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PubMed1992

An evaluation of the Periotest system. Part I: Examiner reliability and repeatability of readings. Dental Implant Clinical Group (Planning Committee).

The clinical success of endosseous dental implants is related to the extent of osseointegration. Many of the presently used methods of evaluating osseointegration are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration and supporting bone stability of implants by means of microcomputer-controlled percussion. Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part, with which this article is concerned, involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The Periotest system generally demonstrated a high degree of reliability and repeatability, with higher variability associated with specific model samples. Further evaluation of the Periotest as a research instrument will be conducted within the clinical environment of the Dental Implant Clinical Research Group study.

Dental Implants↗
PubMed1995

[Intraoral radiographs of dental implants in the edentulous mandible].

Radiographs of dental implants in the edentulous mandible, which are suitable for evaluation studies, are difficult to obtain. This article describes the development of an aiming device for intraoral radiography of the crestal bone around the neck of dental implants. Error analysis of serial radiographs indicated only small deviations in reproducibility. Subsequently three methods of measurements of marginal bone level around the neck of dental implants are described, measurements with: 1. a computerized image analysis system, 2. a magnifying glass, and 3. a digital sliding gauge. The intra- and interobserver error analysis showed that determining the precise bone height on the image is responsible for a large standard deviation for each method. Measurements with a digital sliding gauge are preferable, since this method is easy to put into practice, whereas the accuracy matches the accuracy of the two other methods.

Dental Implants↗
PubMed1991

Dental implants.

Explore the source record for details and available documents.

Adult↗
PubMed1999

Microbiota of successful osseointegrated dental implants.

BACKGROUND: The long-term survival of dental implants depends, in part, on control of bacterial infection in the peri-implant region. Periodontal pathogens colonized implants symptomatic through infection, whereas the microbiota of successful implants was similar to that of periodontal health. This study examined the impact on the peri-implant microbiota of crown restorations; implant type; length of time of loading; history of implant or periodontal infections; and whether implants replaced single or multiple teeth. It was of particular interest to evaluate implant colonization by species in a newly described red complex of periodontal pathogens, Porphyromonas gingivalis and Bacteroides forsythus. METHODS: This study sampled 43 partially edentulous subjects with successfully osseointegrated titanium root-form dental implants. Eighty-one (81) non-submerged and 20 submerged asymptomatic implants, 83 crowned, and 36 uncrowned teeth were sampled from peri-implant or subgingival sites. The microbiota of samples was evaluated using whole genomic DNA probes in a checkerboard assay to 23 subgingival species. RESULTS: Implants were colonized principally by oral streptococci, capnocytophagae, Veillonella parvula, Peptostreptococcus micros, and Fusobacterium nucleatum. The periodontal species, P. gingivalis, B. forsythus, Prevotella intermedia, Prevotella nigrescens, and Campylobacter rectus were detected in a few subjects. The microbiota around crowned implants and crowned teeth was similar. Streptococcus oralis, P. intermedia, and Selenomonas noxia were elevated in samples from uncrowned teeth compared to crowned teeth and implants. Microbial complexity increased as loading time increased, but colonization by periodontal pathogens, including red complex species, was higher in subjects with previous periodontal disease. No differences were observed in the microbiota of 1- and 2-stage implants, or between implants supporting single or multiple restorations. CONCLUSIONS: While presence of crowns had only a minor impact on the peri-implant microbiota, microbial changes were observed the longer the implants had been in function and in those patients with a history of periodontal or peri-implant infections. A history of periodontitis had a greater impact on the peri-implant microbiota than implant loading time. The major influence on the peri-implant microbiota was, however, the microbiota on remaining teeth. P. gingivalis and B. forsythus, red complex periodontal pathogens, colonized several implants, although all implants were successfully osseointegrated.

Adult↗
PubMed2002

An intra-oral hydraulic system for controlled loading of dental implants.

This study reports a method for controlling loads on an in vivo dental implant and its application for the investigation of early loading versus delayed loading of dental implants. The method was developed for the purpose of studying an ongoing hypothesis that amounts to bone loss around dental implants are related to mechanical-mediated adaptation of the alveolar bone. Using a customized intra-oral hydraulic system, the daily loading over a dental implant has been completed and recorded for six Sinclair swine. Each pig had a 5-month duration implant loading. During the experiments (loading), no analgesic treatment was supplied. The mean of the in vivo daily loadings was confirmed through an in vitro bench test after each animal was euthanized. Variations of the averaged loading input among the six animals were smaller than 10%. Preliminary data produced by the model suggests that cervical bone loss is less for early loading than for delayed loading. The current system is expected to provide a useful load control model for the study of alveolar bone adaptation around dental implants in relation to various loadings.

