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Biomedical subjects

H Tal

Publications and source records attributed to H Tal.

At least 19 recordsLinked to original sources

[Implants placement using a novel computerized tactile imaging navigation system].

An implant locating system has been developed. The system contains a stent that maps the jaw bone at the implantation site through the tissue, sends a signal to a computer with a CT scan of the jaw on it, and superimposes the position of the stent on the jaw so that a dental surgeon could angle the implant for placement without requiring to raise a flap to expose the bone. Using a novel tactile technology the system allows safe, accurate, and simple implant placement and design. The ILS software allows: 1. Importing of CT data. 2. Marking a dental arc on the computerized jaw image. 3. Planning of implant location and position on a 3-D view. 4. Affixation of the ILS to the jaw, followed by registration of the stent. 5. Navigated osteotomy and implant placement.

Computer Simulation↗

[Healing of osseous defects by guided bone regeneration using ribose cross linked collagen membranes].

The ultimate goal of periodontal therapy has long been the complete regeneration of the periodontal attachment apparatus. Guided Tissue Regeneration (GTR) and Guided Bone Regeneration (GBR) are two regenerative procedures which converted this goal from a dream to reality. In search of a biocompatible resorbable tissue barrier, collagen, being a natural protein and a weak antigen, has attracted much interest and became the focus of much intention during the 80's and the 90's. The understanding that cross linking of collagen with aldehyde sugars, especially ribose, produces collagen which is highly resistant to resorption in vivo led to the development of a "natural" Crossed-Linked Collagen Barrier (CB-SX). Animal and Human studies have shown that the newly developed membrane is biocompatible, remains intact in the tissues 6 months and more, and results in impressive guided tissue/bone regeneration. Spontaneous early exposure of the membrane is common but the healing potential of the resulted tissue dehiscence is favorable with no tendency for bacterial infection. The commercial version of the CB-SX is especially suitable for GBR procedures; it is highly recommended that the gingival flaps involved will properly be released, will lack tension, and be thoroughly sutured.

Absorbable Implants↗

[Gingival depigmentation for aesthetic purposes using erbium:YAG laser: rationale and technique].

Melanin, carotene and hemoglobin are the most common natural pigments contributing to the normal color of the gums. Although physiologic and ethnic melanin pigmentation is not a medical problem, complains about "black gums" are common. Gingival depigmentation has been carried out using surgical, chemical, electrosurgical and cryosurgical procedures. Recently, Laser Ablation has been recognized as one of the most effective, pleasant and reliable techniques. Effective depigmentation of the gingival requires removal of all or most of the melanocytes from the basal layer of the gingival epithelium. Using non-specific radiation means ablation of all the epithelial cell layers, as well as connective tissue rete pegs, leaving behind only remnants of the epithelial rete ridges. CO2, Nd:YAG and Erbium:YAG lasers, meeting most of these requirements and being available in the dental office, seems to be the lasers of choice for this procedure. Five patients (3 F; 2 M) who were referred to the TAUSDM for cosmetic therapy of "black gums" were treated using Erbium-YAG laser. The laser beam was set up at 850 mj/10 pulses per second producing peak power of 2.13 kwand peak power density of 30.43 kw/sq/cm. The beam was defocused to produce a 3 mm diameter circle, thus reducing the beam penetration while increasing the treated surface. Using the "brush" technique, 800-2,000 pulses were required per patient, with an average of 500-1,100 pulses per 1 sq.cm, depending on the thickness of the epithelium and the intensity of the pigmentation. Treatment required only topical anesthesia. Healing was uneventful and required no supportive therapy. Three months follow up has shown no repigmentation in any of the patients. Patients' evaluation analysis showed that the results were pleasing; no pain was experienced during lasing as well as during healing. Two patients were interupted by the lasing burning smell, which may be reduced or eliminated by operating a power suction during the procedure.

Aluminum Silicates↗

Tetracycline modulates collagen membrane degradation in vitro.

