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Periodontal parameters of osseointegrated dental implants. A 4-year controlled follow-up study.

The aim of this study was to evaluate the periodontal parameters of osseointegrated dental implants. The condition of the peri-implant mucosa was assessed using periodontal parameters, i.e., of plaque index, bleeding on probing, probing pocket depth, probing attachment level and Periotest scores as well as a radiographic parameter, over a 4-year follow-up period. 32 non-submerged ITI dental implants, all placed in the mandible, were studied in 12 patients who had good oral hygiene. All patients were regularly recalled at 6-month intervals. The overall implant success rate was 100%. None of the implants showed any signs of inflammation, radiographic bone loss or any detectable mobility during the follow-up period. Methods similar to those used to evaluate the natural dentition were effectively employed to assess the clinical status of the dental implants. The diagnostic value of these parameters could not, however, be determined from this study due to the absence of any peri-implant tissue complications. The results indicated that some periodontal parameters of healthy peri-implant mucosa might be slightly different from healthy periodontal tissue.

Alveolar Process↗

Clinical and microbiologic comparisons of two dental implant systems.

Clinical soft tissue examination and microbiologic findings were compared for two dental implant systems. Of 20 edentulous patients, ten had been reconstructed with a transosteal implant of gold alloy, TMI-system (Bosker), of and ten with endosseous implants of titanium (Brånemark-system). Clinical parameters evaluated included plaque, gingivitis, sulcus depth and bleeding on probing. Plaque samples from 14 patients were cultured for selected periodontal pathogens. Although some differences in soft tissue clinical behavior were identified, the incidence and prevalence of selected periodontal pathogens appeared to be similar.

Actinomyces viscosus↗

Collagen fiber orientation near dental implants in human bone: do their organization reflect differences in loading?

This study is the first to investigate the collagen fiber orientation in human bone around titanium dental implants after loading. Birefringence under circularly polarized light (CPL) and scanning electron microscopy (SEM) investigation were used to assess both collagen orientation and density. Twenty osseointegrated dental implants were retrieved from the mandible bone of 10 patients and were used in the present study. The implants were retrieved after 6 months of function. The birefringence measurements were performed on digitized images using both the peri-implant bone (PB) and the alveolar bone (AB) retrieved at the moment of implant placing. All images detected at 100x were measured using a software image analysis. The results showed that 32.96% (3.208 +/- 0.435 mm(2)) of the PB area was composed of transverse collagen fibers while only 19.70% (1.957 +/- 0.253 mm(2)) was composed of longitudinally collagen fibers. In the AB 26.99% (2.620 +/- 0.520 mm(2)) of the examined area was composed of transverse collagen fibers while 22.25% (2.160 +/- 0.320 mm(2)) was composed of longitudinally collagen fibers. The CPL measurements of the birefringence indicated that the difference in area between the two collagen fibers orientations was statistically significant (p = 0.03) for both AB and PB. In PB the transverse collagen fibers were significantly increased (p < 0.01) than in AB; also the longitudinal collagen fibers differ significantly in the two groups (p = 0.02). The transverse collagen fibers in PB are more present under the lower flank of the threads where the load acts with a compression vectors, while outside the tip of the implant threads the collagen fibers run more longitudinally due to the loads that act with a tensile vectors. SEM observations showed, in the first collagen layers facing the implant surface, a random direction of the collagen fibers, while in the areas away from the implant surface the collagen fibers were well oriented and run parallel. In conclusion, in these loaded dental implants, the bone adjacent to the first two implant threads shows a significant increase of the amount of transverse collagen fibers that were mainly associated with the lower flank of the threads where compressive load acts. The longitudinal collagen fibers also differs significantly from those found in the AB.

Adult↗

Dental implants in a young patient with Papillon-Lefevre syndrome: a case report.

A case is reported of dental implant placement in a 13-year-old patient diagnosed with Papillon-Lefevre Syndrome. Two titanium dental implants were placed in the mandible for an implant-retained denture after the patient complained of having an unstable prosthesis. Follow-up radiographs showed successful osseointegration and preservation of alveolar bone 1 year after implant placement and the continual wearing of a functional dental prosthesis.

