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PubMed1994

Dental implant esthetics.

As dental implants have become an increasingly popular restorative therapy and their stability and functional benefits have become widely acknowledged, newly applied surgical and prosthetic techniques are enabling dentists to approach patients' esthetic expectations. Esthetic results of implant-supported fixed bridges, retrievable bridges, and overdentures are influenced by the amount of soft and bone tissue as well as by the placement of the implants themselves. Tissue augmentation procedures that restore normal tissue contour and allow more ideal implant placement help minimize esthetic compromises. The use of modified abutments that are angulated and placed directly in the implant can offset weak implant placement. Finally, overdentures should be constructed if these techniques cannot be used or if their use still results in compromised esthetic results.

Dental Implants↗
PubMedDate not supplied

Augmentation procedures of the jaw in patients with inadequate bone for dental implants: radiographic appearance.

Dental implants, metallic posts surgically imbedded in the jaw to support dental prostheses, have provided an attractive alternative to standard removable dentures. Some patients, however, have insufficient bone to accommodate these implants. In this setting, a number of surgical procedures are available to augment the bone in the jaw. It is important for radiologists to be familiar with these procedures because the altered anatomy can be a source of confusion to the unwary. The objective, therefore, was to describe these procedures and their radiographic appearances.

Alveolar Ridge Augmentation↗
PubMed1993

Structure of the bone interface to dental implants in vivo.

Dental implant materials can develop different kinds of interfaces when used for bone or tooth substitution. This paper describes the tissues and the tissue reactions of the interface created in the implantation bed between bone tissue and implants made of dense sintered hydroxylapatite. Healing was clinically and histologically evaluated during a six-month to five-year period. The light microscopic results show extensive bone apposition on the osseous sides of loaded implant cylinders and also on subperiosteally placed granules of dense hydroxylapatite. The presence of the loaded implant did not disturb the normal bone physiology. Bone turnover also included the bone tissue toward the implant surface. At the ultrastructural level, an amorphous collagen-free zone of about 200 nm was frequently observed which was separated from the surrounding mineralized extracellular matrix by a thin, electron-dense layer of about 20-100 A. Contact microradiographs showed an intimate bond to bone. The bone growth extending up the implant cylinder was always accompanied with an embedding of collagen fibers and the presence of a well-developed and complete new gingival attachment apparatus. This was confirmed by scanning electron microscopy. However, any inflammatory reactions in the transmucosal area were accompanied with concomitant bone resorption and loss of bone support.

Alveolar Process↗
PubMed2006

Scanning electron microscopy and energy dispersive X-ray study of a recovered dental implant.

A recovered dental implant has been studied for surface contamination using SEM and EDS microanalysis. The implant had been in place for 4 years in an adult male (age: 56 years), who had poor oral hygiene and was a smoker. Loosening had occurred, and the implant was removed accidentally during the taking of an impression. Using SEM, three distinct regions were identified, a clear one where the metal appeared shiny and unaffected, a discoloured one, where the surface appeared smooth and uncoated, and a region where there was a distinct deposit. All three regions gave elemental compositions of approximately 85% Ti, 12% Al, 3% V, which is a little richer in aluminium than the nominal overall composition of the usual alloy employed in implants. All three regions showed the presence of carbon, with the highest levels being associated with the surface deposit, and the lowest with the clear region. Oxygen was also present in substantial amounts, with most being found in the discoloured region. No nitrogen was detected, which suggests that the organic surface contamination is not due to interaction with proteins, despite their presence in saliva and crevicular fluid within the mouth.

Dental Implants↗
PubMedDate not supplied

Patient self-reported satisfaction with maxillary anterior dental implant treatment.

