791302
Peñarrocha-Oltra, David; Candel-Marti, Eugenia; Peñarrocha-Diago, Maria
Objective: To compare the course of patients treated with tilted implants versus those treated conventionally with axial implants, analyzing the success rate and marginal bone loss. Material and Methods: A PubMed search was made using the key words “tilted implants”, “angled implants”, “angulated implants”, “inclined implants” and “maxillary atrophy.” A review was made of the articles published between 1999-2010. The inclusion criteria were the use of tilted implants, clinical series involving at least 10 patients, and a minimum follow-up of 12 months after prosthetic loading. The exclusion criteria were isolated clinical cases, studies with missing data, and publications in languages other than English or Spanish. The metaanalysis finally included 13 articles: 7 retrospective studies and 6 prospective studies. Results: On analyzing the success rate in the retrospective studies, two reported a higher success rate with tilted implants; one a higher success rate with axial implants; and two reported similar success rates with both implants. On analyzing the success rate in the prospective studies, two reported a higher success rate with tilted implants; two a higher success rate with axial implants; and two reported similar success rates with both implants. On examining marginal bone loss, three studies reported greater bone loss with axial implants and one with tilted implants. Conclusions: There was no evidence of differences in success rate between tilted and axial implants in either the prospective or retrospective studies subjected to review. The marginal bone loss observed with the tilted and axial implants likewise proved very similar. It thus can be deduced that tilted implants exhibit the same evolutive behavior as axial implants. Key words:Axial implants, tilted implants, maxillary atrophy, tilted implants. PMID:22322494
Haga, Maiko; Nozawa-Inoue, Kayoko; Li, Minqi; Oda, Kimimitsu; Yoshie, Sumio; Amizuka, Norio; Maeda, Takeyasu
Osseointegration is the most preferable interface of dental implants and newly formed bone. However, the cavity preparation for dental implants often gives rise to empty lacunae or pyknotic osteocytes in bone surrounding the dental implant. This study aimed to examine the chronological alternation of osteocytes in the bone surrounding the titanium implants using a rat model. The distribution of the osteocytic lacunar canalicular system (OLCS) in bone around the titanium implants was examined by silver impregnation according to Bodian's staining. We also performed double staining for alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP), as well as immunohistochemistry for fibroblast growth factor (FGF) 23--a regulator for the serum concentration of phosphorus--and sclerostin, which has been shown to inhibit osteoblastic activities. Newly formed bone and the injured bone at the early stage exhibited an irregularly distributed OLCS and a few osteocytes positive for sclerostin or FGF23, therefore indicating immature bone. Osteocytes in the surrounding bone from Day 20 to Month 2 came to reveal an intense immunoreactivity for sclerostin. Later on, the physiological bone remodeling gradually replaced such immature bone into a compact profile bearing a regularly arranged OLCS. As the bone was remodeled, FGF23 immunoreactivity became more intense, but sclerostin became less so in the well-arranged OLCS. In summary, it seems likely that OLCS in the bone surrounding the dental implants is damaged by cavity formation, but later gradually recovers as bone remodeling takes place, ultimately inducing mature bone. Copyright © 2011 Wiley-Liss, Inc.
Kayabasoglu, Gurkan; Nacar, Alpen; Altundag, Aytug; Cayonu, Melih; Muhtarogullari, Mehmet; Cingi, Cemal
Dental implants have been associated with the occurrence of postoperative rhinosinusitis. In some patients, preoperative sinus lifting must be performed to increase the chances of successful implant placement. This retrospective study examines the relationship of dental implants after sinus lifting with the occurrence of postoperative rhinosinusitis. A total of 268 dental implants were inserted in 94 patients (62 Males, 32 Females) between 2011-2013. The ages ranged from 29-71 (in males) and 33-64 (in females). Additionally, bilateral sinus lifing was performed in 51 patients, and unilateral sinus lifting was performed in 43 of the patients. Patients were evaluated for sinus pathology for a period of 5-47 months postoperatively using a satisfaction questionnaire, conventional radiographic examination, and nasal endoscopic examination. Four of the patients (4.2%) had a complication of postoperative sinusitis and were treated medically. In one patient, the implant was unsuccessful (even after treatment) and was removed. None of the patients needed surgery due to the sinusitis or any associated complications. The risk for postoperative rhinosinusitis was found to be higher in patients who suffer from chronic sinusitis and in cases in which a large amount of graft was utilized for sinus lifting. These predisposing factors need to be considered when evaluating patients for dental implants and sinus lift procedures.
Gupta, B; Shadbolt, B; Hyam, D
Dental implant rehabilitation is a well-established procedure often conducted in the general dental practise setting. The outcomes for implant placement are reliable when the recipient site is favourable. The goal of this study was to assess the accuracy with which general dental practitioners (GDP) assess the bone volume available for implant placement and their referral patterns for implant sites, which may require bone grafting. Fifty-three GDP were surveyed and asked to assess five different scenarios and cone-beam scans for difficulty (0, 'no difficulty'; 5, 'the most difficult'), and bone grafting requirements ('yes'/'no' and 'who to perform'), prior to implant placement. The GDP assessment of difficulty for the cases was: no graft required, 1.88; aesthetic zone involvement, 3.25; vertical deficiency, 2.8; sinus lift required, 3.68; and horizontal deficiency, 4.4. GDP seemed to have some difficulty identifying which cases required a bone graft, occasionally grafting a site with sufficient bone (12.5%), or not grafting a site with insufficient bone (45-75%). These results show that GDP are accurate in assessing the difficulty of an implant case and conservative when it comes to attempting these complex cases. GDP are less confident when it comes to recognizing cases that require bone grafting, and what options are available. © 2017 Australian Dental Association.
