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PubMed1996

Risk factors in dental implant failure.

The goal of this study was to assess risk factors for dental implant failure. Eighty-three implants were placed in thirty patients who were followed for three years using digital subtraction radiography. The following putative risk factors for implant failure were employed in the model: age, sex, implant length, implant position, implant surface coating, smoking habit, and presence of infection. Implant failure was defined as progressive bone loss compromising the implant. We found that the presence of infection (P < 0.001) and absence of HA coating (P < 0.001) were the primary factors associated with early implant failure.

Adolescent↗
PubMedDate not supplied

Tissue-directed placement of dental implants in the esthetic zone for long-term biologic synergy: a clinical report.

Implant dentistry steadily evolves as more is learned about the unique biologic interrelationship of the dental implant restoration and the surrounding hard and soft tissues. Important factors include the impact of the surface microtopography on biochemically-mediated cell differentiation, the unavoidable bacterial colonization of the implant-abutment (or crown) microgap, the vertical and horizontal dimensions of biologic width, and the histology of surrounding structures. The recipient site, implant design, surgical technique, and location of the restorative platform significantly influence the optimal esthetics and biologic stability of implant restorations. There are differing opinions among clinicians regarding the appropriate positioning of the implant restorative platform in the vertical and sagittal planes relative to the alveolar crest. An apical and palatal orientation of the coronal platform relative to the alveolar crest in the esthetic zone is generally advocated for favorable facial and proximal emergence profiles of the definitive crown. Tissue-directed implant placement primarily considers the long-term consequences of the implant restoration upon the surrounding hard and soft tissues. The goal is to develop optimal gingival contours and a definitive restoration in the esthetic zone that coexist in stable biologic synergy. The rationale and the specific prosthodontic and surgical protocols inherent in the tissue-directed concept are discussed in this report.

Dental Implantation, Endosseous↗
PubMed2004

Passive tactile sensibility in edentulous subjects treated with dental implants: a pilot study.

STATEMENT OF PROBLEM: Edentulous patients treated with implant-supported prostheses have shown increased passive tactile sensibility compared with those using conventional complete dentures. This is thought to be due to the close mechanical coupling between the implant and bone via the osseointegrated interface, yet the phenomenon has received little attention. PURPOSE: The purpose of this study was to measure passive tactile sensibility in a group of edentulous subjects treated with dental implants, and to relate the measured sensibility to a range of factors thought to be of possible relevance, namely, patient age, gender, time since implant placement, implant length, and implant separation. MATERIAL AND METHODS: Twenty edentulous subjects successfully treated with 2 or more Nobel Biocare dental implants in the anterior mandible were studied. The inclusion criteria were : (1) age of less than 50 years, (2) a period of at least 12 months since implant placement, (3) implant length of at least 10 mm and of standard diameter (excluding narrow and wide platform designs), and (4) implant separation of at least 18 mm. Using a computer-controlled custom-made device, pushing forces (2.1, 2.4, 2.7, and 3.0 N/s) were applied directly and perpendicular to the long axes of the implant abutments until the subjects felt the first sensation of pressure. The magnitude of these forces was measured with an integral transducer. The applied force had a ramped staircase pattern, and force application rates were varied between 2.1 and 3.0 N/s. Multilevel modeling was used to analyze the collected data (alpha=.05). RESULTS: The threshold values of passive tactile sensibility ranged between 3.1 and 15.7 N (mean 10.9; SD 3.9). Analysis failed to show any significant association between passive tactile sensibility and the variables studied. CONCLUSION: Within the limitations of this study, which included a small sample size, no relationship was found between passive tactile sensibility associated with long-standing implants and any of the variables studied (age, gender, time since implant placement, implant length, and implant separation).

Age Factors↗
PubMed2006

Early colonization of non-submerged dental implants in patients with a history of advanced aggressive periodontitis.

