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Imaging of dental implants in severely resorbed maxillae using detailed narrow-beam radiography. A methodological study.

OBJECTIVE: To evaluate the accuracy of the detailed narrow-beam (DNB) technique with the Scanora multimodal X-ray unit for the assessment of dental implants in severely resorbed maxillae as an alternative to conventional intra-oral radiography. METHODS: The DNB technique was used in 15 consecutive patients with maxillary overdentures supported by implants in the canine regions. Both conventional intra-oral radiographs and DNB radiographs were also obtained for a further 15 consecutive patients with maxillary fixed prostheses on implants in the canine region. The marginal bone height was scored in relation to the threads on the implants. RESULTS: Intra-observer agreement was 95%. There was an 84% agreement between the two radiographic methods: the difference was at most one thread and was not significant (p = 0.43). CONCLUSIONS: The DNB technique is an accurate alternative when conventional intra-oral techniques cannot be used properly.

Alveolar Bone Loss↗

Dental implants. Permanent replacement for lost teeth.

Implant complications are rare, but they can include nerve injury, bone loss, infection, injury to adjacent teeth and their supporting structures, premature loss of implants or the prosthesis fitted on the implant, bone fracture, and oroantral (ie, mouth, maxillary sinus) and oronasal (ie, mouth, nose) fistulae. Oral implants represent a new technological possibility. Whether it is used to replace a single tooth, several missing teeth, or an entire dentition, dental implants restore the feeling of having one's own natural teeth. This can improve the patient's physical and psychological health.

Dental Implantation↗

Life-threatening hemorrhage from placement of a dental implant.

This report focuses on a potentially fatal hemorrhage arising from dental implant placement in the mandible. Anatomic considerations of the lingual artery and its divisions in the floor of the mouth are discussed. In addition, various methods of controlling bleeding from the floor of the mouth are reviewed. The case presented is unusual in that intraoral ligation of the transected vessel was possible despite the presence of massive sublingual, submental, and submandibular hematomas as well as severely distorted anatomy. This case represents a severe complication resulting from a seemingly minor oral surgical procedure. Those performing endosteal implant placement should be knowledgeable in the management of such complications.

Arteries↗

Cathepsin K levels in the crevicular fluid of dental implants: a pilot study.

OBJECTIVE: To determine the concentration of cathepsin K secreted into the crevicular fluid around dental implants and its correlation with clinical parameters of healthy implants and implants showing clinical signs of peri-implantitis. MATERIAL AND METHODS: Nineteen patients with 40 implants with and without peri-implantitis were enrolled in the study. Peri-implantitis was diagnosed by the pocket probing depth (PD), the modified bleeding index (MBI), the modified plaque index (MPI) and by radiographic signs of bone loss. Gingival crevicular fluid collected from the buccal and lingual sites was adsorbed to filter strips. Cathepsin K levels and total protein within the crevicular fluid were determined by immunoassay and the bicinchoninic method, respectively. RESULTS: Cathepsin K per filter strip normalized to the time of collection was 10.1 (0-33.5) pmol/sample around control implants and 22.4 (3.7-56.3) pmol/sample in the peri-implantitis group. The difference between the medians was significant (p < 0.01). Absolute cathepsin K levels in the crevicular fluid of all implants investigated showed a positive correlation with PD (R = 0.25; p = 0.03), MPI (R = 0.28; p = 0.01) and MBI (R = 0.32; p < 0.01). Absolute cathepsin K levels in the crevicular fluid also correlated with the adsorbed volume of gingival crevicular fluid (R = 0.51; p < 0.01). When normalized to the adsorbed volume of gingival crevicular fluid, the concentration of cathepsin K was 2.2 (0.01-6.4) nM around control implants and 1.7 (0.4-4.6) nM in the peri-implantitis group (p = 0.33). Patients' age correlated with sample volume and with cathepsin K normalized to the adsorbed volume of gingival crevicular fluid (R = 0.39; p < 0.01). Moreover, significant differences between male and female (p < 0.01, p < 0.01), and between mandible and maxilla (p < 0.05, p < 0.01), but not between buccal and lingual sites (p = 0.99, p= 0.93), were observed when analysed for the parameters adsorbed volume and absolute cathepsin K levels. CONCLUSION: Clinical parameters of peri-implantitis are associated with a higher amount of cathepsin K and a higher volume adsorbed to filters strips. To establish cathepsin K as a biochemical parameter to monitor peri-implant tissue health, age, sex and collection site should be considered to avoid interfering influences because of sample inhomogenity. Also a prospective study over time including more patients would be necessary.

Adult↗

The effects of exposing dental implants to the maxillary sinus cavity on sinus complications.

