A thousand years of dental implants: a definitive history--part 1.
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Central America↗
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Performance of six bone collectors designed for dental implant surgery.
OBJECTIVES: The aim of this study was to perform an in vitro comparison of six bone collectors for harvesting of particulate bone. MATERIAL AND METHODS: Four commercially available bone collectors (Frios, Osseous Coagulum Trap, ACE Autografter, Bone Trap) and two custom-designed models were tested. Three different in vitro tests were performed to determine the harvesting capabilities of the collectors. In test I, a bovine mandible was drilled and the bone collectors were used to collect bone chips. The harvested bone volumes and dry weights were measured after harvesting. In test II, three dental implant sites were prepared in a bovine mandible. The bones from the implant osteotomies were collected, and bone volumes and dry weights were measured. In test III, 1 ml of bone chips was mixed with water, and suctioned through the bone collectors. The volumes of the bone chips retained were measured to determine the efficiency of each collector. RESULTS: The Osseous Coagulum Trap and the custom-made collectors were the most effective instruments in test I. The mean volumes ranged from 0.17 to 0.38 ml. In test II, the difference between the collectors was small and the bone volume ranged from 0.28 to 0.37 ml. In test III, the Bone Trap became blocked before the other collectors, and its bone procurement was therefore limited. CONCLUSION: Comparison of six different bone collectors in this in vitro study showed that all collectors are usable in clinical situations but their effectiveness varies.
Animals↗
Enhancement of the damaged edentulous ridge to receive dental implants: a combination of allograft and the GORE-TEX membrane.
A severely damaged edentulous ridge frequently obviates the placement of dental implants or results in placing them at an angle that compromises the prosthetic restoration. This paper demonstrates the repair of severely resorbed edentulous ridges by a combination of bone allografting and the placement of a barrier membrane. The damaged edentulous ridge is treated first in this two-stage process. The implants are then installed at a second surgery.
Adult↗
Quantitative bone remodelling resulting from the use of porous dental implants.
Histomorphometric analyses were used to quantitatively determine the patterns of bony ingrowth which resulted from the placement of porous-surfaced dental implants into the mandibles of Rhesus monkeys for up to 74 months utilizing a two-stage approach. Quantitative histopathologic evaluations were made using ground section microscopy. Implant stability resulting from bone remodelling and ingrowth occurred to varying degrees with all implants. Bone ingrowth occurred from medullary trabeculae and contact with the adjacent cortical plates. Quantitative histomorphometric analyses revealed that in only one case was the bone ingrowth into the available internal pores less than 45%. Minimal fibrous connective tissue ingrowth was observed in the implant crypts and was not thought to be due to micro-motion. The observed bone remodelling indicated a favorable prognosis for long-term implant performance.
Animals↗
Consideration of biomechanical stress in treatment with dental implants.
The most common implant complications, whether associated with the implant or prosthetic restoration, occur as a result of biomechanical stress. These complications include early implant failure, fracture of the prosthesis, abutment or prosthetic screw loosening, implant crestal bone loss, and problems with overdenture attachments. An engineering approach to resolve biomechanical problems involves determining the nature of complications and then designing an approach to eliminate their underlying causes. Treatment planning should incorporate methods to reduce stress and minimize its initial and long-term effects. The treatment plan is altered when forces are greater or bone is less dense than usual to minimize the negative impact of stress on the implant, bone, and restoration. Several parameters under the clinician's control can improve the transosteal environment relative to managing stress on the implant-restoration complex. The goal is to decrease the amount of force, or increase the implant-bone surface area, to decrease the chance of implant-restoration complications.+
Biomechanical Phenomena↗
Nonsurgical management of bilateral mandibular fractures associated with dental implants: report of a case.
A case is presented in which bilateral fractures of the mandible occurred following placement of endosseous dental implants. The management, with approximately 7 years of follow-up, is described and the potential causes of such fractures and their treatment are discussed.
Bone Remodeling↗
Validation of dental implant systems through a review of literature supplied by system manufacturers.
