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PubMed1998

An isolation and in vitro culturing method for human intraoral bone cells derived from dental implant preparation sites.

In dental implantology, the biocompatibility of the osseous tissue to the implant surface and to local environmental factors plays an important role in the process of healing. Bone cells derived from intraoral osseous tissue proves to be an important source of the osteoprogenitor cells required for healing of the periodontium around implants. Historically, the rat calvaria model has been employed to study the effects of various dental treatments on bone in vitro. However, there are morphological and functional differences which exist between bone cells derived from rat calvaria and human intraoral osseous tissue that impose certain limitations on the usefulness of the rat calvaria model for dental implant applications. Therefore, an in vitro culturing method for the isolation, growth and maintenance of human intraoral bone cell cultures derived from osseous tissues is truly warranted. In addition, a method for the accurate characterization of these bone cells as osteoblasts is also vital. The specific objective of this study was to establish isolation and in vitro culturing methods utilizing human intraoral bone cells derived from dental implant preparation sites. This paper describes techniques for the harvesting of human bone cells from the intraoral derived osseous tissues and discuss the procedures for maintaining the primary intraoral bone cell culture. In addition, our studies utilize established protocols for the characterization of these cells as osteoblasts by means of alkaline phosphatase activity determination, identification of cellular osteonectin and osteocalcin antigens, establishing the presence of cells expressing type I collagen and determining the ability of cells to produce calcifications. The utilization of intraoral osseous tissue may prove useful for future dental implant research by providing an in vitro model system more closely related to conditions encountered clinically.

Adult↗
PubMedDate not supplied

The cost of dental implants as compared to that of conventional strategies.

The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy, such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are vital in decision making. This paper compares the costs of different treatment strategies in a randomized clinical trial in patients with resorbed mandibles and persistent problems with their conventional dentures: treatment with a mandibular overdenture on permucosal dental implants, an overdenture on a transmandibular implant, new dentures after preprosthetic surgery, and new dentures only. Data were gathered on an individual patient level to gain insight into specific cost episodes. Direct costs were subdivided into labor, material, technique, and overhead. Data concerning these components were gathered during the consecutive treatment phases in the first year. Results show that the resources used to treat a patient with an overdenture supported by a transmandibular implant are seven times those of a complete new set of dentures. Comparison of the cost ratio of an implant-retained overdenture supported by permucosal implants and conventional new prostheses proves less unfavorable: 1:3. New dentures after preprosthetic surgery are almost as expensive as treatment with permucosal implants.

Analysis of Variance↗
PubMed2026

The use of diode laser and scalpel blade in stage-two dental implant surgery: a comparative study.

OBJECTIVE: The use of lasers in dental implant procedures raises questions regarding the preservation of keratinized tissues and implant outcomes. This study aimed to compare the clinical effects (pain and impression time) and soft tissue healing (keratinization, peri-implant probing, bleeding, and healing) of diode lasers and scalpels used during stage-two dental implant surgery. METHOD AND MATERIALS: A prospective randomized clinical trial with a 1:1 allocation ratio was conducted. The study included 30 patients, each with a single, fully osseointegrated implant. Patients were categorized into two groups. The study group underwent stage-two implant surgery using a 970-nm diode laser. In the control group, implants were exposed using a conventional surgical blade. A comparison between the diode laser and conventional scalpel groups was made based on clinical outcomes (pain and impression time) and soft tissue healing (keratinization, peri-implant probing, bleeding, and healing). Data were analyzed using a paired t test. RESULTS: Pain intensity significantly decreased from immediate postoperative to 7 days in both scalpel (49.87 ± 6.78, t = 28.48, df = 14, P .001) and diode laser (7.67 ± 7.58, t = 3.91, df = 14, P = .002) groups. Immediately after surgery, pain scores were significantly higher in the scalpel group compared with the diode laser group (94.53 ± 4.45 vs 46.93 ± 5.85, t = 25.076, df = 26.151, P .001). Although pain decreased in both groups by day 7, the scalpel group continued to exhibit significantly greater pain (44.67 ± 5.96 vs 39.27 ± 3.73, t = 2.974, df = 23.513, P = .007). Impression time (P = .231) and gingival keratinized tissue (P = .736) did not differ significantly between the scalpel and diode laser approaches. At week 6, the scalpel group exhibited a significantly higher mean peri-implant bleeding index (2.60 ± 0.507) compared with the laser group (0.07 ± 0.258, P .001). However, after 12 weeks, no significant difference was observed (1.58 ± 0.19 vs 1.55 ± 0.21, P = .748). Laser surgery produced significantly better early wound healing at all intervals (P .001), while intraoperative bleeding was more common with the scalpel technique than with the diode laser (100.0% vs 66.7%, P = .042). CONCLUSION: Compared with the scalpel method, the diode laser method resulted in a significant reduction in pain intensity, improved wound healing, and less peri-implant bleeding during the stage-two dental implant surgery.

