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PubMed1986

Characterization of surface roughness in titanium dental implants measured with scanning tunnelling microscopy at atmospheric pressure.

Characterization of the surface topography of implant materials is important for understanding tissue response. We have measured, for the first time, the topography of titanium surfaces used in osseointegrated dental implants. Scanning tunnelling microscopy (STM) which provides 3D real space images was used. In addition to clinical samples, electropolished and anodically oxidized surfaces were also measured. Clinical samples are rather inhomogeneous in character showing grooves and steps with a maximum depth of 0.11 micron. Micropores with an average diameter of about 30 nm are also present. Electropolished samples are rather homogeneous and very smooth, showing steps of 1 to 5 nm in height. The measurements were performed under atmospheric conditions at a resolution in the subnanometer range.

Dental Implantation, Endosseous↗
PubMed1991

The effect of partial coating with hydroxyapatite on bone remodeling in relation to porous-coated titanium-alloy dental implants in the dog.

For inhibition of crestal bone resorption due to stress shielding and disuse atrophy, an hydroxyapatite (HA) plasma coating was added to the coronal portion of partially porous-coated endosseous dental implants. These implants, as well as control non-HA-coated implants were placed in healed mandibular premolar extraction sites in dogs for a 72-week period of function. Histological examination showed that both implant designs became securely fixed by bone ingrowth into the porous-coated apical region of the implants. The plasma-sprayed HA coating resulted in significantly greater bone height formation and maintenance next to the coronal portion of the implant compared with non-HA-coated implants of similar design. In addition, significant resorption of the 20-to-50-microns-thick plasma-sprayed HA coating occurred over the 18-month period of function.

Alloys↗
PubMed2002

[Model investigation of push-out test used for quantitative evaluation of dental implant osseointegration].

A frequently used method for quantitative evaluation of implant-bone interface strength is the push-out test. The objective of the authors' study was to determine the effect of implants' geometric characteristics on the results of push-out method. The degree of osseointegration is determined by a complicated interaction of mechanical, biological and chemical factors. As this study focused on the effects of geometrical characteristics of dental implants, the authors tried to reduce the influence of biological and chemical factors as much as possible. For this reason a model of push-out test was set up. Cylindrical metal rods were imbedded in acrylic resin and were pushed out, meanwhile the force needed to disrupt the connection between the surface of the metal rods and the resin was measured and push-out strengths were calculated. Metal rods with three different lengths (7, 9, and 13 mm) and three different diameters (3.4, 4, 4.5 mm) were investigated. No correlation was found between implant length and maximum push-out strength. The mean push-out strengths were 17.32 MPa, 15.99 MPa and 15.56 MPa in groups, with 3.4, 4 and 4.5 mm diameter, thus the push-out strength decreases with increasing metal rod diameter. This may be attributed to the different distance between the outer circumference of the metal rods and the hole of the supporting table. Supporting this theory metal rods with identical diameter were examined, while the diameter of the hole on the supporting table was changed. The results demonstrated that larger holes on the supporting table resulted in higher push-out strengths. This indicates that comparisons of this variable should only be performed with standardized clearance of the hole on the supporting table. Push-out strengths of groups of cylindrical and conical implants with 9 degrees convergence were also investigated. The mean values were 16.57 MPa and 16.43 MPa, respectively. There was no statistically significant difference between the two groups. This means that results of experiments with all the above mentioned implant types are comparable, at least to that degree of conicity. As masticatory forces act usually on a surface, which is not perpendicular to the implant axis, we compared forces and push-out strengths that acted on surfaces with 10 degrees and 15 degrees inclination. The calculated average push-out strengths were 24.89 MPa and 22.56 MPa, respectively. More than twice as high push-out strengths were measured when threaded metal rods were compared to unthreaded ones (30.15 MPa, 14.89 MPa, respectively). Examining the effect of pitch of threads we compared the mean push-out strengths in three groups of threaded metal rods with pitch of threads 0.7, 1.0 and 1.25. The results were 28.86 MPa, 30.48 MPa, 31.12 MPa, respectively. The differences can be explained with the alteration in the dimension of the interface covered by the acrylic resin. Thus the effect of diameter, inclined opposing surface and threads must not be ignored if one compares the osseointegration capacity of different implants.