BACKGROUND: Structural integrity of implanted bioabsorbable barrier membranes should be preserved for a sufficient time to ensure expected results. Collagen membranes are degraded by metalloproteinases (MMP). Their degradation rate can be altered either by enhancing structural integrity or by delaying the degradation process using MMP inhibitors. Tetracyclines (TTC) present inhibitory effects on matrix MMP. Immersing membranes in TTC solution before implantation can delay their degradation. The purpose of the present study was to evaluate the effect of collagen membranes immersed in varying TTC concentration solutions on the rate of their degradation in vitro. METHODS: Collagen bioabsorbable membranes were prepared as 5 mm diameter membrane discs. Membranes were then incubated at 4 degrees C for 24 hours, in either phosphate buffered saline (PBS, Ca2+ and Mg2+ free) or with TTC-HCl dissolved in PBS concentrations of 5 mg/ml, 50 mg/ml or 100 mg/ml. After rinsing, membranes were incubated with either bacterial collagenase or cultures of human bone lineage cells. Membrane degradation was studied on days 2, 4, 7, and 14. Two- and 3-way analysis of variance was used to analyze results. RESULTS: Samples supplemented with bacterial collagenase exhibited a statistically significant interaction between changes of free protein in the medium, antibiotic concentration used for the immersion, presence of collagenase in the medium, and incubation time (P<0.0001). Membranes incubated with bone cells exhibited similar degradation trends. CONCLUSIONS: Collagen membranes immersed in 50 mg/ml TTC solution exhibited the longest degradation time, both in the clostridial collagenase and the human bone cell lineage assays. Immersion in a 50 mg/ml TTC solution before implantation will delay their degradation.

Absorbable Implants↗

Porous bovine bone mineral in healing of human extraction sockets: 2. Histochemical observations at 9 months.

BACKGROUND: Porous bovine bone mineral (PBBM) has been used in ridge preservation procedures following tooth extractions. The aim of this study was to investigate histochemically tissue sockets grafted with PBBM at 9 months post-extraction. By using different histochemical stainings, characteristics of the newly formed bone; i.e., lamellar/woven ratio at different socket depths, were investigated and the arrangement of bone around the grafted material, as well as the nature of the amorphous organic material found in all specimens, were examined. METHODS: After extraction of 15 single-rooted maxillary teeth from 15 patients, socket sites were grafted with PBBM particles (250 to 1,000 mu). Primary soft tissue closure of the grafted site was established using the rotated split palatal pedicle flap technique. At 9 months, a cylindrical tissue specimen, 2.5 mm in diameter, was trephined from each previously grafted site followed by placement of a screw-shaped implant. Horizontal tissue section cuts, 5 mu wide, were prepared for histological examination. Histochemical staining included alcian blue, periodic-acid Schiff, Mallory trichrome, reticulin, Van Gieson, and picrosirius red (PSR). PSR stained slides were further evaluated morphometrically, using polarized microscopy to determine the amount of lamellar versus woven bone in superficial, mid and deep specimen section cut areas. RESULTS: All staining methods revealed that newly formed bone encircled and adhered to the grafted material in most specimens. Mallory trichrome staining showed osteoblasts present within an osteoid layer, lining the interface zone of PBBM particles and the new osseous tissue. Morphometric evaluation of the PSR stained slides disclosed a constant pattern of increased osseous tissue in a coronal-apical direction. An average of 17.1% osseous tissue with 1:12.9 lamellar/woven bone ratio was calculated in the superficial area. The average bone tissue fraction was 48.3% with a lamellar/woven ratio of 1:3.8 in the mid section area and in the deep area, it increased to 63.9%, with a lamellar/woven ratio average of 1:1.7. Differences between ratios at these sites were statistically significant (P<0.001). An amorphous organic substance was noted in most grafted particles. This material usually attached cell striae and harbored glycoproteins as revealed by periodic-acid Schiff and alcian blue stainings. Mallory trichrome staining showed denatured protein within the decalcified mineral particles; reticulin, Van Gieson stainings, and polarization of PSR stained sections refuted the existence of collagen in the grafted particles. CONCLUSIONS: Cancellous PBBM is a biocompatible filler agent in extraction socket sites and an acceptable graft for edentulous ridge preservation at sites prepared to receive endosseous implants. The osteoconductivity of PBBM was determined based on promoting osseous ingrowth and close integration with the newly generated bone. Grafted particles were not significantly resorbed at 9 months. Further studies are needed to determine the resorbable capability, as well as the nature and significance of the amorphous organic substance of PBBM observed in the grafted particles.