Animals↗
PubMed1999

Why do dental implants fail? Part I.

Many factors are attributed to failure of the dental implant, either directly or indirectly. The focus of this article is to define the causation of dental implant failure, as well as to present an evaluation of the implant literature regarding etiology, classification, management, and treatment of implant failures. This article will highlight the initial signs of implant failure with a view of some clinical cases in terms of classification and degrees of implant failure. Finally, a dental implant failure checklist is formulated to guide the practitioner in defining the cause of implant failure, be it infective or noninfective, and to establish percentages and frequency of occurrence. The checklist applies to all implant systems and will help to determine the factors responsible for causation and the repair procedures, whether they are at the surgical or restorative phases. The definition of implant failure is set forth in terms of ailing, failing, failed, and surviving implants, and the appropriate treatments and dispositions are outlined.

Bone Diseases↗
PubMed1995

Use of dental implants for rehabilitation of mandibulectomy patients prior to radiation therapy.

The use of dental implants can aid in prosthetic rehabilitation of patients after ablative cancer surgery of the oral cavity. Biological effects of radiation therapy and the enhancement of radiation by metal implants have limited the use of dental implants. This article presents a case of dental implants used prior to radiation therapy for rehabilitation of a mandibulectomy patient and discusses the current understanding of radiation effects on bone and metal implants.

Alveolar Process↗
PubMed2003

Three-dimensional topographic and metrologic evaluation of dental implants by confocal laser scanning microscopy.

BACKGROUND: Surface topography of dental implants has changed during the past few years; however, the last systematic study on this topic is dated 1993. PURPOSE: The aim of this study was to correlate dental implants by surface analysis. MATERIALS AND METHODS: A microtopographic analysis of 35 dental implants was performed using confocal laser scanning microscopy. Roughness value (Sa) and developed surface area (ratio, Sdr) were calculated. Implants were grouped according to their surface treatment: "minimally rough" with no further surface treatment (n = 2); ablative structured using etching or blasting (n = 17); titanium plasma spray coated (TPS; n = 9); coated with hydroxyapatite (HA; n = 7). RESULTS: Most implants (n =16) showed Sa values between 3.0 and 5.0 microm. The developed surface area has a mean value of 13.5 and an SD of 6.52. Minimally rough implant surfaces show the lowest Sa values (mean 0.5 microm). Implants with ablative surface treatment have mean Sa values of 3.1 microm. Both groups with additive surface treatment (TPS and HA) present similar roughness values with a mean of 6.0 microm and 5.8 microm, respectively. Ratio Sdr ranges from 3.1 for the minimally rough implants to 11.4 for the ablative treated implants and 14.3 for TPS-coated and 18.4 for HA-coated implants. There is a significant difference between the roughness and ratio values of the different groups. The topographic images show a typical surface according to the underlying surface treatment. CONCLUSIONS: We can confirm the "classic" grouping of dental implants by type of surface treatment into the groups minimally rough, ablative, TPS coated, and HA coated as these treatments lead to different ascending Sas; however, the additional value of the ratio Sdr including both spatial and amplitude aspects of the surface could not be confirmed in this study. Functional parameters describing the topographic differences are still lacking.

Biocompatible Materials↗
PubMed2006

The immediate placement of endosseous dental implants in fresh extraction sites.

The use of endosseous dental implants to rehabilitate both fully and partially edentulous patients has been peer-reviewed in the literature for more than 25 years. Cumulative success rates for the treatment of partial edentulism with dental implants has been reported as 96% in delayed or late-placement sites. Recently, significant attention has been given to the placement of implants in fresh extraction sites to avoid such potential concerns as bone resorption, multiple surgical procedures, increased treatment time, and unsatisfactory esthetics. This article discusses the salient aspects of immediate dental implant placement from a historical, histologic, and clinical-perspective, and describes the surgical methods for this procedure.

Bone Resorption↗
PubMed2002

Influence of the size of the microgap on crestal bone levels in non-submerged dental implants: a radiographic study in the canine mandible.

