Dental implants: the blade implant.
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Intraosseous blade vent implants extend hitherto existing clinical methods of prosthetic treatment of some conditions of defective teeth by new possibilities. It is a method which can produce satisfactory and long-term results. One of the prerequisites is, however, that generally valid and local limitations for indication of the implantation will be respected, that the implantation will be implemented by reliable surgical technique along with high standard prosthetic treatment which in the course of recovery will carry the implant to its functional period. Results of our investigations revealed unequivocally that the use of implants with a low or predominantly low intraosseous part leads in the majority to unsatisfactory results of implantations.
A cementable endosteal blade implant has been developed and evaluated. Inherent in the design are the following factors: minimization of stress concentrators, ease of implantation, and high resistance to loosening. Other potential advantages of this design as compared with conventional endosteal blade implants include reduced hazards of postoperative infection and reduced likelihood of metallic corrosion. Six conventional endosteal implants and six cementable implants were installed in steer mandibles using standard dental surgical techniques and Simplex-brand methyl methacrylate bone cement. They were loaded in uniaxial compresstion at a loading rate of 0.0122 in./min. the stiffness (S), deformation at 900-lb load (D900), proportional limil (PL), and load at 0.04 in. deformation (L0.04) were calculated for each test. The cementable design showed a twofold increase in stiffness, only 17% of the deformation at 900lb, more than twice the proportional limit, and at least twice the load at 0.04 in. deformation when compared with similar values for the conventional endosteal implants. This study reveals that, in addition to being unstable in bone, conventional endosteal implants are also unstable when used with acrylic bone cement. The new design should eliminate most of the problems associated with endosteal blade implantation.
This retrospective study was undertaken to provide information on the radiographic status of blade implants which had been placed in patients in a private dental office at least five years prior to this study. Radiographs and records of 66 implants were studied in 31 patients. Six implants had been removed from five different patients; 60 implants were still in place at the time of this study. In general, the blade implants fared better in the mandible than in the maxilla. Analysis of the data suggests that although as a group patients with stable periodontal disease had significantly fewer implants lost, on an individual basis there is no predictable correlation between the periodontal status of the natural dentition and the survival of a blade implant as indicated by the radiographs. The change in the height of the crestal bone does not appear to be a critical determinant in the retention of the implant. There was no relationship between the time of loading and the survival of a blade implant.
It has been suggested that the long-term success of blade implants could be improved by placing the implants using a two-stage surgical protocol to allow the implant to develop a direct bony interface instead of a fibrous tissue interface. This study compared the implant interfaces of delayed and immediately loaded blade implants in nonhuman primates. A second objective was to compare the effects of hydroxylapatite coating on delayed and immediate loading applications. The delayed loaded uncoated titanium and hydroxylapatite-coated blade implants did osseointegrate. This study also suggests that hydroxylapatite-coated blade implants may form a direct bony interface even when they are loaded immediately after implantation, provided that they are splinted to a firm natural tooth.
Immediate loading of root-form dental implants has shown promising results and offers treatment cost and convenience advantages to patients. Although blade implants have been immediately loaded for over 2 decades, the ability of this implant design to achieve osseointegration has been debated. The aim of the present study was to histologically evaluate the peri-implant tissues of an immediately loaded blade implant retrieved for abutment fracture after a 20-year loading period. Histologic samples were prepared and examined by light microscope. Compact, cortical, mature bone with well-formed osteons was present at the interface of the implant. Bone-to-implant contact was 51% +/- 6%. The histologic data showed that osseointegration was obtained in an immediately loaded blade implant inserted into the mandible, and that mineralized tissues were maintained at the interface over a long period (20 years).
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Based on the findings observed after the insertion of 33 blade implants in 23 patients, ages 31 to 74, for periods up to 60 months, the following conclusions can be made: (1) The blade implant is a technically feasible procedure which can be maintained in the mouth for period up to 5 years, although some degree of bony breakdown will be seen in a majority of the patients at this time; (2) The degree of breakdown around blade implants is almost exclusively located to the locus of the neck of the implant and is most likely due to the lack of attachment at the epithelial-implant interface.
The use of pin and blade implants is evaluated from the point of view of the regional anatomy. Some principles are enunciated and a plea is made for the publication of more clinical analyses.
An investigation on blade implants is in process. These implants represent endstanding abutments of fixed bridgework. It was found that the implants, adapting to heavy masticatory stresses, show a response in the bone representing a connective tissue suspension.
A blade implant that was retrieved in 1990 after 231 months of clinical function (since 1971) was analyzed with respect to clinical, histological, and biomechanical characteristics. The implant clinical records demonstrated no abnormalities or pathological lesions over the tenure of treatment. The bone to implant interface showed a mixture of interfacial tissue components and conditions with adequate direct bone contact (46.4 to 82.3 percent) for classification as osseointegrated. The abutment fracture leading to removal was characterized as a cyclic fatigue mechanism and the distribution of tissue components along the interface could not be correlated with specific biomechanical loading directions. This report considers the clinical and biomechanical records as they relate to the detailed histological investigation.
After a brief revision of the anatomy of the posterior mandible and its natural resorption pattern, the ramus plate-form implant would be the implant of choice for the rehabilitation of this region. This "site specific" implant is inserted on the top of the crest and superficially impacted within the residual alveolar bone at the distal segment of the horizontal branch and guided to climb parallel to the anterior aspect of the ascending ramus. Its form and specific dimensions are perfectly compatible with the frequently limited quantity of available bone above the nerve canal in patients with advanced atrophy of the posterior mandible. It provides a predictable abutment for the implant-supported or dento-implant-supported prostheses of the posterior mandible.
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