Analysis of Variance↗

Histopathological morphometric evaluation of 2 different hydroxyapatite-bone derivatives in sinus augmentation procedures: a comparative study in humans.

BACKGROUND: Xenografts to augment the maxillary sinus have been used extensively. The aim of the present study was to evaluate, qualitatively and quantitatively, two different HA derivatives of natural and synthetic sources on newly formed bone in the augmented sinus. METHODS: A bilateral sinus augmentation procedure with simultaneous (16 out of 20 sites) or subsequent implant placement was performed in 10 patients. The antrum was randomly filled with a deproteinized, bovine hydroxyapatite mineral (B-HA) on one side and a non-ceramic resorbable hydroxyapatite (NC-HA) on the other. Cylindrical specimens were harvested from the augmented core at 12 months. Decalcified specimens were sectioned at a cross-horizontal plane and stained with hematoxylin and eosin for histopathologic and histomorphometric examinations. Tissue area fractions of bone, marrow, and the grafted particles were calculated for each specimen from the lateral to the deep region, and changes in values were compared within each material and between them. RESULTS: New bone formation was evident. B-HA and NC-HA particles were observed in all specimens surrounded by newly formed bone in direct connection or by soft tissue marrow. Morphometrically in the B-HA sites, from the lateral to deeper area, bone area fraction increased from 29.8% to 54.2% (average 42.1%) and marrow area fraction decreased from 37.9% to 26.7% (average 33.3%). The mineral area fraction decreased from 32.3% to 19.1% (average 24.7%). All increasing/decreasing patterns were statistically significant (P < 0.001). In the NC-HA sites, from the lateral to deeper area, bone area fraction increased from 25% to 36.5% (average 32.3%) and marrow area fraction decreased from 51.6% to 41.9% (average 43.2%) (P <0.001). The mineral area fraction decreased from 29% to 21.7% (average 24.6%) (P = 0.038). Comparison between the two HA derivative groups showed a significant difference between the bone area fraction averages (P = 0.0053) and between the increasing patterns along the core depth (P = 0.0006). There was also a significant difference between the decreasing marrow patterns (P = 0.003), but not between their averages. Comparison between the mineral area fractions showed no differences. CONCLUSIONS: B-HA and NC-HA were proven to be biocompatible materials. Although the B-HA-augmented sites showed a higher percentage of bone formation at 12 months, both are suitable bone derivatives in sinus augmentation procedures and can accommodate osseointegrated implants.

Absorbable Implants↗

Efficacy of porous bovine bone mineral in various types of osseous deficiencies: clinical observations and literature review.

Recent developments in osseous regenerative techniques have increased the demand for bone-substitute grafting materials. Porous deproteinized bovine bone mineral (PBBM), a biocompatible xenograft, has been used in different osseous deficiencies prior to or in conjunction with the placement of titanium implants. The different PBBM applications in fresh extraction sites, anatomic defects, and subantral floor elevation techniques are described. The use of an occlusive barrier membrane to regenerate bone via guided tissue regeneration principles was determined for each patient by clinical parameters. PBBM was well amalgamated and incorporated with the augmented hard tissue, but the transition between preexisting bone and the newly regenerated bone-like tissue was distinguishable by clinical examination even after 12 months. Grafted material was also identified using follow-up radiographs. In the presented cases, PBBM showed clinically satisfactory results as a biocompatible filler in bone augmentation procedures.

Adult↗

Porous bovine bone mineral in healing of human extraction sockets. Part 1: histomorphometric evaluations at 9 months.