Cebrian-Carretero, José-Luis; Guiñales-Díaz de Cevallos, Jorge; Sobrino, José-Andrés; Yu, Tomás; Burgueño-García, Miguel
The reconstruction of maxillomandibular defects secondary to oral cancer surgery, represent a great challenge for Maxillofacial surgeons. During the last decades the reconstructive surgery has experimented a big advance due to the development of the microsurgical techniques. At present, we are able to reconstruct complex defects using free flaps that provide both soft and bone tissue. Fibula, iliac crest and scapula free flaps have been the three classic options for the maxillomandibular reconstruction owing to the amount of bone that this flaps provide, allowing the posterior dental rehabilitation with implants. Today, our objective it is not only the aesthetic reconstruction, but also the functional reconstruction of the patients enhancing their life quality. Guided implant surgery in free flap reconstructed patients has become an essential tool, helping to define the exact position of the dental implant in the flap. In this way it is possible to look for the areas with better bone conditions, avoiding the osteosynthesis material used to fixate the flap with the native bone and deciding the best biomechanical option, in terms of number and situation of the implants, for the future dental prostheses. In summary, using the guided implant surgery, it is possible to design an exact and predictable dental implant rehabilitation in patients with oral cancer who are reconstructed with free microvascular flap, resulting in an optimal aesthetic and functional result.
Osman, Reham B.; Swain, Michael V.
The goal of the current publication is to provide a comprehensive literature review on the topic of dental implant materials. The following paper focuses on conventional titanium implants and more recently introduced and increasingly popular zirconia implants. Major subtopics include the material science and the clinical considerations involving both implant materials and the influence of their physical properties on the treatment outcome. Titanium remains the gold standard for the fabrication of oral implants, even though sensitivity does occur, though its clinical relevance is not yet clear. Zirconia implants may prove to be promising in the future; however, further in vitro and well-designed in vivo clinical studies are needed before such a recommendation can be made. Special considerations and technical experience are needed when dealing with zirconia implants to minimize the incidence of mechanical failure. PMID:28787980
Fusari, Pietro; Doto, Matteo; Chiapasco, Matteo
Background. Rehabilitation of edentulous jaws with implant-supported prosthesis has become a common practice among oral surgeons in the last three decades. This therapy presents a very low incidence of complications. One of them is the displacement of dental implants into the maxillary sinus. Dental implants, such as any other foreign body into the maxillary sinus, should be removed in order to prevent sinusitis. Methods. In this paper, we report a case of dental implant migrated in the maxillary sinus and removed by means of the bone lid technique. Results and Conclusion. The migration of dental implants into the maxillary sinus is rarely reported. Migrated implants should be considered for removal in order to prevent possible sinusal diseases. The implant has been removed without any complications, confirming the bone lid technique to be safe and reliable. PMID:23762641
Misch, Carl E
Bruxism is a potential risk factor for implant failure. Excessive force is the primary cause of late implant complications. An appreciation of the etiology of crestal bone loss, failure of implants, failure to retain implant restorations, and fracture of components will lead the practitioner to develop a treatment plan that reduces force on implants and their restorations. The forces are considered in terms of magnitude, duration, direction, type, and magnification. Once the dentist has identified the source(s) of additional force on the implant system, the treatment plan is altered to contend with and reduce the negative sequelae on the bone, implant, and final restoration. One viable approach is to increase the implant-bone surface area. Additional implants can be placed to decrease stress on any one implant, and implants in molar regions should have an increased width. Use of more and wider implants decreases the strain on the prosthesis and also dissipates stress to the bone, especially at the crest. The additional implants should be positioned with intent to eliminate cantilevers when possible. Greater surface area implant designs made of titanium alloy and with an external hex design can also prove advantageous. Anterior guidance in mandibular excursions further decreases force and eliminates or reduces lateral posterior force. Metal occlusal surfaces decrease the risk of porcelain fracture and do not require as much abutment reduction, which in turn enhances prosthesis retention. The retention of the final prosthesis or super-structure is also improved with additional implant abutments. Night guards designed with specific features also are a benefit to initially diagnose the influence of occlusal factors for the patient, and as importantly, to reduce the influence of extraneous stress on implants and implant-retained restorations.
Malmstrom, Hans; Gupta, Bhumija; Ghanem, Alexis; Cacciato, Rita; Ren, Yanfang; Romanos, Georgios E
Bone grafts (sinus lift and/or ridge augmentation) may become an obstacle for some patients who desire implant treatment. The objective of this study was to evaluate the success of six- and eight-millimeters rough surface design short dental implants, for up to 2 years in function, when compared to conventional length (11 mm) implants. A total of 25.6-, 20.8- and 35.11-mm length implants were placed and restored in 30 subjects (11 males, 19 females) between the age of 22 and 80, following a standard protocol. Implant mobility, crestal bone loss as well as periodontal parameters were evaluated immediately after restoration placement, at 6, 12 and 24 months. There was one failure of one 6-mm implant during the healing phase and one restorative failure. The median crestal bone loss at 24 months was 0.45 mm for the 6-mm implants, 0.55 mm for the 8 mm implants and 0.65 mm for the 11-mm implants. The success rate for 6-mm implants was 97% and for 8-mm and 11-mm implants 100%. Based on this preliminary data, we conclude that rough surface design short dental implants (6 and 8 mm in length) have similar success rate when compared to 11-mm implants. Long-term data with larger number of implants and subjects are needed to confirm these results. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Zhao, L P; Zhan, Y L; Hu, W J; Wang, H J; Wei, Y P; Zhen, M; Xu, T; Liu, Y S
For ideal implant rehabilitation, an adequate bone volume, optical implant position, and stable and healthy soft tissue are required. The reduction of alveolar bone and changes in its morphology subsequent to tooth extraction will result in insufficient amount of bone and adversely affect the ability to optimally place dental implants in edentulous sites. Preservation of alveolar bone volume through ridge preservation has been demonstrated to reduce the vertical and horizontal contraction of the alveolar bone crest after tooth extraction and reduce the need for additional bone augmentation procedures during implant placement. In this case, a patient presented with a mandible molar of severe periodontal disease, the tooth was removed as atraumatically as possible and the graft material of Bio-Oss was loosely placed in the alveolar socket without condensation and covered with Bio-Gide to reconstruct the defects of the alveolar ridge. Six months later, there were sufficient height and width of the alveolar ridge for the dental implant, avoiding the need of additional bone augmentation and reducing the complexity and unpredictability of the implant surgery. Soft tissue defects, such as gingival and connective tissue, played crucial roles in long-term implant success. Peri-implant plastic surgery facilitated development of healthy peri-implant structure able to withstand occlusal forces and mucogingival stress. Six months after the implant surgery, the keratinized gingiva was absent in the buccal of the implant and the vestibular groove was a little shallow. The free gingival graft technique was used to solve the vestibulum oris groove supersulcus and the absence of keratinized gingiva around the implant. The deepening of vestibular groove and broadening of keratinized gingiva were conducive to the long-term health and stability of the tissue surrounding the implant. Implant installation and prosthetic restoration showed favorable outcome after six months.