Dental Implantation, Endosseous↗
PubMed1991

Dental implant materials. II. Preparative procedures and surface spectroscopic studies.

The tissue response to an implant may involve both physical and chemical factors. There is little reliable information on the effects of these parameters and the associated ionic release on the cell-material interaction because the majority of studies have not fully characterized the implant material. In this work surface spectroscopy using ISS, ESCA, and SIMS was carried out on Ti6A14V, Co-Cr-Mo, A12O3, and hydroxyapatite dental implant materials that had been subjected to six commonly used preparative procedures. The results showed that each procedure generated an individualistic composition for the outermost surface of each material. These differences could be significant in cellular and tissue response. Improved understanding of these factors requires defined and reproducible surfaces.

Alloys↗
PubMed1979

Porous titanium endosseous dental implants in Rhesus monkeys: microradiography and histological evaluation.

Artificial tooth roots with porous surface coatings were fabricated by sintering spherical powder of titanium alloy to solid cylindrical cores. The tooth roots were implanted subgingivally in healed mandibular premolar extraction sites of fifteen Rhesus monkeys. Supracrestal abutments were screwed into pretapped holes in the superior aspect of the primary subgingival stage four to eight weeks after implantation of the root. Clinical evaluations were performed monthly. Ten animals were sacrificed for histological evaluation of the functioning free standing implants. Of twenty-nine implants placed, three were lost and four were rated failures on the basis of histological evaluation. Postmortem evaluations revealed bone growth into the porous surface coating of the primary stage of all the implants. The most characteristic features which could be used to describe differences in the implant histology were the buccal and lingual crestal bone heights measured in relation to the root porosity. Twelve of sixteen implants had crestal bone heights within one millimeter of the superior aspect of the root. Four other implants displayed excessive bone recession, revealing as much as one half of the root porosity supracrestally. The four implant failures could be related to unfavorable features of recipient bone sites. The results demonstrate that the bone growth into the porous surface coatings of artificial tooth roots is an efficacious method of dental implant fixation.

Alloys↗
PubMed2006

Endodontic or dental implant therapy: the factors affecting treatment planning.

BACKGROUND: Clinicians are confronted with difficult choices regarding whether a tooth with pulpal and/or periapical disease should be saved through endodontic treatment or be extracted and replaced with an implant. METHODS: The authors examined publications (research, literature reviews and systematic reviews) related to the factors affecting decision making for patients who have oral diseases or traumatic injuries. RESULTS: The factors to be considered included patient-related issues (systemic and oral health, as well as comfort and treatment perceptions), tooth- and periodontium-related factors (pulpal and periodontal conditions, color characteristics of the teeth, quantity and quality of bone, and soft-tissue anatomy) and treatment-related factors (the potential for procedural complications, required adjunctive procedures and treatment outcomes). CONCLUSIONS: On the basis of survival rates, it appears that more than 95 percent of dental implants and teeth that have undergone endodontic treatment remain functional over time. CLINICAL IMPLICATIONS: Clinicians need to consider carefully several factors before choosing whether to perform endodontic therapy or extract a tooth and place an implant. The result should be high levels of comfort, function, longevity and esthetics for patients.

Bone Density↗
PubMed2003

Combination syndrome: treatment with dental implants.

Occlusal plane problems are often not evaluated adequately. They can be left untreated or improperly treated. This article reviews one such problem known as Combination Syndrome. The treatment method described involves using a fixed mandibular prosthesis over implants that have been placed immediately after dental extractions.

Alveoloplasty↗
PubMed1980

Myofibroblasts in connective tissue capsules around implanted dental materials.

