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PubMed2002

A modular approach to dental implant therapy: the appropriate selection of one- and two-stage surgeries.

Different clinical situations merit careful consideration of the surgical and restorative approaches taken during the process of tooth replacement using dental implants. When clinically feasible, one-stage surgical procedures and subsequent restoration offer practical advantages. Modular implant designs comprised of separate endosseous implants and transmucosal abutments provide important clinical advantages for one-stage surgeries. The biological and mechanical advantages of conus implant-abutment interfaces reinforce the selection of modular implants for the broad application of one-stage dental implant procedures.

Animals↗
PubMed2004

A comparative study of computed tomography and magnetic resonance imaging for the detection of mandibular canals and cross-sectional areas in diagnosis prior to dental implant treatment.

BACKGROUND: Computed tomography (CT) is effective in the diagnosis of dental implants. However, it has the disadvantage of exposing patients to high doses of x-rays, and the mandibular canals cannot be detected by CT in some clinical cases. PURPOSE: The purpose of this study was to examine the detectability of the anatomic morphology of the molar region in the lower jaw (where implantation is common) by CT and magnetic resonance imaging (MRI), to compare the data, and to determine the usefulness of MRI in diagnosis prior to dental implant treatments. MATERIALS AND METHODS: Eleven female subjects (average age, 59 years) who had partially edentulous mandibles (total of 19 sites) were included in the study. CT and MRI were performed with the same subjects, and the degrees of identification of the mandibular canal in the first and second molar regions were compared. Dimensional accuracy in the second molar region was also compared. RESULTS: With CT, the canals of the first molar regions were not identified in 11 of 19 sites; however, MRI identified the canals in all 19 sites. Using the kappa index, we found that the inter- and intraobserver identification reliabilities (0.84 and 0.87, respectively) were excellent, especially for MRI. Dimensional positioning of the canal in the second molar region was almost the same with MRI as with CT. CONCLUSIONS: MRI is an alternative method in diagnosis prior to dental implant treatment in the mandibular molar region.

Adult↗
PubMed2003

Interventions for replacing missing teeth: surgical techniques for placing dental implants.

BACKGROUND: Many variations in the surgical technique for the placement of dental implants have been developed since the introduction of implant surgery into clinical practice. These include variations in the timing of implant placement in relation to the tooth removal, and variations in the way the recipient bone site is prepared, amongst others. OBJECTIVES: To test the null hypothesis of no difference in the success, function, morbidity, patient satisfaction and cost-effectiveness of different surgical techniques for placing dental implants, against the alternative hypothesis of a difference. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched. In addition, the bibliographies of review articles were checked for studies outside the handsearched journals and personal references were searched. 55 implant companies were also contacted. SELECTION CRITERIA: Randomised controlled clinical trials (RCTs) of implant surgical techniques. DATA COLLECTION AND ANALYSIS: Authors were contacted for details of randomisation and data and quality assessment was carried out (ME, PC). Data were independently extracted, in duplicate, by two reviewers (HW, PC). The Cochrane Oral Health Group's statistical guidelines were followed. MAIN RESULTS: Four RCTs (six publications) were suitable for inclusion in this review of the nine RCTs (11 publications) identified. Two different aspects of implant surgical technique were reported in these RCTs. These were, two versus four implants to support a mandibular overdenture and crestal versus vestibular incision for implant placement. At the patient level there were no statistically significant differences for any of these alternative techniques with respect to implant failures, marginal bone levels, morbidity or patient satisfaction. REVIEWER'S CONCLUSIONS: This review included studies evaluating the surgical techniques of two versus four implants to support a mandibular overdenture and crestal versus vestibular incision for implant placement. Based on the available results of RCTs, there is no strong evidence supporting superior success with one or other of the alternative techniques for either of these two aspects of surgical technique. These conclusions are based on a few RCTs for each aspect of surgical technique and some with relatively short follow-up periods and few patients.

Dental Implantation, Endosseous↗
PubMedDate not supplied

Benchmarking the dental implant evidence on MEDLINE.