BACKGROUND: Extraction socket wound healing is characterized by resorption of the alveolar bone at the extraction site. This produces a decrease in ridge volume, deformations of ridge contours, and, thus, difficulties in delayed placement of root-form implants in an ideal position. Cancellous porous bovine bone mineral (PBBM) applied to fresh extraction sockets has recently been proposed to minimize the reduction in ridge volume. The aim of this study was to investigate the influence of PBBM grafted particles on the histopathologic pattern of the intrasocket regenerated bone and to evaluate histomorphometrically the healed PBBM grafted extraction socket site at 9 months' post-extraction. METHODS: PBBM particles (250 to 1,000 microns in size) were grafted in 15 fresh human extraction sockets in 15 patients. Socket wall bone height was measured from the crestal ridge level before the mineral particles were inserted. Primary soft tissue closure was performed to protect the grafted particles via a pediculated split palatal flap. At 9 months, socket bone walls were remeasured and cylinder bone samples of the previously PBBM-grafted sites were obtained. Decalcified specimens were sectioned at a cross-horizontal plane and stained with hematoxylin and eosin for histopathologic and histomorphologic examination. Tissue area percentage of bone, PBBM, and connective tissue (CT) was calculated for each specimen from the crestal to the apical region and changes in values compared. RESULTS: Average clinical overall bone fill of the augmented socket sites was 82.3%. Histologically, PBBM particles were observed in all specimens. Newly formed bone was characterized by abundance of cellular woven-type bone in the coronal area, while lamellar arrangements could be identified only in the more apical region. New osseous tissue adhered to the PBBM. Histomorphometric measurements showed an increase of mean bone tissue area along the histological sections from 15.9% in the coronal part to 63.9% apically (average 46.3%). CT fraction decreased from 52.4% to 9.5% (average 22.9%) from the crestal to the apical region. PBBM area fraction varied from 26.4% to 35.1% (average 30.8%). Statistical analysis of the comparison between areas of bone, CT, and PBBM was performed in different points along the coronal-apical axis. Differences were significant (P <0.01) at the most crestal, middle, and apical section cut areas, but not at the cervical section cuts. Bone area fraction increased in the apical direction as much as CT correlatively decreased. Unlike CT and bone, PBBM retained constant relative volume (approximately 30%), regardless of the depth of the specimen cores. CONCLUSIONS: PBBM particles are an appropriate biocompatible bone derivative in fresh extraction sockets for ridge preservation. The resorbability of this xenograft could not be recognized in a 9-month period. Further investigation is needed to clarify the resorptive mechanisms of PBBM.

Adult↗

Spontaneous early exposure of submerged implants: II. Histopathology and histomorphometry of non-perforated mucosa covering submerged implants.

BACKGROUND: Spontaneous early exposure is a complication that could account for significant interference during the early healing phase of dental implants. Spontaneous perforations of the mucosa covering implants have been classified according to the degree of implant exposure from 0 (no perforation) to IV (complete exposure). In this study, the characteristics of the epithelium and connective tissue of clinically non-perforated mucosa over submerged implants are histologically and histomorphometrically evaluated. METHODS: Ten randomly selected tissue disks of intact (Class [Cl]-0) mucosa covering submerged implants were removed using a biopsy punch. Identical mucosal punch specimens were obtained from edentulous sites treated by non-submerged (1-stage) implants for use as controls. Specimens were histopathologically examined. The epithelial width and inflammatory infiltrate adjacent to the epithelium were histomorphometrically measured and the data statistically analyzed. RESULTS: Non-perforated mucosa covering the submerged implants (Cl-0) was characterized by an inflammatory fibro-epithelial hyperplasia. In 70% of Cl-0 hematoxylin and eosin-stained sections, there was mineralized material in the connective tissue, mostly sequestra. The epithelial width was 1.5 times higher (0.553 +/- 0.187 mm) when compared to controls (0.345 +/- 0.129 mm; P <0.0001). Concomitantly, the chronic inflammatory infiltrate was almost double in Cl-0 specimens (1,411 +/- 617 cell/mm2) when compared to controls (833 +/- 275 cells/mm2; P<0.001). A positive correlation between the linear combination of the epithelial width and the linear combination of the inflammatory cell concentration was found in both groups: Cl-0: r = 0.669, P= 0.0001; control: r = 0.541, P= 0.005. CONCLUSIONS: Different factors may result in the formation of spontaneous early perforation, most of which are associated with mechanical trauma to the mucosa or tension in the tissue flaps covering the implants. Bone debris produced during the osteotomy could act as an additional predisposing factor; these are sequestrated and accompanied by chronic inflammatory cell infiltration as well as epithelial-covering reaction. Since this study focused only on specimens from intact mucosa, until further investigation of this phenomenon in spontaneously perforated sites is conducted, no conclusions on the role of these histopathological findings can be made.