Adolescent↗

A comparative investigation in dogs: 2-year morphometric results of the dental implant--bone interface.

One hundred twenty titanium and ceramic root-form and titanium blade implants were placed into 30 dog mandibles. Twenty-four implants in six control dogs (in situ for 5 months) did not receive prostheses. Ninety-six implants in 24 dogs supported prostheses for 6, 12, 18, or 24 months. Computerized morphometry data presented the percent of the implant surface apposed directly by bone. A three-way factorial analysis of variance was used to assess significance. Individual implant means ranged from 0% (mobile implant) to 71% bone adaptation. From these data, two-stage titanium root-form implants were shown to be apposed by more bone than the other five systems, and overall, titanium implant systems were apposed by more bone than ceramic systems. Between 41% and 50% of the surface of integrated ceramic implants were apposed by bone, whereas between 50% and 65% of the surfaces of titanium implants were apposed by bone. Also, two-stage surgery for blade implants appears important for implant success. Furthermore, the use of Nomarski differential illumination appears to be useful for examining the quality of interfacial bone to correlate with the amount of bone quantified by morphometric protocols.

Analysis of Variance↗

Scanning electron microscopic evaluation of the effects of an air-abrasive system on dental implants: a comparative in vitro study between machined and plasma-sprayed titanium surfaces.

An in vitro comparative study was conducted in order to evaluate the effects of an air-abrasive system on dental implant surfaces. Eight new titanium dental implants, four standard machined implants (machined group), and four standard plasma-sprayed implants (plasma-sprayed group) were selected for investigation. Both neck and body surfaces of the implants were analyzed. Each pair of implants in each group was treated as follows: the spray of the air-abrasive unit was applied to each area for 5 seconds on the first implant and 15 seconds on the second implant. A total of 24 areas were observed: 16 test implants and 8 controls. Scanning electron photomicrographs were analyzed by 3 examiners using a category rating scale (kappa = 0.594). The images were also computerized for texture analysis. The results indicate that a single air-powder abrasive treatment of the dental implants selected for this study modified their exposed surfaces. After treatment, the threaded neck surface of a machined group implant was least affected, whereas the body was the most altered. In the plasma-sprayed group, comparisons between implant surfaces showed little change. In the machined group, more change was observed in both neck and body areas. In all specimens, a 5-second exposure to the air-powder abrasive did not induce deep changes in the surfaces. A 15-second exposure modified all the specimen surfaces. Further studies are needed to evaluate the effect of these changes on the biological osseointegration process.

Air↗

Imaging techniques and image interpretation for dental implant treatment.

PURPOSE: This article reviews the literature on radiographic imaging techniques and image interpretation for dental implant treatment. MATERIALS AND METHODS: MEDLINE was used to identify published peer-reviewed literature for this report. RESULTS: Radiographic images are indispensable in the evaluation of osseous structures when planning treatment for dental implants. Potential bone sites for implant placement can be assessed clinically by means of palpation or probing through the mucosa; however, diagnostic imaging provides the best means for indirectly measuring bone dimensions. After healing of the implant site, the application of radiology is useful to verify the amount of bone adjacent to the implant and that the transmucosal abutments fit the implant. Upon completion of the implant prosthesis, radiology may be used to monitor initial and long-term success of implant treatment. CONCLUSION: Recommendations for the application of radiology over the course of treatment are made for various implant cases ranging from the overdenture to the single-tooth implant.

Alveolar Process↗

Dental implants for orthodontic anchorage.

The purpose of this article is to review and update current concepts involving the use of dental implants for orthodontic anchorage. Topics to be discussed include indications, implant requirements (eg, materials, size, designs of dental implants), surgery and healing time, biomechanics and forces, loading time, implant maintenance, posttreatment considerations, and disadvantages.

Bone Screws↗

Design optimization of functionally graded dental implant.

