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PubMed1989

Ultrastructure of the peri-implant junctional epithelium on single-crystal sapphire endosseous dental implant loaded with functional stress.

To elucidate the ultrastructure of peri-implant junctional epithelium (IJE) on single-crystal sapphire dental implants connected to the adjacent teeth by a metal superstructure, the peri-implant gingivae of ten monkeys were examined using a transmission electron microscope (TEM) at 3, 6 and 12 months after implant insertion. At the time of examination, the ultrastructural features of the IJE were almost identical to those of junctional epithelium (JE) attached to natural teeth, i.e. developed Golgi complexes, rough-surfaced endoplasmic reticulum, numerous free ribosomes and mitochondria. The innermost cells of IJE were attached to the implant surface by means of basal lamina-like structures (500-1000 A in thickness) and hemidesmosomes, but lacked a dental cuticle as seen on teeth. Such epithelial attachment of the IJE was often indistinct or absent at the apical portion of the IJE which terminated at the level of alveolar crest. A continuous basal lamina-like structure was also present along basal cells at the interface between the IJE and gingival connective tissue except at its apical portion.

Aluminum↗
PubMedDate not supplied

Success or failure of dental implants? A literature review with treatment considerations.

This study reviews the literature concerning the success or failure of dental implants and provides the general dentist with information to decide whether to recommend dental implant therapy to a patient. The authors conducted an extensive literature search for articles relating to dental implant failure. Metaanalyses and multi-center studies were predominant in the selection. Predictors of dental implant success or failure were gleaned from various articles and presented in the form of text and tables. The main predictors for implant success are the quantity and quality of bone, the patient's age, the dentist's experience, location of implant placement, length of the implant, axial loading, and oral hygiene maintenance. Primary predictors of implant failure are poor bone quality, chronic periodontitis, systemic diseases, smoking, unresolved caries or infection, advanced age, implant location, short implants, acentric loading, an inadequate number of implants, parafunctional habits and absence/loss of implant integration with hard and soft tissues. Inappropriate prosthesis design also may contribute to implant failure.

Age Factors↗
PubMed1995

Histologic observations of bone remodeling adjacent to endosteal dental implants.

To examine bone morphology associated with endosteal dental implants at various time intervals, we inserted 20 one-stage and 20 two-stage titanium blade implants and 20 one-stage and 20 two-stage titanium root-form implants into 30 dog mandibles. Sixteen implants in 6 control (c) dogs (in situ five months) did not receive bridgework. Sixty-four implants in 24 dogs supported bridges for six, 12, 18, or 24 months. The entire area of the mandible containing the implants was examined by routine light and Nomarski differential interference microscopy (NM) for bone morphology (including osteon orientation) at the implant surface and at regions away from the implant. Control root-form implants were apposed by woven bone, with homogenous compact bone in the cortical plate distant to the implant. After 6 mo of load, immature bone was predominant apposing the implant, but initial osteonal maturation was apparent. NM clearly demonstrated the interstitial and concentric lamellae of the bone. Surprisingly, compact bone formed internal to the cortical plate, an area where trabecular bone is expected. At later periods of load, more mature osteons were seen apposing the implants; however remodeling events were still apparent. These remodeling events extend further away from the implant than was expected if the events resulted only from surgical repair. Also, when the implant inclined so that half was totally in the cortical plate and half in the marrow (in trabecular patterns), osteonal bone appeared to remodel in both areas. Control blade implants and blades loaded for six months were apposed by immature osteons when the implant was placed into the cortical plate. A trabecular meshwork was inferior to the osteonal bone. At 12 mo of load, the bone internal to the cortical plate appeared similar to the lamina dura supporting teeth; however, no PDL existed; the lamina-dura-like pattern directly apposed the implant. Even after 24 mo of load, extensive bone remodeling was apparent adjacent to the implant, markedly different from the bone making up the existing cortical plate. From these data, remodeling activities to blade implants may involve the development of a lamina-dura-like bone morphology after longer periods of load. Osteonal bone was apparent, but only at regions where the implant was inserted into the cortical plate. Further, bone remodeling was apparent even after long periods of load.

