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PubMed1996

Materials for endosseous dental implants.

The goal of placement of endosseous dental implants is to achieve osseointegration or biointegration of the bone with the implant. A wide variety of materials has been used for these implants, but only a few promote osseointegration and biointegration. Titanium and titanium alloy (Ti6A14V) have been the most widely used of these materials. The surface oxide of titanium appears to be central to the ability of this material to osseointegrate. The oxide limits dissolution of elements and promotes the deposition of biological molecules which allow bone to exist as close as 30 A to the surface of the implant. The details of the ultrastructure of the gap between the implant and bone remain undefined, and the consequences of elements which are released on the interface over time are not known. These areas of investigation are particularly important in defining the differences between commercially pure titanium implants and those made of titanium, aluminium and vanadium. The epithelial interface between the gingiva and titanium appears to contain many of the structural characteristics of the native tooth-gingiva interface, but details are still vague. The connective tissue interface with the titanium appears to be one of tightly fitting tissues rather than adhesion. Ceramic coatings appear to improve the ingrowth of bone and promote chemical integration of the implant with the bone. The characteristics of these coatings are complex and affect the bony response, but the mechanisms remain obscure. The degradation of the coatings is an issue of particular controversy. Progress in dental implantology is likely to continue as the interface between the material and bone is more clearly understood, and biological molecules and artificial tissues are developed.

Alloys↗
PubMed1992

Bone regeneration around titanium dental implants in dehisced defect sites: a clinical study.

Insufficient bone volume can be a significant problem when placing dental implants. This clinical study was designed to evaluate bone regeneration potential at dehisced dental implant sites. Nineteen titanium dental implants with exposed threads were studied. To create a secluded space for bone formation, an expanded polytetrafluoroethylene (e-PTFE) membrane was placed over the exposed implant sites secured with an implant cover screw and completely covered with the flap. Three membranes perforated the overlying soft tissue during the healing time and were removed prematurely. The remaining membranes were removed after an uneventful healing period of 4.5 to 6 months. Fourteen of 19 dehisced implant sites were completely covered with newly formed bonelike tissue; 4 implants demonstrated partial bone fill at reentry and 1 implant showed partial fill with soft tissue. In five implant sites a reentry was performed between 6 and 9 weeks; nonmineralized fibrous tissue was found to fill the space under the membrane. At 16 of the 19 implant sites there were similar dehiscence-type defects that were evaluated as a group. These dehiscences varied from 2.0 to 9.0 mm. The percentage of bone fill at reentry ranged from 28.4% to 100% (mean 89.6%; SD 22.51; SE 5.63) and was highly significant (P < .0001). Six to 12 months after prosthesis connection, 12 of the 19 implants were available for radiographic interpretation and an average bone loss of 1.73 mm (SD = 0.43) was measured. This surgical application of an e-PTFE membrane suggested a viable clinical method for enhancing bone formation around dental implants.

Adult↗
PubMed2004

Image-guided navigation system for placing dental implants.

Navigation-guided surgery has recently been introduced into various surgical disciplines, including oral and maxillofacial surgery. Since the advent of dental implants, dental computed tomography (CT) scans have been used as a diagnostic tool for preoperative planning, but not as part of the surgical phase. This article explains the principles of computer-assisted surgery and describes the use of a computer-guided navigation system in dental implantology. The system uses preoperative dental CT scans for planning and as an integral part of the surgical procedure. This system allows continuous intraoperative coordination of the implantation phase with the preoperative plan, optimizing the accuracy of implant surgery. Deviations from the planned location of the implants are minimal. Several cases are discussed.

Adult↗
PubMed1996

The esthetic dental implant: letting restoration be the guide.

Dental implants originally were placed according to the availability of supportive bone structures. This article describes a new way of approaching implant placement: envisioning the ideal ultimate restoration and developing the treatment plan- and the implant site-to achieve that goal.

Alveolar Bone Loss↗
PubMedDate not supplied

Sensory and motor function of teeth and dental implants: a basis for osseoperception.