OBJECTIVE: The aim of this study was to investigate whether dental implant exposure to the maxillary sinus cavity increases the risk of maxillary sinus complications. STUDY DESIGN: An implant was placed bilaterally in the maxillary sinus of 8 adult female mongrel dogs in a way that it penetrated the bone and mucous membrane of the maxillary sinus floor to the extent of 2 mm, 4 mm, or 8 mm. The implants were left in place for 6 months. RESULTS: Radiographic and histologic examinations did not show any signs of pathologic findings in the maxillary sinus of the 8 dogs. CONCLUSION: This study indicates that implant protrusion into the maxillary sinus cavity is not related to the development of sinus complications in canines.

Animals↗

Rehabilitation of patients with congenital unrepaired cleft palate defects using free iliac crest bone grafts and dental implants.

PURPOSE: To rehabilitate the mastication and speech of edentulous congenital cleft lip and palate patients with the use of endosseous implants in conjunction with bone augmentation. MATERIALS AND METHODS: Between 1992 and 1999, 6 partially and 4 completely edentulous adult patients with complex cleft palate defects were treated. Six patients had large, unrepaired defects of the hard and soft palate, whereas the other 4 had residual oronasal fistulas after failed palatoplasty and bone grafting. In 8 patients, free inlay-antral and simultaneous lateral-onlay bone grafts (3 patients) were obtained from the iliac crest, and dental implants were placed secondarily. In the other 2 patients, the implants were placed without grafting in recent extraction sites. Rigid bars with extensions over the defects were used to support obturator prostheses (n = 7), or patients were provided with fixed implant-supported prostheses (n = 3). In all, 50 cylindric, screw-type dental implants were placed and followed up for 1 to 8 years (mean, 5 years). RESULTS: Six implants were regarded as early failures and 1 was lost during the first year of loading; 1 patient lost all 5 implants. The cumulative success rate at 5 years was 85.7%. DISCUSSION AND CONCLUSION: All 9 successfully rehabilitated patients reported a remarkable functional and psychologic improvement after the treatment. The described treatment protocol also seemed to be effective for correcting velopharyngeal insufficiency in patients using an obturator prosthesis.

Adult↗

Crevicular fluid enzymes from endosseous dental implants and natural teeth.

Several neutrophil-derived enzymes that are present in the gingival crevicular fluid have been evaluated for use as risk markers for periodontal disease progression. However, very little information is available about the presence of these enzymes in peri-implant tissues. The purpose of this cross-sectional study was to compare levels of enzymes in gingival crevicular fluid between natural teeth and endosseous dental implants and between well-integrated and failing implants. Scores of plaque and gingivitis were recorded for 68 integrated implants, five failing implants, and 34 natural teeth in 12 completely edentulous and 18 partially edentulous subjects. Samples of gingival crevicular fluid were obtained from these sites using filter paper strips and were assayed for levels of neutral protease, neutrophil elastase, myeloperoxidase, and beta-glucuronidase. Neutral protease levels were higher (P = .066) at moderately to severely inflamed implant sites (Gingival Index of 2, 3) compared to mildly or noninflamed sites (Gingival Index of = 0, 1). Despite the small number (n = 5) of failing implants evaluated in this study, levels of neutrophil elastase, myeloperoxidase, and beta-glucuronidase were significantly higher (P < or = .001) around failing implants compared to successful implants. Neutral protease levels were also elevated around failing implants, but the difference was not statistically significant. Results of this study indicate that neutrophil elastase, myeloperoxidase, and beta-glucuronidase levels in GCF appear to be good candidates for study as risk markers of implant failure.

Adult↗

Use of dental implants in children: a literature review.

The aim of this literature review is to discuss the use of dental implants in growing patients and the influence of maxillary and mandibular skeletal and dental growth on the stability of those implants. It is recommended to wait for the completion of dental and skeletal growth, except for severe cases of ectodermal dysplasia.

Child↗

Histomorphometric analyses of hydroxyapatite-coated and uncoated titanium dental implants in rabbit cortical bone.

In this article, we report the results of analyses of bone healing around four types of dental implants. Five implants of each type were inserted into the proximal tibia metaphysis of adult New Zealand rabbits and were analyzed using computerized histomorphometry 12 weeks after implantation. Hydroxyapatite-coated implants showed more direct bone contact and more lamellar bone in the threads than the titanium implants. There was a significant correlation between an increase in the percentage of mineralized tissue in the threads of metallic implants and cellular density around the implant, indicating less lamellar bone in contact with metallic implants.

Alveolar Process↗

Dental implants and onlay bone grafts in the anterior maxilla: analysis of clinical outcome.