The continuous increase of man's life span, and the growing confidence in using artificial materials inside the human body necessities introducing more effective prosthesis and implant materials. However, no artificial implant has biomechanical properties equivalent to the original tissue. Recently, titanium and bioceramic materials, such as hydroxyapatite are extensively used as fabrication materials for dental implant due to their high compatibility with hard tissue and living bone. Titanium has reasonable stiffness and strength while hydroxyapatite has low stiffness, low strength and high ability to reach full integration with living bone. In order to obtain good dental implantation of the biomaterial; full integration of the implant with living bone should be satisfied. Minimum stresses in the implant and the bone must be achieved to increase the life of the implant and prevent bone resorption. Therefore, the aim of the current investigation is to design an implant made from functionally graded material (FGM) to achieve the above advantages. The finite element method and optimization technique are used to reach the required implant design. The optimal materials of the FGM dental implant are found to be hydroxyapatite/titanium. The investigations have shown that the maximum stress in the bone for the hydroxyapatite/titanium FGM implant has been reduced by about 22% and 28% compared to currently used titanium and stainless steel dental implants, respectively.

Biocompatible Materials↗

Changes in passive tactile sensibility associated with dental implants following their placement.

PURPOSE: This study investigated the changes that might occur in passive tactile sensibility during a period of 3 months following Implant placement in a group of edentulous subjects treated with dental implants. The effect of changing the velocity of force application on passive tactile sensibility was also investigated. MATERIALS AND METHODS: Five edentulous subjects who had been treated (as a part of an immediate loading study) with 2 or more Nobel Biocare dental implants in the anterior mandible were studied. Pushing forces were applied directly and perpendicular to the long axes of the abutments until the subjects felt the first sensation of pressure, using a computer-controlled, custom-made device. The force was measured with an integral transducer. The applied force had a ramped staircase pattern, which was used at 2 different tip velocities. The measurements were taken on 4 occasions: 1, 2, 4, and 12 weeks after fitting the abutments. RESULTS: Statistical analysis, using multilevel modeling, demonstrated that there was a significant decrease In the tactile threshold over successive weeks following implant placement. It also demonstrated that high velocity exhibited a higher threshold than low velocity. DISCUSSION AND CONCLUSION: It could be concluded that there was a significant increase In passive tactile sensibility during the healing phase following implant placement.

Aged↗

Effectiveness of a sonic toothbrush in maintenance of dental implants. A prospective study.

This study assessed the efficacy of a sonic and a manual toothbrush in reducing plaque and gingivitis around dental implants. Subjects were randomly assigned to either sonic (n = 16) or manual (n = 15) study groups. Groups were balanced according to baseline levels of plaque and gingivitis. The plaque (PI), gingival (GI), and bleeding (BI) indices as well as probing depths were determined at baseline, and at 4, 8, 12, and 24 week follow-up visits. Mean scores per person were calculated for each clinical parameter. Oral hygiene habits, compliance and acceptance were also evaluated over the study period. Within group comparisons from baseline throughout the study, as well as between group comparisons (i.e., sonic versus manual), were determined. Overall, plaque, gingival, and bleeding indices in both groups were lower at each follow-up visit when compared to the baseline. Within group comparisons demonstrated that both the sonic toothbrush subjects and the manual toothbrush subjects had significantly lower PI, GI, and BI scores at each post-baseline visit (4, 8, 12, and 24 weeks) than at baseline (p<0.005). In addition, the sonic toothbrush subjects also had significantly lower probing depths at each post-baseline visit than at baseline (p < 0.005). Between group comparisons demonstrated that the sonic toothbrush subjects over time had significantly lower PI and BI scores around dental implants than the manual toothbrush subjects (Repeated measures MANOVA; PI, p = 0.01; BI, p = 0.017). The sonic toothbrush subjects had lower GI scores and reduced probing depths over time when compared to manual toothbrush subjects but these scores were not statistically significant (GI; probing depth, p > 0.05). No implant problems (e.g., loose screws) were attributable to the sonic toothbrush. Relevant to oral hygiene habits, subjects in both groups demonstrated a high level of compliance with their assigned toothbrush. Overall, the results of this study demonstrated that sonic toothbrushing significantly reduced plaque, gingival inflammation and bleeding, and probing pocket depths around implants over the 6-month trial period. It is concluded that sonic brushing is an effective means of dental implant maintenance.

