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PubMed2001

Alveolar distraction before implantation: a report of five cases and a review of the literature.

This work describes the author's experience with the treatment of alveolar vertical bone atrophy using the distraction osteogenesis technique. Five patients with localized vertical atrophy of the alveolar ridge (loss of one to four teeth) were treated using two different types of distractor devices. All the patients were operated on under local anesthesia without needing hospitalization. The surgical technique used in one of these cases and the results of all of the cases treated are reported in this study. Distraction osteogenesis may be a valid alternative to guided bone regeneration in selected cases for the treatment of vertical atrophy of the alveolar ridge, with a substantial reduction in implantation time.

Alveolar Ridge Augmentation↗
PubMedDate not supplied

Influence of the implant abutment on the Periotest value: an in vivo study.

OBJECTIVE: Periotest values for dental implants depend on the type of prosthetic abutment utilized for the restoration. If Periotest value cannot be measured at the single crown, the Periotest values used for comparison must be derived from the same type of superstructure. METHOD AND MATERIALS: Fifty-nine patients were selected from a regular follow-up program. At the end of the healing period, the Periotest values of Frialit-2 implants were measured at the gingiva former and abutment. The values were then compared with the Periotest measurements obtained at the placement of the final single crown and during the first follow-up examination. RESULTS: Compared to values measured at single crowns, the Periotest value measured at gingiva formers decreased on average by 3.5. The measurement of the abutment revealed a decrease of 1.7. Until the first recall and under functional loading of implants, the Periotest value increased on average by 1.8. These differences significantly differed from 0. CONCLUSION: If measurements at different abutments such as crown abutments or single crowns are necessary, comparison of the Periotest values in accordance with the given mean values will lead to more precise results. It is recommended that Periotest measurements be performed for the first and subsequent prostheses, during all prosthetic stages, to allow comparison if some parts of the prosthetic abutment have to be replaced.

Crowns↗
PubMedDate not supplied

Immediate implant placement following a modified trephine/osteotome approach: success rates of 116 implants to 4 years in function.

PURPOSE: A technique is presented which utilizes a trephine with a 3.0-mm external diameter followed by an osteotome to implode a core of maxillary posterior alveolar bone prior to immediate implant placement. MATERIALS AND METHODS: The technique and its indications and contraindications are described in detail. RESULTS: One hundred sixteen implants were placed and uncovered utilizing this technique. Two implants were mobile at the time of uncovering. DISCUSSION: One hundred fourteen implants were restored and have been functioning successfully for up to 4 years according to the Albrektsson criteria, yielding a success rate of 98.3%. CONCLUSION: No implants have been lost or are failing in function.

Adult↗
PubMedDate not supplied

Removal torques of conical, tapered implant abutments: the effects of anodization and reduction of surface area.

PURPOSE: To examine the effects of anodization (surface coating) and reduction of internal Morse taper surface area on the reversal torque values of Straumann ITI dental implants and abutments. MATERIALS AND METHODS: Eighty ITI solid screw implants were mated with corresponding 5.5-mm solid abutments. The assemblies were divided into 4 test groups of 20 specimens. All abutments were torque tightened into the implant to 35 Ncm. Half of the abutments were anodized and half were in their as-machined state. Each of these 2 groups included half of the implants with the standard internal Morse taper configuration and half with the synOcta (Straumann USA, Waltham, MA) internal positioning interface (indexed). Torque removal testing was then performed on the assemblies. The 4 groups were compared statistically to examine the effect of the 2 variables (anodization and reduction in surface area). Scheffe's test for multiple comparisons was used to compare groups at an adjusted significance level of < or = .05. RESULTS: Torque removal of all specimens revealed that the indexed implant with the non-anodized abutment demonstrated superior removal torque. DISCUSSION: The indexed and standard implants with anodized abutments, and the standard implant with the non-anodized abutment had lower reversal torque values. CONCLUSION: The addition of the indexed internal surface to the ITI implant did not have deleterious effect on the resistance to loosening of standard solid abutments.

