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PubMed2006

Systematic review of survival rates for immediately loaded dental implants.

The primary goal of this paper was to determine the survival rate of immediately loaded (IL) dental implants based on a systematic review of the literature. Secondary goals were to determine the influence of several factors on the implant survival rate, such as the type of reconstruction, implant location, and implant surface characteristics. An electronic search of databases was performed, in addition to a hand search of the most relevant journals. All relevant articles were independently screened according to specific inclusion criteria. The selected papers were reviewed. The literature search yielded 270 applicable articles up to December 2005. Of these, 71 met the inclusion criteria for qualitative data analysis. Eight articles were randomized controlled trials. The overall implant survival rate for the included studies was 96.39%. The database included 10,491 IL implants placed in 2,977 patients, with a maximum follow-up of 13 years. IL is well documented and predictable for the edentulous mandible (overdentures and full-arch prostheses) and for maxillary single crowns. Fewer data were found for maxillary full-arch reconstructions, fixed partial prostheses, and mandibular single crowns. For the latter two types of reconstructions, implants placed in anterior sites generally displayed a higher survival rate versus those placed in posterior sites. Rough surfaces displayed a higher survival rate than machined surfaces in all types of reconstructions. Most failures (97.1%) occurred within the first 12 months of loading. This review showed that it is possible to apply IL with excellent survival rates. Implant micromorphology and careful patient selection may affect treatment outcomes.

Dental Abutments↗
PubMed1992

Finite element stress and strain analysis of the bone surrounding a dental implant: effect of variations in bone modulus.

The long-term clinical performance of a dental implant is dependent upon the preservation of good quality bone surrounding the implant and a sound interface between the bone and the biomaterial. Good quality bone is itself dependent upon the appropriate level of bone remodelling necessary to maintain the bone density and the avoidance of bone microfracture and failure. Both processes are governed by the stress and strain distribution in the bone. In this study, a dental implant which had the same geometry as the Branemark system, but with a bioactive surface coating added to produce a direct bond to the bone, was analysed. A finite element stress and strain analysis has been carried out for a range of bone density distributions under axial and lateral loading. The predictions indicated that there was no evidence of strain shielding around the neck of the implant. With lateral loading, high values of von Mises stresses (18 M Pa) were predicted around the neck of the implant. A reduction in the elastic modulus of the bone around the neck of the implant by a factor of 16 only produced a twofold reduction in the peak stress. This resulted in stress levels capable of inducing fatigue failure in this much weaker bone. This analysis has demonstrated that it is extremely important to have good quality dense bone around the neck of the implant to withstand the predicted peak stresses of between 9 and 18 M Pa. Failure to achieve this after implantation and subsequent healing may result in local fatigue failure and resorption at the neck upon resumption of physiological loading.

Bone Density↗
PubMedDate not supplied

A prospective clinical study in humans of an endosseous dental implant partially covered with a powder-sintered porous coating: 3- to 4-year results.

A dental implant covered partially with a porous coating (EndoPore) developed at the University of Toronto was tested. This new implant is a tapered, truncated-cone endosseous root-form implant fabricated from Ti-6Al-4V. It utilizes a powder-sintered porous surface geometry over most of its length to promote three-dimensional bone ingrowth and implant stabilization. In this trial, three implants were placed in the anterior mandibles of 52 patients and were used subsequently as free-standing units to support an overdenture. Much shorter implants, shorter initial healing periods, and simpler surgical techniques than are customary with other implant designs were used. At the time of this report, all patients with implants had passed 3 years of function, and the cumulative implant success rate was 94.8%. Analysis of carefully standardized radiographs revealed a pattern of crestal bone loss similar to earlier published dog data. On a yearly basis, the mean bone loss was 0.43 mm in year 1, 0.17 mm in year 2, and 0.13 mm in year 3.

Adult↗
PubMed2005

Osteotome sinus elevation and simultaneous placement of porous-surfaced dental implants: a morphometric study in rabbits.