Adolescent↗

Pain and inflammation in 41 patients following the placement of 131 dental implants.

AIMS: To study pain and swelling in the first week after dental implant placement. MATERIAL AND METHODS: A total of 131 implants were placed in 41 patients (17 males and 24 females) under local anesthesia. Pain was scored by means of a verbal and visual analog scale (VAS), while swelling was evaluated by a verbal scale. RESULTS: Most patients who experienced pain reported the latter to be slight, with a peak intensity 6 hours after the operation in 41.5% of cases. A significant relation was observed between pain and the number of implants placed. Swelling was moderate in most patients who reported pain -- peak intensity of inflammation being recorded after 48 hours in 48.8% of cases. A significant association was observed between swelling and older patients, the placement of more than four dental implants, and operations in which sinus lift or bone regeneration procedures were carried out. Swelling was greater in patients with implants positioned in the posterior sector versus those placed in the anterior zone, and in those located at free extreme or totally edentulous patients, versus those placed in interdental spaces. CONCLUSIONS: Following implant placement, pain tends to be mild, with moderate inflammation. The latter is seen to be greater in older patients, in subjects receiving a larger number of implants, and in interventions involving regenerative techniques.

Adult↗

Awareness and needs of dental implants by patients in New South Wales.

An exploratory cross-sectional analytical study of patients presenting for prosthodontic treatment to private general dental practices and public hospitals in New South Wales was completed. Significantly more patients attending private dentists had 'heard' of dental implants compared with the hospital group (G2=79.404; df=1; p<0.001) and significantly more of the former patients were aware that dental implant treatment is available in New South Wales (G2=32.823; df=1; p<0.001). Of the patients attending private practice 19.2% felt that it is likely that they may require dental implant treatment in the future and 14.1% of their current treatment requests involved implants. These figures may be considered moderately high whereas the corresponding figures for the patients attending public hospitals were low.

Attitude to Health↗

Scanning electron microscopic studies of the oral tissue responses to dental implants.

Scanning electron microscopy (SEM) and its associated technologies have proven invaluable in elucidating the interfacial oral tissue responses to dental implants. Since the dental implant must extend from the mandibular or maxillary jaw, through the oral mucosa, and into the oral cavity, these tissue responses include epithelium, connective tissue and bone. The continual occlusal forces acting upon these tissues reinforce the dynamic character of these tissue responses. Immediately upon implantation, a healing phase begins as a response to the implanted biomaterial. Following this immediate response a longer healing phase occurs, beginning approximately 1 week after implantation, resulting in the modeling of bone to the implant as well as the formation of epithelial attachment to the implant. This later, delayed healing continues throughout the lifetime of the implant since these tissues must die and be replaced by similar tissues. Current dental research employing scanning electron microscopy is now documenting these tissue responses. This paper reviews, in detail, SEM observations of these tissue responses.

Animals↗

Alveolar bone formation at dental implant dehiscence defects following guided bone regeneration and xenogeneic freeze-dried demineralized bone matrix.

