Experimental evaluation of dental implants.
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Dental Implantation↗
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A synopsis of recent literature concerning the dental implant.
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Dental Implantation↗
Use of SIG device to accurately place permanent miniature dental implants to retain mandibular overdenture. A case report.
A case of mini-dental implant insertion for retention of a mandibular overdenture in a hospitalized patient has been documented. The additional use of the SIG (drill guide) directional device in the implant placement protocol gave the practitioner more confidence and resulted in the proper alignment of the three ball-top, one-piece fixtures. The three implants were inserted exactly 1 cm apart and parallel to each other. The distal fixtures were approximately 1 cm away from the mental foramina, thereby eliminating the risk of lip paresthesia. Keeper caps were placed in the denture's intaglio after one month. The keeper caps allowed for proper retention of the overdenture. The caps also enabled the patient to easily insert and withdraw his denture, even though he displayed limited manual dexterity. The tissue response was excellent, and oral hygiene was made easier with adequate spacing of the exposed ball-tops. The overall experience for both the operator and the patient was very positive. General dentists should be able to readily master this technique and add it to their armamentarium for the benefit of all their patients.
Dental Implantation, Endosseous↗
Identification of dental implants on radiographs.
In the future, dentists will more frequently encounter patients who have dental implants. To use radiographs to identify implants that were previously inserted by other dentists, dentists have to be familiar with the detailed morphology of different products and types of fixtures as well as with the principles for formation of their radiographic images. In the present study, radiographic images of ten common dental implants were analyzed. Images varied with viewing angles. The influences of surface structures, such as threads, cuts, holes, perforations, and flutes, are demonstrated.
Dental Implants↗
Biocompatibility of polysulfone composite materials for dental implant.
As a part of the work designed to find a material suitable for a dental implant, tissue reaction of various kinds of polysulfone composite materials has first been studied by implantation in the femur of rats and in the mandible of rabbits. Histological examination showed that the porous polysulfone composite containing 20 wt.% of tricalcium phosphate exhibited a favorable osteogenesis. The tooth replica implants made of this composite material were inserted into the extraction sockets of dogs. During 5.5 months of observation, horizontal or diagonal orientation of periodontal fibers, no epithelization, and no alveolar bone resorption were noted. This study suggests a promising feasibility of the polysulfone-calcium phosphate composite material as a dental implant material.
Animals↗
The influence of implant type, material, coating, diameter, and length on periotest values at second-stage surgery: DICRG interim report no. 4. Dental Implant Clinical Research Group.
Many of the presently used methods of evaluating osseointegration at second-stage surgery are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration by means of microcomputer-controlled percussion. In 1991 the Dental Implant Clinical Research Group initiated a long-term clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on clinical performance and crestal bone height. As part of this investigation, the Periotest values for 1,565 root form implants were determined at second-stage surgery and correlated with type, material, coating, diameter, and length. Hydroxyapatite-coated implants and increased implant diameter and length produced Periotest values that indicated a greater extent of stability as compared with noncoated implants with shorter diameters and lengths. Hydroxyapatite-coated cylinder-type implants yielded the most favorable Periotest readings. Not only does the Periotest have the potential of being a valuable instrument for assessing implant mobility at second-stage surgery, but it also appears to have the capability of determining slight differences in the implant-bone complex.
Dental Alloys↗
Design of functionally graded dental implant in the presence of cancellous bone.
In a previous work by the author [Hedia HS, Mahmoud NA. Biomed Mater Eng 2004;14(2):133--143], a functionally graded material (FGM) dental implant was designed without cancellous bone in the model. In this investigation, the effect of the presence of cancellous bone as a thin layer around the dental implant was investigated. It is well known that the main inorganic component of natural bone is hydroxyapatite (HAP) and that the main organic component is collagen (Col). HAP implants are not bioabsorbable, and because induction of bone into and around the artificially made HAP is not always satisfactory, loosening or breakage of HAP implants might occur after implantation in the clinical application. The development of a new material that is bioabsorbable and that has osteo-conductive activity is needed. Therefore, the aim of the current investigation was to design an implant, in the presence of cancellous bone as a thin layer around it, from FGM. In this study, a novel biomaterial, Col/HAP, as a FGM, was developed using the finite element and optimization techniques that are available in the ANSYS package. These materials have a self-organized character similar to that of natural bone. The investigations have shown that the maximum stress in the cortical bone and cancellous bone for the Col/HAP functionally graded implant has been reduced by about 40% and 19%, respectively, compared with currently used titanium dental implants.
