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PubMed2001

Fabrication of imaging and surgical guides for dental implants.

Research and experience have suggested that the success of dental implants depends on a well-developed and careful treatment plan approach. Historically, implant size and angulation were determined with the use of panoramic radiographs and clinical judgment during surgery. This occasionally resulted in mechanical and esthetic compromise. This article describes the step-by-step fabrication process for 4 different imaging and surgical guides. Set-up disks, which enhance the design and fabrication of guides, also are introduced. These guides are used in conjunction with cross-sectional tomography during the preimplant assessment of surgical sites.

Dental Implantation, Endosseous↗
PubMed1997

Study of interface phenomena between bone and titanium and alumina surfaces in the case of monolithic and composite dental implants.

The interface between mandibular bone and dental implants was examined with the in vivo dog model. Implant/bone interfaces were investigated for three types of materials: Ti-30 wt% Ta/Al2O3, titanium and Al2O3 using microscopy techniques covering a large magnification range: scanning electron microscopy, transmission electron microscopy, energy dispersive X-ray analysis and Auger spectroscopy. During the interaction of the Al2O3 ceramic with bone, an interfacial layer about 15 microm thick is formed. The same phenomenon was observed at the titanium bone interface, where the thickness of the layer was about 10 microm. In all cases, interface layers were sharp with well-defined borders between bone tissue and implant materials. No calcification took place inside the interface layer. A chemical analysis performed on this layer shows the presence of titanium, calcium and phosphorus in the case of titanium implants, and aluminium, calcium and phosphorus in the case of alumina implants. A rapid decrease in metal composition with increasing distances from the implant surface is correlated to a slow increase in calcium and phosphorus in the direction of the bone. Direct contact between implant and bone was observed. No biocorrosive effects were detected at the Ti-30 wt% Ta/Al2O3 metal-ceramic interface.

Journal Article↗
PubMed1994

Long-term follow-up on hydroxylapatite-coated cylindrical dental implants: a comparison between developmental and recent periods.

PURPOSE: To compare success rates for dental implants placed from 1985 through 1988 and from 1989 through 1991, and to investigate the factors associated with success or failure. PATIENTS AND METHODS: All hydroxylapatite-coated cylindrical implants placed from 1985 through 1991 were followed yearly. Lifetable survival analyses compared implant success for a "developmental period" from 1985 through 1988 (4 to 8 years follow-up) and a "recent period" from 1989 through 1991 (1 to 4 years follow-up). Reasons for success or failure, time from implant placement to removal related to failure reason, outcome after implant removal, and a morbidity analysis are included. RESULTS: The 7 to 8-year cumulative success rate for all implants placed in the developmental period (maxilla and mandible combined) was 86.5%; it was 84.2% for all maxillary implants and 87.5% for all mandibular implants. The cumulative success rate for all implants placed in the recent period was 97.5%; it was 97.5% for all maxillary implants and 97.6% for all mandibular implants. The difference between the two periods was statistically significant only for the anterior maxilla. Regression analysis on the interval success rates indicates that interval failure did not follow a linear relationship with time. The most common reasons associated with failure were lack of keratinized gingiva, poor oral hygiene, mechanical overload, and malposition. CONCLUSION: Comparison with previously reported cumulative success rates indicated learning curve experiences comparable with other implant systems. Improvements in hardware, surgical and prosthetic techniques, and patient selection have led to an improvement in success rates with the recent period implants.

Bone Resorption↗
PubMedDate not supplied

Composite morphology of the bone and associated support-tissue interfaces to osseointegrated dental implants: TEM and HVEM analyses.

Correlated transmission electron and high-voltage electron microscopic analyses examined the undecalcified bone and associated support tissues of 60 endosseous titanium blade and titanium and ceramic root-form implants in dogs. The implants supported fixed partial dentures for up to 2 years. Data obtained from this investigation suggest that a range of tissues, both mineralized and unmineralized, support osseointegrated dental implants. This study examined the tissues apposing not just isolated aspects of the implant surface, but the entire length of the implant, and found that mineralized and unmineralized tissues existed concurrently. Much of the implant surface was apposed by mandibular bone, and both root-form and blade implants osseointegrated. The densely mineralized collagen fibril matrix was often separated from the implant by only a 20-nm to 50-nm electron-dense, ruthenium-positive deposit. High-voltage electron microscope stereology demonstrated that cellular processes extended directly to the implant from underlying osteocytes. In the same implants, areas containing an unmineralized collagen matrix interposed between the bone and implant surface were observed. In this region osteoblasts interacted with this matrix, and Howship's lacunae, containing vascular elements and osteoclasts, were also observed. The remodeling activities appear to be a homeostasis of catabolic activity (osteoclasts) and metabolic activity (osteoblasts). The apex of the implant was often apposed by a fibrofatty stroma. The support tissue response appears to be the result of the interrelations of osteoblasts, osteocytes, and osteoclasts in association with vascular elements. Therefore, the support tissue response to osseointegrated implants is a dynamic activity that involves the healthy interaction of these cells and tissues along the entire length of the implant.