The present study evaluated rate and extent of alveolar bone formation in dental implant dehiscence defects following guided bone regeneration (GBR) and implantation of xenogeneic freeze-dried demineralized bone matrix (xDBM). A total of 16 titanium plasma-sprayed (TPS) and 16 hydroxyapatite-coated (HA) titanium cylinder implants were inserted in 4 mongrel dogs following extraction of the mandibular premolar teeth. Four implant sites per jaw quadrant (2 TPS and 2 HA implant sites) were prepared into extraction sockets in each dog. Buccal alveolar bone was removed to create 3 x 5 mm dehiscence defects. Two jaw quadrants in separate animals received GBR, GBR + xDBM, xDBM (control), or gingival flap surgery alone (GFS; control). Thus, four conditions were available for each implant type (TPS or HA): GBR, GBR + xDBM; xDBM and GFS. The animals received fluorescent bone labels to allow observations of rate and extent of bone formation. Animals were sacrificed at 12 weeks postsurgery and block sections were harvested for histologic analysis. There were no apparent histologic differences between TPS and HA implant defects. GBR and GBR + xDBM resulted in almost complete bone closure of the dental implant dehiscence defect. Rate of bone formation appeared higher following GBR alone. Extent of bone formation appeared somewhat greater following GBR + xDBM; however, delayed. xDBM alone did not adequately resolve the bony defect. In conclusion, GBR results in rapid, clinically relevant bone closure of dental implant dehiscence defects. Adjunctive implantation of xDBM does not appear to significantly improve the healing response in the model used.

Alveolar Process↗

Coating of titanium alloy with soluble laminin-5 promotes cell attachment and hemidesmosome assembly in gingival epithelial cells: potential application to dental implants.

The formation of a biological seal around the transmucosal portion of dental implants may be crucial for the long-term success of these therapies. Data to date suggest that the gingival epithelium attaches to dental implants through the formation of hemidesmosomes. Biochemical and genetic data indicate that the laminin isoform, laminin-5, a component of basement membranes, plays a crucial role in the assembly and maintenance of hemidesmosomes. We report the use of soluble laminin-5 as a biological coating of titanium-alloy to promote cell attachment of the gingival epithelial cell line, IHGK. Monoclonal antibodies reactive with laminin-5 depleted the coating solution of all cell attachment activity and blocked cell attachment to laminin-5-coated disks. Immunodepletion with antibodies to fibronectin had no effect. Finally, we demonstrate that IHGK cells assembled hemidesmosomes within 24 h of attachment to laminin-5-coated titanium alloy but not to the titanium alloy alone. These results suggest that soluble laminin-5 may have clinical applications as a dental implant coating to promote the formation of a biological seal.

Alloys↗

Rehabilitation of orbital cavity after total orbital exenteration using oculofacial prostheses anchored by osseointegrated dental implants posed as a one-step surgical procedure.

BACKGROUND: Total orbital exenteration is a radical surgical procedure, which typically involves the removal of the entire contents of the orbit including the periorbita, leaving the patient with a deep orbital deformity and results in devastating cosmetic, functional, and psychological consequences requiring difficult and challenging procedures for oculoplastic surgeons. Oculofacial prostheses retained by endosseous dental implants present an attractive and viable alternative when aesthetic and functional demands are beyond the capacity of local reconstructive efforts. PATIENTS AND METHODS: A 72-year-old woman presenting a malignant melanoma of the right eyelids and a 77-year-old man presenting a sebaceous carcinoma of the left upper eyelid underwent a total exenteration followed by positioning of endosseous implants (Straumann system Dental implants) as an integrated one-step combined surgical procedure. The oculofacial prosthesis was placed after epithelialization of the orbital cavity. RESULTS: The implants were perfectly osseointegrated without any complications, providing sufficient retention of the prostheses. A satisfactory aesthetic outcome has been achieved for both patients. CONCLUSIONS: Oculofacial prostheses anchored by osseointegrated dental implants placed as one-step surgical procedure ensure an adequate aesthetic result as well as a considerably decreased rehabilitation time and present a satisfactory solution when reconstruction is not a suitable option.

Dental Implants↗

Dental implants retrieved from humans: a diagnostic light microscopic review of the findings in seven cases of failure.

With the increased use of dental implant systems, an increase in the number of implants removed from patients has also been observed. This investigation attempted to elucidate some underlying causal determinants of implant failure employing light microscopic analyses. Valuable data can be obtained from implants retrieved from patients. Implant success is predicted on proper patient selection and treatment planning, careful surgical procedures, careful prosthodontic management, and continued oral hygiene maintenance.

Aged↗