1. When dental implants are loaded mechanically, a sensation, often referred to as osseoperception, is evoked. The sensory signals underlying this phenomenon are qualitatively different from the signals evoked when loading a natural tooth. In contrast with osseointegrated dental implants, natural teeth are equipped with periodontal mechanoreceptors that signal information about tooth loads. In the present review, the functional properties of human periodontal mechanoreceptors will be presented, along with a discussion about their likely functional role in the control of human jaw actions. 2. Microneurographic experiments reveal that human periodontal mechanoreceptors adapt slowly to maintained tooth loads. Populations of periodontal receptors encode information about both which teeth are loaded and the direction of forces applied to individual teeth. 3. Most receptors exhibit a markedly curved relationship between discharge rate and force amplitude, featuring the highest sensitivity to changes in tooth load at surprisingly low forces (below 1 N for anterior teeth and 4 N for posterior teeth). Accordingly, periodontal receptors efficiently encode tooth load when subjects first contact, hold and gently manipulate food by the teeth. In contrast, only a minority of receptors encodes the rapid and strong increase in force generated when biting through food. 4. It is concluded that humans use periodontal afferent signals to control jaw actions associated with intra-oral manipulation of food rather than exertion of jaw power actions. Consequently, patients who lack information from periodontal receptors show an impaired fine motor control of the mandible.

Animals↗
PubMed2002

Crestal bone loss around submerged and exposed unloaded dental implants: a radiographic and microbiological descriptive study.

The successful maintenance of crestal bone surrounding dental implants is imperative for long-term implant success. Crestal bone loss is reportedly related to stress. However, early perforation and partial exposure of the implant's covering device are a focus for plaque accumulation, which, if left untreated, may result in inflammation. The objective of this study was to evaluate the crestal bone levels adjacent to submerged and exposed unloaded dental implants during the initial healing phase. In addition, the microbiota around exposed implants were studied. Bilateral implants were placed in the mandible of 10 patients. In one quadrant, the implants were covered by the flap. In the other quadrant, the flap was sutured, leaving the cover screws completely exposed. Standardized periapical radiographs were obtained at implant placement and 4 months later. Radiographs were digitalized, aligned, and analyzed with a computer-assisted method. Cultures were obtained from exposed implant sites. All patients showed more crestal bone loss around exposed dental implants compared to submerged implants. Prevotella sp., Streptococcus beta-hemoliticus, and Fusobacterium sp. were the microorganisms identified in most of the sites. The exposure of the implant covering device created foci for bacterial plaque accumulation, which may have facilitated periimplant crestal bone loss. The initial healing phase follow-up may be critical for implant success.

Alveolar Bone Loss↗
PubMed2003

Factors influencing the resonance frequency of dental implants.

PURPOSE: Resonance frequency (RF) analysis has been used by several investigators to assess the boundary conditions of dental implants. However, a scientific investigation of the association between the structural condition of the alveolar bone and the dynamic behavior of dental implants has not yet been reported. The aim of this study was to assess the factors influencing the RF of dental implants using an in vitro modal analysis. MATERIALS AND METHODS: Resonant vibration within implants was induced by an impulse-force hammer. The induced vibration signal was subsequently detected using an acoustic microphone and analyzed by fast Fourier transform. The resultant data were further analyzed to test the statistical effects of the embedding-material boundary height, thickness, and density on the RF values of the sample implants. RESULTS: Significant changes (P <.05) in RF values were revealed for implants embedded within a high-density block when decreasing boundary height reached 6, 5, and 4 mm, at respective thickness increments of 10, 15, and 20 mm. For analogous low-density samples, significant changes (P <.05) in RF values were found when respective decreasing boundary height reached 6, 4, and 3 mm. CONCLUSIONS: Our findings indicate that boundary height, width, and density factors can influence the RF of dental implants and that a lower boundary density and greater boundary thickness can lead to more obvious RF changes.

Alveolar Bone Loss↗
PubMed1998

The oral-burn syndrome and its effects on dental implants.

When the struts of a subperiosteal dental implant exteriorize with white slough on the metal-tissue margins in the absence of movement, pain, or pus, oral-burn syndrome should be considered as a possibility. This study indicates a direct link between oral tissue loss and the frequency and temperature of hot beverages, foods, and smoking.

Animals↗
PubMed2006

[Establishment of a three-dimensional finite element model of mandible with dental implants for immediate loading].