For testing the biocompatibility of dental materials in an experimental animal model the capsular tissues around the implanted dental materials were examined light and electron microscopically. The exudative inflammation and fibrosis at different times after implantation were thought to be the indicators of the degree of the compatibility. Starting from the knowledge of the occurrence of myofibroblasts in reparative granulation tissue we looked for such cells in the capsular tissues. Myofibroblasts were especially found at three weeks after onset of the experiments. Structural peculiarities of this fibroblast modulation are emphasized. Myofibroblasts are considered as an essential link between the early exudative reaction and the late fiber formation in tissue reactions after mechanical injury.

Animals↗
PubMed2001

Preliminary report of immediately loaded Altiva Natural Tooth Replacement dental implants.

BACKGROUND: Osseointegration may be described as a direct contact between living bone and an alloplastic implant. It is thought that a period of undisturbed healing is required to ensure osseointegration. The length of the healing period is dependent on a number of factors, such as implant material, surface configuration, site preparation technique, bone quality, healing capacity of the osteotomy, and implant design. Elimination of the healing period offers distinct advantages in terms of cost of therapy and convenience to patients. Recently, a new one-piece implant design was proposed that provides improved stability of the implant to allow immediate support of an interim prosthesis. PURPOSE: This article presents the initial clinical experiences when the Altiva Natural Tooth Replacement one-piece implant was used in a human clinical trial. MATERIALS AND METHODS: This was a prospective multicenter study of the placement and immediate loading of the one-piece implant. A total of 142 implants were placed in the jaws of 93 patients. Implants were placed consecutively and were followed at specified intervals in three private clinical practices. Clinical performance was recorded relative to implant survival and prosthesis support. RESULTS: The implant survival rate was 93.7%, with similar responses in the maxilla (95.0%) and the mandible (92.7%). When implant failure occurred, it was observed as mobility without infection within 3 to 5 weeks of implant insertion. CONCLUSIONS: On the basis of this trial, there is promising evidence that this implant design can succeed at rates similar to other designs that require conventional healing times.

Adult↗
PubMed2004

Demonstration of the osseoinductive effect of bone morphogenetic protein within endosseous dental implants.

The purpose of this case report was to demonstrate the host osseous response in the maxilla after placing bone morphogenetic protein (BMP) within a specially designed implant. Under normal circumstances, it is usually necessary to wait from 4 to 6 months, or even longer in some cases, for osseous integration. Our objective was to assess the ability of BMP, which was carried on an absorbable collagen sponge in horizontal portals of the subject im plant,to affect the formation of bone in a Macaca fascicularis monkey. A control implant was loaded internally with autogenous bone recovered from the preparation of the osteotomy. The results demonstrated that osseous peri-implant healing occurs using BMP in this format.

Animals↗
PubMed2005

Socket preservation followed by dental implant supported restorative treatment: a case report.

Implant-supported restorative treatment continues to revolutionize all aspects of dentistry. Any clinical procedure(s) with the potential to enhance and improve the success of implant-supported restorative treatment will gain favor with both practitioner and patient. Socket preservation following tooth extraction appears to offer several clinical advantages in preparing the ridge for future implant placement. A case report is presented describing treatment of a patient with evidence of root resorption of the maxillary central incisors, resulting in extraction and socket preservation followed by implant supported restorative treatment.

Adult↗
PubMed2000

A methodological study for the analysis of apatite-coated dental implants retrieved from humans.

