A review of research, as regards tissue reaction to metal, plastic, and dental implants.
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Dental Implants↗
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The most needed application for dental implants.
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Dental Implants↗
Toxilogical considerations of dental implants.
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Animals↗
Material and design considerations for dental implants.
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Dental Implantation↗
Design criteria for dental implants.
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Dental Implantation↗
Bone remodeling in immediately loaded and unloaded titanium dental implants: a histologic and histomorphometric study in humans.
Remodeling is thought to prevent microdamage accumulation caused by repetitive loading and to increase the fatigue life of bone. The bone remodeling rate (BRR) is the period of time needed for new bone to replace the existing bone and to allow for the adaptation of bone to its environment. BRR is expressed as a percentage or volume of new bone within a specific time period. The aim of the present study was to evaluate bone remodeling events on submerged and immediately loaded dental implants. Twelve patients with edentulous mandibles participated in this study. All patients were rehabilitated with fixed mandibular prostheses, with 10 dental implants per patient. An additional implant was inserted in the most distal posterior mandibular jaw region. In 6 patients, these additional implants were loaded with a fixed provisional prosthesis the same day of the implant surgery and loaded. In the other 6 patients, the additional implants were left submerged and not loaded. After 6 months, all the additional implants were retrieved with a trephine. The percentage of woven and lamellar bone, number of osteoclasts and osteoblasts, and percentage of bone labeled by tetracycline at 0.5 mm and 2 mm from the implant surface were evaluated. The percentage of lamellar bone, number of osteoblasts, and percentage of bone tetracycline labeling was significantly higher in the loaded implants than in the unloaded implants (P =.0001). Also in the loaded implants, the percentage of woven and lamellar bone, number of osteoclasts and osteoblasts, and percentage of bone tetracycline labeling was significantly higher at 0.5 mm than at 2 mm from the implant surface (P =.0001). No such differences were found in unloaded implants (P =.377). In conclusion, we found that (1) loading appeared to stimulate bone remodeling at the interface, (2) a higher percentage of lamellar bone was found in loaded implants, (3) the percentage of bone labeling was higher at the interface of loaded implants, (4) no differences were found in the BRRs between immediately loaded and unloaded implants, and (5) immediate loading had not interfered on the lamellar bone formation at the interface and had not produced formation of woven bone at the interface.
Adult↗
The retention mechanics of LTI carbon, carbon-coated aluminum oxide, and uncoated aluminum oxide dental implants.
The in vitro mechanical behavior of identical geometry LTI carbon, carbon-coated aluminum oxide, and uncoated aluminum oxide blade-type dental implants has been evaluated using rosette type strain gauges and a LVDT system. The implants served as a distal abutment for a three-unit fixed prosthesis and functioned for a period of 2 years in female baboons. The comparison of the LTI carbon implants to the carbon-coated aluminum oxide implants allowed for a study of the effect of implant elastic modulus on the mechanical behavior, while the comparison of the carbon-coated and uncoated aluminum oxide implants allowed for a study of the effect of chemical composition at the tissue-implant interface. The results of the mechanical testing indicate that the implant displacement response of the LTI carbon implants was greater than that of the carbon-coated and uncoated aluminum oxide implants. Little difference in displacement response was observed for the carbon-coated and uncoated aluminum oxide implants. No clear trend in the strain response of the buccal mandibular bone was observed for the three implant systems. The greatest differences in strain response, however, was observed between the uncoated aluminum oxide implants and the LTI carbon and carbon-coated aluminum oxide implants.
Aluminum Oxide↗
Microstructure of interface regions and mechanical properties of Ti/Al 2O 3 and Ti-alloy/Al 2O 3 joints for dental implants.