The aim of the study was to evaluate the early colonization of non-submerged implants over a 6-month period in partially edentulous patients treated for advanced aggressive periodontal disease. In 22 patients treated for advanced aggressive periodontitis and in a supportive maintenance program for a period between 12 and 240 months at implant surgery, a total of 68 non-submerged dental implants were installed. Patients had a plaque score below 20%, and less than 20% of the pockets around the teeth were bleeding on probing (BOP). Using DNA-probes (micro-IDent), the presence and concentration of five periodontal pathogens (Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf) and Treponema denticola (Td)) were determined in the five deepest pockets of the rest dentition pre-operatively and after 6 months as well as five places around each implant 10 days, 1 month, 3 months and 6 months after surgery. In each patient, a test to determine the genotype interleukin-1 (IL-1) was performed (PST - micro-IDent). After 6 months, no difference in microbial composition as compared with baseline was found around the teeth in five patients, in 12 minute differences and in five patients important differences were observed. Ten days after surgery, three patients had a complete similar bacterial composition between teeth and implants. In 14 patients, the composition was fairly similar, while large differences in composition and concentration occurred in five patients. This microbiota around the implants remained almost unchanged over a 6-month period and did not hamper the clinical and radiographic osseointegration and did not lead to peri-implantitis, mucositis or initiation of bone destruction.

Adult↗
PubMed2003

Macrophages related to dental implant failure.

PURPOSE: The aim of this study was to evaluate, histologically and quantitatively, the presence of macrophages loaded with metallic particles in the periimplant soft tissues of failed titanium (Ti) dental implants. MATERIALS AND METHODS: The study was performed on sections of metallic Ti implants embedded in methyl methacrylate resin that exhibited macrophages in the soft tissues contiguous with the implant. The volume of periimplant soft tissue was evaluated, and the number of macrophages was determined. The particles within macrophages were analyzed by energy-dispersive x-ray analysis. RESULTS: Macrophages were more abundant in the zone adjacent to the metallic implant as compared with the zone further away from the implant. Energy-dispersive x-ray analysis revealed the presence of Ti within macrophages. CONCLUSIONS: Macrophages loaded with Ti particles can be associated with a corrosion process. The method proposed would allow for the objective evaluation of the presence of macrophages associated with dental implants and other orthopedic materials that contain Ti or other metals.

Cell Count↗
PubMed1996

Comparison of healed tissues adjacent to submerged and non-submerged unloaded titanium dental implants. A histometric study in beagle dogs.

This study involved histometry of the healed tissues around submerged and nonsubmerged dental implants in beagle dogs. In a split-mouth design, 19 submerged and 19 nonsubmerged commercially pure titanium implants, titanium plasma-sprayed in the bone anchoring part and smooth in the transmucosal portion, were placed in the mandibles of 6 dogs. Oral hygiene was performed 3 times weekly. After 3 months of healing, transmucosal abutments were inserted in the submerged implants. Six weeks after second stage surgery, the dogs were sacrificed and specimens obtained and processed for histology and histometry. Using a light microscope and a digitizing pad, the distance from implant top to mucosa border (DIM), the extent of epithelial downgrowth (ED), the attachment level, (AL), the length of connective tissue contact (CTC) and the distance of the first coronal alveolar bone contact from the implant top (DIB) were measured at the mesial and distal aspects. Means +/- standard deviations for submerged and nonsubmerged implants were calculated, with the dog being the unit of measure. No statistically significant differences between submerged and nonsubmerged implants were found for DIM, CTC and DIB. However, significant differences were observed for ED and AL. This study in beagle dogs indicates that the apical extension of the peri-implant epithelium is significantly greater and the attachment level significantly lower adjacent to submerged implants with second-stage transmucosal abutments than in nonsubmerged, one-stage implants.

Alveolar Process↗
PubMed2000

The immediate replacement of teeth by dental implants using homologous bone membranes to seal the sockets: clinical and radiographic findings.

Placement of dental implants into fresh extraction sockets has several advantages compared to the original protocol. However, the soft-tissue handling is often complicated and the aesthetic results less rewarding. A method to use a homologous bone membrane as the sole sealer of the extraction socket after immediate implant placement is introduced and the outcome of 34 cases is presented. In 4 cases early losses of the membranes occurred (2 of these iatrogenic damage) in all other cases the homologous membranes were covered by proliferation of the surrounding mucosa within 2-4 weeks. In 2 of the 4 cases where the membranes were lost, the implants did not integrate, in the other 2 cases the implants did integrate but the sockets did not fill completely with bone and the aesthetic results were not acceptable. In all other cases bone filling of the socket occurred, the implants were stable at 180 days after insertion (functional success rate 94.1%) and the aesthetic results were excellent. The method thus seems very promising but the healing process is delicate and the operation site highly vulnerable during the first postoperative weeks. It should also be stressed that the present study offers conclusions neither about the quality of the newly formed bone nor about the quality of osseointegration offered by this bone.