Biopsy↗

Spontaneous early exposure of submerged implants: III. Histopathology of perforated mucosa covering submerged implants.

BACKGROUND: Spontaneous early exposure of dental implants could interfere with the early healing phase of dental implants. These exposures have been clinically classified according to degree of implant exposure from 0 (intact mucosa) to IV (complete exposure). The characteristics of perforated mucosa (Class I and II) covering submerged dental implants were examined histologically in this study. METHODS: Biopsy specimens of 34 Class I and II perforated mucosa covering submerged dental implants were examined histologically. Serial sections were evaluated from the periphery of the specimen to the center of each perforation lesion. RESULTS: Class I specimens presented hyperplastic epithelium characterized by hyperparakeratosis and acanthosis. Chronic inflammatory cells diffusely infiltrated the connective tissue. Sections closer to the perforation revealed gradual epithelial invagination; in the deepest aspect, there was a cyst-like structure in all Class I specimens examined. A thin layer of connective tissue containing necrotic material and debris formed the "cystic" wall proximal to the implant cover screw. Class II specimens presented the same epithelial patterns; however, the cystic structures were replaced by direct contact between the cover screw and the oral cavity via the perforation. CONCLUSIONS: Spontaneous early perforations are the sequela of either traumatic irritation or failure of the tissue flaps to produce primary healing. Most Class I perforations include epithelial invagination and the formation of a cyst-like structure. Necrosis of the base of the "cyst" or enlargement of the perforation results in direct communication between the oral cavity and the covering screw surface (Class II).

Biopsy↗

Autogenous masticatory mucosal grafts in extraction socket seal procedures: a comparison between sockets grafted with demineralized freeze-dried bone and deproteinized bovine bone mineral.

Successful preservation of the edentulous ridge after extractions may eliminate or reduce the need for ridge augmentation procedures. It has been claimed that grafting fresh extraction sockets and sealing them with autogenous soft tissue grafts promote ridge preservation after tooth extraction. In this study, the survival of free autogenous connective tissue grafts sealing extraction sites was evaluated. In 24 healthy patients, 42 maxillary anterior teeth were extracted. After socket debridement, soft tissue margins of the socket orifice were carefully cut to remove epithelial debris, Sockets were filled with either demineralized freeze-dried bone allografts (DFDBA) or deproteinized natural bovine bone mineral xenograft (DBBMX) to the level of the alveolar bone crest. Circular connective tissue grafts, slightly larger in diameter than the soft tissue socket orifice, were obtained and placed on top of the filler graft material sealing the sockets. Grafts were stabilized and secured by sutures and inspected weekly for the first month. The grafts were classified into 3 groups according to clinical parameters: vital, partially vital and non-vital. After 1 week, 18 grafts were vital, 13 partially vital and 11 non-vital. When only 1 sample unit (1 site per patient) was compared between DFDBA and DBBMX grafted sockets, no significant difference in graft vitality was shown (P = 0.34 for vital; P = 0.67 for vital plus partially vital). After 1 month, all socket orifices were sealed with mucosa. Based on the present observations, it seems that connective tissue grafts sealing fresh extraction sites are mainly dependent on underlying tissue vascularization and that sealing grafted fresh extraction sockets filled with bone substitute allograft or xenograft materials may be beneficial but an unpredictable procedure.