The purpose of this study was to estimate the quantity of dental implant literature available on MEDLINE for evidence-based clinical decision-making and to identify its location. A search strategy based on Medical Subject Headings for dental implants was developed to examine MEDLINE using the Ovid Web Gateway search engine. Sensitive and specific methodologic search filters identified 4 categories of information: etiology, diagnosis, therapy, and prognosis. The results were then subdivided by year to identify trends and sorted to identify the sources of publications. The searches identified 4,655 articles published in English between 1989 and 1999 on human dental implants on MEDLINE. The mean number of articles (+/- SD) per year ranged from 15 +/- 11 for specific searches to 107 +/- 50 for sensitive searches. The number of articles increased by 14% to 43% each year for the sensitive search. When subdivided by clinical category, the mean numbers of articles per year for sensitive and specific searches were, respectively: diagnosis 12 +/- 7.5 and 1.5 +/- 1.6, etiology 58 +/- 33 and 1.9 +/- 2.5, therapy 23 +/- 15 and 0.3 +/- 0.5, and prognosis 67 +/- 33 and 12 +/- 8.3. Four dental journals account for approximately half of these publications. These results provide 6 key central findings: (1) there appears to be a substantial literature of clinically relevant information on implants upon which to base clinical decisions; (2) the implant literature is significantly biased toward articles addressing prognosis; (3) to stay current, one would need to read between 1 and 2 articles per week 52 weeks per year, and this number increases significantly each year; (4) approximately 50% of the articles were published in 4 journals, whereas the remainder reside in approximately 97 other journals, making it difficult to stay current; (5) these trends reaffirm the need for lifelong learning; (6) these trends also suggest the need for computer-based clinical knowledge systems.

Analysis of Variance↗
PubMed1989

Ultrastructural comparisons of ceramic and titanium dental implants in vivo: a scanning electron microscopic study.

Identically prepared, screw-type ceramic and titanium endosteal dental implants were inserted in the jaws of adult mongrel dogs for periods of up to 6 months. Sixteen of the 32 total implants supported fixed bridgework. The interface of bone and soft connective tissues with the dental implants was examined by routine and innovative scanning electron microscopic (SEM) techniques using both secondary and backscattered electron imaging. Results demonstrated excellent bone adaptation to both titanium and ceramic implants. Direct adaptation of bone to the upper third of both type implants was observed with only minimal amounts of any intervening fibrous connective tissue. A composite of trabecular bone and fibrous connective tissue was observed in the lower two-thirds of the implants examined. Areas of bone alteration suggestive of osteoid were observed at the thread apicis of some loaded implants. From this investigation we concluded that similar longitudinal tissue responses were generated to one-piece, cylindrical screw-type titanium and alpha alumina oxide ceramic dental implants. Possible bone remodeling was observed at the thread apicis of the loaded implants, an area where occlusal forces may be distributed. We further suggest that one-stage endosteal implants are capable of maintaining a proportional bone-to-implant interface at the apical support region, similar to that suggested to two-stage implant systems.

Animals↗
PubMedDate not supplied

Single preoperative dose versus long-term prophylactic antibiotic regimens in dental implant surgery.

PURPOSE: The purpose of this prospective study was to compare the efficacy of prophylactic antibiotic regimens commonly used in dental implant surgery. Preoperative single-dose and long-term prophylactic antibiotic regimens were compared. MATERIALS AND METHODS: This was a 2-center prospective study in which 215 patients underwent ambulatory endosseous implant placement. In the first group, 445 dental implants were placed in 125 patients after the administration of a single preoperative dose of prophylactic antibiotic with no postoperative antibiotics. In the second group, 302 dental implants were placed in 90 patients who received a preoperative dose of antibiotics and were instructed to take antibiotics postoperatively for 7 days. In both groups, 0.12% chlorhexidine pre- and postoperative mouth rinses were used. Patients returned for postoperative evaluation at 1 week, 2 weeks, and just prior to surgical uncovering. The surgical sites were assessed for pain, swelling, erythema, and purulence. RESULTS: In the first group, 3 patients developed wound dehiscence at 5 implant sites and 1 developed a minor inflammatory response. None of the patients in this group received further antibiotics. In the second group, 3 patients developed wound dehiscence, 2 developed an inflammatory response, and 1 was diagnosed with infection, for which another course of antibiotics was required. There was no statistical difference between the 2 groups according to the Fisher 2 x 4 exact test (P = .56). DISCUSSION: Indiscriminate use of antibiotics is unacceptable in clinical practice today. Surgeons must adhere to basic principles to gain the most benefit from the use of prophylactic antibiotics. CONCLUSION: Long-term prophylactic antibiotic use in implant surgery was of no advantage or benefit over a single-dose preoperative antibiotic regimen in this patient population.