Titanium and alumina are very well suited as constituents of dental metal/ceramic implants because of their excellent biocompatibility and their special chemical and mechanical properties which can be exploited to tailor composite implant structures. However, prior attempts to join pure titanium without any intermediate layer to alumina ceramic led to unsatisfactory results mainly due to thermal expansion mismatch between both materials. Therefore we used recently developed Ti alloys containing 30%wt Ta or 40%wt Nb for manufacturing dental implants. Moreover, we studied two alternative methods to join pure titanium with alumina using intermediate layers to reduce internal stresses within the joint caused by thermal expansion mismatch. We examined the interface region of these joints by metallographic, mechanical, analytical, and electron microscopy methods. Additionally, a comparison of the properties of the hitherto investigated types of joints with a view of their applicability in dental implants is given. Promising results were obtained for Ti/alumina joints with Nb interlayers. The studies are continuing.
Aluminum Oxide↗
Short dental implants as a treatment option: results from an observational study in a single private practice.
PURPOSE: The purpose was to evaluate clinical outcome of short (6- and 8-mm) dental implants placed in sites with low bone availability (7 to 11 mm) in a single private practice and to compare their survival with that of longer implants. MATERIALS AND METHODS: Implants were placed by a single private practitioner in a variety of clinical indications. Exclusion criteria included uncontrolled diabetes mellitus, alcoholism, and systemic immune disorders. Clinical data relating to implant placement and follow-up appointments, including adverse events, were entered into an electronic database. Two-year survival rates were calculated and life table analyses undertaken for implants measuring 6, 8, and 10 to 16 mm. RESULTS: A total of 630 Straumann implants were placed in 264 patients between April 1994 and December 2003. Of these, 35 implants were 6 mm long, 141 were 8 mm long, and 454 were 10 to 16 mm long. Maximum follow-up was 64.6 months, 83.7 months, and 102 months for implants measuring 6 mm, 8 mm, and 10 to 16 mm, respectively. Two-year survival rates were 94.3%, 99.3%, and 97.4% for 6-mm, 8-mm, and 10- to 16-mm implants, respectively. DISCUSSION: The results indicated that the 2-year outcome for 6-mm and 8-mm implants was comparable to that for longer (10- to 16-mm) implants in this patient population. CONCLUSION: In this study, short (6- or 8-mm) implants were used with good reliability in patients with limited bone availability, without the need for ridge augmentation. Shorter implant length was not associated with reduced survival at 2 years, compared with longer implants.
Adolescent↗
In vitro and in vivo experimental studies on single crystal sapphire dental implants.
Successful attachment of the oral tissues to an endosseous dental implant relies in part on its chemical stability, nontoxic properties and maintenance of normal cell functions in the surrounding tissues. The aim of this study was therefore to investigate these 3 factors experimentally. The corrosion resistance of single crystal sapphire (alpha-Al2O3) implants was analysed with respect to the release of aluminium ions; no ions could be detected in the test solutions. The influence of single crystal sapphire on the behaviour of human epithelial cells and fibroblasts derived from biopsies of the oral mucosa, was studied. The cells were cultured in chemically defined or in low serum-containing media. Compared to the corresponding control cultures, no effects on cell morphology and growth characteristics were observed. Sapphire rods were inserted subcutaneously into rats and tissue responses were examined after 4, 8 and 12 weeks post-implantation. None or slight reactions were found in the tissues. The combined evaluation of these experimental approaches indicates that single crystal sapphire is a material well suited for biological implantation.
Aluminum Oxide↗
Longitudinal study of dental implants in a periodontally compromised population.
BACKGROUND: The purpose of this longitudinal study was to determine the clinical status and the composition of the subgingival microbiota of dental implants and natural teeth in patients with a history of periodontitis. METHODS: Twenty-five partially edentulous patients treated for moderate to advanced adult periodontitis and having a total of 42 implants participated in this 3-year study. The assessment of clinical status was done 1, 2, and 3 years after prosthetic loading (T1, T2, and T3, respectively). Clinical parameters evaluated included probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI). The subgingival microbiota at peri-implant and periodontal sites were analyzed at T1 and T2. RESULTS: No significant difference in clinical parameters between implants and teeth and within the 2 groups between different time points was observed through the study. PD and CAL measurements of sampled periodontal and peri-implant sites did not show any statistically significant difference through the study and between the 2 groups. PI of sampled periodontal sites showed a statistically significant improvement during the study. From the morphological observation of the subgingival microbiota, a significant difference in the composition of motile rods between implants and teeth was found at T1. There were no differences detected in the subgingival microbiota, culturally identified at peri-implant and periodontal sites for the duration of the study. CONCLUSIONS: In conclusion, implants were colonized by the indigenous periodontal microbiota and were well maintained in patients with a history of periodontitis. No significant association between progressing or non-progressing periodontal or peri-implant sampled sites in terms of loss of attachment and infection with at least one of the searched periodontal pathogens was found, suggesting that the presence of putative periodontopathogens at peri-implant and periodontal sites may not be associated with future attachment loss or implant failure.