The objective was to establish a model in rabbits in which to study the healing events associated with localized indirect osteotome-mediated maxillary sinus floor elevation in conjunction with simultaneous placement of sintered porous-surfaced dental implants. On one side of the maxilla of each of 28 rabbits, a sintered porous-surfaced titanium alloy press-fit implant was placed without the use of a bone graft material, while on the collateral side an implant was placed after first adding Bio-Oss graft particles to the osteotomy. Specimens were retrieved for morphometric assessment of bone contact and bone ingrowth of the porous implant surface after 2, 4, 6 and 8 weeks of healing. All implants became osseointegrated by bone ingrowth into the porous implant surface. While the addition of graft particles did not result in a statistically significant increase in the parameters measured, a trend for greater bone contact and particularly bone ingrowth at the apices of the implants was seen as healing time increased. The rabbit maxillary sinus can be used to study healing following placement of sintered porous-surfaced dental implants using the indirect sinus elevation procedure.

Alloys↗
PubMed1993

Augmentation of osseous tissue around nonsubmerged endosseous dental implants.

The placement of one-stage endosseous dental implants and the achievement of success rates greater than or equal to two-stage implants present a unique challenge for combining regeneration and implant placement. This report describes the evolution of a technique in which membrane barrier technology is combined with implant placement. This allows healing to occur with minimal inflammation around the one-stage implant and provides an extended, complication-free healing period for both osseous regeneration and implant integration. Present membrane technology requires a second surgical procedure to remove the membrane, but future resorbable membranes, when available, should make regeneration around one-stage implants a relatively simple clinical procedure.

Alveolar Ridge Augmentation↗
PubMed2001

Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region.

BACKGROUND: The regeneration of gingival papillae after single-implant treatment is an area of current investigation. This study was designed to determine: 1) whether the distance from the base of the contact point to the crest of the bone would correlate with the presence or absence of interproximal papillae adjacent to single-tooth implants, and 2) whether the surgical technique at uncovering influences the outcome. METHODS: A clinical and radiographic retrospective evaluation of the papilla level around single dental implants and their adjacent teeth was performed in the anterior maxilla in 26 patients restored with 27 implants. Six months after insertion, 17 implants were uncovered with a standard technique, while 10 implants were uncovered with a technique designed to generate papilla-like formation around dental implants. Fifty-two papillae were available for clinical and radiographic evaluation. The presence or absence of papillae was determined, and the effects of the following variables were analyzed: the influence of the 2 surgical techniques; the vertical relation between the papilla height and the crest of bone between the implant and adjacent teeth; the vertical relation between the papilla level and the contact point between the crowns of the teeth and the implant; and the distance from the contact point to the crest of bone. RESULTS: When the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was > or = 6 mm, the papilla was present 50% of the time or less. The mean distance between the crest of bone and the most coronal papilla level (interproximal soft tissue height) was 3.85 mm (SD = 1.04). When comparing the conventional and modified surgical technique, the relation shifted from 3.77 mm (SD = 1.01) to 4.01 mm (SD = 1.10), respectively. CONCLUSIONS: These results clearly show the influence of the bone crest on the presence or absence of papillae between implants and adjacent teeth. The data also show a positive influence for the modified surgical technique, aimed at reconstructing papillae at the implant uncovering.

Adult↗
PubMed1993

Guided tissue regeneration around dental implants: three case reports.

This article demonstrates the use of guided tissue regeneration (GTR) principles for regeneration of bone tissue in jaw bone defects associated with dental implant placement. The learning objective of this article is the technique of bone tissue regeneration using the barrier membranes. Three cases are presented to illustrate the procedure. In all of them, the barrier membrane was used to cover the surgical site after the placement of dental implants and bone grafts.

Alveolar Bone Loss↗
PubMedDate not supplied

Three-dimensional templates for placement of root-form dental implants: a technical note.

This report describes a method for gathering information to assist in properly placing dental implants. A diagnostic template is first fabricated, incorporating radiographic markers. Radiographs of the template are obtained, and data from their study are transferred to the laboratory to facilitate the fabrication of a surgical template. This procedure has the potential to map implant sites three dimensionally. Template use can result in a greater number of implants placed in optimal positions.

Contrast Media↗
PubMedDate not supplied

Comparison of dental implant systems: quality of clinical evidence and prediction of 5-year survival.