van Velzen, Frank J J; Lang, Niklaus P; Schulten, Engelbert A J M; Ten Bruggenkate, Christiaan M
To report on a possible relationship between the use of dental floss or superfloss and the development of peri-implantitis. Ten patients with progressive peri-implantitis with an intensive oral hygiene protocol, which consisted of extensive professional supra- and submucosal cleaning, and not responding to this therapy were scheduled for examination. Plaque and bleeding indices and probing depth measurements were assessed, and radiographic examination was performed every two years. In all ten cases, remnants of dental floss were found around the neck and coronal part of a dental implant. After careful removal of these floss remnants and implant cleansing, a significant improvement in the peri-implant conditions in nine of ten cases was noted. In one case, peri-implant probing depth decreased substantially. However, bleeding on probing was still present. In vitro testing yielded that the application of various types of dental floss on the exposed rough implant surfaces may easily lead to tearing of floss fibers. This may result in the deposition of floss remnants on rough implant surfaces, which, in turn, may lead to the development of plaque-related peri-implant inflammation and, subsequently, bone loss. In case of exposed rough surfaces of the dental implant, the peri-implant conditions may be jeopardized by the application of dental floss, and hence, the utilization of interproximal brushes or toothpicks may be preferred for daily home care practices. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Jeelani, S.; Rajkumar, E.; Mary, G. Geena; Khan, Parvez Ahmad; Gopal, Harish; Roy, Soumya; Maheswaran, T.; Anand, B.
Cancer is one of the leading causes of death world-wide. Apart from the most common etiopathological factors related to cancer, at times very rare causes such as irritant or foreign body induced carcinogenesis is not to be overlooked. To systematically review case reports concerned with the association between dental implants and oral squamous cell carcinoma. A Medline (PubMed), Cochrane database, and Google Scholar search was conducted of dental article published in English related to case reports concerned with oral squamous cell carcinoma occurring around dental implants from 2000 to 2014. Twenty articles were retrieved, which included 20 rare case reports which were systematically reviewed and the results were obtained pertaining to age, clinical symptoms, habits, previous history of cancer, potentially malignant disorders, systemic illness, and local factors. It is imperative to identify promptly persisting inflammation associated with implants. Since malignancy may disguise as periimplantitis, especially in patients who are at risk with contributing prominent predisposing factors. PMID:26538881
Sicilia, Alberto; Cuesta, Susana; Coma, Gerardo; Arregui, Ignacio; Guisasola, Cristina; Ruiz, Eduardo; Maestro, Antonio
In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression. Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material. Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out. Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight). Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.
Lee, Hsiao-Chien; Tsai, Pei-I; Huang, Chih-Chieh; Chen, San-Yuan; Chao, Chuen-Guang
The inclusion of a healing chamber in dental implants has been shown to promote biological healing. In this paper, a novel numerical approach to the design of the healing chamber for additive-manufactured dental implants is proposed. This study developed an algorithm for the modeling of bone growth and employed finite element method in ANSYS to facilitate the design of healing chambers with a highly complex configuration. The model was then applied to the design of dental implants for insertion into the posterior maxillary bones. Two types of ITI® solid cylindrical screwed implant with extra rectangular-shaped healing chamber as an initial design are adopted, with which to evaluate the proposed system. This resulted in several configurations for the healing chamber, which were then evaluated based on the corresponding volume fraction of healthy surrounding bone. The best of these implants resulted in a healing chamber surrounded by around 9.2% more healthy bone than that obtained from the original design. The optimal design increased the contact area between the bone and implant by around 52.9%, which is expected to have a significant effect on osseointegration. The proposed approach is highly efficient which typically completes the optimization of each implant within 3–5 days on an ordinary personal computer. It is also sufficiently general to permit extension to various loading conditions. PMID:28293628
Nissan, J; Zenziper, E; Rosner, O; Kolerman, R; Chaushu, L; Chaushu, G
Soft tissue shrinkage during the course of restoring dental implants may result in biological and prosthodontic difficulties. This study was conducted to measure the continuous shrinkage of the mucosal cuff around dental implants following the removal of the healing abutment up to 60 s. Individuals treated with implant-supported fixed partial dentures were included. Implant data--location, type, length, diameter and healing abutments' dimensions--were recorded. Mucosal cuff shrinkage, following removal of the healing abutments, was measured in bucco-lingual direction at four time points--immediately after 20, 40 and 60 s. anova was used to for statistical analysis. Eighty-seven patients (49 women and 38 men) with a total of 311 implants were evaluated (120 maxilla; 191 mandible; 291 posterior segments; 20 anterior segments). Two-hundred and five (66%) implants displayed thick and 106 (34%) thin gingival biotype. Time was the sole statistically significant parameter affecting mucosal cuff shrinkage around dental implants (P < 0.001). From time 0 to 20, 40 and 60 s, the mean diameter changed from 4.1 to 4.07, 3.4 and 2.81 mm, respectively. The shrinkage was 1%, 17% and 31%, respectively. The gingival biotype had no statistically significant influence on mucosal cuff shrinkage (P = 0.672). Time required replacing a healing abutment with a prosthetic element should be minimised (up to 20/40 s), to avoid pain, discomfort and misfit. © 2015 John Wiley & Sons Ltd.
