Treatment of small defects adjacent to oral implants with various biomaterials.
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Alveolar Bone Loss↗
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Facial and glossal distribution of anaesthesia after inferior alveolar nerve block.
The aim of this study was to subjectively determine the distribution of anaesthesia by mapping areas of sensory loss following inferior alveolar nerve block. Fifty healthy dental students were the subjects of this study (men 32, women 18). They were asked to draw the anaesthetized area on a diagram of the face and tongue 20 min after inferior alveolar nerve block. They evaluated the degree of anaesthesia by touching their faces and moving their tongues. All of the 50 subjects reported anaesthesia in the facial area. Of these, 21 (42%) reported the cutaneous distribution of anaesthesia on mental nerve territory only. Seventeen subjects (34%) reported anaesthesia on mental and buccal nerve territory. Nine subjects (18%) reported anaesthesia on mental, buccal, and auriculotemporal nerve territory. Two subjects (4%) reported anaesthesia on mental and auriculotemporal nerve territory and one subject (2%) on mental, buccal and infra-orbital nerve territory. Forty-seven of the 50 subjects (94%) reported anaesthesia of the tongue with the various degree of anaesthesia according to the area. Of these, 17 subjects (34%) reported strong anaesthesia on the anterior area and weak anaesthesia on the middle part of the tongue. Nineteen subjects (38%) reported strong anaesthesia of the lateral area and weak anaesthesia on the medial area, and 11 subjects (22%) reported anaesthesia on only the lateral side of the tongue. Three subjects (6%) reported no anaesthesia of the tongue. The distribution of anaesthesia of the facial and glossal regions determined subjectively after inferior alveolar nerve block, varies significantly between individuals.
Adult↗
Influence of implant microstructure on the osseointegration of immediate implants placed in periodontally infected sites. A histomorphometric study in dogs.
The aim of this study was to evaluate the influence of implant microstructure on the osseointegration of immediate implants placed into infected sites. During 12 weeks, periodontitis was induced in six dogs in the areas of the first to fourth mandibular premolars of both sides. The teeth were extracted and the implants were placed immediately. Implant placement was randomly assigned so that for each side in the mandible a different implant surface, a new grit-blasted/acid-etched group 1 or titanium plasma spray surface group 2 was used, totaling 36 implants in the experiment. The animals were killed 12 weeks after implant placement. Two histomorphometric analyses were performed: percentage of bone/implant contact (BIC) and analyses of the bone density in adjacent and distant areas from the implant surface. The results showed that the percentages of BIC were 52.7% and 42.7% for groups 1 and 2, respectively. The bone density analysis revealed that the percentages of bone in the adjacent areas were 66.6% and 58.8%, and in the distant areas from the implants were 58.7% and 55.8% for groups 1 and 2, respectively. The mean differences of BIC were verified through the Mann-Whitney test and differences in bone density through the Kruskal-Wallis test. The differences were not statistically significant (P>0.05). In conclusion, osseointegration of implants placed into a more challenging healing situation such as immediate implants into periodontally compromised sites was successful for both surfaces; however, the grit-blasted/acid-etched surface, although not statistically significant, had a slightly better performance when compared to the titanium plasma spray surface for all the parameters studied.
Animals↗
Clinical management of the avulsed tooth: present strategies and future directions.
The aim of this review article is to supplement the recently published International Association of Dental Traumatology (IADT) guidelines on treatment of the avulsed tooth. A thorough discussion on the reasoning behind each guideline is presented. In addition, the author's views on alternate treatment strategies and future directions, along with recent research on the subject of the avulsed tooth, are also presented.
Humans↗
Comparison of 3 bone substitutes in canine extraction sites.