Bone and Bones↗
The influence of implant design, application, and site on clinical performance and crestal bone: a multicenter, multidisciplinary clinical study. Dental Implant Clinical Research Group (Planning Committee).
This investigation is designed to provide scientific data that is directly relevant to the placement of dental implants. The study is concerned with the influence of implant design, application, and location on long-term clinical performance and crestal bone response over 5 years of function. It involves approximately 700 patients at 30 Veterans Administration Medical Centers from various geographic regions. Patients are being entered into the study over an 18-month period and monitored (post-loading) over 5 years. The participating centers were randomly assigned to one of two separate, independent study groups. Complications and adverse responses associated with the placement and use of the implants will be evaluated and all failures thoroughly documented. The experimental design and sample size are based on the primary hypothesis that an implant-supported prosthesis will be successful/functional over a 5-year period in at least 90 percent of the cases treated. Secondary hypotheses to be tested are (1) the success rate among implant designs are the same over a 5-year period; (2) the success rate among implant applications are the same over a 5-year period; (3) the success rate of individual implants are the same with regard to jaw location over a 5-year period; (4) the loss of crestal bone at the individual implant sites are the same among the implant designs over a 5-year period; and (5) the complications and adverse responses experienced with the different implant designs are the same over a 5-year period. The experimental design of this multicenter, multidisciplinary, randomized investigation is a cooperative effort of the Department of Veterans Affairs and several United States dental schools.
Alveolar Bone Loss↗
Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part IV. Evaluation of hydroxyapatite-coated implants.
The aim of this study was to evaluate clinically, histologically and histometrically the use of hydroxyapatite-coated dental implants in conjunction with maxillary sinus augmentation procedures. In 4 adult male Rhesus monkeys (Macaca mulatta) the 3 maxillary molars on 1 side of the jaws were extracted and the remaining bone between the alveolar crest and the floor of the sinus was reduced to 3-4 mm. After 3 months, maxillary sinus augmentation procedures were performed in each monkey and the sinuses were grafted with a porous hydroxyapatite bone graft (Interpore-200). At the same time, 2 hydroxyapatite-coated cylinder implants (IMZ) were immediately placed into the augmented sinuses (i.e. simultaneous-implants-loaded group). Four months later, 2 additional similar implants were placed into the previously augmented sinuses (i.e. delayed-implants-loaded group). After 4 months, the abutment connection was performed and all 4 implants were loaded with a gold-alloy bridge for 6 months (i.e. until sacrifice of the animals). The contralateral side of each monkey received the same treatment with the exception that removal of the maxillary molars was performed 7 months after those in the opposite side, and that the implants in this side were not loaded. Thus, 2 additional study groups (i.e. simultaneous-implants-unloaded group and delayed-implants-unloaded group) were obtained. Clinically, all loaded and unloaded implants were stable the day of sacrifice. Histologically, the grafted sinuses exhibited a significant amount of new bone formation with integration of the porous hydroxyapatite graft particles and hydroxyapatite-coat of the dental implants to the new bone. Histometric analysis indicated that on the loaded side the implants placed simultaneously with the sinus lift procedure exhibited greater direct mineralized bone-to-implant contact than the delayed placed implants. In addition, the percentage of direct mineralized bone-to-implant contact was significantly greater in the residual bone in comparison to the augmented area in all groups. Loading of the implants exhibited a positive effect on the percentage of direct mineralized bone-to-implant contact in the augmented area. It could be concluded that hydroxyapatite-coated implants may be of benefit when used in conjunction with sinus augmentation procedures.
Alveolar Process↗
Rehabilitation of maxillofacial trauma patients with dental implants.
Maxillary and mandibular traumatic injuries are inevitable in our society. Dental implants can be considered for the replacement of teeth lost as a result of trauma, even in complicated cases where associated injuries, such as jaw fractures and bone loss, have occurred. Reimbursement for dental services by insurance companies in the case of traumatic injuries to the teeth and supporting structures is discussed.
Adolescent↗
Dental implant replacement of the mandibular first molar tooth in a dog.