Alveolar Process↗
PubMed2003

Quality of dental implants.

BACKGROUND: Clinicians need quality research data to decide which dental implant should be selected for patient treatment. AIM(S)/OBJECTIVE(S): To present the scientific evidence for claims of relationship between characteristics of dental implants and clinical performance. STUDY DESIGN: Systematic search of promotional material and Internet sites to find claims of implant superiority related to specific characteristics of the implant, and of the dental research literature to find scientific support for the claims. MAIN OUTCOME MEASURES: Critical appraisal of the research documentation to establish the scientific external and internal validity as a basis for the likelihood of reported treatment outcomes as a function of implant characteristics. RESULTS: More than 220 implant brands have been identified, produced by about 80 manufacturers. The implants are made from different materials, undergo different surface treatments and come in different shapes, lengths, widths and forms. The dentist can in theory choose among more than 2,000 implants in a given patient treatment situation. Implants made from titanium and titanium alloys appear to perform well clinically in properly surgically prepared bone, regardless of small variations of shapes and forms. Various surface treatments are currently being developed to improve the capacity of a more rapid anchorage of the implant into bone. A substantial number of claims made by different manufacturers on alleged superiority due to design characteristics are not based on sound and long-term clinical scientific research. Implants are, in some parts of the world, manufactured and sold with no demonstration of adherence to any international standards. CONCLUSIONS: The scientific literature does not provide any clear directives to claims of alleged benefits of specific morphological characteristics of dental implants.

Clinical Trials as Topic↗
PubMed2006

An analysis of peripheral giant cell granuloma associated with dental implant treatment.

This report discusses the management of a 21-year-old male who developed a peripheral giant cell granuloma (PGCG) associated with dental implant therapy, and reviews 4 previously reported cases of PGCGs developing in association with dental implant treatment. The patient described in this report was treated with multiple dental implants to manage severe oligodontia. Six years after implant placement, with the patient lost to follow-up, he presented to his dentist complaining of increasing swelling in the right mandibular vestibule. The patient was noted to have a large exophytic, ovoid-shaped, firm, smooth-surfaced, maroon-colored lesion. The lesion was found to be a PGCG associated with a dental implant. The lesion was treated successfully by explantation of the dental implant, complete excision of the lesion, and curettage of the underlying bony defect. No evidence of recurrence was seen over 12 months of follow-up.

Adult↗
PubMedDate not supplied

Physico-chemical characterization of the surface of 9 dental implants with 3 different surface treatments.

UNLABELLED: There are many surface treatments applied to dental implants. The aim of the present investigation is to compare the physicochemical characteristics of titanium dental implant surfaces with different surface treatments. 9 dental implants from the same batch were divided in 3 groups and received 3 different surface treatments: machined, acid etched and a new chemical surface treatment called Avantblast. Scanning electron microscopy and confocal microscopy were used to image the treated surfaces, and energy-dispersive spectrometry and X-ray photoelectron spectrometry to provide a chemical characterization of the surfaces. RESULTS: The acid etched and chemical etched surfaces had an increased roughness over the machined one. Surface chemical composition had differences between processes, as the surface with the new treatment presented a reduced level of impurities and increased thickness of the titanium oxide layer. CONCLUSIONS: Surface roughness of titanium dental implants and thickness of the titanium oxide layer can be increased with a suitable surface treatment.

Dental Implants↗
PubMed1995

The effect of electrical perturbation on osseointegration of titanium dental implants: a preliminary study.

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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.

Animals↗
PubMed2000

Measurements comparing the initial stability of five designs of dental implants: a human cadaver study.

