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PubMedDate not supplied

Reverse torque failure of screw-shaped implants in baboons: baseline data for abutment torque application.

Torque failure for endosseous implants has been used as a biomechanical measure of anchorage, though the significance of such data is not known. A practical understanding of the resistance to torque failure of implant-tissue interfaces at stage 2 surgery would help in assigning torque levels for implant abutment-screw fastening. The purpose of this study was to measure torque failure levels of commercially pure (CP) titanium, Ti-6Al-4V, hydroxyapatite-coated (HA-coated) screw-shaped implants placed into the maxillae and mandibles of baboons. Implants identical in size were placed into the edentulous posterior maxillae and mandibles of six female baboons (n = 37 each group) using a standardized surgical protocol. Reverse-torque data were collected at postinsertion time intervals ranging from 3 to 4 months using a counterclockwise torque driver and the data were analyzed (repeated measures ANOVA) for torque differences related to time, biomaterial, and jaw. The HA-coated implants exhibited significantly greater torque-removal values compared to both metallic implants (HA: 186.0 Ncm [50.1]; Ti-6Al-4V: 78.6 Ncm [18.1]; CP Ti 74.0 Ncm [24.4]). Analysis of torque interactions with jaw showed no significant difference; however, the mandible was found to be greater than the maxilla in torque resistance for all groups tested. Understanding the risks in inferring animal data to human application, the clinical implications of these data suggest that the recommended torque level of 35 Ncm for abutment fastening may provide a margin of safety for most implants of similar design and material as used in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Alloys↗

PubMed2003

Colonization of organoapatite-titanium mesh by preosteoblastic cells.

Titanium (Ti) and its alloys continue to serve as successful implant materials for skeletal repair because of their physical properties and biocompatibility. This study investigates the influence of organoapatite (OA), grown directly onto an L-shaped Ti mesh, on preosteoblastic cellular colonization. Unseeded mesh samples were placed on subconfluent layers of MC3T3-E1 murine calvaria cells and cultured for up to 2 weeks. Cells demonstrated accelerated colonization of the three-dimensional OA-Ti mesh substrates over bare Ti controls. Cells also showed significantly increased proliferation on the OA-Ti mesh over bare Ti controls. Cellular differentiation, measured by alkaline phosphatase and osteocalcin expression, was observed at late stages of the experiment with no notable differences between OA-Ti mesh and bare Ti controls. These results suggest that OA grown onto porous Ti substrates is capable of inducing accelerated colonization of unseeded implant structures by osteogenic cells.

Animals↗

PubMed1996

Retention of asymptomatic bone plates used for orthognathic surgery and facial fractures.

Over the past three decades there has been an improvement in biomaterials that has virtually replaced the use of stainless steel with titanium and its alloys. Based on the possibility of causing corrosion, toxicity, hypersensitivity, and stress protection, stainless steel should not be considered as a permanent implant in maxillofacial fixation. However, because of their superior corrosion resistance, noncarcinogenicity, hyposensitivity, nontoxicity, and excellent tissue compatibility, titanium and Ti-6Al-4V may be retained as permanent implants in maxillofacial fixation. The stress protection offered by such devices, and the possible complications associated with their removal, also support this concept. Finally, the costs incurred in removal do not justify the benefits derived.

Alloys↗

PubMedDate not supplied

A prospective 5-year multicenter study of the Cresco implantology concept.

PURPOSE: The purpose of this study was to investigate the clinical and radiographic outcome of a prospective 5-year longitudinal multicenter test of a simplified implantology concept comprising an abutment-free implant system (Cresco) and a new method for fabrication of passively fitting superstructures, the Cresco Ti Precision method. MATERIALS AND METHODS: The tests were carried out at three different centers. Sixty partially or completely edentulous patients were restored by fixed implant-supported superstructures fabricated according to the Cresco Ti Precision method. In all, 215 Cresco implants were placed for the support of the superstructures. For various reasons, eight patients (13%) could not be followed through the 5 years. The radiographic measurements were recorded from radiographs exposed perpendicular to the implants. RESULTS: The initial implant failure rate (during the healing phase) was 2%, and the survival rate after loading was 98%. The mean peri-implant bone loss was 0.29 mm (SD 0.57). Of the measured sites, 71% showed a crestal bone loss of less than 0.5 mm. Very few mechanical complications were observed. This was attributed to the passively fitting superstructures. CONCLUSION: The results from the present multicenter test demonstrated that the abutment-free Cresco implantology concept is a reliable alternative method for implant-supported fixed prosthetic rehabilitation of edentulous and partially edentulous jaws.