Humans↗
PubMed2000

Can implants be correctly angulated based on surgical templates used for osseointegrated dental implants?

When placing osseointegrated dental implants, the site, angulation and depth of implants can be designed using a computed tomography (CT) or conventional X-ray tomography. To correctly identify placement pre-surgically, various kinds of surgical templates have been proposed. Although it is thought to be important to use templates, no material has been published on their accuracy. The purpose of this study was to propose a method for evaluating the placement accuracy using a specific surgical template. Twenty-one implants were evaluated in 6 patients with mean age of 50.7 years. All implants were implanted by two step surgery in the posterior mandible. A surgical template based on the CT images and the abutment replica on the working models were used for the evaluation of the accuracy of implant placement. The difference between the proposed and actual directions was measured by a milling machine. The difference in the angles between the proposed direction and actual direction were from 0.5 degrees to 14.5 degrees. The average was 5.0 degrees, and there were 12 implants (57%) within 5.0 degrees. This study demonstrated the accuracy of the template described in this article.

Dental Implantation, Endosseous↗
PubMed2001

Augmentation of alveolar bone and dental implant osseointegration: clinical implications of studies with rhBMP-2.

BACKGROUND: The surgical placement of dental implants is governed primarily by the prosthetic design and secondarily by the morphology and quality of the alveolar bone. Implant placement may be difficult, if at all possible, due to alveolar ridge aberrations. In consequence, prosthetically dictated dental implant positioning often entails augmentation of the alveolar ridge and adjacent structures. The objective of this review is to discuss recent observations of the biologic potential, the clinical relevance, and the perspectives of the application of recombinant human bone morphogenetic protein-2 (rhBMP-2) technology for alveolar bone augmentation and dental implant fixation. METHODS: Our studies use discriminating, critical-size, supraalveolar defects in dogs to evaluate the biologic potential of the rhBMP-2 technology. We also use clinical modeling, including peri-implantitis and alveolar ridge defects and the maxillary sinus in preparation for clinical indications, in dogs and inhuman primates. RESULTS: The results suggest that rhBMP-2 has substantial potential to augment alveolar bone and support dental implant fixation and functional loading. CONCLUSION AND CLINICAL RELEVANCE: Inclusion of rhBMP-2 for alveolar bone augmentation and dental implant fixation will not only enhance the predictability of the existing clinical protocol but will also allow new approaches to these procedures.

Alveolar Bone Loss↗
PubMed1998

Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction.

Finite element analysis (FEA) has been proven to be a precise and applicable method for evaluating dental implant systems. By means of FEA, a parasaggital model was digitized from a computed tomography (CT)-generated patient data set, and various single-tooth, osseointegrated, two-dimensional dental implant models were simulated. The specific aims of the study were to: (1) examine the effect of implant diameter variation (3.8 mm-6.5 mm) of both a press-fit, stepped cylindrical implant type and a press-fit, straight cylindrical implant type as osseointegrated in the posterior mandible; (2) compare the stress-dissipating characteristics of the stepped implant versus the straight implant design; and (3) analyze the significance of bite force direction (vertical, horizontal, and oblique 45 degrees) on both implant types. The results of the FEA suggested that (1) using the widest diameter implant is not necessarily the best choice when considering stress distribution to surrounding bone, but within certain morphological limits, for both implant types, an optimum dental implant exists for decreasing the stress magnitudes at the bone-implant interface; (2) stress is more evenly dissipated throughout the stepped cylindrical implant when compared to the straight implant type; and (3) it is important in FEA of dental implants to consider not only axial forces (vertical loading) and horizontal forces (moment-causing loads), but also to consider a combined load (oblique bite force), since these are more realistic bite directions and for a given force will cause the highest localized stress in cortical bone. The theoretical analysis performed implies that clinically, whenever possible, an optimum, not necessarily larger, dental implant should be used based on the specific morphological limitations of the mandible and that a stepped cylindrical design for press-fit situations is most desirable from the standpoint of stress distribution to surrounding bone.