Popa, A C; Stan, G E; Enculescu, M; Tanase, C; Tulyaganov, D U; Ferreira, J M F
Bioactive glasses are currently considered the suitable candidates to stir the quest for a new generation of osseous implants with superior biological/functional performance. In congruence with this vision, this contribution aims to introduce a reliable technological recipe for coating fairly complex 3D-shaped implants (e.g. dental screws) with uniform and mechanical resistant bioactive glass films by the radio-frequency magnetron sputtering method. The mechanical reliability of the bioactive glass films applied to real Ti dental implant fixtures has been evaluated by a procedure comprised of "cold" implantation in pig mandibular bone from a dead animal, followed by immediate tension-free extraction tests. The effects of the complex mechanical strains occurring during implantation were analysed by scanning electron microscopy coupled with electron dispersive spectroscopy. Extensive biocompatibility assays (MTS, immunofluorescence, Western blot) revealed that the bioactive glass films stimulated strong cellular adhesion and proliferation of human dental pulp stem cells, without promoting their differentiation. The ability of the implant coatings to conserve a healthy stem cell pool is promising to further endorse the fabrication of new osseointegration implant designs with extended lifetime.
Kim, Tae Hyung; Knezevic, Alena; Jorgensen, Michael; Rich, Sandra; Nowzari, Hessam
Unlike conventional loading protocols, the immediate loading of single implants has not been fully investigated. The purpose of this study was to assess the prosthetic and esthetic periimplant mucosal outcomes of immediately restored dental implants during a 1-year follow-up. Twenty participants meeting the established inclusion criteria received double-threaded, tapered body dental implants (SuperLine; Dentium). Implants were placed and stabilized at a minimum of 35 Ncm of torque and restored immediately after the surgery with interim restorations. These were replaced with definitive restorations 6 months after implant placement. Clinical measurements at each visit included resonance frequency analysis, the evaluation of the participants' oral health (gingival and plaque indices), and the esthetic outcome of the interim or definitive restoration. Implants placed in this clinical study had a 100% success rate. The oral health and esthetic outcomes were favorable for all participants. Double-threaded, tapered body dental implants that were placed and immediately restored with fixed interim prostheses and with definitive prostheses after 6 months remained stable and functional after 1 year. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
Lee, Hsiao-Chien; Tsai, Pei-I; Huang, Chih-Chieh; Chen, San-Yuan; Chao, Chuen-Guang; Tsou, Nien-Ti
The inclusion of a healing chamber in dental implants has been shown to promote biological healing. In this paper, a novel numerical approach to the design of the healing chamber for additive-manufactured dental implants is proposed. This study developed an algorithm for the modeling of bone growth and employed finite element method in ANSYS to facilitate the design of healing chambers with a highly complex configuration. The model was then applied to the design of dental implants for insertion into the posterior maxillary bones. Two types of ITI® solid cylindrical screwed implant with extra rectangular-shaped healing chamber as an initial design are adopted, with which to evaluate the proposed system. This resulted in several configurations for the healing chamber, which were then evaluated based on the corresponding volume fraction of healthy surrounding bone. The best of these implants resulted in a healing chamber surrounded by around 9.2% more healthy bone than that obtained from the original design. The optimal design increased the contact area between the bone and implant by around 52.9%, which is expected to have a significant effect on osseointegration. The proposed approach is highly efficient which typically completes the optimization of each implant within 3-5 days on an ordinary personal computer. It is also sufficiently general to permit extension to various loading conditions.
Dokou, Panagiota; Karoussis, Ioannis K.; Papavasiliou, George; Kamposiora, Phophi; Vrahopoulos, Theophilos P.; Vrotsos, John A.
Background: Hajdu-Cheney Syndrome (HCS) is a rare hereditary bone metabolism disorder characterized by acro-osteolysis, short stature, craniofacial changes, periodontitis and premature tooth loss. Extensive search of the current literature revealed no reports of implant placement in patients with HCS. Case Report: A 22-year old woman with osteoporosis, generalized advanced chronic periodontitis and premature tooth loss was referred to the Postgraduate Clinic of Periodontology, University of Athens-Greece. The patient was diagnosed in 2001 with HCS. The patient received non-surgical periodontal treatment and several teeth were extracted due to extensive alveolar bone loss. After careful consideration of the possible implications deriving from the patient’s condition and having taken her young age into account, initially, a dental implant was placed in the upper right first premolar region. Specific protocols such as longer healing periods were implemented, so five years after placement and successful osseointegration of this implant, four additional dental implants were placed in the posterior regions of the maxilla and the mandible. Prosthetic rehabilitation followed 6 months after implant placement. Upon completion of periodontal treatment, the patient was enrolled in a periodontal maintenance program. Results: Clinical and radiographic examination of the patient during the periodontal maintenance program after implant placement revealed no abnormalities in the implant region. Conclusion: Patients with HCS suffer from periodontitis, bone destruction and premature tooth loss. This case indicates the successful osseointegration of dental implants in patients with HCS. However, further research is required in order to determine the predictability of dental implant placement in those patients. PMID:27857819
Hagiwara, Yoshiyuki; Narita, Tatsuya; Shioda, Yohei; Iwasaki, Keisuke; Ikeda, Takayuki; Namaki, Shunsuke; Salinas, Thomas J
There are many implant cases in which dental technicians take initiative with regard to the design of implant prostheses, and to a certain extent, this area of care is one in which dentists do not necessarily play the leading role. Moreover, inadequate communication between dental technicians and dentists and insufficient instructions for technicians has been highlighted as issues in the past. The purpose of this questionnaire is to improve the quality of implant prostheses and thereby contribute to patient service by clarifying, among other aspects of treatment, problem areas and considerations in the fabrication of implant prostheses, conceptual-level knowledge, and awareness of prosthodontics on the part of the dentists in charge of treatment and methods for preventing prosthetic complications. A cross-sectional survey was given to 120 certified dental technicians. To facilitate coverage of a broad range of topics, we classified the survey content into the following four categories and included detailed questions for (1) the conditions under which implant technicians work, (2) implant fixed prostheses, (3) implant overdentures, and (4) prosthetic complications. Out of 120 surveys sent, 74 technicians responded resulting in a response rate of 61.6%. This survey served to clarify the current state of implant prosthodontics, issues, and considerations in the fabrication of implant prostheses, and the state of prosthetic complications and preventive initiatives, all from a laboratory perspective. The results of this survey suggested that, to fabricate prostheses with a high level of predictability, functional utility, and aesthetic satisfaction, it is necessary to reaffirm the importance for dentists to increase their prosthetic knowledge and work together with dental technicians to develop comprehensive treatment plans, implement an organized approach to prosthesis design, and accomplish occlusal reconstruction.