BACKGROUND: A number of different dental implant designs are currently in clinical use. A successful outcome of implant placement is thought, at least in part, to be due to the primary stability of an implant after placement. Few data are available for comparing the primary stability characteristics of different implant designs. PURPOSE: This investigation compared the primary stability of five types of endosseous dental implant of varying geometry and surface topography. MATERIALS AND METHODS: Comparison was made between a standard threaded commercially pure titanium implant (Nobel Biocare AB, Göteborg, Sweden), the Mark II self-tapping implant (Nobel Biocare AB, Göteborg, Sweden), the Mark IV tapered self-tapping implant (Nobel Biocare AB, Göteborg, Sweden), the Astra Tioblast (AstraTech AB, Mölndahl, Sweden), and the 3i Osseotite (3I [Implant Innovations Incorporated], Palm Beach, Florida, USA). Fifty-two fixtures were placed in the maxillary bone of nine unembalmed human cadavers. Implant stability as a function of peak insertion torque and resonance frequency values was recorded for each fixture site after placement. Removal torque was also measured 1-hour postinsertion. Assessment of bone quality at each site was made. RESULTS: All of the implants tested demonstrated good primary stability in type 2 and 3 bone. The Standard, Mark II, Osseotite, and Tioblast were less stable when placed into bone type 4. The Mark IV implants appeared to maintain a high primary stability even in Type 4 bone. CONCLUSION: When looking across all bone qualities, the Mark IV implant develops a significantly higher insertion torque than the Standard, Mark II, and Osseotite implant types, and a significantly higher resonance frequency value than the Standard implant, indicating a higher interfacial stiffness at the implant-bone interface.

Aged↗
PubMed2002

Long-term changes in soft tissue height on the facial surface of dental implants.

The success of osseous healing around dental implants has allowed for an increased emphasis on soft tissue healing and esthetic results. However, there is limited information profiling the long-term healing of the soft tissues following prosthesis placement. The purpose of this study was to assess the long-term changes in the position of the facial soft tissue margins following restoration of a one-stage implant system. One hundred and six one-stage ITI implants were evaluated in 39 patients. Implants were placed in maxillary and mandibular anterior regions. Clinical assessment of the soft tissues on the midfacial aspect of the implants was performed over a 2-year period, at 3 and 6 month intervals, following placement of the final restoration. A total of 63 implants were placed as multiple units in the mandible, 23 as single units in the maxilla, and 20 as multiple units in the maxilla. There were no implant failures over this time period. Overall, on the facial aspect of 61% of the 106 implants there was 1 mm or more of soft tissue recession, whereas 19% of the implants showed 1 mm or more of gain in soft tissue height. There was a significantly (P < 0.01) greater number of implants showing a gain in soft tissue levels in the mandibular implants compared with the maxillary implants. Of the 39 patients assessed, 24 showed a loss and five showed a gain of 1 mm or more of the soft tissue levels around the implants. Overall, there was a significant decrease in the mean levels of tissue height of 0.6 mm within the first 6 months, with relatively little change afterward. However, in evaluating only patients showing a loss in tissue height around one or more implants, the mean loss in tissue height was 1.6 mm after 24 months. These results suggest that the potential for significant changes in soft tissue levels after completion of restorative therapy need to be considered for implant therapy in esthetic areas.

Adolescent↗
PubMed2006

[Clinical study of immediate placement and early loading of dental implants].

OBJECTIVE: To evaluate the clinical results of immediate placement and early loading of dental implants. METHODS: Sixty-four dental implants were inserted into the edentulous section of 37 patients immediately after the teeth were extracted. 36 implants were inserted by one-stage operation procedure, of which 17 implants were loaded immediately in 3 edentulous jaws by temporary mandibular overdenture. Fixed crown restoration were completed on 14 implants in 1 - 2 months and on 22 implants in 3 - 4 months. The two-stage operation for another 28 implants were performed after 3 - 6 months and then were restored by routine methods. RESULTS: All implants were inserted successfully and stable. There was no peri-implantitis and X-ray films indicated that no remarkable bone resorption occurred. There were no significant differences in the peri-implant depths of gingival pocket between early loading implants and routine restoration. CONCLUSIONS: Dental immediate implant and early loading after implantation can shorten the treatment period of implant-supported prosthesis. The short-term clinical performance was not different from the routine method.