PURPOSE: Dental implants are accepted as a successful alternative to conventional fixed and removable prostheses for the treatment of partial or complete edentulism. However, there have been few studies of the success of implants from the patients' perspective. The purpose of this study was to assess patient overall satisfaction with the outcome of treatment with maxillary anterior implants. MATERIALS AND METHODS: A self-administered mailed questionnaire, which was developed for this project, and a data abstraction form, which was designed based on information available from the corresponding dental records of 123 eligible subjects, were utilized to survey implant patients. RESULTS: Seventy-eight of 123 eligible subjects responded to the mailed, self-administered, structured questionnaire. Twelve of the 24 questionnaire variables demonstrated statistically significant bivariate associations with the dependent variable "overall patient satisfaction." Five variables--implant position, definitive restoration shape, appearance, effect on speech, and chewing capacity--were strongly associated with overall satisfaction. No demographic or treatment-related, dental record-abstracted variable, of the 25 that were examined, was statistically significant. DISCUSSION: The practitioner who provides implant restorations should be aware of the multidimensional aspects of patient satisfaction with implant treatment. This study suggests that patient satisfaction with key elements influences the overall acceptance of maxillary anterior implant prostheses, which are esthetically critical. Communication between dentist and patient is important to achieve optimal results that will be satisfactory to both. Discussion of treatment limitations may also help patients to develop realistic expectations of the final result. CONCLUSIONS: In this limited investigation, patient satisfaction with implant position, restoration shape, overall appearance, effect on speech, and chewing capacity were critical for patient overall acceptance of the dental implant treatment.

Adolescent↗
PubMed2000

Immediate placement of anatomically shaped dental implants.

Immediate placement of dental implants into tooth extraction sites is an effective treatment option. When immediate placement procedures are performed with a round implant, a void is often evident between the implant and the orifice of the socket. Previous treatment focused on the use of membranes or special closure techniques to induce bone growth into the void. Anatomically shaped dental implants provide a predictable alternative to previous filling techniques since the anatomical implants decrease or completely fill the void at the socket opening. This article describes a surgical technique developed for the immediate placement of these implants in extraction sites.

Computer-Aided Design↗
PubMed1999

Why do dental implants fail? Part II.

Dental implant failure has led to continuous innovations of various implant systems and to different interceptive treatment modalities. These concerns have also led to selection of implant designs that best suit the various types of bone. A checklist has been created to facilitate collection of data on the different factors associated with dental implant failure. The data gathered from this list are the basis of a multinational statistical analysis. This analysis will provide accurate information about the percentage of each element causing implant failure. Different causes of failure, such as host factors, surgical placement, and improper implant selection, were reviewed in Part I of this two-part series. This article discusses failure categories in terms of etiology, failure mode, failure type, failure origin, failure timing, responsible personnel, and different tissue types.

Dental Implantation, Endosseous↗
PubMed2003

Use of HTR synthetic bone grafts in conjunction with immediate dental implants.

Immediate placement of dental implants in fresh extraction sockets is associated with remaining voids around the implants and often a partial dehiscence or thinning of the facial alveolar plate. Nine patients had Bioplant HTR synthetic bone used as a ridge preservation/augmentation material in conjunction with immediate placement of 10 implants. Hard tissue replacement (HTR) was used to fill the remaining socket void and enhance the facial ridge width, and the wound closed as completely as possible. Dental implants were uncovered at approximately 6 months. Measurements taken of the internal socket width and total ridge width at the implant placement and uncovering showed the mean internal socket width was maintained (7.2 mm vs 6.9 mm), and the total ridge width exhibited a mean change from 9.6 mm to 8.8 mm. Of the 10 implant sites, 7 showed a net increase, 2 no change, and 1 a decrease in overall ridge width. All 10 implants were restored for at least 6 months. These clinical results suggest that HTR is a useful adjunct in the placement of immediate dental implants for the preservation of ridge width and provides a good base for functional and esthetic prosthetic reconstruction.

Adolescent↗
PubMed2002

Optimization of the neck region of dental implants with a bioactive, resorbable coating.

With the goal of shortening the postoperative healing phase and the minimization of the risk of peri-implantitis around dental implants, a polymer coating, with improved surface biocompatibility in the region of soft tissue penetration by the implant, was investigated. The polymer used was the relatively slowly resorbable poly-beta-hydroxybuterate (PHB) whose surface was further activated in a NH3--plasma. The influence of surface roughness of the substrate (commercially pure titanium) as well as the influence of the edge radii on the test samples was determined in prior studies. These studies formed the basis for an optimised coating process. In-vitro biocompatibility was determined using a human gingival primary cell culture. Surface morphology was determined with SEM and AFM to complement the cell culture studies.