Kashbour, W A; Rousseau, N S; Ellis, J S; Thomason, J M
To identify and summarise the findings of previous qualitative studies relating to patients' experience of dental implant treatment (DIT) at various stages of their implant treatment, by means of textual narrative synthesis. Original articles reporting patients' experience with dental implant were included. A two-stage search of the literature, electronic and hand search identified relevant qualitative studies up to July 2014. An extensive electronic search was conducted of databases including PubMed, Embase, Scopus, Web of Knowledge, Cochrane Database and Google Scholar. Included primary studies (n=10) used qualitative research methods and qualitative analysis to investigate patients' experiences with dental implants treatment. While the growing interest in implant treatment for the replacement of missing dentition is evident, it is essential to investigate patients' perceptions of different aspects of implant treatment. This textual narrative synthesis conducted to review qualitative studies which provided insight into patients' experience of two types of implant prostheses namely ISOD (implant-supported overdenture) and FISP (fixed implant supported prostheses). Primary reviewed studies tended to include samples of older patients with more extensive tooth loss, and to focus on experiences prior to and post-treatment rather than on the treatment period itself. Findings across reviewed studies (n=10) suggested that patients with FISP thought of implant treatment as a process of 'normalisation'(1) and believed that such implant restorations could be similar to natural teeth, whereas patients with ISOD focused more on the functional and social advantages of their implant treatment. The growing interest in qualitative research is evident in several branches of clinical dentistry and dental implantology is not an exception. Qualitative studies concerning the patients account of their experience of dental implants is however limited. The aim of this review is to
Hvaring, Christina L; Øgaard, Bjørn; Birkeland, Kari
Children with severe hypodontia have a substantial impairment of their dental health starting early in life. The purpose of this study was to describe types and locations of substitutes for missing teeth in patients with severe hypodontia and to compare the crown and soft tissue morphologies of orthodontic space closure, dental implants, and tooth-supported fixed dental prostheses for replacing teeth in the anterior region. Fifty patients missing 6 or more teeth and aged 18 years or older (mean age, 25.6 years) took part in a follow-up study. The patients were examined clinically with panoramic radiographs and clinical photographs. Crown and soft tissue variables (mucosal discoloration, crown morphology, color, and papilla index) were compared for orthodontic space closure, dental implant fixtures, and fixed dental prostheses. Dental implants, orthodontic space closure, and retaining deciduous teeth were the most commonly prescribed treatments. Persisting deciduous teeth showed a good survival rate at the follow-up examination. Mucosal discoloration was seen only for implant fixtures and was evident for almost all fixtures in the anterior mandible and two thirds of those in the anterior maxilla. The papilla index scored poorer for both implant fixtures and fixed dental prostheses compared with orthodontic space closure. Dental implants in the anterior region proved to be an inadequate treatment modality in patients with severe hypodontia because of pronounced mucosal discoloration. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
Yokota, Sou; Nishiwaki, Naruhiko; Ueda, Kyosuke; Narushima, Takayuki; Kawamura, Hiroshi; Takahashi, Tetsu
Calcium phosphate is used for dental material because of its biocompatibility and osteoconductivity. Amorphous calcium phosphate (ACP) coatings deposited by magnetron sputtering can control their thickness and absorbability. This study aimed to evaluate and characterize ACP coatings deposited via magnetron sputtering. It was hypothesized that ACP coatings would enhance bone formation and be absorbed rapidly in vivo. ACP coatings that are 0.5 μm in thickness were deposited via magnetron sputtering on dental implants. Uncoated implants served as controls. The effect of the ACP coatings in vivo was investigated in New Zealand white rabbit. To evaluate the effect of the ACP coatings on the bone response of the implants, the removal torque, implant stability quotient, and histomorphometric analysis were performed on the implants at 1, 2, and 4 weeks after implantation. Results of the x-ray diffraction analyses confirmed the deposition of ACP coatings. Images from the scanning electron microscopy revealed that the coatings were dense, uniform, and 0.5 μm in thickness and that they were absorbed completely. Mechanical stability and bone formation in the case of the ACP-coated implants were higher than those of control. These results suggest that implants coated with thin ACP layers improve implant fixation and accelerate bone response.
Hasan, Istabrak; Heinemann, Friedhelm; Schwegmann, Monika; Keilig, Ludger; Stark, Helmut; Bourauel, Christoph
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.
