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Nonaxial implant alignment often predicates the use of cemented of screw-retained angled abutments with inherent disadvantages, including reduced retrievability on screw loosening. The purposes of this article are to review the relative merits of cemented and screw-retained angled abutments and to present a method of ensuring retrievability of cemented angled abutments.
This study compared the effect that the introduction of mixed dentition alveolar bone grafting and subsequent orthodontic treatment has had on the prosthodontic/reconstructive habilitation of patients with unilateral cleft lip and palate. Two groups, each consisting of 40 consecutive patients with unilateral cleft lip and palate, were compared at the end of their dental treatment. In the group treated prior to the advent of bone grafting, all subjects received a fixed partial prosthesis in the cleft area, and a total of 87 abutment teeth were prepared for complete coverage crowns. In contrast, in the group of patients for whom the alveolus was restored by bone grafting, it was possible to obtain a complete dental arch without prosthodontic intervention in 36 patients (90%). Thirteen subjects in the bone grafting group had the crown anatomy of anterior teeth modified using resin composite or resin-bonded porcelain veneers. Two patients had a premolar transplanted to the anterior region of the dental arch. On average the dental treatment was completed 3 years earlier in the bone grafting group. Thus, alveolar bone grafting with subsequent orthodontic treatment, together with advances in dental materials, have markedly reduced the need for prosthodontic procedures and have also allowed the completion of the dental treatment at an earlier age.
The purpose of this study was to clinically evaluate experimental peri-implant breakdown. Hydroxyapatite-coated, titanium plasma-sprayed, and machined titanium-alloy surfaces were investigated. Eighty-four implants were placed in 14 beagle dogs. Pocket probing depths and clinical attachment level and mobility measurements were made. Dogs were sacrificed at 3 and 6 months. All experimental implants showed a significant loss in clinical attachment level (P < .05). Increased pocket probing depths for experimental implants occurred during the first 2 months, after which a plateau was reached. At the 3- and 6-month evaluation, pocket probing depths at experimental implants were significantly increased (P < .05). No differences among the three implant types were noted for clinical attachment levels and pocket probing depths. In general, greater mobility was found with the titanium-alloy implants than with hydroxyapatite-coated and titanium plasma-sprayed implants (P < .025). In addition, mobility measurements were significantly greater for experimental titanium-alloy implants during the first 3 months (P < .05). Clinical attachment level measurements were most sensitive to peri-implant status. All implants were equally susceptible to ligature-induced peri-implant breakdown. Consequently, meticulous oral hygiene and regular maintenance care are prerequisites for successful implantology.
It is well known that the standard diameter dental implant so often utilized is often inadequate in patients with poor bone quality or quantity, and larger diameter implants have been utilized to overcome this deficiency. The objective of this study was to compare the pull-out resistance of small and large diameter (3.25- and 4.5-mm) dental implants and the relationship of these implants to bone density. Two groups of implants, consisting of 18 implants of each diameter, were placed in the mandibles of five embalmed humans. The bone mineral density of the area surrounding the implant site in the coronal cross section was measured by quantitative computed tomography (QCT). Initial implant stability was tested with a periodontium diagnostic device and pull-out resistance was tested with a mechanical testing system. Results showed the same initial stability for the two implants. The maximum pull-out force required for the large diameter implants was 15% greater than that required for the small diameter implants, although given the small number of samples, this difference was not statistically significant. There were significant positive correlations between the pull-out resistance and the bone density for both the large and small diameter implants (p < 0.05, p < 0.01). We conclude that larger diameter implants appear to have advantages over smaller ones; however, more extensive testing is needed to determine quantitatively the increased load-carrying capacity.
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This manuscript attempts to discuss intracoronal and extracoronal precision attachments. A clinical technique is presented which describes the use of intracoronal precision attachments to retain maxillary and mandibular removable partial dentures. Laboratory techniques are also described in this procedure.
The peri-implant gingivae act as a biological barrier that prevents the ingress of plaque bacteria, oral debris, and saliva components into the internal environment of the jaw. The integrity of this barrier around a total of 163 Steri-Oss HA-coated threaded root-form implants placed in 48 patients was examined at six-month intervals over a 42-month time period, beginning at the time of final prosthetic placement. Five clinical parameters for tissue assessment were used: Mean Implant Sulcus Readings (MISR), Mühlemann Sulcus Bleeding Index (SBI), Miller's Mobility Index (MI), bone loss readings (BL), and gingival condition (GI). Bone loss and mobility were negligible throughout the 42-month study period. At six months post-insertion, 58.6% of the Mean Implant Sulcus Readings exceeded 4 mm. Gingival conditions and bleeding response also were non-ideal in a significant number of cases (52.9 and 62.1%, respectively). However, all three of these assessments later showed dramatic improvement. Patients' inability to "deplaque" their newly acquired implant prostheses effectively may be a factor contributing to the high incidence of undesirable pocket depths and non-optimal gingival appearance at the first six-month assessment point. Attainment of the necessary skills may account for the improved readings at the later evaluations.