Alveolar Process↗
PubMed2002

The immediate dental implant.

Numerous clinical studies have shown that dental implants can be placed immediately in extraction sockets with success when sites are carefully selected. Dental implants have been placed at the time of extraction with a variety of techniques. All the techniques report survival rates of 94 percent to 100 percent over a varied healing period of three months to approximately seven years. this article will review clinical criteria for determining patient selection for immediate implants and the advantages and disadvantages of immediate implant placement.

Dental Implantation, Endosseous↗
PubMed1992

Immediate placement of osseointegrated dental implants into extraction sockets: advantages and case reports.

Osseointegrated dental implants have proven to be predictably successful when appropriate guidelines are followed. The technique as outlined by bränemark includes a post-extraction period of up to 12 months in order to allow for bone healing. This delay, combined with ridge resorption following extraction, may contribute to several problems. Insufficient available bone for ideal implant placement and prolonged treatment time are two common difficulties. Recently, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results while, at the same time, minimizing or eliminating the above-mentioned difficulties. This paper will discuss the technique of immediate placement of osseointegrated dental implants into extraction sockets and its potential advantages. A future article will detail surgically-related difficulties with this technique.

Alveolar Bone Loss↗
PubMed2000

Dental implantation for restoration of posttraumatic deformities: avulsion injuries.

Soft and hard tissue defects of the cranio- and maxillofacial area, especially after an avulsion injury, are challenging to reconstruct. Sophisticated soft and hard tissue transfer techniques have allowed satisfactory reconstruction of the gross anatomic structure. However, these methods do not allow optimal restoration of fine anatomic detail or function. The advent of dental implants and modified dental implants for craniofacial applications has allowed maximization of cosmetic and functional restoration. Prosthodontists are capable of fabricating subunits of the cranio- and maxillofacial area with fine detail, reproducing the coloring, texture, and idiosyncrasies of a patient's native skin. Dental implant technology has allowed these prostheses to be bone anchored, yielding a reproducible and stable attachment. This method of attachment in turn allows flexibility in the design of the prosthesis, to maximize restoration, and imparts an increased sense of confidence to the patient. Illustrated are six examples demonstrating the versatility of dental implants in the reconstruction of avulsion injuries of the cranio- and maxillofacial complex.

Alveolar Process↗
PubMed1989

[Prosthetic rehabilitation with the removable partial dentures using telescopic crowns after removal of unsuccessful dental implants].

It is well-known that unsuccessful dental implants sometimes give rise to pronounced inflammatory bone resorption of the upper and lower jaw, and that in such cases it is practically much difficult to attain adequate prosthodontic rehabilitation after removal of the implants. On this study it is completely reported that two patients suffering from implant-induced osteomyelitis could be finely compensated for with the removable partial dentures using telescopic crowns after removal of the implants, and then the results are shortly discussed from the view of pathology, oral surgery and prosthodontics. In the first case a 52-year-old woman had been suffering from osteomyelitis of the right mandible due to the both bladevent and endodontic-endosseous implant, and in another case a 43-year-old woman had been suffering from osteomyelitis of the right maxilla due to the endosseous subperiosteal implant, and they had borne insufficient mastication on the affected side of the jaws. Several months after removal of the unsuccessful dental implants, they were rehabilitated with the removable partial dentures using telescopic crowns to recover and maintain good functions such as occlusion, mastication, cosmetics and speech, and oral and general health.

Adult↗
PubMed1996

The development of the ITI Dental Implant System as a model for the cooperation between research and industry.

For thirty years now oral implants and methods for implantation have been developed further to assure a lifetime stability of these devices and to optimize function and esthetics. Coming from osteosynthesis the Institut Straumann in cooperation with leading clinicians had a considerable share in this development. Out of this longtime cooperation an institutionalized form was devised, where clinicians, material scientists and engineers were united in the International Team for oral Implantology (ITI). This scientific organization, although legally and financially independent from Institut Straumann, works in close cooperation with the company in an unique form of symbiosis. The ITI takes care of research and education of clinicians and practitioners and it gives the needed input for the development of new products to the Institut Straumann as its exclusive licensee. The company again pays license fees to the ITI Foundation enabling thus a continuous scientific clinical research. Over many years a whole philosophy and implant system - the ITI Dental Implant System - was developed this way with its sound scientific background.

