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Biomedical subjects

Carl E Misch

Publications and source records attributed to Carl E Misch.

At least 19 recordsLinked to original sources
PubMed2006

Consensus conference panel report: crown-height space guidelines for implant dentistry-part 2.

The International Congress of Oral Implantologists sponsored a consensus conference on the topic of Crown Height Space on June 26-27, 2004 in Las Vegas, Nevada. The panel communicated on several occasions before, during, and after the meeting, both as a group and among individuals. A consensus of one opinion was not developed for most issues. However, general guidelines emerged related to the topic. The following article is Part 2 of a summary of several of the guidelines that should be of benefit to the profession at large. (Part 1 appeared in Implant Dentistry 2005;14:312-321.).

Alveolar Ridge Augmentation↗
PubMed2006

Significance of keratinized mucosa in maintenance of dental implants with different surfaces.

BACKGROUND: The need for keratinized mucosa (KM) or immobile keratinized mucosa (i.e., attached mucosa [AM]) for the maintenance of osseointegrated endosseous dental implants has been controversial. The purpose of this study was to investigate the significance of KM in the maintenance of root-form dental implants with different surfaces. METHODS: A total of 339 endosseous dental implants in place for at least 3 years in 69 patients were evaluated. The width of KM and AM, modified plaque index (mPI), gingival index (GI), modified bleeding index (mBI), probing depth (PD), and average annual bone loss (ABL) were measured clinically and radiographically by a masked examiner. Based on the amounts of KM or AM, implants were categorized as follows: 1) KM <2 mm (KL); 2) KM > or =2 mm (KU); 3) AM <1 mm (AL); and 4) AM > or =1 mm (AU). Implants were further subdivided into the following four subgroups based on their surface configurations: 1) smooth surface implants (SI) with KM <2 mm (SKL); 2) SI with KM > or =2 mm (SKM); 3) rough surface implants (RI) with KM <2 mm (RKL); or 4) RI with KM > or =2 mm (RKM); or 1) SI with AM <1 mm (SAL); 2) SI with AM > or =1 mm (SAM); 3) RI with AM <1 mm (RAL); or 4) RI with AM > or =1 mm (RAM). The effect of KM or AM on clinical parameters was evaluated by comparing the different KM/AM groups. In addition, the significance of the presence of KM on implant prostheses types (i.e., fixed versus removable) and on implant locations (i.e., anterior versus posterior) was evaluated. RESULTS: Comparison of ABL among the four subgroups in KM or AM failed to reveal statistically significant differences (P >0.05); however, statistically significantly higher GI and mPI were present in SKL or SAL compared to the other three subgroups (P <0.05). GI and mPI were significantly higher in KL (0.94 and 1.51) than KU (0.76 and 1.26) and higher in AL (0.95 and 1.50) than AU (0.70 and 1.19) (P <0.05), respectively. The difference in GI between posterior implants with or without an adequate amount of KM was also significant (P <0.05). CONCLUSIONS: The absence of adequate KM or AM in endosseous dental implants, especially in posterior implants, was associated with higher plaque accumulation and gingival inflammation but not with more ABL, regardless of their surface configurations. Randomized controlled clinical trials are needed to confirm the results obtained in this retrospective clinical study.

Adult↗
PubMed2006

Short dental implants in posterior partial edentulism: a multicenter retrospective 6-year case series study.

BACKGROUND: Implants <10 mm long in the posterior regions of partial edentulous patients have a higher failure rate in many clinical reports. The purpose of this case series study was to evaluate implant survival when a biomechanical approach was used to decrease stress to the bone-implant interface. METHODS: A retrospective evaluation of 273 consecutive posterior partially edentulous patients treated with 745 implants. 7 or 9 mm long, supporting 338 restorations over a 1- to 5-year period was reviewed from four private offices. Implant survival data were collected relative to stage I to stage II healing, stage II to prosthesis delivery, and prosthesis delivery to as long as 6 years follow-up. A biomechanical approach to decrease stress to the posterior implants included splinting implants together with no cantilever load, restoring the patient with a mutually protected or canine guidance occlusion, and selecting an implant designed to increase bone-implant contact surface area. RESULTS: Of the 745 implants inserted, there were six surgical failures from stage I to stage II healing to prosthesis delivery. No implants failed after the 338 final implant prostheses were delivered. A 98.9% survival rate was obtained from stage I surgery to prosthetic follow-up. CONCLUSIONS: Short-length implants may predictably be used to support fixed restorations in posterior partial edentulism. Methods to decrease biomechanical stress to the bone-implant interface appear appropriate for this treatment.