Adult↗

PubMed1999

In vivo biocompatibility and mechanical study of novel bone-bioactive materials for prosthetic implantation.

Two epoxy materials with or without adhesively bonded hydroxyapatite (HA) coatings were studied for their biocompatibility and mechanical pushout strength using in vivo implantation in the rabbit lower femur for a duration of 10 days to 6 months. Both were two-part epoxies cured at room temperature for 24 h, with material 1 (Ampreg 26; SP Systems Limited, Cowes, UK) postcured at 110 degrees C (Tg approximately 80 degrees C) and Material 2 (CG5052; Ciba Geigy Limited, Cambridge, UK) at 125 degrees C (Tg approximately 120 degrees C). Implantation in dead rabbit bone was performed to provide mechanical baseline levels. Polymethylmethacrylate (PMMA) and conventionally HA-coated titanium alloy (Ti-6Al-4V) were used as control materials. In the biological study, different fluorescent dyes were used to label newly formed bone. After 6 weeks of implantation, results from mechanical pushout tests showed that the interfacial shear strength (ISS) values were significantly higher than for dead bones with each of the different implants (p < .01-.001). HA-coated material 2 showed a significantly higher ISS value than the uncoated material (p < .05) after 6 weeks' implantation. However, the ISS value for the uncoated material 2 was significantly higher than for PMMA controls (p < .05). No significant differences in the ISS values were shown between HA-coated materials 1 and 2 and Ti-6Al-4V on in vivo implantation for 6 weeks. Failure points of the pushout test from the three HA-coated materials were defined by scanning electron microscopy. Specimens implanted with both HA-coated epoxies were fractured within the HA-coatings or the bone, while with HA-coated Ti-6Al-4V cracked between the coating and metal implant. The percentage of bone in contact with the implant surface was obtained by image analysis which showed that there were no significant differences between different materials after short time implantation (up to 6 week). Long-term implantation of the HA-coated material 2 showed that the percentage of bone contact had increased from 52.8+/-1.1% (6 week) to 80.0+/-0.3% (3 months) (p < .01) and remained at 81.0+/-0.8% (6 months). Measurements of bone mineralization rate (BMR) showed that after 3 weeks of implantation, there were no significant differences between PMMA and uncoated materials 1 and 2. After 6 weeks, the BMRs in animals implanted with either HA-coated material 1 or 2 were significantly higher than with HA-coated Ti-6Al-4V (p < .05-.0001 in both cases), but with HA-coated material 2 was lower than with this material uncoated (p < .05-.001). No significant differences were found between the two HA-coated epoxy materials. In addition, there were always lower BMRs during the third week of implantation than other periods regardless of biomaterial implanted. The study indicated that the adhesively bonded HA-coated novel epoxy materials were superior to conventional plasma-sprayed Ti-6Al-4V implants with respect to both BMR and bone integration with the implant surfaces. Adhesively bonded HA-coated epoxy materials had similar ISS values to HA-coated Ti-6Al-4V, but the former failed within the bone and coating, while the latter showed splitting between coating and metal.

Algorithms↗

PubMedDate not supplied

Single tooth replacement by Morse taper connection implants: a retrospective study of 80 implants.

The goal of this study was to provide data relative to the use of a new implant system (Mac System, Cabon, Milan, Italy) with a Morse taper implant-abutment connection for single implant restorations. The implant system is composed of an endosseous screw made of commercially pure titanium grade 2, while the abutment is titanium alloy (Ti-6Al-4V). A total of 80 single implants were placed in 69 patients (36 women and 33 men, mean age 42 years, range 16 to 61). All patients gave their informed consent and received a thorough clinical and radiographic examination. Smokers and diabetics were excluded from the study. Three implants were placed in areas of previous tooth impaction, 5 were placed in posttraumatic edentulous areas, 2 were used in situations involving tooth agenesis, and 60 replaced teeth lost because of caries or periodontal disease. All patients were edentulous for at least 1 year prior to treatment. The implants received a definitive prosthesis and had been in function for a mean period of 3.5 years. At second-stage surgery, 2 implants were removed because of lack of osseointegration. After 2 years of loading, 1 implant showed evidence of peri-implantitis and was removed. In addition, 2 fractured abutments and 1 loosened abutment were observed. Few mechanical or infectious complications were seen, and this may have been the result of high stability of the conical connection.