PURPOSE: To establish a three-dimensional finite element model of mandible with dental implants for immediate loading, which will provide a basis for study of the biomechanical characteristics of the immediate loading implant-bone interface. METHODS: A female edentulous mandible was adopted for CT scanning, the scanned data were saved with the form of DICOM, and then input into compute. Universal Surgical Integration System which was developed by ourselves and ANSYS 10.0 were used to divide mesh and establish finite element model. Three dental implants simulating the real shape of ITI thread implant were embedded in the anterior region of the mandible, of which implant-bone interface was granted with situation of smooth friction simulating the case of immediate loading. RESULTS: The accurate finite element model of mandible with dental implants for immediate loading was established, which included 127811 tetrahedron elements with 182252 nodes. A single dental implant model comprised 13924 elements with 21420 nodes, the thread of it was continuous and smooth. CONCLUSION: The biomechanical similarity, the geometrical analogy and clinical indication of the model were quite good. The three-dimensional finite element model developed by this method can apply for precise analysis of the rule of biomechanics on the implant-bone interface for immediate loading.

Dental Implants↗
PubMed2001

Periapical abscess formation and resolution adjacent to dental implants: a clinical report.

The vitality of teeth adjacent to dental implants should be considered in the treatment planning of dental implants. Both the restorability of an endodontically treated tooth and the risk of infection of the adjacent implant are important factors in planning for success. Given the illustrated difficulties and difficulties associated with resolving periapical infections of teeth and implants, it is essential to define the vitality of teeth by careful pulp testing and to consider the integrity of existing questionable, endodontically treated teeth before implant treatment. The risk of periapical infection at teeth adjacent to implants must be minimized.

Alveolar Bone Loss↗
PubMed2003

Ailing and failing endosseous dental implants: a literature review.

Although the overall success rate of implant dentistry is very high, dental implants occasionally fail. It is essential for the clinician to recognize unhealthy implants and to determine whether they are ailing, failing, or failed prior to beginning any salvage efforts. Ailing and failing implants are amenable to therapy. Implants diagnosed as failed should be removed. This review provides the reader with information on non-surgical and surgical therapies available for managing ailing and failing implants. Undoubtedly, the best steps to avoid encountering ailing or failing implants involve proper case selection, excellent surgical technique, placing an adequate restoration on the implant, educating the implant patient to maintain meticulous oral hygiene, and evaluating the implant both clinically and radiographically at frequent recall visits.

Anti-Infective Agents, Local↗
PubMed1994

The Endopore dental implant system: implant treatment simplified.

The Endopore implant system is a new dental implant system that is distinctly different from other implant systems presently available. Its unique design allows for ease of placement, use of shorter implants, three-dimensional ingrowth of bone (and thus greater resistance to torque), and a faster healing period. Its truncated-conical design allows for better distribution of stress and more leeway for error when it is placed adjacent to vital structures or in narrow regions of bone. The prosthetic components have been deliberately designed to be simple and cost-effective, yet provide all the variety that is required to restore any clinical situation. For an overdenture, the unique abutment and prosthetic technique allows for a cost-effective method of providing stability to an existing or newly-fabricated full denture. For fixed prosthetics, the prosthetic components have been designed to allow the use of straight-forward crown and bridge techniques, with a minimal number of additional laboratory parts or costs required to restore the case. Furthermore, a full arch can be restored with a screw-retained fixed/retrievable restoration, using the new UMA abutments. The surgical and prosthetic techniques required by the Endopore system are simple and inexpensive, and could be managed by a general dentist with a good knowledge of sterile surgical technique. Multicentre trials by private practitioners in Canada and the United States indicate that implant treatment by a general practitioner using the Endopore system can be predictably and reliably successful.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1992

Rates of osseointegration of dental implants with regard to anatomical location.

PURPOSE: Implantation of commercially pure titanium dental implants can be obtained predictably and consistently. The initial research focused on the edentulous population, with most of the fixtures being placed into the anterior mandibular area. There has been increased use of dental implants for partially edentulous patients. MATERIALS AND METHODS: This study reports the results of 169 consecutively treated patients with 673 fixtures. Patients were observed for 7 months to 8 years following occlusal loading. RESULTS: Implant osseointegration was 89.1% in the anterior maxillae; 71.4% in the posterior maxillae; 96.7% in the anterior mandible; and 98.7% in the posterior mandible. CONCLUSION: Osseointegration may be most dependent on anatomical location in the jaws.