STATEMENT OF PROBLEM: The use of endosseous implants to support and retain dental prostheses has become a routine treatment option in many dental practices. Although physical, mechanical, and chemical differences exist among implant systems, survival claims are similar. PURPOSE OF STUDY: This review solicited literature from six implant manufacturers that was thought, by their standards, to be pertinent to the validation of their implant system. METHODS: The literature was reviewed and categorized. CONCLUSION: On the basis of the literature supplied by the manufacturers, only one implant system demonstrated scientifically valid long-term success.
American Dental Association↗
[Dental implants. Innovations--quality assurance--acquisition].
In connection with implants the characteristics and possibilities of innovation are studied taking into consideration the measures prescribed by the public acquisition law. The author stresses that the Association for Facial-Mandibular and Oral Surgery has to take an initiative role in the innovation of implants.
Dental Implantation↗
Esthetic restoration of a single-tooth dental implant using a subepithelial connective tissue graft: a case report with 3-year follow-up.
This case report describes the use of a subepithelial connective tissue graft to restore the gingival papillae and augment ridge soft tissues adjacent to a dental implant. The patient was referred for periodontic and prosthodontic evaluation after the placement of an implant--with the implant head 6.5 mm below the adjacent cementoenamel junction--in an area of inadequate bone volume with deficient interproximal papillae and ridge soft tissues. The resulting esthetic defect was restored by means of a combined technique that used a subepithelial connective tissue graft and an emergence profile-contoured crown. A 3-year clinical follow-up with complete regeneration of the gingival papillae is described.
Adult↗
Monitored anesthesia care for dental implant surgery: analysis of effectiveness and complications.
The optimal method of providing safe and effective sedation for outpatients undergoing lengthy dental operations is unclear. We provided monitored anesthesia care (conscious sedation) for 102 consecutive dental implant procedures, using intravenous midazolam and fentanyl as primary pharmacologic agents. Midazolam was administered by multiple, intermittent injection or via continuous infusion. The dose of midazolam required for the induction of sedation ranged from 3.4 +/- 1.6 mg to 4.0 +/- 2.0 mg. Maintenance of adequate sedation required a mean midazolam administration rate of 4.0 +/- 2.1 mg/h to 5.1 +/- 2.1 mg/h, and a mean fentanyl administration rate of 54 +/- 29 mcg/h to 60 +/- 27 mcg/h. Continuous monitoring allowed for rapid detection and treatment of 40 separate hemodynamic and respiratory problems. There was no evidence of patient injury, and all patients returned home on the day of surgery. A post-operative telephone survey revealed that 65% of patients had complete amnesia for operative events, 96% were satisfied with monitored anesthesia care, and 94% would desire a similar anesthetic technique for future procedures.
Anesthesia, Dental↗
Further data on the predictability of the indirect sinus elevation procedure used with short, sintered, porous-surfaced dental implants.
The object of this report was to provide further data supporting the use of short (primarily 7-mm-long) dental implants with a sintered, porous-surface geometry to treat the posterior maxilla using the indirect, osteotome-mediated, localized sinus elevation procedure. Records were available for 104 Endopore implants (Innova) in 70 patients, for whom the majority of implants had been placed in the location of the maxillary first molar. The mean initial subantral bone height before implant placement was 4.2 mm, with a range of 2 to 6.7 mm, and all implants were placed using hand osteotomes and a graft of bovine hydroxyapatite. After an average time in function of 3.14 years, only two implants had been lost, both as a result of unusual circumstances. It is concluded that the use of short, sintered, porous-surfaced implants and localized indirect sinus elevation is a predictable and minimally invasive approach to manage the posterior maxilla with minimal preoperative subantral bone height.
Biocompatible Materials↗
A three-dimensional finite element analysis of a porous rooted Co-Cr-Mo alloy dental implant.