A new dental implant system was used to replace the mandibular right first molar tooth in an eleven-month-old male/intact, utility trained German shepherd dog. The permanent mandibular right first molar tooth had been extracted as treatment for an extensive carious lesion when the dog was 9-months of age. There were no complications associated with placement of the dental implant. However, peri-implant osteomyelitis occurred secondary to a traumatic oral wound 6-months following implant placement. The 17-month post-operative examination indicated that the implant system used in this case could be maintained in a working dog that uses extreme bite forces. However, periodontal inflammation and vertical bone loss exposing the implant fixtures were noted during oral examination. Further clinical applications are required to determine if the periodontal inflammation and vertical bone loss noted in this case were complications associated with the implant, maturity of bone at the time of implant fixture placement, general biting/chewing forces placed on carnassial teeth, or the oral trauma that occurred 6-months following implant placement.
Animals↗
Therapeutic use of hyperbaric oxygen for irradiated dental implant patients: a systematic review.
The aim of this systematic review was to investigate the effectiveness of hyperbaric oxygen (HBO) therapy for irradiated patients who require dental implants using data from randomized controlled clinical trials (RCTs). The review was prepared according to Cochrane Collaboration guidelines. The Cochrane Oral Health Group Specialist Register and the Cochrane Controlled Trials Register were searched (Cochrane Library 2002, Issue 2), together with Medline from 1966 or Embase from 1974. Several journals were hand-searched, and fifty-five implant manufacturers were contacted in an attempt to identify ongoing or unpublished studies. The results were that no RCTs comparing HBO with no HBO for implant treatment in irradiated patients were identified. Our principal conclusions are that clinicians ought to be aware and make patients aware of the lack of reliable clinical evidence for or against the clinical effectiveness of HBO therapy in irradiated patients requiring dental implants. There is a need for RCTs to determine the effectiveness of HBO.
Cranial Irradiation↗
Bone height measurements around a dental implant after a 6-month space flight: a case report.
PURPOSE: In space, astronauts are subject to microgravity, which reduces skeletal loading and osteoblast function and can cause bone resorption and a decrease in bone density. No known research to date has studied the effect of microgravity on dental implants. This study evaluated peri-implant bone changes around a dental implant placed in a French astronaut who spent 6 months in Russia's Mir Space Station. MATERIALS AND METHODS: Measurements were performed by 2 examiners before the flight (baseline), after the flight (stage 1), and following a recovery period (stage 2). Standardized periapical radiographs were taken, and data were recorded using a photomicroscope and a measuring scale. RESULTS: Cumulatively, the implant sustained 0.43 mm of mesial bone gain and 0.31 mm of distal bone loss. DISCUSSION: The observed peri-implant bone height changes were within normal limits and the implant appeared very stable during the course of this study. CONCLUSION: Peri-implant bone levels remained stable after 6 months in microgravity, and the implant continued to function without complications.
Alveolar Bone Loss↗
Immediate loading of dental implants in partially edentulous patients: a clinical report.
Immediate loading of dental implants offers attractive advantages for patient and prosthodontist alike. Current data support immediate loading of splinted screw-shaped implants in the parasymphysis region. This report presents a case of a partially edentulous patient successfully restored with a fixed implant prosthesis following an immediate loading protocol.
Aged↗
Maxillary reconstruction with a fibula osteoseptocutaneous free flap and simultaneous insertion of osseointegrated dental implants.
The fibula osteoseptocutaneous flap is a good option for reconstruction of three-dimensional composite maxillary defects. This flap provides both bone and soft-tissue reconstruction and allows osseointegrated dental implantation, either simultaneously or in a second-stage procedure. Simultaneous placement of osseointegrated dental implants reduces operative sessions and allows faster oral rehabilitation for properly selected patients. The defects may result from trauma or resection of benign tumors or low-grade malignancies. Between August of 1999 and July of 2001, three patients underwent maxillary reconstruction with the fibula osteoseptocutaneous flap and simultaneous osseointegrated dental implants. The cause of the defect was trauma in two cases and resection of an adenoid cystic carcinoma in the other. The mean length of the fibula used for bony reconstruction was 4.7 cm. One osteotomy was performed in one case and no osteotomy was necessary in the other two. Skin islands of 8 x 2.5 cm and 16 x 3.5 cm were used for two patients. For the other patient, a double skin island was used for both nasal (6 x 4 cm) and oral (6 x 5 cm) reconstructions. Two osseointegrated implants were inserted into the fibular bone for each patient. Six months after the first-stage procedure, palatal rotation flaps or mucosa grafts were used to cover the exposed implant necks and prepare the implants for prostheses. One month after the second-stage procedure, prostheses were placed. An implant-supported prosthesis was used for one patient and implant/tissue-supported prostheses were used for the others. At a mean follow-up time of 30 months (range, 16 to 38 months), all patients were able to use the dental prosthesis for chewing (beginning 6 weeks after the final procedure) and all patients were satisfied with the cosmetic results.