Adult↗
PubMed2002

Transmission of bone strain in the craniofacial bones of edentulous human skulls upon dental implant loading.

STATEMENT OF PROBLEM: Little is known about how craniofacial bones that are distant from dental implants are loaded. Whether bone experiences different strain when implants of different diameters are loaded is unknown. PURPOSE: This study was designed to (1) characterize bone strain both adjacent to and distant from dental implants and (2) compare bone strain in response to the same loads on small-diameter and large-diameter implants. MATERIAL AND METHODS: On 4 edentulous, dry adult human skulls, the buccopalatal midpoint of the edentulous occlusal surface was marked unilaterally in the maxillary first molar area with a round bur. A hole for implant placement was prepared, and 2 self-tapping titanium implants (3.75 x 7 mm and 4 x 7 mm) were placed in the same location and at the same orientation, one after the other. A 4-mm-long titanium abutment was connected to the implant. Each implant was loaded 10 degrees lateral to its longitudinal axis, simulating a lateral occlusal force in 3 of the skulls. In skull 2, loading was along the longitudinal axis of the implant and simulated a vertical occlusal force. The magnitude of the ramp forces was 0 to 100 N. Uniaxial strain gages and/or 3-element strain rosettes were implanted in the supramolar cortical bone, the supraincisor cortical bone, the zygomaticomaxillary suture, and the zygomaticotemporal suture. All strain gages/rosettes were excited with 500 mV DC, and the output signals were recorded with a strain conditioner. Tensile strain was expressed as positive values and compressive strain as negative values. Student t tests were used to test for normal distribution of bone strain within each skull; Wilcoxon tests were applied for skewed distribution between small- and large-diameter implants and between 50-N and 100-N loads (P<or=.05). RESULTS: Bone strain both adjacent to and distant from the implants was complex: compressive strain in the buccal cortical bone superior to the implants; tensile strain in the ipsilateral supraincisor cortical bone but compressive strain in the contralateral supraincisor cortical bone; and tensile strain anterior to the zygomaticotemporal suture but compressive strain posterior to the suture. With the same applied loads, bone strain was higher for large-diameter implants than for small-diameter implants for all the above cortical locations (P<.01 to.001) except posterior to the zygomaticotemporal suture. CONCLUSION: Within the limitations of this study, bone strain resulting from dental implant loading was distributed to cortices not only adjacent to but also distant from dental implants. The large-diameter implant was more facilitative of stress transfer to cortical bone than the small-diameter implant tested.

Adult↗
PubMedDate not supplied

Clinical evaluation of dental implants with surfaces roughened by anodic oxidation, dual acid-etched implants, and machined implants.

PURPOSE: The purpose of this study was the clinical and radiographic comparison of dental implants with surfaces roughened by anodic oxidation (TiUnite), dual acid-etched implants (Osseotite), and machined implants. MATERIALS AND METHODS: Seventy-four patients (mean age, 52.8 +/- 14.2 years; range, 23 to 80 years; 41 men and 33 women) received 198 dental implants-58 TiUnite implants (25 patients), 52 Osseotite implants (27 patients), and 88 machined implants (22 patients). Clinical measurements and radiographs were evaluated at the time of surgery, at the restorative phase, and 2 years postloading. To account for statistical correlation among multiple implants in the same subject, a "per patient" mode of analysis was conducted. A 1-way analysis of variance of bone loss was conducted by type of implant as well by area of the mouth. In addition, differences in mean bone loss were tested for bone density category, gender, and smoking status using Student t tests. RESULTS: Eighteen TiUnite implants (31.0%) were placed in the maxilla and 40 (69.0%) in the mandible. The Osseotite group included 29 maxillary implants (55.8%) and 23 mandibular implants (44.2%). The machined group included 49 maxillary implants (55.7%) and 39 mandibular implants (44.3%). All 198 implants were considered radiographically and clinically successful. No mobility, signs of infection, or inflammation were detected. DISCUSSION: Implant size, location, bone quality, gender, age, and smoking did not influence the comparative clinical outcomes of the 3 groups (P > .05). A trend toward greater coronal bone loss in the TiUnite group was detected. CONCLUSION: Within the limitations of the present study, TiUnite, Osseotite, and machined dental implants had similar short-term clinical outcomes. No statistically significant differences in bone loss could be detected among implant groups or among the different regions of the oral cavity. The present data underlined the significance of surgical and prosthetic treatment planning.