PURPOSE: The purpose of this study was to evaluate the healing response with 3 different bone substitute materials in extraction sites in the dog. MATERIALS AND METHODS: Four dogs had their mandibular and maxillary premolars extracted atraumatically. The sites were immediately grafted with anorganic bovine bone (Bio-Oss, Osteohealth, Shirley, NY), Bone Source (Leibinger, Inc, Kalamazoo, MI), or Embarc (Lorenz Surgical, Jacksonville, FL), or left untreated as a control. After 8 weeks, the sites were removed for histologic evaluation of bone fill and the healing response. RESULTS: All sites healed well without signs of infection. No significant differences were noted in the shape of the ridges between groups. The control sites had radiographic bone fill by 8 weeks. The Bio-Oss sites showed bone fill with a similar appearance to the control sites. The Bone Source and Embarc sites showed implant material taking up most of the extraction site. In all sites the control and Bio-Oss sites had significantly more bone formation than the Embarc and Bone Source sites (P <.05). The control sites contained woven bone. The Bio-Oss sites were similar to the control sites, but with remnants of Bio-Oss in the bone. The Bone Source and Embarc sites were filled predominantly with the graft material without evidence of resorption and replacement of the materials, and with minimal bone formation. CONCLUSIONS: Based on this study, the control and Bio-Oss sites were similar, with bone filling most of the extraction site. The other 2 materials did not show replacement with bone.
Alveolar Bone Loss↗
Histologic evaluation of immediate versus delayed placement of implants after tooth extraction.
OBJECTIVE: Full osseointegration is necessary to achieve long-term success of dental implants. We aimed to find out the relative merits of immediate and delayed insertion of implants after dental extraction. STUDY DESIGN: We completed a histologic and histomorphometric examination of the tissue adjacent to delayed and immediate implants in 8 beagle dogs. In 4 dogs, implants were inserted immediately after the extraction of second premolars; in the remaining 4, the implants were inserted 6 months after the extraction. Fluorochrome bone markers were injected on 2 occasions before the dogs were killed 8 months after the implants had been inserted. Each implant and its surrounding tissue was examined macroscopically and microscopically. Both histologic dynamic and histologic static histomorphometry were used in this analysis. Statistical significance was tested by using the Student t test for paired and unpaired observations, the Dunnett t test, and Fisher's least significant difference method for multiple comparisons. RESULTS: The implants placed immediately had 76% of their surface covered with bone, whereas the implants placed after bony healing had 81% of their surface covered with bone. The fibrous tissue at the cervical end of the implant was more dense; the delayed implants also had a greater number of adhesive epithelial elements (hemidesmosomes). Use of dynamic and static histomorphometry revealed no significant differences between the 2 groups. CONCLUSION: We found new soft and hard tissue around dental implants 8 months after their insertion in both groups. Pseudoankylotic healing was seen in the osseous part. The lower level of osseointegration in the immediately placed implants was attributable to the early resorption of bone in the crestal part, resulting in a larger part of the implant being surrounded by soft tissue.
Animals↗
Bonded provisional restorations for esthetic soft tissue support in single-implant treatment.
During the early phases of single-implant treatment, clinician needs and patient expectations can be challenging. This article describes a technique for making a simple bonded provisional restoration. In addition to minimizing patient discomfort without increasing laboratory costs, the technique enables soft tissue preservation through all treatment phases, from tooth loss to implant loading.
Acrylic Resins↗
Structural variation of type XII collagen at its carboxyl-terminal NC1 domain generated by tissue-specific alternative splicing.
This paper reports the identification of two structural variations in the NC1 domain of rat and mouse type XII collagen. The long NC1 domain encoding 74 amino acids showed homology to chicken type XII and XIV collagens. The short NC1 domain was composed of 19 amino acids. Through genomic DNA analyses, two alternative exons were identified, each of which contained the variable NC1 sequence. With the amino-terminal NC3 splicing alternatives, we propose here a new descriptive nomenclature: types XIIA-1 and XIIB-1 which include a long NC1 sequence encoded by exon 1 (from the 3'-end), and types XIIA-2 and XIIB-2 which include a short NC1 sequence encoded by exon 2. Types XIIA-1 and XIIB-1, the predominant transcripts in 15-day old mouse embryos, showed decreased expression in 17-day old embryos when type XIIB-2 expression was sustained at constant levels. In adult mice, type XIIB-1 associates with ligament and tendon, whereas type XIIB-2 is expressed in various other tissues. The long NC1 domain contains an extended acidic region (pI = 3.4) followed by a terminal basic region (pI = 13.8). Because the short NC1 domain lacks these features, structural variations in the type XII collagen NC1 domain suggests different functional roles in a tissue-specific fashion.