Coated Materials, Biocompatible↗
PubMedDate not supplied

The influence of mandibular dentition on implant failures in bone-grafted edentulous maxillae.

PURPOSE: To evaluate the influence of mandibular dentition on the performance of maxillary implants prior to definitive prosthesis attachment in maxillae that have been reconstructed with autogenous bone grafts. MATERIALS AND METHODS: A retrospective review of 90 consecutive patients, 31 men and 59 women, with a mean age of 57.4 years, was conducted. All patients underwent treatment planning to receive endosseous implants in the edentulous maxilla in conjunction with autogenous bone grafting. During the time from implant and/or bone graft placement until placement of the definitive restorations in the maxillae, the mandibular dentitions were recorded and categorized into 6 groups based upon the presence and distribution of teeth. RESULTS: Of 643 implants placed, 118 (18.4%) were lost between implant placement and definitive prosthesis placement. The type of mandibular dentition was significantly associated with implant failure during this time interval (P < .001). In particular, the patients with implants opposing unilateral occlusal support showed the highest rate of implant failure (43.8%, or 28 of 64 implants). Implants that opposed a mandibular implant-supported fixed prosthesis demonstrated an implant failure rate of 14.3% (10 of 70), and in patients with a removable mandibular denture, the implant failure rate was 6.2% (4 of 65 implants failed). The overall mean patient follow-up was 64.2 months. At 60 months, the cumulative implant failure rate based on the Kaplan-Meier method was 20.2%. DISCUSSION: Unfavorable concentration of forces on the maxilla may contribute to increased risk of implant failure. CONCLUSION: Effort should be made to create a favorable occlusion in the mandible, with attention being paid to broad distribution of occlusal contacts.

Adult↗
PubMed2001

Immediate implant placement on removal of the natural tooth: retrospective analysis of 1,081 implants.

Conventional implant therapy dictates a period of 1 to 2 years from the start of treatment to the completion of the restoration. In contrast, immediate implant placement has resulted in the initiation of prosthetic treatment in as little as 3 to 6 months with the additional benefit of reducing alveolar bone resorption, patient morbidity, and expense. This article reports on the criteria for immediate implant placement into an extraction socket, as well as a reliable technique and a retrospective analysis of 1,081 implants placed immediately into extraction sockets. Of the 1,081 implants placed, 35% were followed for 1 year, 46% were followed for 2 to 5 years, and 19% for 5 to 11 years postloading. The criteria for success were complete stability and no further bone loss than had appeared at the second stage surgery and on the day of restoration. The overall survival rate in this current study is 95%.

Adolescent↗
PubMed1997

[Success of implants in the moderately resorbed edentate maxilla].

In applications of implants in the moderately resorbed maxilla factors such as bone quantity and the loading of the bone are of importance for the prognosis. Long-term studies have shown that for the maxilla the results were less good than for the mandible. The main reason for this is the condition of the bone, especially reduced bone quantity together with a thin corticalis an low bone density. Beside these factors there are also the general negative factors such as rheumatoid arthritis, osteoporosis, smoking and radiotherapy. The prognosis of implant supported prostheses is not primarily determined by the number of implants, but by the condition of the bone and to some extent by the splinting effect of the implants.

Alveolar Bone Loss↗
PubMedDate not supplied

Longitudinal follow-up of osseointegrated implants in patients with resected jaws.