Adult↗
PubMed1996

Soft and hard tissue response to endosseous dental implants.

The last two decades have seen a remarkable growth in the development of dental implants and their incorporation into the practice of dentistry. This turn of events was made possible by an improved understanding of biological response of living tissues to implants as well as clinical trials that validated the long-term success of these implants. Despite major structural differences between teeth and implants, such as the absence of a periodontal ligament around implants, the latter appear to provide a reliable functional replacement for their natural counterparts. This review briefly summarizes the major structural differences of the interfacial region of teeth and dental implants and their supporting tissues. It focuses on our current understanding of the soft and hard tissue responses to submerged and nonsubmerged root-form dental implants. The influence of a number of factors that affect the tissue response is reviewed, including biomaterials, implant design, surgical technique, and the local microbiota. Our recently acquired ability to modulate wound healing with guided tissue regeneration and growth factors will undoubtedly play an important role in the future utilization and success rates of dental implants.

Animals↗
PubMed1993

An in vivo analysis of an elliptical dental implant design.

The interface attachment strength and histology of an elliptical hydroxylapatite-coated (HA) endosseous dental implant were compared with those of an otherwise identical cylindrical dental implant. The implant designs were tested in two canine in vivo models: healed mandibular extraction sites and the femoral unicortical plug. The implants were evaluated 15 weeks post-implantation. The elliptical geometry of the dental implant was not found significantly to enhance axial pull-out strength or torsional implant-bone interface attachment in either in vivo model. The cylindrical implant absorbed more energy to failure in both the mandible and the femur; however, the difference was not statistically significant. Differences in the interface shear attachment strength between the two models (mandible and femur) were statistically significant when the maximum load to failure was normalized by the actual bone contact surface area. In all cases, femoral values were significantly greater. Examination of HA-coating thickness revealed uniform coatings on both implant types which were well maintained in vivo. Mechanical failure occurred primarily at the metal substrate-HA interface in each type of implant in both models. The amounts of bone apposition to both implants in both models were identical. Coating break-up and inflammatory response to the particulate debris were minimal.

Analysis of Variance↗
PubMed2006

Survival of immediately loaded dental implants in deficient alveolar bone sites augmented with beta-tricalcium phosphate.

PURPOSE: Dental implant placement in atrophic alveolar ridges often necessitates grafting procedures, followed by immediate or delayed implant placement. This study assessed the survival of immediately loaded dental implants placed in deficient alveolar bone sites at bone grafting. MATERIALS: From 1999 to May 2002, 1 operator (A.P.) inserted 1065 implants (607 in mandibles, 458 in maxillae) into 338 partially edentulous patients. Most implants were placed into compromised residual ridges or prepared tooth extraction sockets. Implants placed in augmented areas were splinted to implants in nonaugmented sites for stability. In all cases, beta-tricalcium phosphate was mixed with blood from the surgical site to augment the ridge level or fill spaces between the implant and socket wall. When indicated, the same materials were used for sinus floor augmentation. All implants were tapered screws with roughened surfaces, primarily (75%) from 1 manufacturer. One of the authors (Z.O.) prosthetically restored a total of 189 implants that were placed in 35 patients. In this group of patients, complete restorative data were available. All implants were monitored for 12-48 months (mean = 19.2; median = 24). RESULTS: A total of 1039 implants survived, and 26 failed, including 5 in the anterior mandible and 21 in the maxillae. In the restorative group, 186 implants survived, and 3 maxillary implants failed. All implant failures in this study occurred in the augmented sites. CONCLUSION: Within the limitations of this study, immediate loading of splinted implants in augmented sites is a predictable procedure.

Alveolar Ridge Augmentation↗