Adolescent↗

PubMed1999

Evaluating sol-gel ceramic thin films for metal implant applications: III. In vitro aging of sol-gel-derived zirconia films on Ti-6Al-4V.

Sol-gel-derived zirconia films were deposited onto polished Ti-6Al-4V substrates by dip-coating from an alkoxide precursor solution. No change in morphology of the zirconia film was observed after aging at 37 degrees C for 4-12 weeks in pH 4.0 buffer solution or Hanks' balanced salt solution (HBSS), although a precipitate predominantly composed of calcium phosphate was formed on those films aged in HBSS. X-ray diffraction identified the phase of the zirconia film as either cubic or tetragonal, and revealed no degradation to the monoclinic phase after aging. By a substrate straining test, the fracture strain of the coating was revealed to be 1.5%, above the yield strain of the titanium alloy substrate. At this strain level, through-thickness cracks formed in the coating where slip bands emerged from the substrate. Qualitatively, the adhesion of the film was sufficient to prevent gross delamination of the film at high strain levels, although small regions of delamination were caused by compressive buckling of the film. This behavior indicates generally good adhesion. No change in this behavior was observed after aging.

Alloys↗

PubMed2003

Hemocompatibility of titanium oxide films.

Hemocompatibility is a key property of biomaterials that come in contact with blood. Surface modification has shown great potential for improving the hemocompatibility of biomedical materials and devices. In this paper, we describe our work of improving hemocompatibility with Ti-O thin films prepared by plasma immersion ion implantation and deposition and by sputtering. The structure and surface chemical and physical properties of the films were characterized by X-ray diffraction, Auger electron spectroscopy, atomic force microscopy (AFM), contact angle measurement, and Hall effect measurement. The behavior of fibrinogen adsorption was investigated by 125I radioactive isotope labeling and AFM. Systematic evaluation of hemocompatibility, including in vitro clotting time, thrombin time, prethrombin time, platelet adhesion, and in vivo implantation into dog's ventral aorta or right auricle from 17 to 90 days, proved that Ti-O films have excellent hemocompatibility. It is suggested that the significantly lower interface tension between Ti-O films and blood and plasma proteins and the semiconducting nature of Ti-O films give them their improved hemocompatibility.

Adsorption↗

PubMed1998

In vitro testing of surface-modified biomaterials.

The influence of surface modification treatments such as ion implantation and sputter coating on an in vitro rat bone-marrow cell culture was studied by scanning electron microscopy and X-ray microanalysis. 316 L stainless steel, Ti-6Al-4V and Ti-5Al-2.5Fe were nitrogen ion-implanted with three fluences: 10(15), 10(16) and 10(17) ion cm-2 with an energy beam of 40 keV. Both nitrogen and carbon sputter-coated 316 L stainless steel samples were also studied. Polished 316 L stainless steel, Ti-6Al-4V, Ti-5Al-2.5Fe and Thermanox were also studied, in order to give comparative information. The materials were inoculated with a droplet of cell suspension and were maintained for 3 wk. A mineralized extracellular matrix was formed on all materials except on nitrogen sputter-coated 316 L stainless steel. The morphology of the cell cultures obtained on nitrogen-ion implanted materials was similar to those obtained on the untreated materials and Thermanox. The observation of the interface between the cell layer and the substrata showed the presence of calcium- and phosphorus-rich globular deposits associated with collagen fibres. A higher density of these globular deposits was observed on the ion-implanted materials.

Journal Article↗

PubMed2005

Effect of laser perforation on the remodeling of acellular matrix grafts.