PURPOSE: To investigate the effects of bone grafting and radiotherapy on implant survival rates. MATERIALS AND METHODS: This follow-up study involved 36 patients with 180 implants who were treated between January 1989 and December 2000 by prosthodontic rehabilitation using osseointegrated implants following jaw resection. They comprised 20 patients with malignant tumors, 12 with benign tumors, and 2 patients each with osteomyelitis and cysts. RESULTS: A total of 15 implants (11 in the maxilla and 4 in the mandible) were removed for various reasons during the follow-up study. Implant survival rates were calculated using the Kaplan-Meier method; the overall survival rate for the 180 implants was 88.6%. Specific implant survival rates were as follows: in residual bone, 73.8% for the maxilla and 95.2% for the mandible; in grafted bone, 80% for the maxilla and 94.1% for the mandible; in irradiated bone, 79.7%; and in nonirradiated bone, 93.5%. DISCUSSION: Radiotherapy, a dose of 30 Gy, was performed in patients with malignant tumors but not in patients with benign tumors, cysts, or osteomyelitis. No differences were found in the results for implants placed due to jaw resection for malignant tumors and those for implants placed due to benign tumors, cysts, or osteomyelitis. Implants lost varied in length from 7 to 18 mm. Among these, loss was more frequent with shorter implants (lengths to 10 mm). CONCLUSION: The clinical results obtained in the present study compare favorably with those obtained by others. However, jaw reconstruction and rehabilitation should not be performed by the oral surgeon alone; oral and maxillofacial function should be restored using a team approach in close cooperation with specialists in prosthodontics and periodontics to improve the result of implant treatment.

Adult↗
PubMedDate not supplied

Dental implants placed in extraction sites implanted with bioactive glass: human histology and clinical outcome.

PURPOSE: To evaluate the clinical outcome of implants placed into sites grafted with bioactive glass. MATERIALS AND METHODS: Seventeen consecutively treated patients were referred to a private specialist surgical practice for the repair of dentoalveolar defects, and/or ridge maintenance at the site of extraction sockets, prior to implantation. Bioactive glass available in 1 of 2 forms was utilized as an alloplastic grafting material. Bone cores were trephined out at the time of implantation and processed and examined to evaluate the tissue response under the light microscope. Implant mobility, marginal bone levels, and soft tissue health were all evaluated over a 2- to 3-year follow-up period to determine treatment success. RESULTS: A total of 40 Astra Tech dental implants were placed. The overall success rate at the end of the study was 88.6% for implants that were in function for a mean period of 29.2 months (22 to 24 months). One patient with 5 successful implants died at 18 months after functional loading. At that time the cumulative success rate was 90%. Another patient who was diagnosed with cancer of the large bowel lost 3 implants. If this patient were excluded from the data, the cumulative success rate increases to 96.8%. Mean marginal bone loss measured 0.5 mm mesially and 0.4 mm distally over a maximum follow-up of 36 months. Human histology demonstrated that connective tissue was seen to exist without any inflammatory response, for up to 6 months. Increasing evidence of bone formation was seen in direct relation to the bioactive glass material beyond this time frame. DISCUSSION: The need to repair and augment dentoalveolar defects necessitates the use of autogenous bone or a substitute that may be seen to avoid the additional morbidity of a donor site procedure and without risk of cross infection. The use of bioactive glass has been proposed as a viable bone substitute. The current study draws attention to the long healing time required to achieve even a small amount of new bone incorporation into the graft, as seen histologically. However, the high rate of osseointegration and continued medium-term function of implants placed into these grafted sites would indicate that the use of bioactive glass does not prohibit osseointegration. However, it is likely that the initial integration will have derived from those areas in contact with native bone. CONCLUSION: Implants will survive for up to 3 years in sites grafted with bioactive glass, even when such grafts appear to only slowly conduct new bone growth.

Adult↗
PubMedDate not supplied

Flapless implant surgery: a 10-year clinical retrospective analysis.

PURPOSE: This article is a retrospective clinical analysis of implants placed with a flapless approach. MATERIALS AND METHODS: Seven hundred seventy implants were placed in 359 patients to restore both completely edentulous and partially edentulous arches with fixed prostheses or removable complete dentures. Each patient was examined after 3 months, 6 months, 1 year, and then once every year. Prostheses were removed, if possible, and implant mobility was assessed, periapical radiographs were obtained, and periodontal probing was performed. Implants were considered failed if they had mobility or pain, had to be removed, or if they showed more than 0.5 mm of bone loss per year and signs of active peri-implantitis. RESULTS: The cumulative success rate for implants placed using a flapless 1-stage surgical technique after a 10-year period varied from 74.1% for implants placed in 1990 to 100% at 2000. DISCUSSION: Since flapless implant placement is a generally "blind" surgical technique, care must be taken when placing implants. Angulation of the implants affected by drilling is critical to avoid perforation of the cortical plates, both lingual or buccal, especially on the lingual in the mandibular molar area and the anterior maxilla. There should be no problem if the patient has been appropriately selected and an appropriate width of bone is available for implant placement. There is a learning curve to every surgical procedure, after which it becomes routine. There are many advantages for the patient as well as for the surgeon, since the procedure is less time consuming, bleeding is minimal, implant placement is expedited, and there is no need to place and remove sutures. CONCLUSION: Flapless implant surgery is a predictable procedure if patient selection and surgical technique are appropriate.