Adolescent↗
PubMedDate not supplied

Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

The zygomaticus dental implant, designed by Nobel Biocare for the Brånemark System, is indicated primarily for the severely resorbed maxilla. Though the zygomaticus implant has had a remarkable success rate in a very difficult patient population, there are some shortcomings to the protocol for placement. The sinus slot technique described herein provides a simplified approach to zygomaticus implant placement, as compared to the currently recommended protocol.

Bone Resorption↗
PubMed1996

Thresholds for tactile sensitivity perceived with dental implants remain unchanged during a healing phase of 3 months.

The aim of the present study was to determine the tactile pressure thresholds perceived with dental implants during a three-month healing phase following implant placement (osseointegration phase). The absolute threshold of tactile perception was measured in a group of patients 1 week, 1, 2 and 3 months following implant placement (ITI Dental Implant System, Straumann AG, Waldenburg, Switzerland). Contralateral and neighbouring teeth were measured at the same time. For determination of the axial forces exerted on the implants and teeth, and electronic device with semi-conductor strain gauges was used (Hämmerle et al. 1995). The results demonstrated mean thresholds of tactile perception for the implants of 160.2 g (SD 61.7 g, range 77 approximately 283 g) at 1 week, 133.4 g (SD 51.9 g, range 32 approximately 239 g) at 1 month, 147.9 g (SD 53.5 g, range 70 approximately 257 g) at 2 months, and 146.9 g (SD 57.4 g, range 77 approximately 248 g) at 3 months. Statistical analysis using Student's paired t-test revealed no significant differences between the values over time. The control teeth exhibited mean values for tactile perception of 13.1 g (SD 9.6 g, range 5 approximately 47 g) at 1 week, 10.2 g (SD 6.4 g, range 4 approximately 29 g) at 1 month, 14.8 g (SD 15.9 g, range 2 approximately 58 g) at 2 months, and 15.4 g (SD 12.2 g, range 3 approximately 36 g) at 3 months. Again, these values did not differ significantly from each other and indicated the absence of systemic alterations in perceived pressure threshold over the observation period. The mean perceived pressure threshold was more than 10 times higher for implants than for natural teeth (P < 0.001) at all observation times. It is concluded that the absolute threshold of tactile perception with dental implants during the phase of osseointegration is not affected by bone and soft tissue healing taking place during the time period.

Adult↗
PubMed2002

Radiographic identification of threaded endosseous dental implants.

STATEMENT OF PROBLEM: The identification of dental implant bodies in patients without available records is a considerable problem due to increased patient mobility and to the large number of implant systems with different designs. PURPOSE: The purpose of this study was to document features that would help dentists identify threaded implant bodies from their radiographic images. MATERIAL AND METHODS: More than 50 implant manufacturers were contacted and asked to provide implants with dimensions as close as possible to 3.75 mm (diameter) x 10 mm (length). Forty-four implants were donated, 28 of which were identified as threaded. Radiographs were made of these implants at 0 degrees, 30 degrees, 60 degrees, and 90 degrees horizontal rotation combined with -20 degrees, -10 degrees, 0 degrees, +10 degrees, and +20 degrees vertical inclination relative to the radiographic beam and film. A total of 20 images per implant were taken and examined to identify consistent, unique features that would aid in implant identification. At a 20 degrees vertical inclination, vital features of implants were distorted enough to be deemed unrecognizable. Therefore, only those observations made from radiographs between -10 degrees and +10 degrees vertical inclination were used for implant identification purposes. RESULTS: All implants could be recognized from radiographs made between -10 degrees and +10 degrees vertical inclination. A series of tables and flowcharts describe the implants according to their identifying features. CONCLUSION: Information from this study should help dentists identify threaded endosseous implants from their radiographic images.