Adult↗
A 3- to 6-year study of overdentures supported by hydroxyapatite-coated endosseous dental implants.
PURPOSE: The purpose of this study was to evaluate the clinical effectiveness of hydroxyapatite-coated cylindrical implants to support overdentures. These implants were placed between 1990 and 1994 and have been followed up over a period of 3 to 6 years. MATERIALS AND METHODS: One hundred thirty-nine Calcitek dental implants were placed in 43 patients to support 14 maxillary and 30 mandibular overdentures. Standardized clinical review procedures were used. RESULTS: At exposure all the implants were found to be osseointegrated. To date only 7 implants (5%) have completely failed and two associated overdentures (5%) have been lost. The cumulative survival rate of all implants over 6 years was 92%. However, if failure is defined by the loss of more than 4 mm of cervical bone, 33 implants could be classified as being in the process of failing. Using these figures, interval success rates as low as 82% were found by year 6, and the cumulative success rate would fall to 39%. Maxillary survival and success rates were significantly lower than mandibular rates, at 38% and 10%, respectively, by year 5. CONCLUSION: Failure rates were higher in the maxillary arch, in poor quality bone, in smokers, and where implants were opposed by a natural dentition or an implant-supported prosthesis. The results suggest that the cervical bone level adjacent to the Calcitek cylindrical hydroxyapatite-coated implant failed to establish a steady state, particularly in the maxillary arch. Doubts remain regarding the long-term prognosis of these cylindrical implants.
Adult↗
Morphology of the bone that supports endosteal dental implants. Transmission electron microscopic and high voltage electron microscopic observations.
The morphologic features of the bone-dental implant interface were investigated using an in vivo dog model. The undecalcified bone and associated support tissues were serially sectioned and examined with both conventional and high voltage transmission electron microscopy. A varied morphologic appearance of the tissues supporting clinically and radiographically appearing integrated implants was observed. Osteoblasts were observed at the implant interface, and osteocytes were routinely seen encased within lacunae extremely close to the implant surface. Often these osteocytes extended cellular projections to the implant surface. The variable tissue types observed were suggestive of healthy lamellar and appositional type mineralization patterns adjacent to the implants.
Animals↗
Immediate/early loading of dental implants: a report from the Sociedad Española de Implantes World Congress consensus meeting in Barcelona, Spain, 2002.
BACKGROUND: Immediate/early loading protocols are becoming frequently used in implant dentistry, but the prerequisites for achieving good results and the limitations of such protocols are not fully known. Moreover, the terminology used in immediate/early loading is still confusing. PURPOSE: The purpose of this article is to present the outcome of a consensus meeting on immediate/early loading. MATERIALS AND METHODS: A consensus meeting was organized during the Sociedad Española de Implantes World Congress in Barcelona on May 23, 2002, with the objective to present and discuss the experiences from immediate/early loading protocols in dental implant treatment. The purpose was also to discuss definitions of the terminology used in immediate/early loading. The consensus meeting agenda included presentations from invited experts, followed by a consensus discussion. RESULTS: A consensus statement was agreed on. CONCLUSIONS: Multiple independent investigators have demonstrated that immediate/early loading of implants is possible in many clinical situations; however, additional documentation is required.
Dental Implantation, Endosseous↗
Pattern of permanent teeth present in individuals with ectodermal dysplasia and severe hypodontia suggests treatment with dental implants.