A three-dimensional finite element model was used to investigate the biomechanical response of a porous rooted Co-Cr-Mo alloy implant. The load displacement responses calculated from the finite element model were verified with experimentally-determined values for three-cylindrical, porous rooted Co-Cr-Mo alloy dental implants retrieved from canines after two years in function. Models were developed based on histological analyses of tissue surrounding the implants. The results of the study indicate that the assumption of a direct bone-to-implant interface (i.e., an ankylosed implant) may not be a good representation for a porous rooted implant retained by bone ingrowth.
Animals↗
[A one-year study on enzyme level in gingival crevicular fluid around osseointegrated dental implants].
OBJECTIVE: To investigate the changes of gingival crevicular fluid(GCF) volume, aspartate aminotransferase (AST) and alkaline phosphatase(ALP) levels in GCF around dental implants during the first year after rehabilitation. And to explore the relationships between these changes and peri-implant inflammation as well as bone loss. METHODS: 26 Branemark implants in 12 adults were included in this study. Examinations were carried out in a total of 52 sites in preinsertion period and 3, 6, 12 months following rehabilitation. RESULTS: GCF volume, GCF-AST, GCF-ALP were firstly increased and then fallen during the first year after rehabilitation. GCF volume, GCF-AST, GCF-ALP in sites with peri-implant mucositis were higher than those in health sites, and were increased with the severity of peri-implant mucositis. GCF volume, GCF-AST, GCF-ALP in sites with bone loss were significantly higher than those without bone loss. CONCLUSION: GCF volume, GCF-AST, GCF-ALP could reflect peri-implant inflammation and bone changes to some degree.
Adult↗
Histomorphometric evaluation of six dental implant surfaces after early loading in augmented human sinuses.
This study investigated the bone-to-implant contact (BIC) and osteoconductive capacity (OC) of 6 different implant surfaces after early loading in humans. Two implants with different surfaces were placed side-by-side in the grafted (n= 5) and nongrafted (n = 1) sinuses of 3 volunteers. Single-tooth restorations were delivered 60 days later. After 6 months of full occlusal loading, implants were retrieved in block sections for histomorphometric analysis. One implant (acid etched) placed in grafted bone failed when loaded. There were no other complications. In grafted bone, the microtextured surface achieved the highest BIC value (94.08%), followed by the oxidized (77.32%), hydroxyapatite (HA) (74.51%), sandblasted and acid-etched (51.85%), and titanium plasma-sprayed (TPS) (41.48%) surfaces. In native bone, the acid-etched surface achieved a higher BIC value (69.03%) than the HA surface (59.03%). The highest OC value in grafted bone was exhibited by the microtextured surface (34.31%), followed by the HA (28.62%), sandblasted and acid-etched (25.08%), oxidized (17.55%), and TPS (-20.47%) surfaces. The HA surface exhibited a higher OC value (30.39%) in native bone compared with the acid-etched surface (24.0%). As a whole, highest BIC and OC values were exhibited by the microtextured surface, and lowest values were exhibited by the TPS surface. All other surfaces demonstrated excellent BIC (>50%) but varied in OC (range = 17.55%-28.62%). These findings are tempered by the limited scope and sample size of the study and should be considered preliminary. More research is needed to determine the impact of implant surface texture on BIC and OC.
Acid Etching, Dental↗
Three-year data from a randomizd, controlled study of early loading of single-stage dental implants supporting maxillary full-arch prostheses.
PURPOSE: The aim of this 3-year randomized controlled trial (RCT) was to compare biologic and technical treatment outcomes and patient satisfaction after early (< or = 14 days postimplantation) loaded implants with those of implants loaded after a healing period of 3 to 4 months in the edentulous maxilla. MATERIALS AND METHODS: Twenty-four patients with completely edentulous maxillae were randomized into a test group (n = 16) and a control group (n = 8). All patients received 5 or 6 solid screw-type titanium implants with sandblasted, large-grit, acid-etched (SLA) surfaces. In total, 142 implants were placed and 139 implants were loaded with full-arch prostheses. Clinical assessments were obtained at loading and after 3, 6, 12, 24, and 36 months. Radiographs of implants and existing teeth were taken at loading; after 6, 12, 24, and 36 months; and at 12, 24, and 36 months, respectively. RESULTS: The cumulative implant success rate 3 years after loading was 100%. At the 3-year examination the mean (P < or = .005), distal (P < or = .005), and mesial (P > .05) crestal bone levels were better in the test group. No significant differences between the test and control groups were noted for any other outcome measure. The most common adverse event in both groups was tooth-crown fracture. DISCUSSION: A review of the literature, both printed and electronic, revealed no study fulfilling the criteria of an RCT dealing with the early loading of maxillary full-arch prostheses. This study fulfills those criteria. CONCLUSION: In this study population it has been concluded that the early (approximately 2 weeks) loading protocol is a viable alternative to the standard (3 to 4 months) protocol in the rehabilitation of a completely edentulous maxilla with a complete implant-supported fixed prosthesis.