Pikner, Solweig Sundén; Gröndahl, Kerstin
Dental implant failures have a multifactorial background; dependency within patient/jaw exists. Failures caused by bone loss are rare. Lately, advanced bone loss around implants has been discussed. Our aim was to study advanced bone level changes (>or=2 mm) regarding "clustering effect," prediction, and dependency. Further, we also aimed to study if the number of radiographs/radiographic examinations could be reduced. Six hundred and forty patients (3,462 Brånemark implants) with radiographic follow-ups >or=5 years were included, whereas patients with overdentures and augmentation procedures were excluded. Progression rate for implants with advanced bone loss was largest during the first year; thereafter, slow. A cluster effect was found with more advanced bone loss in few patients. Position was important for lower jaw implants with larger bone loss for implants placed close to midline. Age, jaw type, and implant placement were identified as predictors. The longer the follow-ups, the more bone loss around a randomly selected and examined implant, and the more implants per patient, the higher the risk for bone loss >or=2 mm around any other implant. Still, it seems safe to exclude radiographic follow-ups during the first 5 years. Dependency within the patient was found, hence the "one-implant-per-patient technique" can be applied. The number of intraoral radiographs per examination and, more importantly, radiographic examinations can be reduced without jeopardizing good clinical management, a statement valid even for Brånemark implants with advanced bone loss.
Berketa, J; James, H; Marino, V
Dental implants have become a popular choice of treatment in replacing individual lost teeth or entire dentitions. The physical properties of high corrosion resistance, high structural strength and high melting point, suggest the retention of intact implants following most physical assaults. As the implants are machine made, they lack the individualisation required for their use as identifiers of the deceased, however the Straumann™ Company (Waldenburg, Switzerland) has recently released information that within the chamber of their implants they have laser etched batch numbers. The number of implants with the same batch number varies from 24 to 2400. The purpose of this study was to ascertain if the batch number was still identifiable following intense heat exposure in a furnace. A Straumann™ Standard Plus 3.3 x 8 mm implant, with no healing cap nor abutment attached was incinerated to 1125 degrees Celsius. Another Straumann™ Standard Plus 3.3 x 8 mm implant was also incinerated in the same way as the first implant but with an abutment attached. The results indicated that the first implant had totally oxidised within the internal chamber whilst the second implant following the removal of the abutment revealed an intact identifiable batch number. If the companies constructing implants were to place individual serial numbers rather than batch numbers on these implants then the potential exists for a new approach to be established for the identification of the deceased.
Lee, Jin Whan; Wen, Hai Bo; Battula, Suneel; Akella, Rama; Collins, Michael; Romanos, Georgios E
This study evaluated the stability and histologic proof of osseoincorporation of Trabecular Metal (TM) dental implants, which feature a tantalum-based porous midsection. A total of 48 TM implants (test group) and Tapered Screw-Vent implants (control group) were immediately placed bilaterally into mandibular extraction sockets in dogs. Resonance frequency analysis was performed at weeks 0, 2, 4, and 12 after implant placement. Histologic and histomorphometric evaluations of the implant interface were performed. Changes in mean implant stability quotients (ISQ) revealed no statistical differences between the test and control groups. Histologic analysis showed bone ingrowth into the porous tantalum structure of all test group implants. Histomorphometric analysis revealed an increased percentage of bone-to-implant contact between 4 and 8 weeks in both test and control groups. The porous sections of the test group exhibited significantly more new bone inside the pores at week 12 in comparison to weeks 2 and 4. No correlation was observed between ISQ and histomorphometric parameters. In a canine immediate extraction socket model, both test and control implants demonstrated comparable implant stability and bone-to-implant contact. Bone ingrowth was evident within the tantalum porous section of the test implants during the early healing.
Chrcanovic, Bruno Ramos; Kisch, Jenö; Albrektsson, Tomas; Wennerberg, Ann
Some studies indicated that implant failures are commonly concentrated in few patients. To identify and analyze cluster behavior of dental implant failures among subjects of a retrospective study. This retrospective study included patients receiving at least three implants only. Patients presenting at least three implant failures were classified as presenting a cluster behavior. Univariate and multivariate logistic regression models and generalized estimating equations analysis evaluated the effect of explanatory variables on the cluster behavior. There were 1406 patients with three or more implants (8337 implants, 592 failures). Sixty-seven (4.77%) patients presented cluster behavior, with 56.8% of all implant failures. The intake of antidepressants and bruxism were identified as potential negative factors exerting a statistically significant influence on a cluster behavior at the patient-level. The negative factors at the implant-level were turned implants, short implants, poor bone quality, age of the patient, the intake of medicaments to reduce the acid gastric production, smoking, and bruxism. A cluster pattern among patients with implant failure is highly probable. Factors of interest as predictors for implant failures could be a number of systemic and local factors, although a direct causal relationship cannot be ascertained. © 2017 Wiley Periodicals, Inc.
Tran, Duong T; Gay, Isabel C; Diaz-Rodriguez, Janice; Parthasarathy, Kavitha; Weltman, Robin; Friedman, Lawrence
To compare dental implant survival rates when placed in native bone and grafted sites. Additionally, risk factors associated with dental implant loss were identified. This study was based on the hypothesis that bone grafting has no effect on implant survival rates. A retrospective chart review was conducted for patients receiving dental implants at the University of Texas, School of Dentistry from 1985 to 2012. Exclusion criteria included patients with genetic diseases, radiation and chemotherapy, or an age less than 18 years. To avoid misclassification bias, implants were excluded if bone grafts were only done at the same time of placement. Data on age, sex, tobacco use, diabetes, osteoporosis, anatomical location of the implant, implant length and width, bone graft, and professional maintenance were collected for analysis. A total of 1,222 patients with 2,729 implants were included. The cumulative survival rates at 5 and 10 years were 92% and 87% for implants placed in native bone and 90% and 79% for implants placed in grafted bone, respectively. The results from multivariate analysis (Cox regression) indicated no significant difference in survival between the two groups; having maintenance therapy after implant placement reduced the failure rate by 80% (P < .001), and using tobacco increased the failure rate by 2.6-fold (P = .001). There was no difference in the dental implant survival rate when implants were placed in native bone or bone-grafted sites. Smoking and lack of professional maintenance were significantly related to increased implant loss.