Alternative Splicing↗
Restoration of mechanical strength and morphological features of the periodontal ligament following orthodontic retention in the rat mandibular first molar.
Biomechanical properties and morphological features of the periodontal ligament (PDL) in the rat mandibular molars were examined during orthodontic retention. Seventy-three male rats of the Wistar strain, 8 weeks of age, were used for biomechanical analysis and six rats for morphological analysis. An elastic band was inserted between the mandibular first and second molars for 4 days; after removal of the elastic band the interdental space was filled with resin for 4 and 8 days. The maximum shear stress, tangent modulus, and failure strain energy density of the PDL of the first molar in the experimental animals decreased markedly following application of an orthodontic force. They increased rapidly and were restored completely to the control levels by the 8th day after retention. Light microscopy showed severe compression and extension of the PDL in the experimental animals on the 8th day after retention. Birefringent collagen fibre bundles running across the compressed and expanded PDL were observed, although they appeared to be thinner with less insertions into the alveolar bone or cementum in the experimental animals than in the controls. This suggests that the periodontal collagen fibres were partially reorganized and rearranged during retention. The reorganization and rearrangement of periodontal collagen fibres seemed to be partly related to the restoration of mechanical strength of the rat molar PDL during the 8 days of retention.
Alveolar Process↗
An increased prevalence of {beta}-lactamase-positive isolates in Japanese patients with dentoalveolar infection.
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Anti-Bacterial Agents↗
The use of a new allograft material for osseous reconstruction associated with dental implants.
This article introduces the use of a new bone graft material. The material is a human collagen allograft resorbable matrix impregnated with demineralized freeze-dried bone granules. This material is harvested from the same donor. A series of three cases of extractions with immediate implant placement accompanied by osseous defects were used to demonstrate the use of this material. Bone cores were harvested at Stage II uncovering of the implants. The histologic and clinical results are reviewed.
Absorbable Implants↗
Immediate loading of implant-fixed mandibular prostheses: a prospective 18-month follow-up clinical study--preliminary report.
A prospective study was conducted on 13 consecutive patients who received immediately loaded mandibular fixed-implant prostheses. The exclusion criteria were 1) general: heavy smoking, demonstrated bruxism, or general ill health and 2) local: lesions in the bone area to be implanted or inadequate morphology requiring augmentation techniques. After suturing the surgical wounds, impressions were taken, and transitional prostheses were screwed in within 2 weeks of surgery. A total of 61 implants of four different designs were placed. Thirty-two of the implants were placed at the same time as performing the extractions of the residual dentition. In 13 of the implants, there was a 2-month period between extraction surgery and implantation. The other 16 implants were inserted in alveolar bone that had been edentulous for more than 12 months. Despite these differences, all 61 implants were immediately loaded. Parallel x-rays were taken of the 13 patients at the time of transitional prosthesis placement, at the time of definite prosthesis placement, and 6 months later at the first control. During the 18-month follow-up period, two implants failed, and the remaining 59 implants were found to be clinically immobile, asymptomatic, and free of any radiolucency, giving a survival rate of 96.7%. Analysis of radiographic bone levels gives us a cumulative success rate of 93.4%. These figures are comparable to those obtained in similar studies and are no different than those from implant prostheses loaded in the conventional delayed manner. Based on these preliminary results, we can conclude that the immediate loading of mandibular implants is a viable and efficient approach.
Dental Implantation, Endosseous↗
The nonfunctional immediate provisional in immediate extraction sites: a technique to maximize esthetics.
