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PubMed2000

Maintaining cosmetics and marginal bone with a dental implant.

Inherent concerns for all implant systems exist. These concerns include complex restorative procedures, abutment rotational problems, marginal bone loss, and, in some cases, less than ideal cosmetic results. To overcome or reduce these problems, a new implant has been designed. The implant has been evaluated in this prospective study. Thirty-three new design implants were placed in 11 patients for an average time of 27.25 months. The new implant design proved to be easier to restore, posed no abutment rotational problems, resulted in no marginal bone loss problems (positive bone maintenance), and produced exceptional favorable cosmetic results.

Adult↗
PubMed1992

Relative production of IL-1 beta and TNF alpha by mononuclear cells after exposure to dental implants.

Interleukin-1 (also known as osteoclast activating factor, OAF) is a cytokine produced primarily by monocytes and macrophages and is thought to mediate many of the immunologic, metabolic, and endocrine alterations seen with microbial infection, tissue injury, inflammatory disease, and bone loss. Stimuli for IL-1 production include microorganisms, endotoxins (LPS), antigen-antibody complexes, clotting components, and other cytokines. The purpose of this study was to determine whether dental implants stimulated peripheral blood mononuclear cells (PBMCs) to produce IL-1 beta (OAF) as well as tumor necrosis factor (TNF alpha). This production may lead to bone loss or failure of an implant. Three duplicates of five different implants were incubated with 2 x 10(6) PBMCs/ml in 20% autologous serum; the esterase positive PBMCs amounted to 14.5%. Measured by radioimmunoassay techniques and compared to controls, all of the implants except one caused significant in vitro generation of IL-1 beta and TNF alpha. The stimulation of IL-1 beta/TNF alpha production by these materials suggests that they are not physiologically inert and that the IL-1 beta (OAF) production may contribute to a less favorable osseoadaptation. OAF has a physiologic (homeostatic) role in maintenance and alteration of osseous structures, but the level at which physiologic becomes pathologic is unknown. Although there were statistical differences between the cellular response to these implants, the clinical significance of the differences remains to be determined.

Cells, Cultured↗
PubMed2005

Issues and considerations in dental implant occlusion: what do we know, and what do we need to find out?

Implant dentistry continues to struggle with what are the appropriate occlusal concept(s) for implant-supported restorations. The biological and mechanical consequences of the loading environment leads to establishing and maintaining an implant interface in a wide variety of bone quality and quantity, implant and prosthesis designs. To the restorative dentist, the role of occlusion is more focused on extending the service life of the restoration and the connecting abutment(s) than protecting the osseous integration of the implant(s). This study reviews the relevant issues regarding implant occlusion along with implant and prosthesis design in order to provide optimal patient care.

Animals↗
PubMed1999

A 5-year comparison of hydroxyapatite-coated titanium plasma-sprayed and titanium plasma-sprayed cylinder dental implants.

OBJECTIVE: A preliminary report from this study showed that hydroxyapatite-coated (HA) titanium plasma-sprayed (TPS) cylinder implants had fewer failures than TPS cylinder implants before prosthetic loading. The purpose of this article is to report the long-term success associated with the 2 systems. In addition, local and systemic factors that may influence the success or failure of the implants were analyzed. STUDY DESIGN: Each of 65 subjects was randomized to either HA-coated TPS or TPS cylinder implants. Loss of an implant was considered a failure. Failures were analyzed in terms of the coating of the implant, age and gender of the patient, location and length of the implant, opposing dentition, and smoking status. Data were statistically analyzed through use of chi-square tests. RESULTS: Of 351 implants that were placed, 13 were lost before prosthetic loading and 17 were lost after prosthetic loading. The overall success rate was 92.8%. Three hundred thirty-eight implants were prosthetically loaded. The implant success rate after prosthetic loading was 95.3%. There was an overall nonsignificant higher failure rate for the TPS implants (8.0%). Patient age and patient gender were nonsignificant variables. Ten-mm implants had a significantly higher failure rate (17.4%; chi-square, 1.00; P = .39). Before prosthetic loading, more implants failed in the posterior mandible; after prosthetic loading, more implants failed in the anterior maxilla (chi-square, 8.97; P = .03). More implants failed when they were opposed by natural dentition or hybrids (chi-square, 7.36; P = .007). Smoking history was a significant factor (chi-square, 5.2; P = .002). CONCLUSIONS: Statistically, there is little difference between the 2 systems. Local and systemic factors appear to play a greater role in implant failure than does the surface of the implant.

Adult↗
PubMed2000

The ankylos endosseous dental implant: assessment of stability up to 18 months with the Periotest.