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The present investigation evaluated the clinical and microbiological effects of long-term undisturbed plaque formation on peri-implant tissues. Four mongrel dogs were used in the study. The mandibular 3rd and 4th premolars were extracted. Three months later, four Brånemark implants (BR, n = 8) or Integral implants (IN, n = 8) were placed in the edentulous area of each dog. After another 3 months, an abutment connection was performed. Plaque control regiment was maintained for 30 days until the superstructure was placed (Day 0: baseline). Then the plaque control program was terminated to allow gross plaque accumulation. Clinical, radiographical and microbiological data were recorded at the baseline, and at 90 and 180 days after the termination of the plaque control. Values for the clinical indices such as probing depth, plaque index and bleeding on probing increased at day 90 on both the implant and tooth sites, and remained unchanged at day 180. Significantly more implant sites showed bleeding on probing than did tooth sites. Neither implants nor tooth sites showed clinically significant changes in mobility. No distinct bone resorption was observed over time by radiography. In microscopic morphological observations, cocci dominated at the baseline, and decreased by day 180, while the proportion of motile bacteria increased. In a culture study, black-pigmented anaerobic rods, which consisted predominantly of Porphyromonas gingivalis-like bacteria, were consistently found from the baseline to day 180. No Actinobacillus actinomycetemcomitans-like organisms were isolated. These results indicate that, although the long-term plaque accumulation did not cause marked periodontal destruction, the peri-implant tissue may be more susceptible to plaque accumulation than the periodontal tissue, and that teeth may serve as a reservoir for the bacterial colonization of the implant sulcus.
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As stated at the outset, this technique is not for every case. Each case must be selected with great care, consideration and careful planning. In concert with observing the Implant Lighthouses, this technique can produce a successful case. It can be done to save time, without compromising the prescribed techniques and quality.
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This report outlines the experimental, surgical, and prosthodontic protocols for a prospective clinical trial using the Endopore dental implant to replace single maxillary teeth. Twenty patients (10 male, 10 female) ranging in age from 30 to 60 years each received one implant (mean length 10.1 mm), which, after an initial healing period of 4 months, was restored with a single crown. Records collected included radiographs, Periotest mobility measurements, supragingival Plaque Index, and an assessment of peri-implant soft tissue health using pocket probing depths, sulcular bleeding following probing, and probing attachment levels. Radiographs were exposed at predetermined intervals following crown placement (1 and 6 months, and then yearly) in a standardized procedure using a specialized filmholder that attaches to each implant after removal of the crown. At the time of this preliminary report, all of the 20 implants placed had been uncovered and were in function; 16 of the implants had been in function for 6 months or more, 14 had passed 1 year of function, and 3 had passed the 2-year function point. There have been no failures to date.
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The relationship between mobility assessment with the Periotest system and histologic findings was evaluated for oral implants. Five screw-type implants of pure titanium were placed in the mandibles of four monkeys. Two implants in each monkey were occlusally overloaded. These implants were brushed once a week. Plaque was allowed to accumulate around unloaded implants with abutments in the same monkeys. During the experiment, six of eight implants with occlusal overload showed increased manually detectable mobility. Two of these were lost. After 18 months of experimentation, the mobility was assessed using the Periotest system. Sections of the implants and surrounding tissue were cut. For the excessive occlusally loaded implants with manually detectable mobility, positive Periotest values were recorded, and for all other implants the values were negative (range = -7 to -2). All implants with plaque accumulation were histologically osseointegrated but showed marginal bone loss. Two of the implants with occlusal overload had lost osseointegration completely, and two other implants were osseointegrated in the apical part only. A statistically significant association between the Periotest values and the histologic bone level or the proportion of bone-implant contact was observed. If only clinically stable implants (i.e., without manually detectable mobility or with a negative Periotest value) were included in the analysis, no significant correlation was found. The Periotest values revealed only slightly more information concerning the osseointegration of implants than manual mobility assessments.
Traditionally, the procedure of implant placement requires a surgical periosteal flap to be raised. In a percentage of implant cases, there is no need for flap surgery for implant placement, or for a follow-up surgical procedure for abutment connection. In this clinical investigation, 20 maxillary and mandibular implants were placed in seven adult male patients. The sites for implant placement were prepared according to an alternative surgical technique without raising a surgical flap. Patients were recalled periodically for 2 years to evaluate healing and clinical integration of implants. The results showed normal clinical healing at the first week of reexamination in all implant sites; periodontal probing of less than 2 mm circumferentially around all healing caps at 3 months and later at subsequent recall periods; no radiolucency observed in the peri-implant zone; no sign of clinical mobility during recall examination; and no persistent or irreversible sign or symptoms of pain, infection, or necrosis. This alternative surgical technique can provide several advantages over the traditional 2-step procedure.