Adolescent↗
PubMed2000

Autogenous bone harvest and bone compacting for dental implants.

The long-term success of a dental implant depends on having or creating an adequate amount of autogenous bone. An instrument is described that conserves the drilled bone during implant preparation, as well as during bone-block graft preparation. Compression of the autogenous bone is performed within the instrument. Also, a simple particulate bone harvest technique from the anterior mandible is offered. The value of a compacted cake of corticocancellous autogenous bone is discussed for dehiscence/fenestration defects as well as for sinus lift bone grafting.

Alveolar Ridge Augmentation↗
PubMed1998

Histologic observations on 230 retrieved dental implants: 8 years' experience (1989-1996).

The histologic examination of dental implants retrieved from humans is important to establish the causal determinants of implant failure, and to compare and validate the results obtained from animal studies. This study presents a retrospective review of the histologic features of 230 implants retrieved in an 8-year period (1989-1996). All the implants were treated to obtain thin (20 to 30 microm) ground sections. The majority of implants were retrieved because of mobility (n=56), peri-implantitis (n=54), or fractures (n=90). Peri-implantitis occurred more frequently before (n=44) than after (n=10) abutment connection. A dense fibrous connective tissue with no inflammatory cells was present at the interface in the implants retrieved for mobility; bone was found only in the most apical part. In many of these implants epithelial cells were present. The main histologic features of peri-implantitis consisted of the presence of a bone sequestrum near the implant, many bacteria present on the implant surface, and an inflammatory infiltrate (macrophages, lymphocytes, and plasma-cells) nearby. Histology showed that in the implants removed for fracture, there was a very high percentage (80 to 100%) of peri-implant bone.

Animals↗
PubMed1998

Current status of ceramic coatings for dental implants.

There are various ceramic coatings available for dental implants. From a commercial standpoint, plasma-sprayed hydroxyapatite (HA) is the most popular. These coatings are typically partially amorphous after processing and contain crystalline phases other than HA. Plasma-sprayed HA and the other bioactive ceramic coating materials have been shown to enhance bone apposition as compared with uncoated metal implants. Some of the other available materials include the bioglasses, other calcium phosphates such as fluorapatite and tricalcium phosphate, and the inert ceramics such as alumina. The plasma-spray process is not optimum for all types of ceramic coatings, because it is not suitable for coating porous surfaces; the exact control of structure and chemistry is difficult with this process, and bond strength is not as high as is desired for some applications. Alternative methods for coating include sol-gel processing, ion beam and radio frequency (RF) sputtering, pulsed laser deposition, hot isostatic pressing, and electrophoretic deposition. The use of osteoinductive agents in conjunction with ceramic-coated implants is of current interest, and the degree and type of bonding of these agents appear to vary with the composition of the ceramic coating. Because there seems to be no satisfactory means of incorporating osteoinductive agents into ceramic coatings during any of the conventional coating procedures, the best approach seems to be to diffuse the agents into the coating after processing. Other possibilities include the tethering of the agents to the surface of the ceramic by suitable organic molecules or the placing of the agent in some carrier material such as a cement, which is placed around the implants.

Bone Morphogenetic Proteins↗
PubMed2005

Reimbursement for dental implants: dispelling some popular myths.