Dental Implantation, Endosseous↗
PubMed2002

Radiographic identification of nonthreaded endosseous dental implants.

STATEMENT OF PROBLEM: The identification of dental implant bodies in patients without available records is a considerable problem due to increased patient mobility and to the large number of implant systems with different designs. PURPOSE: The purpose of this study was to document features that would help dentists identify non-threaded implant bodies from their radiographic images. MATERIAL AND METHODS: More than 50 implant manufacturers were contacted and asked to provide implants with dimensions as close as possible to 3.75 mm (diameter) x 10 mm (length). Forty-four implants were donated, 16 of which were identified as non-threaded. Radiographs were made of these implants at 0 degrees, 30 degrees, 60 degrees, and 90 degrees horizontal rotation combined with -20 degrees, -10 degrees, 0 degrees, +10 degrees, and +20 degrees vertical inclination relative to the radiographic beam and film. A total of 20 images per implant were taken and examined to identify consistent, unique features that would aid in implant identification. At a 20 degrees vertical inclination, vital features of implants were distorted enough to be deemed unrecognizable. Therefore, only those observations made from radiographs between -10 degrees and +10 degrees vertical inclination were used for implant identification purposes. RESULTS: All implants could be recognized from radiographs made between -10 degrees and +10 degrees vertical inclination. A series of tables and flowcharts describe the implants according to their identifying features. CONCLUSION: Information from this study should help dentists identify non-threaded endosseous implants from their radiographic images.

Dental Implantation, Endosseous↗
PubMed2002

Bone mineral density measurement with dental quantitative CT prior to dental implant placement in cadaver mandibles: pilot study.

PURPOSE: To correlate torque forces during insertion of screw-type dental implants with bone mineral density (BMD) values determined preoperatively. MATERIALS AND METHODS: Dental quantitative computed tomography (CT) was performed with simultaneous imaging of five postmortem mandibles and a calibration standard containing defined concentrations of calcium hydroxyapatite. CT numbers were converted to local BMD values by assuming a linear relationship (BMD = a x HU + b), where a and b are calibration coefficients. The a, b, P, and t values, correlation coefficients, and standard errors were calculated. Dental implants (n = 25) were set, and insertion torques were recorded. BMD was determined at the implantation site and correlated with torque forces recorded during implant insertion. Calibration coefficients derived for specimens were compared with those derived for actual patients. RESULTS: Calibration coefficients (at 120 kV) for the postmortem specimens were a = 0.760 +/- 0.03 (mean +/- SD) and b = 2.8 +/- 3.7 and for the patients were a = 0.804 +/- 0.06 and b = 5.2 +/- 4.2. Calibrated BMD values at the location of dental implants exhibit a significant correlation (R(2) = 0.83, P <.001) with insertion torques on the basis of a second-order model, which yields torque = (0.0055 x BMD + 0.73)(2) for the implants used and the surgical technique applied. CONCLUSION: Correlation exists between BMD measured with dental quantitative CT and the insertion torque of dental implants.

Bone Density↗
PubMed1989

[Histological investigation of improvement of mandibular atrophy for application of hydroxyapatite dental implant].

