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PubMedDate not supplied

Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report.

PURPOSE: To evaluate the survival rate of immediately loaded ITI sand-blasted, large-grit, acid-etched (SLA) solid-screw dental implants in the edentulous maxilla after 8 months of loading. MATERIALS AND METHODS: Twenty-eight patients (mean age 63 years) with edentulous maxillae each received 6 implants and 1 implant-supported fixed provisional prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patient received a definitive, screw-retained, implant-supported fixed prosthesis. A total of 168 implants were placed. Clinical parameters were registered after 1 month of loading with the implant-supported fixed prostheses as well as 8 months after implant placement. Radiologic examinations and assessments were made at implant placement and after 8 months. RESULTS: The mean marginal bone level at implant placement was 1.6 mm (range 0 to 5.1; SD 1.1) apical of the reference point (the implant shoulder). The mean marginal bone level at the 8-month follow-up was 3.2 mm (range 0.4 to 5.9; SD 1.1) apical of the reference point. Three implants failed during the healing period. DISCUSSION: The improved results in the present study might be a result of the positive effect of splinting the implants immediately after placement. CONCLUSION: ITI SLA solid-screw implants immediately loaded (ie, loaded within 24 hours of placement) and supporting fixed prostheses had successful survival rates after 8 months. The present results constitute a solid baseline for future follow-up studies.

Aged↗
PubMed1989

The interrelationship between the root surface and alveolar bone of the replanted avulsed tooth after etching.

It has been suggested that removal of the damaged nonvital periodontal ligament (PDL) may result in slower destruction of tooth substance following replantation of teeth. It has also been suggested that citric acid conditioning of surgically exposed dentin may enhance connective tissue attachment on root surfaces. The aim of this study was to examine the interrelationship between the acid etched root surface of the replanted tooth and the alveolar bone. Forty-five available anterior teeth from six monkeys were divided into 3 groups in this experiment. All teeth were extracted and dried for 2 hrs. In the first group the teeth were replanted immediately after endodontic therapy. The teeth in the second group were replanted after immersion in 10% sodium hypochlorite and subsequently irrigation with normal saline. In the third group, the cementum and necrotic PDL were removed by grinding the root surfaces which were then treated with citric acid (PH = 1) for 3 minutes followed by normal saline irrigation. All teeth were replanted without splinting and were subjected to histological examination at 12 week post-replantation. Close apposition of collagen fibrils of the new connective tissue to the exposed root surface was observed in most cases in the second and third group, although bony ankylosis and inflammatory root resorptions were also found in some areas. Teeth in the first group, the control experiment, had much more replacement and inflammatory resorptions. Then the result suggested that demineralization with citric acid on the denuded avulsed tooth prior to replantation may decrease the chance of replacement resorption and result in fibrous adhesion to the alveolar bone.

Adhesiveness↗
PubMed1997

Comparative in vitro effectiveness of closed root debridement with fine instruments on specific areas of mandibular first molar furcations. II. Furcation area.

The purpose of this study was to demonstrate the extent of deposits removed from within the furcation area of mandibular first molars following the use of curets with a modified blade and slim ultrasonic inserts in an in vitro model simulating a closed root debridement approach to furcation treatment. The furcation areas of 100 artificial mandibular first molars were uniformly coated with black model paint. The molars were fixed into a custom acrylic model, maintained in a firm position with modified occlusal splints, and the roots covered with a heavy rubber dam. The model was set in a mannequin and mounted on a dental chair recreating a clinical situation. Fifty molars (25 right, 25 left) were instrumented with the experimental curets and an equivalent number of molars with the ultrasonic inserts. An experienced dental hygienist completed all the instrumentation, spending 4 minutes on each molar. The molars were sectioned buccolingually from the crown apically to separate the roots, and areas in the internal surface of mesial and distal roots were analyzed to determine the percentage of deposits remaining using a computerized imaging routine system. A 2-factor analysis of variance was conducted to test for differences between both types of instruments. The curets produced furcation root surfaces with significantly less percentage of residual deposits than the ultrasonic inserts (P < 0.01). This study indicates the potential value of small bladed curets in debriding involved furcations during initial therapy and supportive periodontal therapy. The current findings should be corroborated in a clinical study.