PURPOSE: Loss of alveolar bone in the anterior maxilla may preclude implant placement or compromise positioning and thus diminish the final esthetic result of the restoration. Bone augmentation can overcome such difficulties but may affect osseointegration. The aim of this study was to report the outcome of buccal onlay bone grafting in the anterior maxilla in routine dental implant practice. MATERIALS AND METHODS: Seventeen consecutive patients (12 men and 5 women, mean age 31.4 years) received autogenous bone grafts from the mandibular symphysis to the anterior maxilla. A total of 35 Brånemark System MK II implants were placed in grafted bone. RESULTS: Fifteen patients had a mean period of graft consolidation of 19.7 weeks (range 13 to 32 weeks). Two patients had simultaneous graft and implant placement; 1 implant failed to Integrate in this group. This represents a survival rate of 97.1% of implants in functional loading after a mean follow-up period of 153.6 weeks from occlusal loading (range 74 to 283 weeks). DISCUSSION AND CONCLUSION: Mandibular block onlay grafts appear to be a predictable method for augmenting the width of the anterior maxilla prior to implant placement.

Adolescent↗

Comparison of acellular dermal graft and palatal autograft in the reconstruction of keratinized gingiva around dental implants: a case report.

The use of autogenous gingival grafts has proved to be an effective and predictable way to increase the amount of keratinized gingiva. However, discomfort and pain at the donor site are unavoidable. Acellular dermal matrix (ADM) allograft can be used as a donor tissue to eliminate the need for another surgical site and alleviate pain and trauma. The purpose of this study was to evaluate the effectiveness of ADM allograft in increasing the width of keratinized gingiva around dental implants. A patient with inadequate keratinized gingiva around dental implants in maxillary and mandibular anterior regions received either an ADM graft or palatal autograft by random allocation. The width of keratinized gingiva and other clinical periodontal parameters were recorded initially and at 3 and 6 months after surgery. Both grafts provided satisfactory results. The width of keratinized tissues was increased by using the ADM allograft, but by a lesser amount than seen with the autogenous gingival graft.

Adult↗

Influence of occlusal forces on stress distribution in preloaded dental implant screws.

STATEMENT OF PROBLEM: Abutment and prosthetic loosening of single and multiple screw-retained, implant-supported fixed partial dentures is a concern. PURPOSE: The purpose of this study was to investigate stress distribution of preloaded dental implant screws in 3 implant-to-abutment joint systems under simulated occlusal forces. MATERIAL AND METHODS: Three abutment-to-implant joint systems were simulated by using the 3-dimensional finite element analysis method: (1) Branemark external hexagonal screw-retained abutment, (2) ITI 8-degree Morse tapered cemented abutment, and (3) ITI 8-degree Morse tapered plus internal octagonal screw-retained abutment. A thermal load and contact analysis method were used to simulate the preload resulting from the manufacturers' recommended torques in implant screw joint assemblies. The simulated preloaded implants were then loaded with 3 simulated static occlusal loads (10 N; horizontal, 35 N; vertical, 70 N; oblique) on the crown position onto the implant complex. RESULTS: Numeric and graphical results demonstrated that the stresses increased in both the abutment and prosthetic screws in the finite element models after simulated horizontal loading. However, when vertical and oblique static loads were applied, stresses decreased in the external hexagonal and internal octagonal plus 8-degree Morse tapered abutment and prosthetic screws with the exception of the prosthetic screw of ITI abutment after 70-N oblique loading. Stresses increased in the ITI 8-degree Morse tapered cemented abutment after both vertical and oblique loads. CONCLUSION: Although an increase or decrease was demonstrated for the maximum calculated stress values in preloaded screws after occlusal loads, these maximum stress values were well below the yield stress of both abutment and prosthetic screws of 2 implant systems tested. The results imply that the 3 implant-to-abutment joint systems tested may not fail under the simulated occlusal forces.

Bite Force↗

Dental implant therapy in the treatment of an oroantral communication after exodontia.

A new technique in which a dental implant was the ultimate therapy for the treatment of an oroantral communication (OAC) that was created subsequent to the extraction of a maxillary first molar is described. A search of the English-speaking literature has not revealed implant therapy as part of documented modalities for the treatment of an OAC created following dental extraction. The OAC was closed by a sandwich technique that uses two resorbable membrane materials (Bio-Gide, Osteohealth, Shirley, NY) that surround a bone substitute (Bio-Oss, Osteohealth). This procedure, together with additional onlay grafting with the same bone substitute, was used also to regenerate subantral bone to enable the subsequent placement of an endosseous implant after 12 months. An 8-month postoperative radiograph showed creation of a new maxillary sinus bony floor and subantral bone of good quality, and height that can permit the placement of an endosseous dental implant.

Adult↗