Al-Johany, Sulieman; Al Zoman, Hamad A.; Al Juhaini, Mohannad; Al Refeai, Mohannad
Aim The purpose of this survey was to assess the level, sources, and need for information about dental implants among a selected sample of dental patients in Riyadh, Saudi Arabia. Materials and methods Patients’ knowledge and awareness in using dental implants as an option in replacing missing teeth were evaluated through a standardized self- explanatory questionnaire distributed in two places in Riyadh: Military Hospital and College of Dentistry, King Saud University (Darraiyah campus). The questionnaires were handed to the patients during their regular dental visits. A total of 379 subjects were included in this survey. Results The results of this study indicate that 66.4% of the subjects knew about dental implants. The subjects’ friends and their relatives were the main source of information about dental implants for 31.5% of the subjects, and dentists were the secondary source for 28.3% of the sample. About 82.4% of the subjects need more information about dental implants and 85.2% of them chose the dentist to be the desired source for such information, followed by the internet in 28.5% of the cases. Almost 74.4% of those surveyed did not know if their regular dentists use dental implants. High cost was the major factor in preventing patients from choosing implants in 86.5% of the cases while the long treatment time and fear of surgery was the factor in 71% and 68.6% of the subjects, respectively. Conclusion The results of this survey showed an acceptable level of awareness about dental implants among a selected sample of dental patients in Riyadh. It also showed the need for providing more general and accurate information to the patients about this treatment modality. PMID:23960495
Al Qahtani, Mohammed S A; Wu, Yanyun; Spintzyk, Sebastian; Krieg, Peter; Killinger, Andreas; Schweizer, Ernst; Stephan, Ingrid; Scheideler, Lutz; Geis-Gerstorfer, Jürgen; Rupp, Frank
Wettability is increasingly considered to be an important factor determining biological responses to implant materials. In this context, the purpose of this study was to compare the dynamic wettability of dental implants made from different bulk materials and modified by different surface modifications, and to analyze the respective changes of wettability upon irradiating these implants by UV-A or UV-C light. Four original screw-type implants were investigated: One grit-blasted/acid-etched and one anodically oxidized titanium, one zirconia and one polyetheretherketone implant. Additionally, experimental, screwless, machined titanium cylinders were included in the study. Part of that cylinders and of blasted/etched implants were further modified by a magnetron-sputtered photocatalytic anatase thin film. Scanning electron microscopy was used to investigate the surface micro- and nanostructures. Samples were treated by UV-A (382nm, 25mWcm(-2)) and UV-C (260nm, 15mWcm(-2)) for entire 40min, respectively, and their wettability was quantified by dynamic contact angle (CA) analysis from multi-loop Wilhelmy experiments. All implants are characterized by submicron- and nanosized surface features. Unexposed implants were hydrophobic (CA>90°). Upon UV-A, solely the implants with anatase coating became superhydrophilic (CA<5°). Upon UV-C, the blasted/etched implants turned superhydrophilic, the anodized titanium and the zirconia implants were considerably (CA=34° and 27°, respectively) and the PEEK implants slightly (CA=79°) hydrophilized. The wettability of implant surfaces can be improved by UV irradiation. The efficiency of UV-A and UV-C irradiation to lower the CA by photocatalysis or photolysis, however, is strongly dependent on the specific material and surface. Thus, attempts to photofunctionalize these surfaces by irradiation is expected to result in a different pattern of bioresponses. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All
Tsegga, Tibebu; Wright, Thomas
Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obliterate the restorative space. Multiple surgical techniques have been described to address these dilemmas. The use of osteoperiosteal flaps has been described to address vertical height deficiencies. The purpose of this paper is to document and introduce a maxillary segmental osteoperiosteal flap intrusion to increase the restorative space with simultaneous dental implant placement. As with most dilemmas in treatment planning dental implants, multiple acceptable treatment options are available to the practitioner. This technique is another of many that can be added to the available options. When appropriately planned in select cases, this technique will result with ideal dental implant restorations without compromising the esthetic and functional harmony of the native dentition.