BACKGROUND: Accumulating evidence suggests that alveolar crestal bone resorption occurs as a result of the microgap that is present between the implant-abutment interface in dental implants. The objective of this longitudinal radiographic study was to determine whether the size of the interface or the microgap between the implant and abutment influences the amount of crestal bone loss in unloaded non-submerged implants. METHODS: Sixty titanium implants having sandblasted with large grit, acid-etched (SLA) endosseous surfaces were placed in edentulous mandibular areas of 5 American fox hounds. Implant groups A, B, and C had a microgap between the implant-abutment connection of <10 microm, 50 microm, or 100 microm, respectively, as did groups D, E, and F, respectively. Abutments were either welded (1 -piece) in groups A, B, and C or non-welded (2-piece screwed) in D, E, and F. All abutment interfaces were placed 1 mm above the alveolar crest. Radiographic assessment was undertaken to evaluate peri-implant crestal bone levels at baseline and at 1, 2, and 3 months after implant placement whereupon all animals were sacrificed. RESULTS: The size of the microgap at the abutment/implant interface had no significant effect upon crestal bone loss. At 1 month, most implants developed crestal bone loss compared with baseline levels. However, during this early healing period, the non-welded group (D, E, and F) showed significantly greater crestal bone loss from baseline to one month (P <0.04) and 2 months (P < 0.02) compared with the welded group (A, B, and C). No significant differences were observed between these 2 groups at 3 months (P > 0.70). CONCLUSIONS: Crestal bone loss was an early manifestation of wound healing occurring after 1 month of implant placement. However, the size of the microgap at the implant-abutment interface had no significant effect upon crestal bone resorption. Thus, 2-piece non-welded implants showed significantly greater crestal bone loss compared with 1-piece welded implants after 1 and 2 months suggesting that the stability of the implant/abutment interface may have an important early role to play in determining crestal bone levels. At 3 months, this influence followed a similar trend but was not observed to be statistically significant. This finding implies that implant configurations incorporating interfaces will be associated with biological changes regardless of interface size and that mobility between components may have an early influence on wound healing around the implant.

Alveolar Bone Loss↗
PubMed1999

Clinical experiences with dental implants.

The clinical utilization of dental implants has accelerated in recent years, and new applications continue to emerge. Concomitantly, alternative implant systems have introduced conceptually different approaches to treatment using altered protocols. The purpose of this paper is to address some of the background issues pertinent to the long-term success, survival, safety, and effectiveness of these devices. The requirements for clinical acceptance of implants are controlled initially by regulatory bodies; however, the dentist eventually must make a decision on which type of implant should be used in clinical practice. This clinical decision-making process should involve the strategy of using an evidence-based approach to ensure quality of care and reduction of liability for negligent care. This is particularly the case when treatment is undertaken in identified high-risk categories. While short- to medium-term data have been accumulated on the success rates of several implant systems, it is apparent that long-term data comparing and contrasting the various advantages and disadvantages of different systems do not exist, and adequate criteria applicable to the collective clinical experience need to be defined. Expanding areas of application are dependent on continuous improvements in implant hardware, surgical protocol development, and rationalized osteopromotive and site installation augmentation technology. Many treatment endeavors are still largely at the pilot study level of development, and long-term prospective clinical trials on large numbers of patients are required to document results adequately and to elucidate the most likely productive areas for future investigation.

Clinical Protocols↗
PubMed2004

Finite element analysis of an osseointegrated stepped screw dental implant.

An osseointegrated stepped screw dental implant was evaluated using 2-dimensional finite element analysis (FEA). The implant was modeled in a cross section of the posterior human mandible digitized from a computed tomography (CT) generated patient data set. A 15-mm regular platform (RP) Branemark implant with equivalent length and neck diameter was used as a control. The study was performed under a number of clinically relevant parameters: loading at the top of the transmucosal abutment in vertical, horizontal, and 45 degrees oblique 3 orientations. Elastic moduli of the mandible varied from a normal cortical bone level (13.4 GPa) to a trabecular bone level (1.37 GPa). The study indicated that an oblique load and elastic moduli of the cortical bone are important parameters to the implant design optimization. Compared with the cylindrical screw implant, the maximum von Mises stress of the stepped screw implant model was 17.9% lower in the trabecular bone-implant area. The study also showed that the stepped screw implant is suitable for the cortical bone modulus from 10 to 13.4 GPa, which is not necessarily as strict as the Branemark implant, for which a minimum 13.4 GPa cortical bone modulus is recommended.

Biomechanical Phenomena↗
PubMed2003

Evaluation of hard tissue replacement composite graft material as a ridge preservation/augmentation material in conjunction with immediate hydroxyapatite-coated dental implants.