Osseointegration is an ongoing histometric process that may vary during clinical function. The implant must be stable at uncovering, which reflects the status of bone-implant interface. The physiology of bone healing associated with endosseous implants suggests that this process occurs between 8 and 12 months, and Periotest values (PTVs) tend to reflect changes in the stability of the bone-implant interface. Stability generally increases gradually from the time of uncovering to an optimal PTV that occurs at a point close to 12 months. This stable interface must remain intact for long-term clinical survival. Rapid development of this optimal PTV is highly desirable in order to prevent premature overloading of the bone-implant interface. The Ankylos implant is a new screw-type implant design in which the thread pitch and length vary to maximize trabecular bone contact. The purpose of this report is to evaluate to 18 months the stability (PTVs) of this implant design. More than 457 implants were placed and followed for a period of 18 months by the multicentered, multidisciplinary Ankylos Implant Clinical Research Group (AICRG). Implant stability (PTVs) was assessed using the Periotest at abutment connection and at 3, 6, 9, 12, and 18 months after uncovering. The Periotest values for all implants rapidly reached an optimal status between uncovering (-3.1 PTVs) and 3 months (-3.4 PTVs). This rapid increase in stability has not previously been reported for other implant designs. The mandibular arch was more negative (-3.8 PTVs) at uncovering as compared with the PTVs for the maxillary arch (-1.7 PTVs). Negative PTVs were recorded (1) as length and diameter increased, (2) as bone density increased, (3) in certain jaw regions, (4) as the number of implants/case increased, and (5) for implants stabile at placement. The Ankylos screw implant design produced rapid stabilization 3 months after uncovering.

Analysis of Variance↗
PubMed1990

Presurgical evaluation for dental implants using a reformatting program of computed tomography: maxilla/mandible shape pattern analysis (MSPA).

A new analysis technique that provides a shape pattern of the maxilla or mandible is described. This technique uses a software program of computed tomography multiplanar reformation (CT/MPR). The successive cross-sectional images obtained by the CT/MPR are numbered, and the height and width of the maxilla and mandible at each of these cross-sectional images at specified levels are measured. The measured height and width are plotted against the number of the cross-section. This technique, termed maxilla/mandible shape pattern analysis (MSPA), creates an easy profile of the shape of the maxilla and mandible, and it enhances treatment planning for the placement of dental implants.

Aged↗
PubMedDate not supplied

Short (8-mm) dental implants in the rehabilitation of partial and complete edentulism: a 3- to 14-year longitudinal study.

PURPOSE: This study aimed to evaluate the clinical effectiveness of different implant sizes (8- and 10-mm lengths with 3.75-, 4.1-, and 4.8-mm diameters) in diverse host bone sites in a selected sample of partially and completely edentulous patients. MATERIALS AND METHODS: Over a 14-year period, 129 patients (68 women and 61 men) were consecutively treated with a fixed prosthesis (single or multiunit, screw or cement retained) supported by 265 different-sized implants (154 standard 10-mm; 111 shorter 8-mm). Two types of implants were used (141 titanium plasma-sprayed and 124 Sand-blasted, large-grit, acid-etched). RESULTS: Dropouts were recorded for 23 patients with 23 prostheses supported by 42 implants. In the remaining 106 patients (223 implants), 8 implants failed (4 standard and 4 shorter), in type 3 or 4 bone. Mean marginal bone loss and gingival crevice probing depth associated with either implant length were statistically comparable (P> .05). The 14-year cumulative survival rates for all short and standard implants were 97.9% and 97.1%, respectively. Survival rates were 92.3% and 95.9% for titanium plasma-sprayed short and standard implants, respectively, and 100% and 98.5% for the Sand-blasted, large-grit, acid-etched short and standard implants, respectively. Six of the 8 lost implants required implant replacement after the host sites' healing period. The remaining 2 lost implants were managed by converting the distal unit of the fixed partial prosthesis to a cantilever. CONCLUSION: Within the limits of the study design and observation period, a mix of implant sizes did not appear to compromise the effectiveness of implant therapy in this particular population group.

Alveolar Bone Loss↗
PubMed1990

[Hydroxyapatite coated dental implants. Biological criteria and prosthetic possibilities].

Incorporating contemporary implant research and the most advanced principals of biomaterials and bioengineering puts HA-coated implant system into clinical practice. This system utilizes a streamline precision two-stage procedure similar to the swedish method and other osseointegrated systems to ensure complete fixation and an unloaded healing phase prior to the functional use of implants. The surgical concept has been theoretically improved upon by enhancing the titanium cylinders with a HA coating of 50 to 65 microns to the body. The advantages of HA have been extensively discussed. Research has shown that a biochemical reaction occurs between HA and bone and the interface between bone and ceramic is stronger than either the ceramic or bone alone. Bone adapts well to all biocompatible metals and bone will "chemically" bond to HA. An activated sintering process has been developed that enables HA to be chemically bound to the titanium cylinder using a modification of the plasma flame spray technology. This HA coating has been developed to meet the most rigorous biomechanical requirements for bonding in high stress applications of orthopedics as well as intraoral use. Biointegration is defined as "mechanochemical" clinically significant interface that predictably develops between vital load bearing bone and a bioactive calcium-phosphate ceramic metal such as HA. The design and planning of the HA-coated metal system also provides a variety of restorative choices and have been extensively discussed in this article. Clinical reports appear excellent, and the current implant system is into its fifth year of clinical use. The use of HA-coated implants has very well satisfied restorative needs as well as following sound biologic principle.