Adult↗
PubMed2006

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↗
PubMed2005

A positive correlation between occlusal trauma and peri-implant bone loss: literature support.

The relationship between occlusal overload and peri-implant bone loss remains a controversial topic in implant dentistry. A causal relationship between the incidence of marginal bone loss next to an implant and occlusal overload implies a treatment plan and occlusal scheme would benefit from a force management approach. A MEDLINE-assisted and hand search of peer-reviewed English literature and relative textbooks were used for a selective review of articles addressing biomechanical stress and bone loss in cellular biomechanics, engineering principles, mechanical properties of bone, animal studies, clinical reports, bone physiology, and implant design biomechanics. These papers demonstrate occlusal overload on implants may increase the incidence of marginal bone loss.

Alveolar Bone Loss↗
PubMed2005

Consensus conference panel report: crown-height space guidelines for implant dentistry-part 1.

The International Congress of Oral Implantologists sponsored a consensus conference on the topic of crown height space on June 26 and 27, 2004, in Las Vegas, Nevada. The panel communicated on several occasions before, during, and after the meeting, both as a group and among individuals. A consensus of 1 opinion was not developed for most issues. However, general guidelines emerged related to the topic. The following article is part 1 of a summary of several guidelines that should be of benefit to the profession at large.

Bite Force↗
PubMed2005

Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.

Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.

Biomechanical Phenomena↗
PubMed2005

Short dental implants: a literature review and rationale for use.

Implant prostheses are often used to restore partially or completely edentulous patients. The posterior regions of the mouth often have less available bone height than the anterior regions. The bone density of the remaining bone after tooth loss is often less in the posterior regions than the anterior region of the mouth. A review of the literature reveals implants shorter than 10 mm often have a higher failure rate than longer implants. These complications may be related to an increase in crown height, higher bite forces in the posterior regions, and less bone density. As a result, biomechanical methods to decrease stresses to the implant-bone interface are warranted. The forces to the implants may be reduced by eliminating lateral contacts in mandibular excursions and eliminating cantilevers on the prosthesis. The area of forces applied to the prosthesis may be increased by increasing the implant number, increasing the implant diameter, increasing the implant design surface area, and splinting the implants together. As a result of these biomechanical methods to decrease stress, Misch, et al reported a 99% implant survival with 7-mm and 9-mm implants in the posterior regions of the jaws. It is interesting to note that the natural teeth follow a similar biomechanical approach to accommodate the higher bite forces in the posterior regions of the mouth. The molar teeth do not become longer than the anterior teeth. The diameter is increased, the design of the roots is different, and the roots are splinted together. The anterior teeth have incisal guidance and eliminate posterior lateral forces to the posterior teeth in all mandibular excursions. A similar biomechanical approach is logical for posterior implants, especially when shorter implants are used to support the prosthesis.

Alveolar Bone Loss↗
PubMed2004

Creation of interimplant papillae through a split-finger technique.

PURPOSE: The purpose of this pilot study is to propose a technique, the split-finger approach, to preserve/promote papillae formation. MATERIALS AND METHODS: Twenty-one patients with 39 implants consecutively placed in the maxillary anterior region were evaluated at 6 months to 1 year after prosthodontic restoration. The implants evaluated included 16 single-tooth implants, 1 2-unit implant prosthesis, 2 4-unit tooth implants, 1 6-unit prostheses, and 1 7-unit restoration. The papillae were recorded as 0 = no papillae; 1 = < or =50% of the gingival embrasure height; 2 = >50% but <100% of embrasure height; 3 = 100% closure of the proximal space; and 4 = overgrowth of the interproximal tissue. RESULTS: Data from this pilot study showed no class 0, class 1, or class 4 interproximal papillae after the final restoration. The 16 single-tooth restorations and 32 papillae had an average mesial papilla score of 3 and an average of 2.82 for the distal interproximal space. The average papilla score of the other implant papillae sites were 2.7 at 6 months to 1 year. A lower papilla score was noted in interimplant papillae. CONCLUSIONS: The proposed split-finger technique could serve as a clinically useful alternate procedure to promote/augment papillae formation around dental implants.

Dental Implants↗
PubMed2004

Rationale for the application of immediate load in implant dentistry: Part I.