Adolescent↗

Spontaneous early exposure of submerged implants: I. Classification and clinical observations.

BACKGROUND: It is believed that during the osseointegration phase of submerged dental implants, complete mucosal coverage and isolation of the implant from the oral cavity avoids trauma and infection and establishes favorable conditions for osseointegration. Spontaneous early exposure is one of the complications that could adversely affect osseointegration of implants. METHODS: This study clinically classifies spontaneous early exposure and describes and analyzes this complication in a group of 148 patients treated with 372 submerged implants: 216 (58%) in the mandible and 156 (42%) in the maxilla. Edentulous sites were exposed by mid-crestal incisions and full thickness gingival flaps. Incisions were closed in an attempt to achieve complete closure and healing by primary intention. Measurements were taken to avoid mechanical trauma to the mucosa over the implants. Patients were followed up weekly and examined to identify early exposures. Perforations were classified according to the degree of exposure from 0 (no perforations) to 4 (complete exposure). RESULTS: Of the implants 51 (13.7%) presented spontaneous early exposure, (13%) in the mandible and 23 (14.7%) in the maxilla. Class 2 perforation was the most frequent, followed by Class 3, Class 1 and Class 4. Inflammation at the mucosal orifices of the perforations was minimal, but no objective index (bleeding, probing) was taken in order to avoid morphological changes of the lesions that were biopsied for histological examination. CONCLUSIONS: Early perforation and partial exposure of the implant's covering device are a focus for plaque accumulation which, if left untreated, may result in inflammation, damage to the peri-implant mucosa, and possible peri-implant loss.

Biopsy↗

Subgingival acellular dermal matrix allograft for the treatment of gingival recession: a case report.

Root coverage procedures using subgingival soft tissue grafts or guided tissue regeneration have attracted much interest within the past 2 decades. Recently, acellular dermal matrix allograft (ADMA) has been introduced as a substitute for palatal donor tissue in gingival augmentation procedures. This study was undertaken to examine the potential of ADMA to be used as a substitute for autogenous connective tissue graft material in a root coverage procedure in a case with moderate gingival recession combined with reduced keratinized attached gingiva. After thorough root planing and conditioning of the root surface with a saturated solution of tetracycline-HCl, a trapezoidal mucoperiosteal flap was raised and the papillae were de-epithelialized. The exposed bone surrounding the exposed root surface was perforated with a No. 2 round drill, and the exposed root and surrounding bone were covered by ADMA. The allograft was stabilized by 5-0 vicryl sutures. The flap was coronally positioned to completely cover the ADMA. Healing was uneventful. Eight-month observations and measurements showed root coverage of more than 3.5 mm (>80%), a gingival margin that was harmonious with the neighboring teeth, and an increase of the zone of keratinized attached gingiva, from 1 to 3 mm. Within the limitations of these clinical observations, it is suggested that ADMA may be a possible substitute to free autogenous connective tissue grafts and/or bioabsorbable barrier membranes. Further clinical and histological studies are necessary to understand the healing process of this surgical wound.

Alveolectomy↗

Immediate loading of modular transitional implants: a histologic and histomorphometric study in dogs.

Modular Transitional Implants (MTI) are made from pure titanium and are used to support fixed provisional restorations during the osseointegration of definitive implants. This study histologically examined the jaw response to loaded MTIs in the dog mandible. Three implants were inserted transmucosally into each side of the mandible in 3 dogs. Stability was examined using a Periotest. Anterior and posterior implants were splinted using a cemented acrylic resin fixed partial denture to allow immediate loading. The middle implant remained unloaded and was used as a control. Dogs were sacrificed 11 to 12 weeks after implantation, and tissue blocks containing the implants were removed. Histologic examination showed that 10 of the 18 implants had good bone-to-implant contact, with the percentage of bone contacting the threaded portion of the implant varying from 30% to 65%. There was no statistical difference (p > 0.1) in percentage of bone-to-metal contact between loaded and unloaded implants. Six implants were entirely surrounded by connective tissue with or without inflammation; two implants were lost during the study. The success rate did not differ between loaded and unloaded implants. In the successful implants trabecular bone made good contact with the implant, forming supporting struts. There was bone remodeling in some bone-to-metal contact areas. It is believed that success was mainly influenced by the initial bone density at the implant site and by the uncontrolled load that the animals applied to the implants during the early healing stage.