BACKGROUND AND OVERVIEW: Dental implants are being placed with increasing regularity. Many dentists do not take advantage of insurance coverages for this treatment because they are under the impression that no aspect of implant therapy is covered. This article discusses a number of insurance benefits that may be available to dental patients but not readily apparent to treating dentists and their staff members. CONCLUSIONS AND PRACTICE IMPLICATIONS: Some dentists and patients may assume incorrectly that a dental insurance plan does not reimburse for any implant therapy when, in fact, there may be some benefit available for at least a portion of the treatment. In addition, some dentists and patients may not consider implant therapy even when it is the preferred treatment option because of the assumed lack of reimbursement. Knowing that some reimbursement is available may make the difference in the patient's accepting the best treatment for his or her condition. Furthermore, since an increasing number of patients now make some contribution toward their dental insurance plan premiums, they deserve to know their options and to receive appropriate benefits.

Current Procedural Terminology↗
PubMedDate not supplied

Analysis of thte possible impact of inflammation severity and early and delayed loading on nitric oxide metabolism around dental implants.

PURPOSE: The aim of the present study was to analyze the possible impact of clinical status, presence and severity of inflammation, and loading on nitric oxide (NO) metabolism around mandibular dental implants. MATERIALS AND METHODS: A total of 34 implants in 17 patients, loaded either early (EL) or after a delay (DL), were classified according to the presence and severity of clinical inflammation in the peri-implant sites. Clinical parameters were recorded, peri-implant sulcular fluid (PISF) samples were obtained, and PISF nitrite levels were spectrophotometrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, and 9 months postloading at available sites. RESULTS: Compared to noninflamed sites, inflamed sites demonstrated higher mean total nitrite levels (P = .032) that tended to increase with the severity of inflammation at both EL and DL implants. At noninflamed sites, EL implants provided significantly higher PISF volume than DL implants (P = .001). At noninflamed sites, EL implants revealed higher total nitrite levels; on the contrary, at inflamed sites, DL implants revealed higher total nitrite levels. In general, nitrite levels demonstrated a pattern of decrease followed by an increase during follow-up. DISCUSSION: Increased NO production with the presence and the severity of inflammation supports the contribution of NO in the peri-implant inflammatory process. Loading is also likely to have an impact on NO metabolism, which suggests a role for NO in remodeling and adaptation of bone around dental implants. CONCLUSION: Besides the presence of inflammation, the severity of inflammation and loading also seem to have an impact on NO metabolism around dental implants.

Adult↗
PubMed2003

Dental implants in patients with type 2 diabetes mellitus: a clinical study.

PURPOSE: Systemic factors, such as diabetes mellitus, can influence the success rate of dental implants. The authors describe their experience using the MIS implant system (Medical Implant System, Shlomi, Israel) for retention of overdentures in patients with type 2 diabetes mellitus and provide data regarding the level of satisfaction of the patients, the improvement of function, mucosal and periimplant health, and bone level around implants in this group. METHODS: The study group consisted of 41 patients with type 2 diabetes mellitus who received 141 implants for retention of overdentures. RESULTS: The success rate was 97.3% and 94.4% 1 and 5 years following implantation, respectively. The majority of patients reported improvement of function following the new treatment. A high correlation was observed between mucosal health and improvement of function. No correlation was found between failed implants and glucose level. CONCLUSION: The clinical outcome of dental implants in a selected group of patients with well-controlled type 2 diabetes mellitus is satisfying and encouraging. Further investigations and clinical trials over a longer period of time are needed to determine the long-term survival of implants in diverse groups of patients with diabetes mellitus.

Aged↗
PubMed2000

Advances in endosseous implants: the 'sandwich' split cortical graft for dental implant placement.

Endosseous implants have restored normal function and dental health to many patients. When implants were introduced as an effective treatment modality, their efficacy was limited by the amount of available bone. Today, various grafting procedures can surgically create bone width and volume. Implants can be placed in more ideal locations for successful prosthetic reconstruction. Autogenous bone has been considered the "gold standard," and the most predictable graft material. However, harvesting autogenous bone requires a second surgical site, increased surgical and healing time, and increased morbidity. A loss of a single tooth or multiple teeth leads to atrophy of the alveolus and reduction of osseous width and height (volume). "Sandwich" split cortical graft surgery can be used as the surgical procedure of choice to re-establish bone volume and contour. With this procedure, the recipient site is also the site for the donor cortical bone. A bone replacement graft material is placed within the cancellous compartment and is contained by the autogenous cortical block harvested from the recipient bed. Sandwich split cortical graft surgery offers the obvious advantage of autogenous bone without the need for a second surgical site.