Cooperative Behavior↗
PubMed2005

Resonance frequency analysis of one-stage dental implant stability during the osseointegration period.

BACKGROUND: Currently, there is no available clinical tool to evaluate the amount of osseointegration and stability around dental implants. It has been recently suggested that changes in the stiffness of an implant in bone during healing may be monitored by using resonance frequency analysis (RFA). The aim of this study was to determine whether RFA can be integrated into the routine clinical evaluation of initial healing of dental implants. METHODS: Thirty-one patients (18 female and 13 male; mean age of 51.7 years) were included into this study. A total of 122 implants and three different, but comparable, implant designs were evaluated by using RFA. The specific transducer for each implant system was used. ISQ (implant stability quotient) readings were obtained for each implant at the time of surgery, 3 and 6 weeks postoperatively, and at the time of loading (3 or 6 months following surgery). Data were analyzed for different healing times, various anatomical locations, implant length, and type. Average time in function was 12 months. RESULTS: Two implants failed during healing. Implant stability was higher on the mandible compared to the maxilla for each implant system studied (Mann-Whitney test, P <0.01). ISQ readings decreased significantly at 3 and 6 weeks post-surgery compared to readings obtained at surgery (Wilcoxon matched pairs sign-rank tests, P <0.01). A recovery to the initial ISQ levels was noted at the time of implant loading. The possible effects of different types and lengths of implants to ISQ readings were examined. CONCLUSIONS: Results of this study support the need for a clinical tool to evaluate dental implant stability prior to loading, especially for implants placed in the maxilla. It appears that implant stability is weakest at 3 to 6 weeks in one-stage non-loaded dental implants. ISQ readings can be used to determine different healing phases and the stability of dental implants. However, it is difficult to define a general standardized range of ISQ readings for successful implant integration for various implant systems. Thus, RFA values/ISQ levels should be calibrated for each implant system separately. Further studies are needed to compare the early changes seen in immediately loaded dental implants and to determine whether there is any time in which the total recovery in ISQ levels may occur.

Dental Implantation, Endosseous↗
PubMed1997

Dental implants and the geriatric patient.

Dental care of the aging patient presents a number of problems not encountered in younger patients. Most of these problems result from tissue changes that occur during aging. Dental implants and implant-retained and/or implant-supported prostheses are viable treatment options for older patients. The majority of elderly patients in their younger retirement years are relatively healthy and not limited in activity. The clinician must be aware of the physical, metabolic, and endocrine changes associated with aging and how these changes may affect implant treatment. The elderly deserve the best care the dental profession can offer.

Aged↗
PubMed2006

Dental implant treatment for patients with psychiatric disorders.

The literature with respect to whether or not psychiatric disorders represent a contraindication to dental implant treatment is sparse and contradictory. This paper describes three cases in which patients with psychiatric disorders were provided with dental implant retained prostheses. It is concluded that mental health disorders are not necessarily a contraindication to dental implant treatment and dental implant treatment can provide valuable psychological support. If any doubt exists about the effect of a psychiatric disorder on the prognosis of implant treatment the opinion of a psychiatrist should be obtained. The development of liaison psychiatry for dental hospitals should be seen as an ideal.

Aged↗
PubMed1996

[Cost-effectiveness analysis of dental implants].

In this article the cost-effectiveness of dental implants (rootform and transmandibular) is compared with making complete dentures combined with vestibuloplasty and just a set of new dentures. The cost components of labour and technique are analysed at the individual patient level. Effectiveness was measured using a ratio scale. Several assumptions for the long run effectiveness of the treatment options are necessary due to lack of information about this in the literature. Assumptions were made regarding: survival rate, life span of dental implants and complete dentures, costs of aftercare and development of oral health in the long run. The main conclusion is that overdentures on rootform implants are superior to complete dentures combined with preprosthetic surgery or overdentures on a transmandibular implant. The choice between treatment with rootform implants or just a new set of dentures is a more difficult matter.

Cost-Benefit Analysis↗