Immediate loading in implant dentistry is increasing in popularity as a clinical procedure. A scientific rationale of immediate occlusal loading of the implant support system should emphasize methods to decrease surgical trauma during implant placement and to decrease bone loading trauma during the early loading period. The surgical trauma may be reduced by decreasing heat generation and pressure necrosis. The early loading trauma may be decreased by decreasing the bone strain adjacent to the implant interface. Greater microstrain conditions in bone increase the remodeling rate of bone. The higher the remodeling rate, the weaker the bone and the more risk of occlusal overload. Occlusal overload may lead to implant failure. Since strain is directly related to stress, methods to decrease stress are beneficial. In the present report, the stress-reducing influences include increasing the number of implants.

Dental Implantation, Endosseous↗
PubMed2004

Rationale for the application of immediate load in implant dentistry: part II.

Immediate loading of an implant interface has been used for completely and partially edentulous patients. A biomechanical rationale to decrease the initial risk of overload is reasonable, because implant failure and overload has been well established. This article addresses methods to decrease stress to the transitional restoration. Forces may be influenced by patient factors, implant position, cantilever forces, occlusal load direction, occlusal contact intensity, and diet. The surface area of load distribution may be increased by implant size, implant design, and surface condition of the implant body. A blend of these factors affects the amount of stress to the developing implant interface and hence may affect the risk of immediate occlusal loading for implant prostheses.

Alveolar Process↗
PubMed2004

Implant plastic surgery: a review and rationale.

Implant dentistry has been established as a predictable treatment modality with high clinical success rates. Esthetic considerations of implant restorations have been gaining increased interest over the years. The role of periodontal plastic surgical procedures in the creation and maintenance of peri-implant soft tissue heights to facilitate better esthetics has become more popular. The available plastic surgery procedures and their clinical applications are reviewed in this article. Emphasis is placed on factors to consider for proper case selection and ideal treatment planning.

Alveoloplasty↗
PubMed2003

Dental implant design and its relationship to long-term implant success.

The purpose of this review is to evaluate the effects of the biomechanical aspects of dental implant design on the quality and strength of osseointegration, the bone-implant interface, and their relationships to the long-term success of dental implants. The engineering design of implants is based on many interrelated factors, including the geometry of the implant, mechanical properties, and the initial and long-term stability of the implant-tissue interface. There is no one "optimal" design criterion. However, implants can be engineered to maximize strength, interfacial stability, and load transfer by using different materials, surfaces, and thread designs. Limited information is currently available in addressing how implant thread design influences the overall implant success. Therefore, this article reviews and discusses design elements of various dental implant systems currently in use as they affect the quality of osseointegration and their relationship to overall long-term success patterns.

Alveolar Process↗
PubMed2003

Five-year prospective study of immediate/early loading of fixed prostheses in completely edentulous jaws with a bone quality-based implant system.

BACKGROUND: The concept of immediate loading of root-form implants for fixed restorations has received increasing interest over the last 5 years. Several authors have commented on parameters that may influence results, including implant number, implant length, bone density, and patient habits. The trigger for bone remodeling around an implant may occur from the surgical trauma of insertion or the mechanical environment of strain at the interface. In the classic two-stage approach, these were divided episodes, separated by 3 to 6 months. Immediate loading compresses this time frame; the two driving mechanisms for bone repair occur concurrently. A scientific approach to the interface development is to match the bone healing response of trauma (woven bone of repair) to the response of mechanical load (reactive woven bone), so the sum of these two entities does not result in fibrous tissue formation and clinical mobility of the implant. PURPOSE: It is the purpose of this article to review the scientific rationale of these statements and coordinate them to bone physiology and bone biomechanics. MATERIALS AND METHODS: Findings from previous reports in the literature were reviewed and summarized to form the basis of a prospective study using a bone quality-based implant system (Biohorizons, Maestro Dental Implants, Birmingham, AL, USA). A transitional prosthesis was delivered either on the day of surgery or within 2 weeks for 30 patients and 31 arches. A total of 244 implants were used to support these restorations, for an average of 7.8 implants per prosthesis. After 4 to 7 months, the final restorations were fabricated. One year after the final restoration was loaded, the implant survival was 100%; the 31 restorations also had a survival of 100% over this time frame. This report presents these implants and restorations over a 1- to 5-year period, with an average follow-up period of 2.6 years. RESULTS: The bone loss from implant insertion to final prosthesis delivery averaged 0.7 mm. The first-year bone loss after final prosthesis delivery averaged 0.07 mm. A slight increase in bone height was observed after the first year, but generally no increase was observed over the remaining evaluation period. CONCLUSIONS: In the current report, no implant failure occurred, and crestal bone loss values were similar to or less than values reported with the conditional two-stage approach. This may be related to the number and position of implants, implant design, and/or the surface condition of the implant loading.

Alveolar Bone Loss↗