Adipose Tissue↗
PubMedDate not supplied

A dynamic modal testing technique for noninvasive assessment of bone-dental implant interfaces.

A dynamic modal testing technique has been developed to noninvasively assess the interface surrounding an endosseous dental implant with a lateral tap from an impedance head hammer. The technique assesses the rotational stiffness of the interface based on the shape of the power spectrum of the force-time curve produced on impact. In vitro experiments were performed to determine the sensitivity of the technique for detecting clinically relevant structural differences between interfaces. The modal test data were able to distinguish interfaces based on the type of bone at the interface and the degree of fixation between the implant and the interface.

Analysis of Variance↗
PubMedDate not supplied

Pain and anxiety following the placement of dental implants.

PURPOSE: This study investigated pain experience and anxiety following dental implant placement using questionnaires and salivary cortisol measurements. MATERIALS AND METHODS: Patients about to undergo implant placement were instructed to keep recovery diaries to assess pain experience (limitation of activities, postoperative symptoms) and to record average pain, worst pain, and interference with daily activities on a visual analog scale (VAS). To assess anxiety, patients completed the Spielberger self-evaluation questionnaire and collected salivary samples to measure cortisol levels. Saliva was collected 1 week before surgery, the day of surgery, and 3 and 6 days postoperatively. A repeated-measure analysis of variance was used to analyze pain and anxiety data. RESULTS: Eighteen patients (12 women and 6 men) who received 30 implants were recruited for the study. Following implant placement, most patients reported mild to moderate interference with daily activities and postoperative symptoms. No patient reported high levels of any symptom. Average pain experience decreased significantly with time (F = 6.17; P < .001), from a VAS score of 24/100 on day 1 to 12 on day 3 and 9 on day 6. Worst pain (F = 7.84; P < .001) and limitation of daily activities (F= 6.26; P < .001) were also highest on the first postoperative day; they also decreased to about half the maximum level by the second or third day. State anxiety, as evaluated by the Spielberger self-evaluation scale, was highest on the day of surgery. The salivary cortisol level did not validate this, as it did not differ with the time of collection (F = 2.22; P = .075). CONCLUSIONS: Patient self-assessment indicates that implant placement is a mild to moderately painful and anxiety-provoking procedure. Some limitation of daily activities and symptoms are expected to occur, particularly during the first 3 postoperative days.

Activities of Daily Living↗
PubMed2006

Dental implants in patients with bruxing habits.

Bruxism (teeth grinding and clenching) is generally considered a contraindication for dental implants, although the evidence for this is usually based on clinical experience only. So far, studies to the possible cause-and-effect relationship between bruxism and implant failure do not yield consistent and specific outcomes. This is partly because of the large variation in the literature in terms of both the technical aspects and the biological aspects of the study material. Although there is still no proof for the suggestion that bruxism causes an overload of dental implants and of their suprastructures, a careful approach is recommended. There are a few practical guidelines as to minimize the chance of implant failure. Besides the recommendation to reduce or eliminate bruxism itself, these guidelines concern the number and dimensions of the implants, the design of the occlusion and articulation patterns, and the protection of the final result with a hard occlusal stabilization splint (night guard).

Biomechanical Phenomena↗
PubMedDate not supplied

Ancient "dental implants": a recently proposed example from France evaluated with other spurious examples.

The recent announcement of the discovery of a first or second century AD Roman example of a dental implant appears to fall into a category of spurious claims regarding ancient dentistry. Several earlier claims of the discovery of impressive examples of ancient dentistry are reviewed, followed by a discussion of the recent discovery from France. This survey of all of these claims regarding finds of ancient dental implants, plus data from the modern and rapidly evolving field of implant dentistry, suggests that these "ancient implants" are the product of the imaginations of 20th-century archaeologists.

Crowns↗
PubMed1986

Dental implants: tissue-integrated prosthesis utilizing the osseointegration concept.