BACKGROUND: Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bone replacement grafts are often used to correct these problems. This study evaluated the use of a layered composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxyl-ethyl-methacrylate), and calcium hydroxide grafts (HTR) as a ridge preservation/ augmentation material used in conjunction with an immediate DI placement technique. METHODS: Twenty-three patients requiring 1 or 2 extractions that were treatment planned for immediate DI placement received 4.0 or 3.25 mm diameter hydroxyapatite-coated cylindrical implants in the extraction sockets. HTR was used to fill the remaining socket void and enhance the facial ridge width. A collagen hemostatic was placed to cover the DI sites, flaps released, and primary closure attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total ridge width at DI placement and uncovering. RESULTS: Thirty DIs were placed in the 23 patients. Mean initial internal socket width was 6.9 mm. The total ridge width showed a mean change from 9.1 mm to 8.4 mm; 60% of the areas showed a net increase or no change, while 40% showed a decrease in overall ridge width. DI success rate was 97% out to 6 months of loading. CONCLUSION: The results of this study suggest that HTR is a useful adjunct in the placement of immediate DIs for filling of socket voids and preservation of ridge width.

Adolescent↗
PubMed2000

Peri-implant mucosal inflammation and bone loss: clinical and radiographic evaluation of 108 dental implants after 1-year loading.

OBJECTIVE: To evaluate the clinical outcomes, and a possible correlation between peri-implant mucosal inflammation and marginal bone loss, 1 year after restoration in a group of Chinese patients with dental implants. METHODS: Observation of the clinical and radiographic parameters of 108 IMZ and Frialit-2 dental implants in 70 patients. RESULTS: One year after loading, there were no signs of mobility and peri-implant radiolucency in any of the implants. The average bone loss adjacent to implants was 0.63 mm (SD 0.78). The prevalence of peri-implant mucosal inflammation, as indicated by sulcus bleeding index (SBI) of 1.0 or more, was 32.9%. Significant positive correlation was found between mucosal inflammation and bone loss (P < 0.05). 92% of the observed sites had plaque index (PLI) scores greater than 1. CONCLUSIONS: The 1-year outcomes from this patient group indicate that IMZ and Frialit-2 implants provide satisfactory clinical results. One of the etiologic factors of alveolar bone loss around implants seems to be plaque-associated marginal inflammation. Improvement of oral hygiene, elimination of soft tissue inflammation, and proper treatment of periodontal disease of natural teeth are critical for maintaining the implants.

Adolescent↗
PubMed2006

Surface treatments of titanium dental implants for rapid osseointegration.

The osseointegration rate of titanium dental implants is related to their composition and surface roughness. Rough-surfaced implants favor both bone anchoring and biomechanical stability. Osteoconductive calcium phosphate coatings promote bone healing and apposition, leading to the rapid biological fixation of implants. The different methods used for increasing surface roughness or applying osteoconductive coatings to titanium dental implants are reviewed. Surface treatments, such as titanium plasma-spraying, grit-blasting, acid-etching, anodization or calcium phosphate coatings, and their corresponding surface morphologies and properties are described. Most of these surfaces are commercially available and have proven clinical efficacy (>95% over 5 years). The precise role of surface chemistry and topography on the early events in dental implant osseointegration remain poorly understood. In addition, comparative clinical studies with different implant surfaces are rarely performed. The future of dental implantology should aim to develop surfaces with controlled and standardized topography or chemistry. This approach will be the only way to understand the interactions between proteins, cells and tissues, and implant surfaces. The local release of bone stimulating or resorptive drugs in the peri-implant region may also respond to difficult clinical situations with poor bone quality and quantity. These therapeutic strategies should ultimately enhance the osseointegration process of dental implants for their immediate loading and long-term success.

Biomimetic Materials↗
PubMed2004

Interventions for replacing missing teeth: maintaining health around dental implants.

BACKGROUND: To maintain healthy tissues around dental implants it is important to institute an effective preventive regimen (supportive therapy). Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES: To test the null hypothesis of no difference between different interventions for maintaining healthy tissues around dental implants. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 February 2004. SELECTION CRITERIA: All randomised controlled trials of oral implants comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS: We carried out a quality assessment of the included RCTs in duplicate and contacted the authors for missing information. We independently extracted the data in duplicate. We followed the Cochrane Oral Health Group's statistical guidelines. MAIN RESULTS: Fourteen RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review. Two trials evaluated the efficacy of powered and sonic toothbrushes, respectively, when compared to manual toothbrushing and showed no statistically significant differences. One RCT compared Listerine versus placebo mouthwashes showing a reduction of 54% in plaque and 34% in marginal bleeding compared with the placebo. One trial compared self administered subgingival chlorhexidine irrigation versus chlorhexidine mouthwash. The group using chlorhexidine irrigation resulted in statistically significantly lower mean plaque scores and a marginal bleeding index than the group using chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage. One study compared etching gel with mechanical debridement showing no statistical differences. Follow ups ranged between 6 weeks and 5 months. It was not possible to make any meta-analysis as each trial assessed different interventions. REVIEWERS' CONCLUSIONS: There is only little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long term maintenance. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).

Dental Implants↗