Cell Division↗
PubMed1989

[Dental implants in the private dental office].

The surgical procedure of the implant technique in the private dental office is restricted because of the small number of staff members. All procedures for the implant treatment should be performed with a minimum of staff members: one dentist, a couple of dental hygienists or assistants, with a minimum amount of equipment. Therefore, sufficient conditions for the practicing dentist to perform the implant treatment are summarized as follows: It requires 1) a rather simple operative technique, 2) methods with few special instruments, 3) methods requiring a short operative time, 4) easy reconstruction from mistreated cases, 5) readily available materials, 6) methods applied for all types of tooth deficiency, 7) the material suitable for the aged, 8) stable prognosis. Over several years, using "Bioceram implants" which are manufactured by Kyocera Co., Ltd. (Japan) and by conforming to the conditions as described above, more than 300 cases of the implant treatment have been performed.

Dental Implantation, Endosseous↗
PubMed2005

Collagen fiber orientation in human peri-implant bone around immediately loaded and unloaded titanium dental implants.

BACKGROUND: The main factor in determining the mechanical properties of bone is the collagen configuration. METHODS: This study investigated the birefringence in human bone around loaded and unloaded titanium dental implants to evaluate the collagen fiber orientation using circularly polarized light (CPL) and scanning electron microscopy (SEM). A total of 10 titanium dental implants, five immediately loaded and five unloaded, were used. The birefringence measurements were performed on digitized images of both loaded and unloaded implants. All images detected at 50x were measured using a software image analysis. RESULTS: In the bone around loaded implants, the transverse collagen fiber area was 45,481+/-3,037 pixel2 (mean+/-SD), while the area of longitudinal collagen fibers was 13,676+/-2,232 pixel2 (mean+/-SD). In the unloaded implants, the transverse collagen fiber area was 32,174+/-2,554 pixel2 (mean+/-SD), while the area of longitudinal collagen fibers was 89,073+/-1,960 pixel2 (mean+/-SD). The CPL measurements of the birefringence for transverse collagen fibers of loaded versus unloaded implants indicated that the differences were statistically significant (P <0.05). The results for the longitudinal collagen fibers of loaded versus unloaded implants were also statistically significant (P <0.05). CONCLUSIONS: In the bone around loaded dental implants, transverse collagen fibers were more abundant, while in the unloaded implants, collagen fibers run more longitudinally. The load seemed to determine the collagen fiber orientation.

Biocompatible Materials↗
PubMed2001

The provision of dental implants in the National Health Service Hospital dental services--a national questionnaire.

OBJECTIVE: To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. DESIGN/SETTING: Anonymous postal questionnaire in the United Kingdom. SUBJECTS: Consultants in restorative dentistry. RESULTS: Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2-150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. CONCLUSIONS: There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.

Contraindications↗
PubMed2001

Histomorphometric comparison of implant anchorage for two types of dental implants after 3 and 6 months' healing in baboon jaws.

STATEMENT OF PROBLEM: A complete understanding of dental implant prognosis requires better knowledge of the bone anatomy after implant healing. Such baseline data are necessary to compare against load-induced changes in anatomy. PURPOSE: The purpose of this article is to describe and compare measures of implant support (percentage [%] integration and percentage [%] bone area) for various implants in baboon jaws after healing times of 3 and 6 months. MATERIAL AND METHODS: Commercially pure titanium (cpTi) and titanium alloy (Ti-alloy) screw-shaped implants were placed in the posterior jaws of 9 female baboons after 2 months of postextraction healing. Specimens were harvested after 3 months (5 baboons: 8 cpTi, 7 Ti-alloy) and after 6 months (4 baboons: 8 cpTi, 8 Ti-alloy). Each implant provided 6 polished horizontal sections for data collection, which was accomplished from digitized images with the IMAGE analysis system (reliability at 1.6%). Three- and six-month data for each parameter were compared with the use of ANOVA (P<.01). RESULTS: The results revealed a significant increase in the % integration (cpTi 39.1 to 56.2; Ti-alloy 40.0 to 55.2) and the % bone area (cpTi 38.8 to 47.9; Ti-alloy 38.9 to 49.2) from 3 to 6 months for both implants. This significant increase was also true for comparisons by jaw for each implant material (P<.01 for overall and by jaw comparisons). CONCLUSION: A time-dependent increase in jawbone anchorage was measured in this nonhuman primate population, and it was shown that the 6-month maxillary data were comparable to the 3-month mandibular data. These results lend support to the clinical strategy of waiting longer to load implants in the maxilla.