Adult↗
Use of abutment-teeth vs. dental implants to support all-ceramic fixed partial dentures: an in-vitro study on fracture strength.
The aim of the present in-vitro study was to compare the fracture strength of all-ceramic Fixed Partial Dentures supported by tooth-analogues and periodontal membrane with the same supported by dental implants. As ceramics are highly brittle, they cannot withstand deformations of more than 0.1% without fracturing. Hence, when planning an all-ceramic FPD, it is essential to evaluate abutment support, as the fracture strength of all-ceramic constructions depends on the stability of the support to reduce strain in the beam of the prosthesis. The support provided by implants differs, however, from the support provided by natural teeth as the implants are anchored directly in the bone with no intermediate tissue. One question that arises is whether strain and stress in the prosthesis are lower when the prosthesis is loaded on implants compared to natural teeth and hence if all-ceramic FPDs benefit from implant support. Twenty-four three-unit all-ceramic FPDs-12 supported by two dental implants and 12 by two tooth-analogues serving as end abutments-were made. All FPDs were subjected to preloading in a preloading procedure and subsequently subjected to load until fracture occurred. Load at fracture were registered and comparisons between the two groups were made. The loads at fracture were statistically significant higher in the group supported by implants compared to the group supported by tooth-analogues (p = 0.003). Within the limitations of this in-vitro study, the following conclusions can be drawn: All-ceramic fixed partial dentures can be used in combination with dental implants. The solid support gained from implants might thus be beneficial for the outcome of such treatment due to decreased strain and stress levels in the prosthesis when loaded on implants compared to when loaded on natural teeth. Clinical studies are, however, needed to confirm these findings as there are more factors that influence the final clinical outcome.
Dental Abutments↗
Initial healing in the dog of submerged versus non-submerged porous-coated endosseous dental implants.
It has previously been reported that porous-coated root form endosseous dental implants, became well integrated when used in the traditional 2-stage surgical approach. In this study, the placement of the implant in a 1-stage (non-submerged) technique was to be explored. Implants were placed in the mandibles of dogs, and 2 designs were used differing only in that one (experimental) had a 3-mm transgingival extension, permitting it to be exposed to the oral cavity from the outset. 12 (3 per animal) non-submerged implants were placed on 1 side of 4 beagle dogs and 12 control (submerged) implants were placed contralaterally. All implants were allowed to heal for 6 weeks, after which histological preparations were made. 2 of 12 non-submerged implants were lost due to post-operative complications; otherwise, all implants healed uneventfully. Histomorphometric analysis revealed bone-implant contact, as assessed by absolute bone contact (ABC) and contact length fraction (CLF), to be greater for the submerged design, suggesting that bone healing may be delayed with the non-submerged approach. As well, at this early stage of healing, for both implant designs, ABC and CLF were significantly greater on proximal than on buccal and lingual aspects.
Alloys↗
Early detachment of titanium particles from various different surfaces of endosseous dental implants.
Titanium (Ti) endosseous dental screws with different surfaces (smooth titanium--STi, titanium plasma-sprayed-TPS, alumina oxide sandblasted and acid-etched--Al-SLA, zirconium oxide sandblasted and acid etched--Zr-SLA) were implanted in femura and tibiae of sheep to investigate the biological evolution of the peri-implant tissues and detachment of Ti debris from the implant surfaces in early healing. Implants were not loaded. Sections of the screws and the peri-implant tissues obtained by sawing and grinding were analysed by light microscopy immediately after implantation (time 0) and after 14 days. All samples showed new bone trabeculae and vascularised medullary spaces in those areas where gaps between the implants and host bone were visible. In contrast, no osteogenesis was induced in the areas where the implants were initially positioned in close contact with the host bone. Chips of the pre-existing bone inducing new peri-implant neo-osteogenesis were surrounded by new bone trabeculae. The threads of some screws appeared to be deformed where the host bone showed fractures. Ti granules of 3-60 microm were detectable only in the peri-implant tissues of TPS implants both immediately after surgery and after 14 days, thus suggesting that this phenomenon may be related to the friction of the TPS coating during surgical insertion.
Animals↗