Patients demand the esthetic replacement of missing teeth in an economic and expedient manner. When teeth are extracted, or have been missing for some time, the resorption process often limits the opportunity to replace those missing teeth with dental implants. The technique presented allows the restoration of missing teeth while maintaining the hard and soft tissues. It also prevents the patient from having to wear a removable appliance during the healing phase, and this maximizes the patient's comfort and esthetics. The new method described here has been used in 55 patients with a success rate of over 98%.
Adolescent↗
Enhancement of primary stability of dental implants using cortical satellite implants.
PURPOSE: This study aims to assess the effect of satellite implants on the primary stability of dental implants placed in fresh extraction sites in vitro. METHOD: 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. RESULTS: 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. CONCLUSION: 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.
Animals↗
Analysis of 435 screw-vent dental implants placed in 161 patients: software enhancement of clinical evaluation.
This paper demonstrates how a computer software program was utilized in a private practice to supplement the clinical evaluation of one implant system. Clinical data were entered into a computer database at the time of implant placement and up to 13 years for follow-up appointments. Data were divided into two groups and subjected to lifetable analyses. The focus group consisted of a machined-titanium, screw-type implant with an internal abutment connection from one manufacturer. The residual database consisted of mixed implant designs with a variety of abutment connections and surfaces from several other manufacturers. Lifetable survival data between the two groups were generated. Cumulative survival rates from 0 to 13 years were 94.2% (n = 435) for the focus group and 90.1% (n = 2339) for the reference group. There were 25 implants lost in the focus group and 11 other implants were deemed "at risk." Survival results from other lifetable analyses are also presented for the two groups. Documentation of empirical clinical data in a computer software database over a period of time can help private practice clinicians better evaluate the dental implant systems used in their practices.
Adolescent↗
Immediate placement in extraction sites followed by immediate loading: a pilot study and case presentation.
The purpose of the study was to compare the results of implants immediately loaded in edentulous sites with implants loaded immediately in extraction sites. Since December 1998, we selected a small group of patients for immediate or early loading. Seventy-five implants were placed in nine jaws of seven patients. Two of the patients received implants in both the maxilla and mandible. Of the 75 implants placed, 29 were placed in immediate extraction sites. Twenty-six of the 29 that were placed in immediate extraction sites were loaded in less than 3 weeks. Of the 75 implants placed, 62 were loaded early (less than 3 weeks). Two implants have been lost. The remaining 13 implants were buried and allowed to heal in the customary manner. None of the buried implants failed. One of the implants lost was in an extraction site and one was in a nonextraction site. Of the 33 implants that were placed in edentulous areas and immediately loaded, one was lost. This is compared with the 29 implants placed in extraction sites that were immediately loaded. We conclude that the success rates for implants immediately loaded in extraction sites and edentulous sites are comparable.
Alveolar Ridge Augmentation↗
SwissPlus Implant System, Part 1: Surgical aspects and intersystem comparisons.
Implant survival in poor-quality bone continues to pose a significant clinical challenge to dentists. The SwissPlus System comprises one-piece, straight and tapered implant designs with self-tapping, apical threads, and a microtextured surface on the intraosseous portion of the implant bodies. Although both designs are indicated for all ranges of bone density, Tapered SwissPlus features double-lead threads and a soft-bone surgical protocol designed to enhance initial mechanical stability at the time of placement. This paper presents an overview of the SwissPlus System with emphasis on the surgical aspects. Presented test data also illustrate intersystem compatibility and differences between the straight SwissPlus and ITI synOcta implants.
Bone Density↗
Reimplantation and immediate loading of an accidentally avulsed beaded implant: case report.
We present a case of reimplantation of an accidentally avulsed beaded Endopore (Innova Corp., Toronto, Canada) implant. The technique of immediate splinting and pharmacotherapy is described together with the clinical and radiologic evaluation for reosseointegration. This single case of reimplantation with immediate functional loading would suggest that, contrary to the manufacturer's recommendation, the Endopore implants can be successfully loaded immediately, functionally or nonfunctionally.
Accidents↗