Adolescent↗
PubMedDate not supplied

Histomorphometric and fluorescence microscopic evaluation of interfacial bone healing around 3 different dental implants before and after radiation therapy.

PURPOSE: Radiation therapy influence on bone healing around 3 types of endosseous dental implants in dogs was evaluated. MATERIALS AND METHODS: Implants with 3 different surfaces (A = machined commercially pure titanium screws, B = commercially pure titanium plasma spray-coated cylinders, C = hydroxyapatite [HA] -ceramic coated cylinders) were first implanted unilaterally into the right posterior edentulous mandibles of 7 dogs as nonirradiated controls. After 12 weeks without functional loading and after sequential fluorochrome labeling these implants were retrieved by block dissection. In this same surgery, implants were placed on the contralateral side. Three weeks postimplantation the implant-containing hemimandibles were Cobalt 60 irradiated with the biologic equivalent of 5,000 cGy. Twelve weeks postimplantation and after labeling these irradiated implants were retrieved at sacrifice. On scanning electron, light, and fluorescence microscopic images of undecalcified longitudinal ground sections of the implants with surrounding tissues, percent bone-to-implant contact (% BIC), bone formation, and remodeling were histometrically and subjectively evaluated. RESULTS: Woven bone formation started 1 week after implantation at the implant interfaces on both the nonirradiated and the irradiated sides. Average BICs (total/cortical/spongious bone bed) of 26%/49%/36% for surface A, 46%/48%/64% for surface B, and 81%/83%/78% for surface C were observed. In the irradiated hemimandibles average BICs (total/cortical/spongious bone bed) were reduced to 11%/9%/4% for surface A, 43%/46%/43% for surface B, and 63%/85%/76% for surface C, with increased resorption of peri-implant bone and retarded bone formation after irradiation. DISCUSSION: Reductions of total % BIC in all irradiated implants, though not statistically significant, were significant (P < or = .05) on implant surfaces A and B in the spongious bone bed. CONCLUSION: Retarded bone formation on surfaces A and B in the spongious bone bed represented a more radiation-sensitive situation at the time of radiation onset compared to advanced bone formation and maturation at surface C.

Animals↗
PubMed2005

Mini dental implants: an adjunct for retention, stability, and comfort for the edentulous patient.

OBJECTIVE: This article examines the success of mini-dental implants (MDI'S) by assessing four subjective measures of patient satisfaction for MDI's in the edentulous maxilla and mandible: comfort, retention, chewing ability and speaking ability. Success rates, surgical techniques, and financial advantages of the MDI's are reviewed. STUDY DESIGN: Thirty consecutive patients received four MDI's between the mental foramen of the mandible from 9/18/2003 to 10/22/2004. Questionnaires were sent to all thirty patients an average of 5 months postoperatively. The patients ranked comfort, retention, chewing ability, and speaking ability from 1 to 10 (1=poor and 10=excellent). RESULTS: A total of 116 MDI's were placed in 13 months and 113 remain stable for a 97.4% implant success rate. Pre-operatively patients rated their retention at 1.7+/-0.42 and post-operatively at 9.6+/-0.37, for a difference of 7.9 (p=3.6-19). Comfort was the next greatest improvement, with a pre-operative rating of 2.2+/-0.63 and a post-operative rating of 9.4+/-0.45, for a difference of 7.2 (p=3.5-15). Chewing ability also improved, with a difference of 7.0 (p=2.9e-16). In the final category of speaking ability, the pre-operative to post-operative difference was 3.2 (p=1.1e-5). CONCLUSION: MDI's are a highly successful implant option for patients with poor tolerance to maxillary and mandibular prosthesis. The implants are relatively affordable and overall patient satisfaction is excellent.

Aged↗
PubMed1994

Treatment with dental implants in patients with severe osteoporosis: a case report.

The case report of a woman with severe osteoporosis who was treated with dental implants is presented. Polyarthritis was diagnosed in 1955, and a corticosteroid medication treatment was started in 1960. During the years, the patient has undergone multiple joint surgeries. Dental implants were inserted in the maxilla in 1987 and in the mandible in 1988. Due to a compression of the spine, the patient lost 12 cm in body height between 1991 and 1993; a spontaneous femur fracture was diagnosed in December 1992. However, the arch bone has been stable; the 6- and 5-year follow-up results of the maxillary and mandibular implants, respectively, are presented.

Arthritis↗
PubMedDate not supplied

Development of gingival esthetics in the terminal dentition patient prior to dental implant placement using a full-arch transitional fixed prosthesis: a case report.