UNLABELLED: The purpose of this study was to investigate the possibility of applying the hydroxyapatite dental implant to the atrophic mandible after alveolar ridge augmentation using hydroxyapatite granules. The lower P3, P4 and M1 of 3 mongrel dogs were extracted. At 30 weeks, alveolar ridge augmentation was performed with porous hydroxyapatite granules. Sixteen weeks later, hydroxyapatite dental implants were applied to the area. And 4 weeks later, the specimens were taken out and fixed by 10% formalin alcohol. They were embedded in polyester resin and prepared into undecalcified sections. And the sections were stained with toluidine blue to observe the surrounding tissue of the dental implants histologically under light microscopy. RESULTS: 1) Bone formation was seen in most part of the intergranular spaces. However, in the buccal area, there were some spaces in which bone formation was entirely not observed. 2) At 4 weeks after implantation, almost all of the surface of the hydroxyapatite dental implants was attached to the surrounding osseous tissues. But in some parts of the implant surface, especially the buccal, fibrous connective tissue was seen. 3) These results provide a basis for the technique of hydroxyapatite dental implantation with porous hydroxyapatite granules in the atrophic mandibles after alveolar ridge augmentation.

Animals↗
PubMed2006

The influence of cyclosporin a on mechanical retention of dental implants previously integrated to the bone: a study in rabbits.

BACKGROUND: Immunosuppressive agents may induce severe changes on bone metabolism and may impair the osseointegration process during the implant healing. No data are available concerning the influence of cyclosporin A on dental implants previously integrated to the bone. The aim of this study was to evaluate the influence of cyclosporin A administration on the mechanical retention of bone previously integrated to dental implants. METHODS: Eighteen female New Zealand rabbits were submitted to an implant surgery. Each animal received one commercial dental implant of 10 x 3.75 mm. After 12 weeks of an undisturbed healing period, six animals were randomly sacrificed and the removal torque test was performed (group A). In addition, six animals were submitted to a daily injection of cyclosporin A in a dosage of 10 mg/kg (group C), and six animals received saline solution as a control (group B). After 12 weeks of cyclosporin A administration, groups B and C were sacrificed and submitted to a removal torque test in which higher values can be interpreted as higher mechanical bone retention to the implant surface or higher osseointegration. RESULTS: The removal torque results were 30.5 (+/-9.8) Ncm for group A, 50.17 (+/-17.5) Ncm for group B, and 26 (+/-7.8) Ncm for group C. The statistical analysis showed significant differences between groups A and B (P <0.05) and groups B and C (P <0.01). CONCLUSION: Cyclosporin A administration may impair the mechanical retention of dental implants previously integrated to the bone.

Animals↗
PubMed2005

Evidence-based considerations for removable prosthodontic and dental implant occlusion: a literature review.

The dental literature is filled with discussions of dental occlusion, occlusal schemes, philosophies, and methods to correct and restore the diseased, worn, or damaged occlusion. Traditionally, these discussions have been empirical in nature and not based on scientific evidence. Due to the empirical nature of the literature, the study of occlusion has been extremely complex and troublesome to both pre- and post-doctoral students. The introduction of osseointegrated implants has further complicated the situation. Dentists may apply the principles of occlusion for the natural dentition directly to implant-supported and retained restorations. Although this may be successful, this rationale may result in overly complex or simplified treatment protocols and outcomes. There is an emerging body of scientific literature related to dental implant therapy that may be useful in formulating treatment protocols and prosthesis designs for implant-supported restorations. This review focuses on some of the "classic" removable prosthodontic literature and the currently available scientific literature involving removable prosthodontic occlusion and dental implant occlusion. The authors reviewed the English peer-reviewed literature prior to 1996 in as comprehensive manner as possible, and material after 1996 was reviewed electronically using MEDLINE. Electronic searches of the literature were performed in MEDLINE using key words-animal studies, case series, clinical trials, cohort studies, complete denture occlusion, dental implant function, dental implant occlusion, dental implant occlusion research, dental implant functional loading, dental implants, dental occlusion, dental occlusion research, denture function, denture occlusion, dentures, implant function, implant functional loading, implant occlusion, occlusion, and removable partial denture occlusion-in various combinations to obtain potential references for review. A total of 5447 English language titles were obtained, many of which were duplicates due to multiple searches. Manual hand searching of the MEDLINE reference list was performed to identify any articles missed in the original search.

Animals↗