Acrylic Resins↗
PubMed2006

Local gingival blood flow at healthy and inflamed sites measured by laser Doppler flowmetry.

BACKGROUND: This investigation aimed to: 1) develop a method to obtain reproducible laser Doppler flow readings (LDFRs) at the gingiva of the maxillary front teeth; 2) evaluate regional gingival blood flow (GBF) in healthy gingiva by laser Doppler flowmetry; 3) compare hand-held LDFR (H-LDFR) with splint LDFR (S-LDFR); and 4) monitor changes in GBF in experimental gingivitis (EG) and chronic gingivitis (CG). METHODS: The LDFR, gingival index (GI), and plaque index (PI) were measured at 13 gingival sites (teeth #6 to #11) in 10 healthy volunteers (five males and five females), 23 to 34 years of age, over a period of 12.5 +/- 3.27 days employing a partial-mouth EG model and in 11 patients (three males and eight females), 20 to 63 years or age, with CG. LDFRs were obtained by S-LDFR or H-LDFR. RESULTS: H-LDFRs were significantly higher than S-LDFRs (P <0.05). All EG subjects developed gingivitis (PI: 2.77 +/- 0.23; GI: 1.5 +/- 0.53). EG-LDFRs at diseased sites increased slightly but not significantly over the study period. All CG-patients had high plaque and inflammation scores (PI: 2.8 +/- 0.2; GI: 1.63 +/- 0.78). CG-LDFRs at sites with GI >1 were significantly higher than LDFRs at healthy sites (P <0.05). CG-LDFRs were significantly higher than EG-LDFRs at sites with a comparable GI (P <0.05). CONCLUSIONS: LDFRs are positively correlated with the degree of gingival inflammation. GBF demonstrated significant differences in EG and CG. Modifications of the probe are needed to enhance its clinical applicability in clinical research of periodontal diseases.

Adult↗
PubMed1996

Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys.

The breakdown of bone around oral implants following excessive occlusal load or plaque accumulation was evaluated in monkeys. 5 screw type implants of pure titanium (Astra) were inserted in the mandible of 4 monkeys (Macaca Fascicularis). 2 implants were placed in each of the lateral segments and 1 in the frontal area. Each monkey was provided with 2 cemented splints covering the premolars and molars in the right and left side of the maxilla, respectively. 6 months after insertion of the fixtures, a fixed partial prosthesis was mounted on the 2 implants in one of the lateral segments. The prosthesis was in supra-occlusal contact with the antagonizing splint. Each prosthesis was replaced during the course of the experiment. The renewed prosthesis caused a lateral displacement of the mandible during occlusion, and therefore resulted in a lateral rather than axial excessive occlusal load. Implants retaining the prosthesis were brushed 1 x a week and subgingival cleaning was performed 1 x a month. The remaining implants were never cleaned and, additionally, a cotton cord was placed passively around each of these to promote plaque accumulation. 5 out of 8 implants with excessive occlusal load lost osseointegration (mobility and peri-implant radiolucency). The loss of osseointegration was observed 4.5 months to 15.5 months after the occlusal overload was commenced. None of the implants with plaque accumulation lost osseointegration, although an average loss of 1.8 mm in the radiographic bone level was assessed after 18 months.

Alveolar Bone Loss↗
PubMed2003

Occlusal and TMJ loads in subjects with experimentally shortened dental arches.

To determine whether shortened dental arches (SDAs) cause functional overloading of the teeth and the temporomandibular joints, which has been implicated in periodontal diseases and temporomandibular disorders, we investigated the influences of SDA on occlusal and joint loads. Bite force and masticatory muscle electromyograms were recorded in five dentate subjects who clenched maximally on intra-oral appliances, creating symmetrical SDAs experimentally. Muscular forces estimated from the recorded electromyograms were fed into a finite element jaw model for calculating bite forces and joint loads. Comparison between the measured and the calculated bite forces ensured that the joint loads were representative. The bite force on each tooth increased with missing molar occlusions, while joint loads decreased. The bite force per root surface area was always greatest on the most posterior tooth, and these values were most constant. The findings provide no evidence that SDA causes overloading of the joints and the teeth, which suggests that neuromuscular regulatory systems are controlling maximum clenching strength under various occlusal conditions.