PURPOSE: The objective of this study was to assess the pattern of permanent teeth present in a self-selected sample of 17 female and 35 male patients with ectodermal dysplasia presenting for treatment with dental implants. METHODS: Mean age of sample: 18.7 years, age range: 5.9 to 60.9 years. Panoramic radiographs were examined independently by two investigators to determine the permanent teeth present. None of the sample reported extractions of permanent teeth prior to presenting for implants. RESULTS: Permanent teeth most likely to be present, reported as a percentage of the patient sample with that tooth, were: maxillary central incisors (42%), maxillary first molars (41%), mandibular first molars (39%), maxillary canines (22%), mandibular second molars (17%), maxillary second premolars (15%), and mandibular premolars (12%). Comparing dentition by quadrants, mandibular anterior teeth (canines and incisors) were least likely to be present. CONCLUSIONS: Results support previous findings that the maxillary central incisors, maxillary first molars, mandibular first molars, and maxillary canines are the most conserved teeth in hypodontia. Successful use of osseointegrated implants in the anterior mandibles of most of these patients suggests that habilitation of the mandible with dental implant-supported prostheses is a reasonable option.
Adolescent↗
Fibroblast growth on surface-modified dental implants: an in vitro study.
A major consideration in designing dental implants is the creation of a surface that provides strong attachment between the implant and bone, connective tissue, or epithelium. In addition, it is important to inhibit the adherence of oral bacteria on titanium surfaces exposed to the oral cavity to maintain plaque-free implants. Previous in vitro studies have shown that titanium implant surfaces coated with titanium nitride (TiN) reduced bacterial colonization compared to other clinically used implant surfaces. The aim of the present study was to examine the support of fibroblast growth by a TiN surface that has antimicrobial characteristics. Mouse fibroblasts were cultured on smooth titanium discs that were either magnetron-sputtered with a thin layer of titanium nitride, thermal oxidized, or modified with laser radiation (using a Nd-YAG laser). The resulting surface topography was examined by scanning electron microscopy (SEM), and surface roughness was estimated using a two-dimensional contact stylus profilometer. A protein assay (BCA assay) and a colorimetric assay to examine fibroblast metabolism (MTT) were used. Cellular morphology and cell spreading were analyzed using SEM and fluorescence microscopy. Fibroblasts on oxidized titanium surfaces showed a more spherical shape, whereas cells on laser-treated titanium and on TiN appeared intimately adherent to the surface. The MTT activity and total protein were significantly increased in fibroblasts cultured on titanium surfaces coated with TiN compared to all other surface modifications tested. This study suggests that a titanium nitride coating might be suitable to support tissue growth on implant surfaces.
3T3 Cells↗
Brånemark and ITI dental implants in the human bone-grafted maxilla: a comparative evaluation.
The development of new characteristics concerning implant surface makes it interesting to clinically compare different implant systems in the bone-grafted maxilla. The aim of this evaluation was to compare clinical data of a two-staged procedure on the augmented extremely atrophic maxilla using either Brånemark- or ITI-fixures. In 25 patients (18 females, seven males) the severely atrophied maxilla was reconstructed with autogenous iliac or mandibular bone and either Brånemark or ITI implants. Seventy-eight Brånemark implants and 80 SLA-ITI implants were inserted in the augmented bone and the patients were followed between 20 and 67 months post implantation. The bone graft was transplanted to add bony volume in the maxillary sinus, the anterior floor of the nose and/or the alveolar ridge. After a healing period of 4(1/2) months, dental implants were inserted and left for healing for 8 months. Twelve consecutive patients received machine-surfaced Brånemark fixtures and 13 consecutive patients received SLA-ITI fixtures. Gradual loading was applied after healing abutment application. After 6 months the permanent prosthetic reconstruction was provided to the patient, either as a fixed or removable bridge. Comparison in survival rate was performed: 15 machined Brånemark fixtures were lost, resulting in an overall survival rate of 81%. Two ITI fixtures were lost, resulting in an overall survival rate of 98%. The results of this evaluation show that sandblasted large grit acid etched surface-treated ITI implants has a significant higher survival rate than machine-surfaced Brånemark implants in autogenous grafted maxillary bone.
Adult↗