Adult↗
A histological evaluation of a functional endosseous, porous-surfaced, titanium alloy dental implant system in the dog.
We have previously reported the clinical and radiographic findings of a trial in dogs of a new dental implant system after a functional period of eight months. The present report consists of the corresponding qualitative and quantitative histological data. The implant system was fabricated from Ti-6A1-4V and employed a porous-surfaced configuration to achieve implant fixation by bone ingrowth. A similar porous surface was used on the apical 1/3 of the transgingival collar in an attempt to gain ingrowth and attachment of gingival connective tissue. The qualitative histological data confirmed that while such attachment to the collar did occur for some implants, in the majority of implants (22 of 32) the porous region of the collar became contaminated with bacterial plaque, resulting in implant failure (four implants) or suggesting future implant failure (18 implants). Statistical analyses of the quantitative histological data indicated that there were no significant differences in surface contact of bone with the middle third of the porous implant surface (CLF) when initial healing interval (four or eight weeks), implant location, or aspect of implant (buccal vs. lingual vs. mesial vs. distal) were compared. However, comparison of the current group of functional implants with an earlier group of similarly implanted non-functional implants indicated that function produced a highly significant increase in CLF.
Alloys↗
Electron microscopy of bone response to titanium cylindrical screw-type endosseous dental implants.
This study investigated the undecalcified bone and enveloping tissues supporting commercially pure titanium one-stage and two-stage endosseous dental implants placed into the mandibles of adult mongrel dogs. Correlative light microscopy, transmission electron microscopy, and high-voltage transmission electron microscopy demonstrated a dynamic bone interface to the implants. Mineralized tissue was routinely observed within 20 to 50 nm from the implant interface, separated from the implant interface only by an electron-dense deposit. The densely mineralized collagen fiber matrix was oriented parallel to the implant interface, as were osteocytes that were found close to the interface. Osteocytic projections progressed through canaliculi, often directly to the implant interface. Unmineralized areas that appeared to have the potential for mineralization were also identified.
Alveolar Process↗
Osseointegration assessment of dental implants using a synchrotron radiation imaging technique: a preliminary study.
PURPOSE: This study tests the possibility of using synchrotron radiation (SR) x-ray micro-imaging as a new method to evaluate osseointegration. MATERIALS AND METHODS: A simple imaging setup with primarily unmonochromatic SR was used to study the interface of a dental implant in contact with bone. The samples were prepared by sectioning the undecalcified specimen of a titanium screw implanted in the tibia of a New Zealand white rabbit. Radiographs of the interface between surrounding tissues and dental titanium implant were imaged using the SR imaging system at PLS (Pohang Light Source) 5C1 beamline, a micro-computed tomography (microCT) system (SkyScan-1072), and a conventional dental x-ray system (Siemens Heliodent MD). RESULTS: The image quality of the osseointegrated titanium implant was compared among the 3 imaging systems. The SR imaging technique showed greater details than other radiographic modalities for evaluation of the healing stage of bone-implant contact. DISCUSSION: The evaluation was especially focused on the image quality of the osseous contact at the bone-to-implant interfaces. CONCLUSIONS: This SR imaging technique provides finer details and can be expected to make an impact in the clinical study of osseointegration.
Animals↗