The stability of thermally processed hydroxyapatite coatings for oral and orthopedic bioprostheses has been questioned. Information on the chemical changes, which occur with hydroxyapatite biomaterials post-implantation in humans, is lacking. The purpose of this investigation was to begin to examine post-implantation surface changes of hydroxyapatite-coated implants using scanning electron microscopy (SEM), x-ray microanalysis (EDAX), Fourier transform infrared spectroscopy (FTIR), and x-ray diffraction (XRD). Three retrieved dental implant specimens from humans following clinical failure due to peri-implantitis were examined. Unimplanted cylinders served as controls. Clinically, the retrieved specimens were all enveloped by a fibrous tissue capsule with bone present at the apical extent of the implant. SEM analysis showed that the retrieved surfaces were coated with both calcified and proteinaceous deposits. EDAX scans of the retrieved specimens demonstrated evidence of hydroxyapatite coating loss reflected by increasing titanium and aluminum signals. Other foreign ions such as sodium, chloride, sulfur, silica, and magnesium were detected. XRD of the control specimens showed that the samples were predominantly apatite; however, two peaks were detected in the diffraction pattern, which are not characteristic of hydroxyapatite, indicating that small amounts of one or more other crystalline phases were also present. The retrieved specimens showed slightly larger average crystal size relative to the control sample material, and the non-apatite lines were not present. FTIR evaluation of the retrieved specimens revealed the incorporation of carbonate and organic matrix on or into the hydroxyapatite. Narrowing of and increased detail in the phosphate peaks indicated an increase in average crystal size and/or perfection relative to the controls, as did the XRD results. Based on these results, we conclude that chemical changes may occur within the coating, with the incorporation of carbonate and concomitant reduction in hydroxyapatite coating thickness. Thermodynamic dissolution-reprecipitation of the coating itself and subsequent surface insult by bacterial and local inflammatory components may be involved with these changes.

Aluminum↗
PubMed1997

Critical evaluation of patient responses to dental implant therapy.

STATEMENT OF PROBLEM: Successful rehabilitation of the edentulous condition requires functional and psychosocial adaptation by the patient. Quality of life is markedly affected by the amount of satisfaction or dissatisfaction with their dental therapy. Patient concerns are primarily related to comfort, function, and esthetics. When these do not meet the patients expectations, anxiety, insecurity, diminished self-esteem, and introversion are typical psychosocial responses. PURPOSE: The objectives of the study were to assess the patient's subjective feelings about: (a) comfort, (b) function, (c) esthetics, (d) speech, (e) self-image, and (f) overall dental health with their existing complete dentures, and after implant therapy and prosthodontic rehabilitation. MATERIAL AND METHODS: Two health-related quality of life (HRQL) questionnaires were developed to evaluate the effectiveness of dental implant therapy; one dealing with their feelings about their conventional complete dentures, and the second dealing with implant therapy. The first questionnaire was administered with supervision before receiving implant treatment. The second questionnaire was administered within 1 year after completion of prosthetic rehabilitation. Twenty-six patients who received implants to support a mandibular prosthesis and a new maxillary denture formed the experimental population. RESULTS: Discriminative and evaluative analysis of subjective patient responses provided reliable, accurate, and reproducible results. Assessment of subject feelings before and after implant therapy and prosthodontic rehabilitation demonstrated significant differences when before treatment responses were compared with the responses after therapy. CONCLUSIONS: Significant differences for comfort, function, speech, esthetics, self-image, and dental health were demonstrated when conventional complete dentures and dental implant therapy were compared. HRQL data provided scientific evidence of an improved quality of life after dental implant therapy (p < 0.000).

Adaptation, Physiological↗
PubMed2007

Effects of diabetes on the osseointegration of dental implants.

The increased prevalence of diabetes mellitus has become a public health problem. Hyperglycaemia entails a rise in the morbidity and mortality of these patients. Although a direct relationship with periodontal disease has already been shown, little is known about the results of dental implants in diabetics. The present paper reviews the bibliography linking the effect of diabetes on the osseointegration of implants and the healing of soft tissue. In experimental models of diabetes, a reduced level of bone-implant contact has been shown, and this can be reversed by means of treatment with insulin. Compared with the general population, a higher failure rate is seen in diabetic patients. Most of these occur during the first year of functional loading, seemingly pointing to the microvascular complications of this condition as a possible causal factor. These complications also compromise the healing of soft tissues. It is necessary to take certain special considerations into account for the placement of implants in diabetic patient. A good control of plasma glycaemia, together with other measures, has been shown to improve the percentages of implant survival in these patients.

Dental Implants↗