Adult↗
PubMed1997

A 5-year prospective clinical study of Astra Tech dental implants supporting fixed bridges or overdentures in the edentulous mandible.

In a 5-year prospective clinical study, 155 endosseous implants were installed in the mandible anterior to the mental foramina in 33 edentulous patients (13 males and 20 females). Usually 6 implants were installed for fixed prostheses (FP), 13 patients with 77 implants, and 4 implants for overdentures (OD) with a Dolder bar, 20 patients with 78 implants. At the time of abutment connection 1 implant in 2 patients was found to be loose and removed. However, in both these patients overdentures were successfully placed on the remaining 3 implants. Narrow-beam radiography was used for radiological evaluation. The mean (SD) total marginal bone loss in 5 years was 0.48 (0.38) mm (0.36 (0.22) mm in the FP group and 0.56 (0.45) mm in the OD group). Very few complications were reported during the 5 years, most of them being related to the superstructures. The overall cumulative implant survival rate was 98.7% (100% in the FP group and 97.4% in the OD group). The survival rate of the superstructures was 100%. The present study has demonstrated that Astra Tech implants offer reliable and predictable medium-term support for fixed prostheses and overdentures in the edentulous mandible.

Adult↗
PubMedDate not supplied

A 1-year radiographic evaluation of marginal bone around dental implants.

The aim of this study was to report alveolar bone loss during the first 12 months after implant abutment connection. Marginal bone loss around 62 endosseous root-form implants in 62 patients was measured on periapical radiographs. Changes in bone density were measured by the digital subtraction image radiographic method. At 3-month intervals for 1 year, bone loss around the four types of implants used (standard series, mini series, and hexlock implants of the Steri-Oss system; and 3i standard implants) was investigated. Rapid bone loss around all four implant types occurred in the first 3 months. Most of the implants showed resorption of alveolar bone beyond the polished neck at 12 months. The bone level stabilized at the first thread of the implants with no correlation to either the time of exposure of the polished neck or the type of implant. Bone density decreased at the marginal bone and increased at the newly formed alveolar crest.

Adolescent↗
PubMed2006

Removal torque and physico-chemical characteristics of dental implants etched with hydrofluoric and nitric acid. An experimental study in Beagle dogs.

OBJECTIVE: To study the composition, surface characteristics and response to removal torque of an implant surface subjected to hydrofluoric acid etching and posterior passivating with hydrofluoric and nitric acid. STUDY DESIGN: Twelve implants were initially selected and their physico-chemical characteristics were evaluated by means of energy-dispersive X-rays (EDS), scanning electron microscopy (SEM) and photoelectron spectroscopy (XPS). In addition, 24 implants - 12 measuring 8 mm and 12 measuring 10 mm in length - were implanted in 6 Beagle dogs. Twelve implants were removed after a recovery period of 6 weeks, followed by removal of the remaining 12 implants after 12 weeks, using a torque calibrator (Gauge Tonichi model BGT150CN-S) with a force registry range of 0-150 Ncm. RESULTS: EDS analysis of the surface chemical composition only revealed the presence of titanium in the etched surfaces. In the same way as with the surfaces of other dental implants, XPS analysis revealed traces of other elements present in the surface, fundamentally carbon. Following dual acid etching, the surface showed the roughness resulting from acid action, with a morphology that proved to be quite homogeneous. The roughness values obtained exceeded 1 mm. The mean removal torque values after 6 weeks were 79.7 Ncm for the 8 mm implants and 115 Ncm for the 10 mm implants. After 12 weeks, these values increased to 101.2 Ncm and 139.7 Ncm, respectively. CONCLUSIONS: Hydrofluoric and nitric acid etching affords optimum surface characteristics comparable to those of other surfaces. The recorded removal torque values raise the possibility of human clinical application for early or immediate loading procedures.

Acid Etching, Dental↗
PubMed1990

Electrical stimulation of bone and its implications for endosseous dental implantation.

Applied electrical potentials can alter cellular movement, stimulate production or destruction of cells, and change the chemical concentration and composition of both soft tissue and bone. These actions vary depending on the microamperage and duration of the applied current and whether it is continuous or pulsed, the type of metallic electrode, and the types of cells or tissues involved. Relative to skeletal effects, researchers have accumulated data from bone cell cultures, embryonic and adult animal bone, and human clinical studies. This article reviews the historical use of electric current for fracture healing, the piezoelectric effect found in tissues, and the possible deleterious effects of electrical stimulation. The types of electric current presently used for treating extremity fractures and reports where electric current has been used on tissues in the oral cavity are discussed. Alternate sources of energy to stimulate bone and possible implications for use of electrical stimulation to augment attachment of endosseous dental implants are also included.

Bone Regeneration↗