Adaptation, Physiological↗
PubMed1997

Comparative in vitro effectiveness of closed root debridement with fine instruments on specific areas of mandibular first molar furcations. I. Root trunk and furcation entrance.

The purpose of this study was to compare curets with a small blade to slim ultrasonic inserts on their efficacy in removing artificial deposits from the root trunk and furcation entrance areas of mandibular molars using an in vitro model simulating a clinically closed root debridement approach. The study was conducted on 100 artificial mandibular first molars (50 right side and 50 left side) with anatomical roots. Root trunks, furcation entrances, and furcation areas of each molar were colored by a coat of black model paint. The teeth were fixed in a custom acrylic model and maintained in a firm position by modified acrylic occlusal splints. The root areas were covered with a heavy rubber dam imitating gingival tissue. The model was attached to a mannequin and mounted on a dental chair. Fifty molars (25 right, 25 left) were instrumented with the experimental curets and an equivalent number of molars with the ultrasonic inserts. The instrumentation was carried out by one experienced operator, spending 4 minutes on each molar. The instrumented areas were individually analyzed to determine the percentage of deposits remaining, using a computerized imaging routine system. One-way analysis of variance was conducted to test for differences between both types of instruments. Results revealed that the curets were significantly more efficient (P < 0.01) than the ultrasonic inserts in removing paint from both root trunks and furcation entrances. These findings should be corroborated in a clinical study to determine the potential value of the instruments tested during initial therapy or supportive care of involved mandibular furcations.

Acrylic Resins↗
PubMed1997

Clinical probing and radiographic assessment in relation to the histologic bone level at oral implants in monkeys.

Clinical probing level and radiographic bone level were compared to histologic bone level around screw type oral implants in 4 monkeys (Macaca Fascicularis). Two implants in each monkey retained a fixed partial prosthesis in supra-occlusal contact with an antagonizing splint. These implants were brushed 1 x a week and subgingival cleaning was performed 1 x a month. Unloaded implants in the same monkeys were never cleaned and, additionally, a cotton cord was placed around these to promote plaque accumulation. After 18 months, intraoral radiographs of the implants were obtained and probing levels were recorded with a metal probe using a standardized force of 0.2 N (Vivacare TPS Probe) and again using a moderate, unstandardized pressure. Immediately afterwards the animals were sacrificed. Sections, approximately 50 microns thick, of the implants and surrounding tissue were cut. The average probing levels with unstandardized pressure were 1.1 mm and 3.9 mm coronal to the histologic bone levels for implants with plaque accumulation or excessive occlusal load, respectively. With standardized probing force, the difference between the probing levels and histologic bone levels were even larger. The radiographic bone levels were on average only 0.5 mm and 0.1 mm short of the histologic bone levels for the two groups of implants. Only the radiographic bone level revealed a statistically significant correlation with the histologic assessment.

Alveolar Bone Loss↗
PubMed1979

Experimental and postexperimental effects of posteriorly directed extraoral traction in adult Macaca fascicularis.

The experimental, postexperimental, and postretention effects of continuous high-pull headgear force application to the maxilla were evaluated in four adult, nongrowing Macaca fascicularis monkeys. Force was applied at 450 grams per side to face-bows attached to cast maxillary splints with an implanted occipital plug for anchorage. The active experimental phase lasted from 84 days to 205 days, and its effects were documented histologically, cephalometrically, and with dry skull preparations. Postexperimental, retention, and postretention responses were documented cephalometrically. The findings of the present investigation lead to the following conclusions: 1. The termination active sutural growth is of little significance to the remodeling potential of the sutural articulations and the morphologic adaptability of the facial skeletal complex. 2. The length of time necessary for resorptive remodeling of the sutural bony projections is partially responsible for the slower rate of detectable skeletal movement in adult animals. 3. The sutural ligament in adult animals is initially less responsive to the effects of extraoral force application, possibly because of a diminished level of cellular activity at older ages. 4. Increases in age do not appear to affect the osteogenic potential of the periosteal envelope. 5. Retention aids in establishing a maintainable equilibrium following experimentally induced sutural and skeletal remodeling, but it is of little importance in maintaining the altered position of the denition. 6. The amount of postexperimental skeletal reorientation following force application to the maxilla may be related to the force level and the duration of force.