Adult↗
PubMedDate not supplied

Restoration and reinforcement of endodontically treated teeth with a polyethylene ribbon and prefabricated fiberglass post.

In the past it was considered appropriate to place a cast post and core in every pulpless tooth without regard to the remaining supportive tooth structure present. Recent research and the advent of adhesive bonding techniques have caused clinicians to reevaluate their restorative protocol. This article reviews the current literature with regard to restoration of the endodontically treated tooth and presents a method for restoration and reinforcement utilizing a combination of polyethylene ribbon and a prefabricated fiberglass post.

Composite Resins↗
PubMed1996

Six years of in vitro/in vivo experience with Composipost.

Some years ago, we created the following classifications for endodontic posts: (1) first generation posts (self-threaded posts, screw posts, serrated-carved posts); (2) second generation posts (passive posts); (3) third generation posts (nonmetallic passive posts). In this last group, we the placed carbon-fiber posts, which have a modulus of elasticity very similar to the modulus of elasticity of dentine and can realize a tooth-post-core monobloc instead of an assemblage of heterogeneous materials. This is quite a new philosophy in rebuilding endodontically treated teeth and is based on the use of integratable materials that homogeneously distribute masticatory loads and reduce stress.

Acid Etching, Dental↗
PubMed1996

Coronoradicular rehabilitation with a carbon-fiber post.

Endodontically treated teeth present a myriad of problems because of coronal destruction from caries, previous restorations, and coronal access. Previously, a post was considered necessary to strengthen a tooth and to resist intraoral forces. However, recent research has indicated that not all endodontically treated teeth require a post, core, and crown. Each clinical situation must be evaluated and the need for a post and/or the appropriate post determined. The recent introduction of a carbon-fiber post may reduce some of the problems inherent with metal posts. Proper placement, advantages, and disadvantages are discussed.

Acid Etching, Dental↗
PubMedDate not supplied

Multicenter retrospective analysis of the solid-screw ITI implant for posterior single-tooth replacements.

PURPOSE: This report involves the retrospective analysis of ITI implants placed and/or restored by a group of 7 clinicians located throughout the United States (5 periodontists and 2 prosthodontists). MATERIALS AND METHODS: Six hundred seventy-five posterior single-tooth implants were restored in 471 patients (average time of loading 21.30 months, with a range of 1 to 78 months). Three hundred seventy implants and 71 implants were placed in mandibular and maxillary molar sites, respectively, and 108 and 126 were placed in mandibular and maxillary premolar sites, respectively. RESULTS: A cumulative survival rate of 99.1% was obtained for all sites (6 failures). The survival rates for individual sites were as follows: 98.4% mandibular molars, 100% maxillary molars, 100% mandibular premolars, and 100% maxillary premolars. "At-risk" implants (1 to 2 mm of radiographic bone loss) were noted at 5 sites. DISCUSSION: Minimal restorative problems were found with either screw-retained (n = 71) or cemented restorations on solid abutments (n = 600); 80.3% of screw-retained and 98.2% of cemented restorations were free of complications, respectively. Patient satisfaction scores were high (97.4%) as determined by the Patient Satisfaction Questionnaire. CONCLUSION: The data suggest that solid-screw (4.1 or 4.8 mm wide) ITI implants can be a satisfactory choice for posterior single-tooth restorations.

Bicuspid↗