Despite significant advances in dental therapeutics, there are patients for whom no reasonable treatment is available that will reliably restore or maintain their existing dentition. The causes of future edentulism include advanced caries, failing root canal therapy, inadequate numbers of teeth to support a fixed prosthesis, untreatable periodontal disease, or a history of failed previous rehabilitations. For these patients, dental implants may provide a more predictable future than retention of their remaining teeth. It is proposed that transitional fixed prostheses designed specifically for a patient with terminal dentition offer the advantage of maintenance and development of proper gingival esthetics with improved function. Prior to implant placement, the gingival frame is established, enhancing the overall appearance of the final, full-arch implant rehabilitation. The specific prosthodontic and surgical techniques required for successful treatment of these patients are presented.

Acrylic Resins↗
PubMed2003

Removal and replacement of a fractured dental implant: case report.

To achieve satisfactory function and esthetics following the fracture of a dental implant, the clinician is often faced with the imposing prospect of fixture removal and the restoration of adequate osseous support for subsequent fixture placement and eventual restoration. This article describes a technique that allowed removal of the fractured fixture, conservative elevation of the sinus floor and the immediate insertion of a larger diameter fixture, to permit eventual replacement.

Bicuspid↗
PubMed2005

An antibacterial surface on dental implants, based on the photocatalytic bactericidal effect.

BACKGROUND: It is well known that the moderately roughened surfaces of dental implants enhance direct bone-implant contact. However, rough implant surfaces, as compared to smooth surfaces, are thought to pose a higher risk of bacterial infection when exposed to the oral cavity. PURPOSE: This study was focused on evaluating the photocatalytic bactericidal effects of anatase titanium dioxide (TiO(2)) on gram-negative anaerobic bacteria known to be associated with periimplantitis. MATERIALS AND METHODS: A film of photocatalytic anatase TiO(2) was added onto the surface of commercially pure titanium disks by plasma source ion implantation (PSII) followed by annealing. The photocatalytic properties of the film were confirmed by the degradation of methylene blue. Actinobacillus actinomycetemcomitans and Fusobacterium nucleatum cells were incubated anaerobically and seeded on the disk. The disks were then exposed to ultraviolet A (UVA) illumination from black light in an anaerobic environment. After illumination, the number of viable cells was counted in terms of colony-forming units. RESULTS: The anatase TiO(2) film added by the PSII method and annealing exhibited a strong photocatalytic reaction under UVA illumination. The viability of both types of bacteria on the photocatalytic TiO(2) film was suppressed to less than 1% under UVA illumination within 120 minutes. CONCLUSION: The bactericidal effect of the TiO(2) photocatalyst is of great use for sterilizing the contaminated surface of dental implants.

Aggregatibacter actinomycetemcomitans↗
PubMed2006

A comprehensive and critical review of dental implant placement in diabetic animals and patients.

OBJECTIVES: A thorough and exhaustive analysis of the available studies concerning placement of endosseous dental implants in diabetic subjects has not been previously published. The aim of the present study was to perform a comprehensive and critical review of experimental and clinical studies published in the international peer-reviewed literature in the English language regarding endosseous implant installation in diabetic subjects and to draw evidence-based conclusions on the effectiveness and predictability of dental implant therapy in diabetic patients. MATERIAL AND METHODS: Literature search for articles published up to and including March 2005 in the English language was performed with a personal computer (PC) using The National Library Of Medicine (http://www.ncbi.nlm.nih.gov/PubMed) and Cochrane Oral Health Group databases. Search strategy included a specific series of terms and key words. The reference lists of identified publications, relevant texts and previous workshops were also scanned. Data sources also included several hand-searched journals and contact with experts, when it was considered appropriate. Search was conducted independently by the three reviewers (S. K., I. K. K., I. F.). At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently by the three reviewers. Disagreement regarding inclusion of full papers was resolved by discussion among the reviewers. RESULTS: The search provided 227 potentially relevant titles and abstracts. At the first phase of evaluation, 199 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 28 publications was retrieved for more detailed evaluation. These publications included 11 experimental studies and 16 clinical studies (one clinical study corresponded to two publications). Finally, 11 experimental and eight clinical studies were accepted. Clinical studies included four prospective and four retrospective studies. Because of the limited number of available studies and their heterogeneity, focusing on a specific predefined question to be answered by a systematic review was not feasible and therefore no meta-analysis was planned. CONCLUSION: Within the limits of the existing investigations, experimental studies seem to reveal an impaired bone healing response to implant placement in diabetic animals compared with non-diabetic controls, both quantitatively and qualitatively. The majority of clinical studies tend to indicate that diabetes is no contraindication for implant placement, on condition that it remains under metabolic control. However, definitive guidelines with objective criteria, such as type and duration of diabetes and glucosylated hemoglobin levels, need to be established in the future.

