[Results after sagittal incision of the mandible and simultaneous maxillary osteotomy using the authors' own method].
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Biomedical subjects
Publications and source records attributed to F Sutter.
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The animal experimental methods as well as the clinical application in patients and histological results of a new reconstruction plate for use in bridging defects in the lower jaw are discussed. The principles of fixation of the plate with hollow titanium powder sprayed screws and a titanium mesh for stabilising the autologous cancellous bone are also given. Resection was carried out in irradiated and non-irradiated mandibles of dogs. The direct contact between the surface of the screw and the bone as well as proliferation of bone into the hollow screw are demonstrated by light and scanning electron microscope studies. New methods for the evaluation of the interface between implant and bone are described.
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The results of a research project which has been under way for the last 7 years are reported. The project has been centred around a series of animal (monkey) experiments designed to test the suitability of cylindrical titanium implants with titanium-sprayed surfaces. The following results have been obtained: 1. The bone applies itself "ankylotically" (i.e. without an intervening layer of connective tissue) to the surface of the implant and, as revealed by observation over periods of up to 1 3/4 years, even remains attached to the implant surface when placed under load. 2. The fibres of the connective tissue between the bone and the epithelium insert into the titanium-sprayed surface and appear to be functionally orientated. 3. If the post of the implant is situated in a region of immobile, keratinized mucosa signs of adhesion of the epithelial cells to the titanium-sprayed surface become apparent. 4. The clinical success of the implant is clearly dependent on (a) the presence of tethered, immobile mucosa ("gingiva") around the post of the implant, and (b) perfect oral hygiene.
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Hollow cylinder implants of titanium with a titanium spray surface were implanted in macaca speciosa, as previously described (Schweiz.Mschr.Zahnheilk.86: 713, 1976). This time, however, the implants were submitted to masticatory forces. Histologically it can be shown that the ankylotic contact between implant and bone, which is initially obtained, remains after 6-16 months. In one case the substance encasing the implant at its deepest part was identified as genuine osteocementum.
A new implant consisting of a hollow cylinder of titanium is described. It is well suited to investigate the tissue reaction to several surface textures in the animal experiment (Macaca speciosa). From a test series, for which the implants were surfaced with powdered titan (titan plasma), one was selected which had been worn for 7 months as a partial support. The solid incorporation observed radiologically presents itself, light microscopically, as an immediate growing in of the bone into the rough implant surface. There is no evidence of the formation of a soft tissue bed. Electron microscope pictures reveal that the bone closely anchored to the titan plasma surface.
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Removal of implants is performed in cases of irreversible implant failure and in patients having psychological problems with implants. The explantation procedure can be complicated in some situations. In the present article, techniques of explantation and some related considerations are presented.
Limited bone height restricts the use of long dental implants, so short implants may be selected in these situations. Recent reports on clinical results with short implants have been negative, however, and have suggested that indications for the use of these implants are limited. To verify these findings, a multicenter study of short ITI implants was carried out. In a 6-year period 253 short implants with a length of 6 mm were placed into 126 patients, who were followed up from 1 to 7 years. Altogether 7 implants were removed; 6 of these were located in the maxilla and 1 in the mandible. The quality of survival was comparable with the clinical results of longer implants from the same implant system. Although the clinical results of these short implants were favorable, it is recommended that they be used in combination with longer implants, especially when used in the less dense bone that is often seen in the maxilla.