Autologous cells migrate only slightly into acellular matrix grafts. This study was carried out in small-diameter, allogeneic matrix grafts to investigate the effects on cell repopulation and remodeling caused by increased wall porosity induced by laser perforation. Allogeneic ovine carotid arteries were decellularized by dye-mediated photooxidation (Photofix). Matrix grafts (10 cm x 4 mm i.d.) were perforated with holes of 50 microm diameter at a density of 50 holes/cm(2) using a Ti-sapphire laser. The grafts were implanted in the carotid arteries of 10 sheep and were compared to nonperforated grafts implanted contralaterally. The prostheses were retrieved after 6 weeks or 3 or 6 months following implantation and were evaluated by histologic examination, immunohistochemical staining, and scanning electron microscopy. All grafts, except one of the perforated specimens, remained patent. Perforated implants, examined at 6 weeks, showed faster recellularization with endothelial cells than did the corresponding contralateral controls. Perforated grafts, examined at 6 months, showed a significantly thicker neointima and clear signs of neovascularization: endothelial cells, basal lamina, elastic fibers, circular and longitudinally orientated smooth muscle cells in comparison to nonperforated specimens. Repopulation of the decellularized matrix with host cells was higher in the perforated than in the nonperforated prostheses. These results suggest that the increased matrix porosity induced by laser perforation promotes graft remodeling and reconstitution with host cells.

Animals↗

PubMed2003

Action of FGMgCO3Ap-collagen composite in promoting bone formation.

To improve the biological properties of materials as bone substitutes, functionally graded CO3 apatite crystals containing magnesium, FGMgCO3Ap, were synthesized to be mixed with atelocollagen and made into a composite pellet. A radio-labeled cell adhesion experiment showed that the degree of adherence of mouse MC3T3E1 osteoblast-like cells to the FGMgCO3Ap-collagen composite was better than to CO3Ap-collagen and much better than to the Ti plate. When the composites were implanted beneath the periosteum cranii of rats, the FGMgCO3Ap-collagen composite was metabolized faster than the CO3Ap-collagen composite and better formation of new bone and osteoblast arrangement at the interface between the composite and the periosteum cranii was observed. When the composites were implanted into the femur of rabbits, clear bone formation with a higher degree of bone density was observed for the FGMgCO3Ap-collagen composite. These results suggest that the Mg2+ ions taken into the apatite crystals may contribute to the acceleration of osteoblast adhesion to apatites and promote bone formation, cross-talking with osteoblasts at the molecular level.

3-Hydroxysteroid Dehydrogenases↗

PubMed2001

Biocompatibility and performance of the Wallstent and several covered stents in a sheep iliac artery model.

PURPOSE: To compare the biocompatibility and performance of various stent-grafts to those of a bare stent in an ovine model with a subchronic (3 months) endpoint. MATERIALS AND METHODS: Three different types of stent-grafts (ePTFE/nitinol, n = 8; polyester/nitinol, n = 8; and polycarbonate urethane/cobalt-alloy, n = 8) and a bare stent as a control (Ni-Co-Ti-steel-alloy, n = 8) were implanted in the iliac arteries in eight female sheep. One type of each stent-graft was implanted per animal, two implants at each side. The implantation sites for each type varied from animal to animal. Angiographic control and intravascular ultrasound (IVUS) imaging were performed before and after implantation, after 2 months, and before explantation at 3 months and were used to characterize patency and to assess intimal hyperplasia. After 3 months, the implants were retrieved and subjected to histologic evaluation (after methacrylate embedding, cutting, and histologic staining) to characterize the biologic response. RESULTS: Implantation was technically successful in all procedures. At 2 and 3 months after implantation, all segments in which stents had been implanted were patent. Marked neointima formation was found in the polyester-covered stent-graft that showed significant luminal narrowing of 50%, compared to the ePTFE-covered (24%) and polycarbonate urethane-covered endoprostheses (22%), as well as the bare stent (Wallstent; 9%; P < .001). A minimal inflammatory vessel wall reaction was demonstrated for the polyester-covered and ePTFE-covered endoprostheses; the polycarbonate urethane-covered stent-graft's response was demonstrable but not significantly different from that of the Wallstent. At 3 months, the ePTFE-covered stent-graft showed incomplete (>90%) endothelial coverage; in the other endoprostheses, complete but partially immature endothelialization was found. CONCLUSION: All stent-grafts induced an inflammatory vessel wall reaction with neointimal hyperplasia. The polyester-covered endoprosthesis caused a marked reaction with 50% luminal stenosis. Endothelialization was retarded with the ePTFE-covered stent-graft. The bare stent performed best in regard to neointimal formation and caused the least inflammatory response.

Alloys↗

PubMed1984

In vivo metal-ion release from porous titanium-fiber material.