Tarica, Diane Yoshinobu; Alvarado, Veronica M; Truong, Samantha T
With conflicting results in the literature and various manufacturer recommendations, it is not known what cementation protocols are currently being used for implant restorations in US dental schools. The purpose of this survey was to determine what dental cementation protocols are taught and recommended by 62 US dental schools and postgraduate programs. From February to September 2008, 96 questionnaires consisting of 8 questions were sent to the chairperson or director of restorative departments, advanced prosthodontics programs, and implant programs. The questionnaire asked recipients which implant manufacturers provided the products used at their dental schools. Additionally, recipients were queried as to the choice of material and techniques for abutment and restoration preparations prior to definitive cementation. Data were analyzed with descriptive statistics. A total of 68 (71%) surveys were returned, and 52 (84%) of the 62 predoctoral and postgraduate programs were represented. After deleting duplicate responses, 31 surveys were returned from restorative department chairpersons, 29 from advanced prosthodontic program directors, and 2 from implant program directors. Frequency of responses to each question was tabulated, and results are presented in 3 sections. For all 3 types of programs, Nobel Biocare was reported to be the most widely used implant system, followed by Biomet 3i, Straumann, Astra Tech, and Zimmer Dental systems. The most commonly used technique prior to definitive cementation is to airborne-particle abrade the intaglio surface of the restoration. Resin-modified glass ionomer is the most frequently used luting agent for cementing implant restorations. The 5 most commonly used materials to fill screw access openings are cotton pellets, composite resin, rubber-based material, gutta-percha, and light-polymerized provisional composite resin. Most predoctoral and postgraduate programs teach students to fill the screw access opening completely to
Deeb, George R; Soung, George Y; Best, Al M; Laskin, Daniel M
Although various prophylactic systemic antibiotic regimens have been suggested to minimize failure after dental implant placement, the role of antibiotics in implant dentistry is still controversial. The purpose of the present survey was to determine the current antibiotic prescribing habits of oral and maxillofacial surgeons in conjunction with routine dental implant placement to determine whether any consensus has been reached among such practitioners. An electronic survey was sent by electronic mail to all members of the American College of Oral and Maxillofacial Surgeons. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. The survey participants were also asked to specify whether they were in solo private practice, group private practice, academia, military, or "other." The results were tabulated and analyzed using SAS software. Descriptive statistics and χ(2) analyses were used. A total of 217 members responded to the survey. Overall, 112 of 217 (51.6%) prescribed antibiotics preoperatively (95% confidence interval [CI] 50.0 to 58.2%) and 152 of 213 (71.4%) prescribed antibiotics postoperatively (95% CI 65.0 to 77.0%) during routine dental implant placement. Also, 72 (34%) indicated that they prescribed antibiotics both pre- and postoperatively. The most common preoperative regimen used was amoxicillin 2 g given 1 hour before the procedure (32%, n = 36). The most common postoperative regimen used was amoxicillin 500 mg 3 times daily for 5 days (53%, n = 81). We found no consensus among oral and maxillofacial surgeons regarding the use of antibiotics in association with routine dental implant placement, the type of regimen to use, or whether such use is even effective in preventing early implant loss. Furthermore, most of the antibiotic regimens being used are not in accordance with the
Chang, Yu-Chi; Ho, Kuo-Ning; Feng, Sheng-Wei; Huang, Haw-Ming; Chang, Chia-Hsun; Lin, Che-Tong; Teng, Nai-Chia; Pan, Yu Hwa; Chang, Wei-Jen
Modification of the physiochemical properties of titanium surfaces using glow discharge plasma (GDP) and fibronectin coating has been shown to enhance the surface hydrophilicity, surface roughness, cell adhesion, migration, and proliferation. This in vivo study aimed to evaluate the bone integration efficacy of a biologically modified implant surface. Two different surface-modified implants (Ar-GDP and GDP-fib) were placed in the mandibular premolar area of six beagle dogs for 2-8 weeks. Three techniques [histologic evaluation, resonance frequency analysis (RFA), and microcomputed tomography (micro-CT) evaluation] were used to detect the implant stability and bone-implant contact. The implant stability quotient values of GDP-fib implants were significantly greater than the Ar-GDP implants at 2 and 4 weeks (P < 0.01). The bone volume/total volume ratio of GDP-fib implants was greater than the Ar-GDP implants in micro-CT evaluation. A high positive correlation was observed between RFA and micro-CT measurements. At 2 weeks, osteoblasts were seen to line the implant surface, and multinuclear osteoclasts could be seen on the surface of old parent bone. After 8 weeks, a majority of the space in the wound chamber appeared to be replaced by bone. Enhancement of the stability of biologically modified implants was proved by the results of RFA, micro-CT, and histological analysis. This enhanced stability may help fasten treatment and be clinically beneficial.
Chang, Yu-Chi; Ho, Kuo-Ning; Feng, Sheng-Wei; Huang, Haw-Ming; Chang, Chia-Hsun; Lin, Che-Tong; Teng, Nai-Chia; Pan, Yu Hwa; Chang, Wei-Jen
Modification of the physiochemical properties of titanium surfaces using glow discharge plasma (GDP) and fibronectin coating has been shown to enhance the surface hydrophilicity, surface roughness, cell adhesion, migration, and proliferation. This in vivo study aimed to evaluate the bone integration efficacy of a biologically modified implant surface. Two different surface-modified implants (Ar-GDP and GDP-fib) were placed in the mandibular premolar area of six beagle dogs for 2–8 weeks. Three techniques [histologic evaluation, resonance frequency analysis (RFA), and microcomputed tomography (micro-CT) evaluation] were used to detect the implant stability and bone-implant contact. The implant stability quotient values of GDP-fib implants were significantly greater than the Ar-GDP implants at 2 and 4 weeks (P < 0.01). The bone volume/total volume ratio of GDP-fib implants was greater than the Ar-GDP implants in micro-CT evaluation. A high positive correlation was observed between RFA and micro-CT measurements. At 2 weeks, osteoblasts were seen to line the implant surface, and multinuclear osteoclasts could be seen on the surface of old parent bone. After 8 weeks, a majority of the space in the wound chamber appeared to be replaced by bone. Enhancement of the stability of biologically modified implants was proved by the results of RFA, micro-CT, and histological analysis. This enhanced stability may help fasten treatment and be clinically beneficial. PMID:27366739
Montoya-Carralero, José-Maria; Parra-Mino, Pablo; Ramírez-Fernández, Piedad; Morata-Murcia, Isabel Maria; Mompeán-Gambín, Maria del Carmen; Calvo-Guirado, José-Luis
Bisphosphonates inhibit bone resorption and are used to treat a range of pathologies, including Paget disease, osteoporosis, multiple myeloma and metastases associated with breast or prostate cancer. At present, there is no effective treatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Since quality of life deteriorates for those suffering osteonecrosis, maximum precautions should be taken with patients at risk, and especially whenever oral surgery, including dental implant placement, is contemplated. Dentists and oral or maxillofacial surgeons must keep up to date with the latest approaches to prevention, particularly when treating patients who are presently taking, or who will be taking bisphosphonates and are also candidates for dental implants.
Guttal, Satyabodh Shesharaj; Desai, Jhanvi; Kudva, Adarsh; Patil, Basavaraj R
Orbital defects can result from cancer, birth anomalies, or trauma leading to an onslaught of problems in the function and psyche of the patient. These defects are restored by surgical reconstruction and followed by placement of orbital prosthesis for cosmetic makeup. The use of dental implants in retaining orbital prosthesis improves patient a