As an alternative to conventional removable dentures, osseointegrated dental implants can now be used in carefully selected edentulous or partially edentulous patients. The implant consists of a dental prosthesis and an anchorage unit made up of screw-connected components. The implantation procedure is performed in two phases: fixture installation and fixture uncovering and abutment connection. After completion of these surgical procedures, the dental prosthesis is fabricated and inserted. Follow-up examinations are scheduled at 1, 3, and 6 months and then annually thereafter. During a 2-year period at the Mayo Clinic, 358 osseointegrated dental fixtures were implanted in 70 patients. The overall success rate in this consecutive series of patients was 98%, and the associated complications were minimal and easily resolved.

Aged↗
PubMed2002

3D volume rendering using multislice CT for dental implants.

OBJECTIVES: To determine the precision and accuracy of three-dimensional (3D) volume rendering spiral multislice computed tomography (CT)-based linear measurements of the mental foramen for dental implants, in vitro, and their precision, in vivo. METHODS: Five cadaver heads were imaged by multislice spiral CT (Toshiba Aquilion) with 0.5 mm thick axial slices (0.5 mm/0.5 s of table feed) at 0.5 mm interval reconstructions. The image data sets were transferred to a networked computer workstation. Using computer graphics the data were analysed with a 3D volume rendering technique using Vitrea software. Two oral and maxillofacial radiologists, independently, made electronic linear measurements from the superior border of the mental foramen to the crest of the alveolar process. The soft tissues were removed and physical measurements made using a 3 Space (Polhemus, Colchester, VT, USA) electromagnetic digitizer with a personal computer running Windows 98. The same linear measurements of 15 patients using the same imaging methodology were performed and the precision was analysed. RESULTS: The findings showed no statistically significant inter- or intra-observer differences in vitro and in vivo, or between imaging and physical measurements in vitro (P>0.05). CONCLUSIONS: 3D multislice spiral CT imaging allows highly accurate measurements for dental implant placement in proximity to the mental foramen. Computer graphics software, using volume rendering is suitable for implant planning.

Aged↗
PubMed2006

Posttraumatic dental implant placement in a patient with maple syrup urine disease.

Maple syrup urine disease (MSUD) is an inborn error of metabolism resulting from a defect in the oxidation of the branched-chain amino acids leucine, isoleucine, and valine. Patients present in early infancy with brain edema; delay in diagnosis and treatment is common and associated with residual neurologic damage, which includes alternating muscular hypotonia and hypertonia, dystonia, and seizures. These signs can result in trauma, especially to the anterior maxilla, which is the most traumatized region. In patients with MSUD, a fixed prosthesis is recommended because a removable one can be dangerous because of the risk of aspiration. Rehabilitation, using dental implants, is especially challenging in these patients because of the strong muscular forces of the tongue and lips. An implant-supported fixed prosthesis might provide an effective functional, esthetic, and predictable solution for patients with late-treated MSUD. The present report describes a 10-year follow-up of the successful, posttraumatic use of a dental implant to replace an anterior maxillary tooth in a patient with MSUD.

Adult↗
PubMed1994

Evaluation of the effects of diagnostic radiation on titanium dental implant osseointegration in the micropig.

The effect that diagnostic radiation may have on peri-implant supporting alveolar tissues is not well understood. Fifty-four (54) titanium dental implants were inserted into the posterior mandible of nine micropigs. At implant placement surgery, 18 implants were exposed to either 2 (diagnostic) or 10 (excessive) doses of diagnostic radiation; the remaining 36 implants served as controls. Fourteen weeks after implant placement, standardized clinical radiographs were taken, pigs were euthanized, and implants with supporting alveolar tissues were prepared and examined by light and scanning electron microscopy (SEM). Ninety-seven sections were evaluated by SEM for morphometric and morphologic analyses. The mean percent of implant length in contact with bone was 47% for the controls and 53% for the implants receiving radiation. Five implants were lost during the initial healing phase and four implants were clinically mobile at time of euthanasia, giving a success rate of 83% (45/54). Correlative light microscopy of peri-implant supporting tissues revealed no distinct differences between the microvasculature of controls versus implants exposed to radiation. Standardized clinical radiographs revealed crestal saucerization in both control and radiated implants. This study revealed no statistically significant difference for the percent of implant length in contact with alveolar bone for controls or implants exposed to 2 or 10 doses of diagnostic radiation at implant placement time.

Alveolar Process↗