Dense and porous Ti, Ti-alloy, and stainless steel specimens were implanted in canine trabecular bone. After 6 and 12 months the specimens were retrieved together with bone tissue immediately adjacent. The trace metal content in the tissue samples was determined using neutron activation analysis, differential pulse polarography, graphite furnace atomic-absorption spectrophotometry, electron microprobe analysis, and laser microprobe analysis. The results are discussed in view of (i) the release of Ti ions, which is larger for porous than for bulk specimens, (ii) the various artifacts arising in electron microprobe (EMP) and laser microprobe mass analysis (LAMMA) determination of compositional gradients of trace metal-ion content in bone tissue, (iii) the absence of measurable quantities of V in bone tissue, and (iv) the difference in local tissue accumulation between Ti, released from Ti specimens, and Ni, released from stainless steel specimens.

Alloys↗

PubMed1996

Analysis of osteoblast mineral deposits on orthopaedic/dental implant metals.

Neonatal rat calvarial osteoblasts were cultured on Ti-6Al-4V, Co-Cr-Mo alloy, 316L stainless steel and polystyrene (reference substrate) in the presence of ascorbic acid and 10 mM beta-glycerophosphate for 16, 17, 18, 19, 20, 21, 24 and 28 d. Scanning electron microscopy examination revealed that osteoblasts cultured on these orthopaedic/dental implant metals synthesized and deposited an extracellular matrix containing collagenous and non-collagenous components, as well as mineral nodules of various morphologies. Energy dispersive spectrometry revealed that the mineral deposits consisted of three distinct chemical compositions: calcium phosphate, calcium-sulphur-phosphorus, and calcium only. Backscattered electron imaging demonstrated that both the calcium phosphate and calcium-only deposits were electron dense, while the calcium-sulphur-phosphorus deposits were electron translucent. X-ray diffraction analysis indicated that the bulk of the osteoblast mineral deposits was amorphous hydroxyapatite; in addition, electron diffraction analysis revealed small regions of crystalline hydroxyapatite.

Alloys↗

PubMed2001

Evaluation of systemic metal diffusion after spinal pedicular fixation with titanium alloy and stainless steel system: a 36-month experimental study in sheep.

It is known that titanium alloys cause more extensive local metallosis due to fretting corrosion than stainless steel implants. The aim of the present study was to investigate possible systemic metal releases (Ti, Al, V, Cr, Ni) in sheep where L4-L5 were implanted with titanium alloy (Ti6Al4V, ASTM F 136) and stainless steel (AISI 316 L). 16 sheep were used: 8 were implanted with Ti6Al4V and 8 with stainless steel. At 6, 12, 24 and 36 months, the following examinations were performed: histology, atomic absorption spectrophotometry (AAS) and scanning electron microscopy (SEM), on liver, lung, kidney, brain, spleen and lumbo-aortic lymph nodes. Hair, urine and arteria blood samples were also analysed by AAS before implantation and at sacrifices. A histologic and ultrastructural study was performed on peri-implant tissues, too. Particular attention was paid to avoid contamination from dissection instruments or use of containers. In basal and in samples at 6 and 12 months, no metals were found in blood, urine, hair or other target tissues of the animals implanted with either Ti6Al4V or stainless steel. Regarding Al, V, Co and Ni, negative results in all tissues and body fluids were obtained also at 24 and 36 months. On the contrary, Ti traces were found in lumbo-aortic lymph nodes and lungs of one sheep only (10 and 30 ng/g, respectively) at 24 months. At 36 months, a systemic diffusion of Ti was observed in all tissues of both sheep instrumented with Ti6Al4V (2-16.5 ng/g), except for body fluids and hair. Metal research in target tissues by light and SEM micro-probe analysis provided negative results. Current data suggest that the amount of Ti found in organs after stable pedicular fixation is extremely low and not biologically available. This observation would lead us to exclude the hypothesis of any toxic reaction and such a release seems to be due to the passive diffusion through lymphatic fluids. Additional studies are needed to confirm if this long-term release of Ti particles might cause tissue damage.

Animals↗

PubMedDate not supplied

Fatigue properties of carbon- and porous-coated Ti-6Al-4V alloy.