Alloys↗
PubMed2003

Biological behavior of sol-gel coated dental implants.

The biocompatibility of dental implants coated with titania/hydroxyapatite (HA) and titania/bioactive glass (BG) composites obtained via sol-gel process was investigated using an in vitro and in vivo model. A device for the in vitro testing of screw-shaped dental implants was developed, in order to well compare the two experimental models studying the behavior of human MG63 osteoblast-like cells seeded onto a particular geometry. The expression of some biochemical parameters of osteoblastic phenotype (alkaline phosphatase specific activity, collagen and osteocalcin production) and some indications on cells morphology obtained by scanning electron microscopy were evaluated. The in vitro and in vivo models were compared after implants insertion in rabbit tibia and femur. The removal torque and histomorphometric parameters (percentage of bone in contact with implant surface and the amount of bone inside the threaded area) were examined. A good agreement was found between the in vitro and in vivo models. These experiments showed better performances of HA and BG sol-gel coated dental implants with respect to uncoated titanium; in particular, it was found that in vitro the HA coating stimulates osteoblastic cells in producing higher level of ALP and collagen, whereas in vivo this surface modification resulted in a higher removal torque and a larger bone-implant contact area. This behavior could be ascribed to the morphology and the chemical composition of the implants with rough and bioactive surfaces.

Journal Article↗
PubMed1980

Implant-bone interface characteristics of bioglass dental implants.

Three-dimensional finite element analysis (FEA) has been used to determine the implant-bone interface characteristics of bioglass dental implants. The results of the FEA were verified by comparison with the results of mechanical testing performed on animal implant specimens. The results of the study showed that the assumption of a discontinuous change of elastic properties at the bone-implant interface was a poor assumption for the bioglass implants. Interface elastic moduli of 354.0, 155.0, and 47.0 MPa for conditions of 25, 50, and 100% tissue attachment were determined for the bioglass implants.

Animals↗
PubMed2000

Humoral immunity host factors in subjects with failing or successful titanium dental implants.

BACKGROUND: Treatment with titanium dental implants is in general successful. However, an unknown number of implants do not integrate and are removed either by exfoliation or at the time of second stage surgery. It would be of importance to identify subjects at risk and predict early implant failure. METHODS: In a retrospective study serum IgG antibody titers and avidity in sera from 40 subjects who had experienced titanium dental implant treatments with non-osseo-integration as the outcome (NOTI) and in sera from 40 age and gender matched control subjects who had received successful titanium dental implants (SOTI) were studied. Serum IgG titers to whole cell Actinomyces viscosus, Bacteroides forsythus, Porphyromonas gingivalis, Staphylococcus aureus, and Streptococcus intermedius sonicated antigen preparations were studied by ELISA. RESULTS: Serum IgG antibody titers to S. aureus were significantly higher in subjects with SOTI than in NOTI (p<0.001) suggesting that higher titers indicate protection against implant failure as a result of S. aureus infection. Statistically significant higher serum IgG antibody avidity to P. gingivalis and B. forsythus were found in subjects with SOTI than in subjects with NOTI (p<0.01 and p<0.001, respectively). Statistical analysis failed to demonstrate antibody titer or avidity differences to the other pathogens studied. The likelihood that SOTI was associated with a high OD reading for S. aureus was 13.1:1 (p<0.001). Whether subjects were edentulous or not, or if they had lost teeth because of periodontitis or caries did not seem to matter. CONCLUSION: Serum IgG antibodies relative to B. forsythus, P. gingivalis and S. aureus may be associated with the outcome of implant procedures and explain why early implant failures occur.

Adult↗
PubMed1993

Dental implants in periodontal care.

Dental implants are becoming more commonly used in periodontal offices. The literature related to implants this past year was filled with important material that will change the way we diagnose and formulate treatment plans. This review covers the key points that must be understood to maximize success with dental implants.

Dental Implants↗