Animals↗

Castration prevents calcium channel blocker-induced gingival hyperplasia in beagle dogs.

1. The purpose of this study was to investigate testosterone's role on the calcium channel antagonist oxodipine-inducing gingival hyperplasia in a dog model. 2. Two experiments were conducted using castrated and intact male dogs. Oxodipine was administered orally for 90 days, at a dose of 24 mg/kg/day. In the first experiment, the occurrence of gingival hyperplasia was evaluated. In the second, the gingival index (GI) and gingival hyperplasia index (GHI) were recorded and correlated with serum levels of testosterone. 3. A significant positive correlation between GI, GHI and plasma testosterone was noted. Castrated dogs were injected with testosterone, 4 months after the start of oxodipine treatment, while in the non-castrated dogs, administration of oxodipine was stopped. Castration correlated with lack of GH, while testosterone injection to the same dogs was associated with an increase of GI and GHI. 4. Since it is known that testosterone receptors are present in the gingiva, it is proposed that oxodipine-induced gingival hyperplasia could be mediated by the calcium channel blocker on plasma testosterone levels.

Animals↗

Bone regeneration for reintegration in peri-implant destruction.

Complications and deterioration around functional osseointegrated implants stem from two major factors: bacterial-initiated disease and overloading. Peri-implant breakdown can occur during the postsurgical phase and before the reconstructive phase as a result of surgical trauma and/or predisposed compromised recipient bone site. Technical errors also potentially contribute to bone loss, which results in the loss of osseointegration. Two case reports associated with peri-implant destruction are presented. The possible etiologic factors are discussed, and an attempt to regenerate lost peri-implant tissue is demonstrated via guided bone regeneration principles using barrier membranes.

Adult↗

Effect of non-erupted third molars on roots of approximal teeth. A radiographic, clinical and histologic study.

This study was undertaken to evaluate clinically and histologically root resorption in extracted human second molars in close proximity to non-erupted third molars. The control group consisted of extracted second molars that were proximal to fully erupted third molars. Eight out of the 11 teeth in the study group presented different degrees of radiographic root resorption, nine presented clinical resorption, and all 11 had histologic evidence of root resorption. In the control group, no signs of root resorption were seen radiographically or clinically. Histologically, limited sites of resorption were identified in all teeth, which were partially repaired by cellular cementum. Histologic observation of study specimens revealed root surface resorption in 10 out of the 11 teeth, one showing replacement resorption as well. Inflammatory resorption was observed in the three most advanced cases in the study group. Reparative cementum partially lining resorbed areas was evident in all teeth with surface resorption. Within the limits of this study, radiographic identification of distal root resorption of second molars in close proximity to non-erupted third molars appears reliable. The findings may support the hypothesis that the presence of a non-erupted third molar in close proximity to the distal root of the second results in root resorption.

Adult↗

Periodontal and peri-implant bone regeneration: clinical and histologic observations.

The principle of guided tissue regeneration by barrier membranes to restore lost periodontal tissue around natural teeth has also been used around osseointegrated implants in an attempt to restore alveolar ridge defects. While most periodontal procedures in the literature describe root coverage by mucogingival surgery, which achieves healing through soft tissue attachment, regeneration of denuded root surfaces is performed by guided tissue regeneration using expanded polytetrafluoroethylene barrier membranes and demineralized freeze-dried bone allografts as inductive/conductive materials. In this study the technique is applied in two partially exposed cylindrical hydroxyapatite-coated implants in extraction sites in one patient. Surgical reentry in both sites is presented, with histologic examination revealing new bone formation on the exposed root surface and the hydroxyapatite-coated implants.

Alveolar Bone Loss↗