PURPOSE: This literature review was conducted to evaluate the quality of current evidence of clinical performance provided by American Dental Association-certified dental implant manufacturers and manufacturers with strong market penetration in the United States. The study also compared the clinical performance of different dental implant systems. MATERIALS AND METHODS: A letter was sent to 6 implant manufacturers requesting 10 references each that validated the manufacturer's implant system in a variety of clinical applications. References were reviewed and classified relative to strength of evidence. Data extraction was then performed. Comparisons of implant survival data from 5-year studies were made, and data were pooled to establish an overall 5-year survival rate with confidence intervals (CIs). RESULTS: A total of 69 references were provided by the 6 implant manufacturers (Astra Tech, Centerpulse, Dentsply/Friadent, Implant Innovations, Nobel Biocare, and Straumann) but only 59 articles were available for review. Of those references, most were level-4 (case series) or level-5 (expert opinion) articles. Five-year survival data were extracted from 17 articles demonstrating overlap of CIs from the weighted average of the pooled data from each specific manufacturer; substantial equivalence of all implant systems was demonstrated based upon survival alone at 5 years. When all data were pooled, the 5-year survival rate of 96% (CI: 93% to 98%) was observed for a total of 7,398 implants. DISCUSSION: No obvious differences in implant survival were observed when comparing implant systems. CONCLUSIONS: The evidence supporting implant therapy is generally derived from level-4 case series rather than higher-level cohort or controlled clinical trials. Articles that directly compared different implant systems were not found. Five-year implant survival rates easily exceeded the minimums recommended by the American Dental Association certification program. (More than 50 references.)

Bibliometrics↗
PubMed1979

Clinical, radiographical, and histological evaluation of porous rooted polymethylmethacrylate dental implants.

Forty-three porous rooted polymethylmethacrylate (PMMA) dental implants were inserted into twenty-four dogs. Successful implants were maintained for up to three years. Histological sections with the implants in situ of implants revealed a soft tissue-implant interface similar to natural teeth. Bone and fibrous tissue ingrowth into the pores attached the implant to the bone. Failures were attributed to mechanical weakness of the implant, thin buccal cortical bone, and excessive implant-gingiva interface.

Alveolar Process↗
PubMed1989

Clinical management of failing dental implants: four case reports.

Two-stage, endosseous dental implants have become a clinically acceptable treatment modality for the restoration of function and esthetics in edentulous areas. One system (Biotes, Nobel-pharma) currently has full approval from the ADA for use in full edentulous cases, while several other systems have provisional approval. Several professional journals and lay magazines have published information about implants, and this has stimulated interest on the part of both the dentist and the patient. Many different brands of implant systems are now available for the clinician to utilize, and the manufacturers of these implants have established training programs designed to teach both the generalist and the specialist the correct placement and restoration of their particular implants. With an increase in the number of implants being placed, it is inevitable that the number of complications will likewise rise. While current implant literature is replete with information concerning the concept of osseointegration, success rates, and examples of restorative techniques, there is very little information available on guidelines for patient evaluation and selection, clinical maintenance homecare, or treatment considerations for system failure. It is conceivable that an implant that was correctly placed and exhibited all the criteria for success at the time of surgical exposure may develop problems subsequent to restoration. Since the investment for the patient is significant in terms of time, finances, and trust in the practitioner(s), the periodontist may be called upon to intervene in such cases to improve the prognosis. The purpose of this paper is to present four case reports that illustrate several treatment modalities for the clinical management of implant problems that developed at the time of, or following, exposure.

Adult↗
PubMed2005

The human bone-oxidized titanium implant interface: A light microscopic, scanning electron microscopic, back-scatter scanning electron microscopic, and energy-dispersive x-ray study of clinically retrieved dental implants.

BACKGROUND: Surface modification of titanium implants by anodic oxidation may lead to enhanced bone integration. For instance, in vivo studies have demonstrated formation of more bone contacts in less time than for turned control implants. In addition, oxidized implants have shown a higher resistance to torque forces, indicating a strong interlock between bone and the oxide layer. However, the structure of the oxidized titanium-bone interface in high resolution is not known. PURPOSE: The aim of the study was to analyze the human bone-oxidized titanium interface at a high-resolution level. Of particular interest was the relationship between bone tissue and the pores of the surface oxide. MATERIALS AND METHODS: Twelve clinically retrieved implants with an oxidized surface (TiUnite, Nobel Biocare AB, Göteborg, Sweden) were used. Seven were regular dental implants and five were experimental mini-implants and had been subjected to immediate, early, or no loading. They were retrieved after 5 to 9 months of healing and were processed and analyzed using light microscopy, scanning electron microscopy (SEM) in normal and back-scatter (BS-SEM) modes, and energy-dispersive x-ray (EDX) analysis techniques. RESULTS: Bone formation was observed to occur from adjacent bone structures toward the implant surface, and it was evident that bone formation had occurred at the implant surface. SEM, BS-SEM, and EDX revealed that mineralized bone had grown into the pores of the surface oxide layer, including pores with small diameters (< 2 microm). CONCLUSIONS: The clinically retrieved oxidized implants showed evidence of bone growth into the pores of the surface oxide layer. The findings indicate the establishment of a strong interlock between the bone and the oxidized titanium implant, which is suggested to be beneficial for clinical performance.