Animals↗
PubMed1999

[Maxillo-mandibular fixation by mono-cortical screws. Clinical indications and surgical methods].

BACKGROUND: Intermaxillary fixation is one of the most reknown and widely used techniques in maxillofacial traumatology. It's carried out usually by means of direct criss-cross teeth wiring or through the wiring of a metallic archbar on the upper and lower jaws. These techniques are time-consuming operations, they can produce dental or periodontal damages, and are not well tolerated by the patient, even under local anesthesia. Recent experiences in oral implantology and in the use of miniscrews for rigid internal fixation suggest the experimentation of new, easy to use and better tolerated systems for bone-anchored intermaxillary fixation. METHODS: 1-0 stainless steel wires and titanium monocortical screws, 2 mm of diameter and 12 and 15 mm of length, have been used as alveolar-bone anchorages for the intermaxillary fixation of 10 mandibular fractures. The fixations have been performed either under general or local anesthesia, with 2, 4 or 6 points of alveolar bone anchorage, maintaining the fixation for 15 days in condylar fractures and for 40 days in all the other cases. RESULTS: A really good compliance of the patient towards all the procedures performed under local anesthesia, with a clear reduction of postoperative discomfort has been observed. Infection or rejection of the implanted screws did not occur as well as cases of alveolar or dentoparodontal damages. CONCLUSIONS: This preliminary report on a new intermaxillary fixation technique didn't point out any significant complication of the procedure, showing at the same time that this technique can be easily performed under local anesthesia on out-patients with a better compliance, lower postoperative discomfort and good skeletal stability.

Bone Screws↗
PubMed2002

Peri-implant tissue response of immediately loaded, threaded, HA-coated implants: 1-year results.

STATEMENT OF PROBLEM: Although high success rates have been reported with immediately loaded implants, the peri-implant tissue response has not been well documented. PURPOSE: This study evaluated implant success and peri-implant tissue response of immediately loaded, threaded, hydroxyapatite (HA)-coated root-form implants supporting mandibular bar overdentures with opposing conventional maxillary complete dentures in humans. MATERIAL AND METHODS: Five patients (3 men, 2 women; mean age 61 years) each received 4 HA-coated endosseous root-form implants in the interforaminal region in the mandible. The implants were rigidly splinted with a metal framework within 24 hours. The final EDS clip prosthesis was placed 1 to 2 weeks thereafter. The implants and peri-implant tissues were evaluated clinically and radiographically 0, 1, 3, 6, and 12 months after prosthesis placement. Data were analyzed with a repeated measures 1-way analysis of variance (P<.05). RESULTS: All implants were stable at the end of the observation period (mean Periotest value = -5.9 +/- 1.4). No peri-implant radiolucencies were noted, and no implants were lost. The mean marginal bone changes were -0.42 plus minus 0.34, -0.84 +/- 0.55, -1.14 +/- 0.80, and -1.16 +/- 0.89 mm at the 1-, 3-, 6-, and 12-month follow-ups, respectively (P<.001). Significant declines in the rates of marginal bone changes at each time interval were noted (P<.001). In addition, there were significant decreases in probing depth (P<.001) and plaque index (P<.001) but no significant difference in the frequency of bleeding upon probing (P=.64). CONCLUSION: Within the limitations of this study, the peri-implant tissue response of immediately loaded, HA-coated implants was favorable and comparable to that of conventional, delayed-loaded implants after 1 year.

Aged↗