Absorbable Implants↗
PubMed2007

Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts.

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.

Adult↗
PubMed2006

Resonance frequency analysis after the placement of 133 dental implants.

INTRODUCTION: The primary stability of dental implants is related to the bone in contact with the latter, and can be evaluated by resonance frequency analysis. MATERIAL AND METHODS: Measurements were made in 133 implants (62 in the upper jaw and 71 in the mandible) of resonance frequency and insertion force to determine implant stability on the day of surgery, with an evaluation of its relationship to different variables. RESULTS: The stability quotient of the implants on the day of surgery was 62.1, with an insertion force of 35.7 N. The insertion force was proportional to the resonance frequency, with an increasing stability quotient with growing insertion force. The stability quotient was greater in the larger diameter implants, shorter implants, in mandibular placement and in areas of more compact bone. CONCLUSIONS: The stability quotient on the day of implant placement is greater in higher bone density areas.

Adult↗
PubMed1995

[Dental implants: cost-effectiveness analysis].

The efficacy and effectiveness of dental implants have been proven during the last years. An economic evaluation must be integrated within the clinical evaluations to determine economic (allocative) efficiency. According to the literature dental implants will show better results. The treatment is, however, more expensive. Assessment of costs and benefits can lead to more efficiency in dental care. The possibilities to evaluate the outcome of treatment are discussed and essential aspects of the economic evaluation are described.

Consumer Behavior↗
PubMed2007

Short-term success of osseointegrated dental implants in HIV-positive individuals: a prospective study.

PURPOSE: Except for the occasional case report, there are no studies evaluating the success rate of osseointegrated dental implants in individuals infected with the human immunodeficiency virus (HIV). This study investigated the short-term clinical outcome of implant placement in a group of HIV-positive and HIV-negative individuals who required complete dentures. METHODS AND MATERIALS: Edentulous subjects were recruited from an HIV-dedicated clinic and a dental school clinic. Two BioHorizons dental implants were placed in the anterior mandible to support an overdenture opposing a maxillary denture. Outcome measurements obtained six months after activation of implants were presence of pain, mobility, soft tissue status, and radiographic bone level. Descriptive statistics were used. RESULTS: Twenty-nine edentulous adults, including 20 HIV-positive subjects (test) and nine HIV-negative subjects (control), participated. The test group had six females, 14 males; 13 Whites, four African-Americans, and three Hispanics with a mean age of 48.9 years (range: 35-59). The mean CD4 count was 467 cells/mm3 (range: 132-948). The control group had six females, three males; seven Whites, and two Hispanics with a mean age of 65.3 years (range: 50-82). Short-term success rate was 100% for both groups. No difference in clinical outcome was found between the groups. CONCLUSION: This study demonstrated dental implants are well tolerated and have predictable outcomes for HIV-infected individuals for the duration of the study and probably over an even longer term.

Adult↗
PubMed1995

Localized chronic suppurative bone infection as a sequel of peri-implantitis in a hydroxyapatite-coated dental implant.

Plaque-induced lesions can produce peri-implant bone loss with ultimate implant loss. Although the peri-implant tissues seem to be more resistant than the periodontal ones to plaque and calculus, they can produce a more extensive spread of the infection to the deeper tissues around implants. The case of a 45-year-old female patient is presented in which, over a three year period, there was a progressive loss of peri-implant bone and the formation of a periapical radiolucency with an external fistula. The implant was removed and examined with the cutting-grinding system. Microscopy examination showed that most of the hydroxyapatite (HA) was still adherent to the metal. There was a detachment in the area of the HA-titanium interface. The implant surface was almost completely covered by bacteria. Bacteria were also present in the bone medullary spaces surrounding the implant. The infection of the periodontal tissues had progressed into the alveolar bone, thus producing a localized bone infection. The cause of the implant failure is probably related to a defective connection of the abutment or to overloading of the implant due to the presence of interlocks in the prosthetic restoration.

Bone Resorption↗