A porous metal coating applied to a solid substrate implant has been shown, in vivo, to offer advantages over current polymethylmethacrylate cement fixation in orthopedic devices. These advantages may be lost, however, in devices requiring a sintering heat treatment to apply the coating since these treatments may have a detrimental effect on the substrate material mechanical properties. In addition, more biocompatible interface coating materials have come of interest with recent literature reports of metal ion release. These coatings may be of particular use in porous-coated systems since the surface area of implant in contact with the surrounding tissues is greatly increased. This study investigated the effects that both a porous Ti- 6Al -4V alloy coating and a ULTI carbon coating have on the fatigue properties of a Ti- 6Al -4V alloy substrate system. The fatigue properties of uncoated as-received, uncoated sinter heat treated and notched Ti- 6Al -4V material were also investigated. The results of this study revealed endurance limits for Ti- 6Al -4V alloy tested with a rotating beam system of 617 MN/m2 (uncoated as-received), 624 MN/m2 ( ULTI carbon-coated), 377 MN/m2 ( sinter heat treated), 220 MN/m2 (notched) and 138 MN/m2 (porous-coated). No effects on fatigue properties were observed when testing the material in saline compared with air. The slight increase in fatigue strength for the carbon-coated material is thought to be due to the increase in surface hardness resulting from the formation of titanium carbides on the surface. The low-endurance limit of the porous-coated material is due to both the transition from the as-received equiaxed microstructure to a lamellar microstructure upon sintering and to the notch effect created by the porous coating.

Alloys↗

PubMed1995

The influence of surface-blasting on the incorporation of titanium-alloy implants in a rabbit intramedullary model.

The apposition of new bone to polished solid implants and to implants with surfaces that had been blasted with one of three methods of grit-blasting was studied in a rabbit intramedullary model to test the hypothesis that blasted implant surfaces support osseous integration. Intramedullary titanium-alloy (Ti-6Al-4V) plugs, press-fit into the distal aspect of the femoral canal, were implanted bilaterally in fifty-six rabbits. Four surface treatments were studied: polished (a surface roughness of 0.4 to 0.6 micrometer) and blasted with stainless-steel shot (a surface roughness of five to seven micrometers), with thirty-six-grit aluminum oxide (a surface roughness of five to seven micrometers), or with sixty-grit aluminum oxide (a surface roughness of three to five micrometers). Localized attachment of new bone to the surfaces of the blasted implants was present radiographically at twelve weeks. The total bone area was significantly affected by the level of the section (the diaphysis had a greater bone area than the proximal part of the metaphysis and the proximal part of the metaphysis had a greater bone area than the distal part of the metaphysis; p < 0.001) and the quadrant within each section (the posterior and anterior quadrants had greater bone area than the medial and lateral quadrants; p < 0.00001). The length of the bone-implant interface was significantly affected by the surface treatment (the length of the bone-implant interface for the implants that had been blasted with sixty-grit aluminum oxide was greater than the length for the polished implants; p = 0.02), the time after implantation (the interface was longer at six and twelve weeks than at three weeks; p < 0.00001), and the level of the section (the interface was longer at the diaphysis than at the proximal part of the metaphysis and longer at the proximal part of the metaphysis than at the distal part of the metaphysis; p = 0.004). Blasting of the surface of titanium-alloy implants did not have an effect on the area of bone formation around the implants, but it did significantly affect the area of bone formation on the implant and the shear strength at the bone-implant interface. The two effects were not necessarily parallel, as significantly less (p < 0.05) bone formed on implants that had been blasted with stainless-steel shot than on those blasted with aluminum grit, whereas their interface shear strengths were similar.

Alloys↗

PubMed1998

The Endopore implant-enhanced osseointegration with a sintered porous-surfaced design.

The Endopore implant provides a novel method for reliable fixation of endosseous dental implants within the bone. Through the use of a porous-surfaced zone formed by sintering Ti alloy particles of the appropriate size and under appropriate processing conditions to a sold Ti alloy core of desired shape (tapered truncated cone), an implant is now available that can be placed using a relatively simple surgical procedure using either surgical burs or hand osteotomes. Of even greater value is the suitability of this implant design for treatment of cases that because of minimal bone height cannot be treated routinely using other currently-available implants. The high success rates experienced with significantly shorter implant lengths compared with other designs indicate the appropriateness of this system for difficult-to-treat cases. The Endopore system represents the next generation of endosseous dental implants characterized by uncomplicated and reliable treatment for a wider range of dentally-compromised patients. Its history is founded on extensive and fully-documented research at the human preclinical stage as well as human use experiences. The results during the past nine years have confirmed the high expectations that those early studies suggested.

Dental Implantation, Endosseous↗