Coated Materials, Biocompatible↗
PubMed1990

Histometric and ultrastructural studies of tissues surrounding Astra dental implants in dogs.

Twenty-four Astra titanium dental implants were inserted bilaterally, three on each side, into the mandibles of four dogs to study mucosal and bone-implant junctions. After a healing period of 6 months, the dogs were sacrificed and bone sections with implants were removed and processed for histologic evaluation. All implants were stable, and radiographs disclosed complete bone healing. The surrounding mucosa closely resembled that surrounding natural teeth. Histometric analysis of the alveolar bone revealed that, on average, 61.3% of the implant surface interface was integrated in the bone at the light-microscopic level.

Alveolar Process↗
PubMed1995

Computer-assisted dental implant surgery using computed tomography.

Standard planning for dental implants consists of a prosthesis simulation on diagnostic casts and radiographic examination of anatomical structures. The clinician visually locates the planned trajectory on the surgical site in the patient's mouth without direct correlation between the radiographs and the anatomy. We have developed a computer assisted technique to define the optimal position of the bone implant using computed tomography to accurately place the implant in the planned position using a guide drilled into a resin splint.

Computer Simulation↗
PubMed1997

[Clinical study of occlusal forces on dental implants].

The object of this investigation was to analyze occlusal force in patients applied an implant-supported prosthesis. The occlusal force was measured on four free end saddle patients applied 10 dental implants (F. E.) and two bounded saddle patients 4 dental implants. The pressure sensitive sheet and the image scanner (Dental Prescale 50H type R and Occluzer FPD 703, Fuji Photo Film Co.) were used. The occlusal force (O. F.) occurred in implanted portion was almost the same as that on a natural tooth. O. F. and O. F. bearing rate (B. R.) on the posterior dentitions applied implants tended to increase toward the distal side. The total O. F. had a tendency to increase after applying implant-supported prosthesis, and comparing implanted side with non-implanted (natural teeth) side, B. R. was equilibrium. On the other hand, occlusal contact areas, O. F. and B. R. were decreased at the most distal tooth of residual dentition on the implant side of F. E.

Aged↗
PubMedDate not supplied

Short (6-mm) nonsubmerged dental implants: results of a Multicenter clinical trial of 1 to 7 years.

Limited bone height restricts the use of long dental implants, so short implants may be selected in these situations. Recent reports on clinical results with short implants have been negative, however, and have suggested that indications for the use of these implants are limited. To verify these findings, a multicenter study of short ITI implants was carried out. In a 6-year period 253 short implants with a length of 6 mm were placed into 126 patients, who were followed up from 1 to 7 years. Altogether 7 implants were removed; 6 of these were located in the maxilla and 1 in the mandible. The quality of survival was comparable with the clinical results of longer implants from the same implant system. Although the clinical results of these short implants were favorable, it is recommended that they be used in combination with longer implants, especially when used in the less dense bone that is often seen in the maxilla.

Adult↗
PubMed2002

Stress and strain distribution behavior in the bone due to the effect of cancellous bone, dental implant material and the bone height.

The stress and strain distribution in the bone surrounding a dental implant have been analyzed using the finite element and optimization techniques. The effect of removing cancellous bone completely or not was investigated. Two models were used, the first model without cancellous bone and the second with it. The elastic modulus of the implant material and the length of the implant neck or the height of bone surrounding the implant were used as design variables in the two models. In the first model a higher level of stress in the cortical bone surrounding the neck of the implant was found. While in the second model, it was found surrounding the tip of the implant. The result indicates that the stress concentration factor in the bone of the first model is reduced by 30% compared to the initial design. However, when the implant was surrounded by sleeve of cancellous bone (second model) the stress concentration is reduced by 16% for cortical bone and 15% for cancellous bone. This reduction help to reduce fatigue failure and bone resorption.

Coated Materials, Biocompatible↗