Animals↗
PubMed2002

A comparative analysis based on different strength criteria for evaluation of risk factor for dental implants.

A numerical analysis is developed to study the interaction phenomena between endousseus titanium dental implants and surrounding jawbone tissue. The interest is focused on the most appropriate evaluation of the stress state arising in the tissue because of the implant under physiological loading. The problem is considered with regard to linear elastic response of the one and to short time effect. Different configurations of bone-implant system are described, using axial-symmetrical and three-dimensional models, by means of finite and geometric element method. The investigation attains to the stress states induced in bone that lead to a limit condition near the effective failure surface. The parameter commonly adopted in literature, such as the Von Mises stress, represents an excessive simplification of problem formulation, leading to an incorrect evaluation of the real failure risk for the implant, due to the assumption of the isotropic and deviatoric nature of the adopted stress measure. More suitable criterion can be assumed, such as the Tsai-Wu criterion, to take into account the anisotropy that characterises the response of bone, as well as the influence of a hydrostatic stress state. The analysis developed offers a comparison of results by using different criteria, leading to an evaluation of reliability of the procedure to be followed and addressing also to an evaluation of a risk factor for the implant investigated.

Anisotropy↗
PubMed1990

A histological comparison in the dog of porous-coated vs. threaded dental implants.

The histological findings of an 18-month trial, in the dog of a partially porous-coated endosseous dental implant made of Ti-6Al-4V, with a truncated conical shape, are described and compared with those for a cylindrical, threaded, endosseous implant made of commercially pure Ti. Six beagle dogs each received two porous-coated implants on one side of the mandible and two threaded implants on the contralateral side. Each set of two implants supported a two-unit fixed bridge for an 18-month functional period. Methylmethacrylate sections of both the buccolingual and mesiodistal aspects of each implant were examined qualitatively and by computer-assisted morphometry. The morphometric measurements were used for determination of the length of implant surface in direct contact with bone on each aspect of each implant. The data were expressed both as an absolute length and as a fraction of the maximum length available for contact (contact length fraction or CLF). On the buccal and lingual aspects of the implants, both the absolute lengths and CLF were significantly smaller for the porous-coated design. For the mesial and distal aspects, the absolute lengths and CLF were less for the porous-coated design, but the differences were not significant. However, when the absolute contact length was related to the corresponding vertical bone height, significant differences were observed, the absolute contact length being greater for any given bone height for the porous-coated design. Taken together, the data suggest that shorter implants may be used with the porous-coated design.

Alloys↗
PubMed1995

Accuracy and precision in the radiographic diagnosis of clinical instability in Brånemark dental implants.

The aim was to evaluate accuracy and precision in the radiographic diagnosis of clinical instability in Brånemark dental implants. In two clinics specialized in the Brånemark osseointegration technique we identified all patients in whom lack of clinical stability of one or more fixtures had been observed during a 5-year period. Radiographs of these fixtures (n=62) were mixed with radiographs of clinically stable fixtures (n=158). Eight observers were asked to determine whether or not a perifixtural radiolucency was seen by means of a 5-point rating scale expressing the confidence with which the presence or absence of a radiolucency was determined. Receiver operator characteristic analysis was used to calculate the A(z) values and the variability in A(z) values between and within observers was determined. In addition, we evaluated the agreement in rating codes within observers between repeat examinations. The A(z) values (mean=0.844 at the first reading and 0.856 at the second) indicated that the accuracy in radiographic diagnosis of clinical fixture instability was at least as good as that associated with other radiographic tasks such as approximal caries diagnosis and diagnosis of small periodontal bone lesions. Interobserver variability was larger than intraobserver variability. Intraobserver agreement in rating codes was relatively high and less than an average of 6% of all ratings differed with two rating codes or more. Despite the relatively good diagnostic accuracy, the probability of predicting clinical fixture instability from a radiographic examination can be low in populations with a low prevalence of fixtures showing clinical instability.

Alveolar Process↗