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PubMed2000

[Histological study on the polyhydroxybutyric ester(PHB) membrane used for guided bone regeneration around titanium dental implants].

OBJECTIVE: To evaluate the effects of PHB membrane around dental titanium implants used in guided bone regeneration technique. METHODS: Endosseous cylindrical implants were placed in dogs' mandibles after extraction of all the mandibular premolars and the first molars immediately. Ideal implant placement sites were modified by creating standardized 3 mm x 5 mm facial dehiscent defects. The defects were covered with PHB membrane and titanium membrane respectively, then the membranes were fixed on the periosteum by sutures, and the remainder served as controls. Tissue closure was achieved with mattress and interrupted single sutures, and antibiotic injection was given to the dogs in the following 3 days. The dogs were divided into three groups according to the healing time of 1, 2 and 3 months, then the three groups of dogs were sacrificed. After that, tissue blocks containing the implants and the control ones were removed and studied by gross observation, X-ray radiograph and fluorescence microscope, and the surfaces of the membranes were observed by scanning electron microscope. The specimen used for light microscope study were fixed with 10% formaldehyde for 24 hours, and decalcified with 0.5 mol/L EDTA for 2 weeks. After the titanium implants were carefully removed, the tissue blocks were embedded into the paraffin wax, and the sections were obtained. RESULTS: The PHB membrane degraded slowly and partly 3 months after placement, and the biodegradable property of the PHB membrane deserved a longer period of study; The bone defects covered with PHB and titanium membrane were filled with much more new bone than that of the control group. CONCLUSION: PHB membrane can enhance bone formation and can be used for guided bone regeneration.

Animals↗
PubMed1997

Supracrestal bone regeneration around dental implants using a calcium carbonate and a fibrin-fibronectin sealing system: clinical and histologic evidence.

This study evaluated a new surgical technique for the treatment of an alveolar ridge deficiency in 11 patients. Twenty-two implants were placed, 15 of which presented with a combination of supracrestal and dehiscence kinds of defects, and seven presented only supracrestal bone loss. Surgical procedures were performed utilizing a combination of the resorbable space-making material calcium carbonate stabilized with a fibrin-fibronectin sealing system and the immediate placement of titanium dental implants. After implant placement, the mean height for supracrestal and dehiscence defects measured 2.57 +/- 1.41 mm and 2.47 +/- 1.54 mm, respectively. The defects were filled with calcium carbonate and a fibrin-fibronectin sealing system, and the flaps were sutured, avoiding any compression of the treated area. Healing was uneventful in all instances. At second-stage surgery at 6 months, a hard bone-like tissue was detectable at the defect sites. Histologic examination of four defects confirmed the presence of newly formed bone and revealed residual particles of calcium carbonate. There was a mean gain of 2.05 +/- 1.47 mm in the supracrestal defects and of 2.23 +/- 1.62 mm in the dehiscences. The results indicated that calcium carbonate, combined with a fibrin-fibronectin sealing system, is a viable alternative in the treatment of supracrestal and dehiscence bony defects.

Adult↗
PubMed1990

[Comparative study of two different types of dental implants in dogs. Experimental study].

Mandibular incisors were taken out in 13 adult dogs. Twenty days after the extraction, two implants either of titanium or hydroxylapatite were placed in a second operation. The clinical, pathological and radiological results suggest that metallic implants produce fibrous tissue around the implant. In most cases, fibrous tissue does not ossify and this facilitates the formation of a malunion and the mobilization of the implant. However, the results with hydroxylapatite implants appear to be satisfactory due to the formation of an osseous tissue mandibular bone. This tissue prevents the mobilization of the implant allowing support to a dental prostheses.

Animals↗
PubMed2007

Development of a three-dimensional finite element model of a human mandible containing endosseous dental implants. II. Variables affecting the predictive behavior of a finite element model of a human mandible.

The purpose of this study was to propose a systematic approach to validate a finite element model (FEM) of the human mandible and to investigate the effects of changing the geometry and orthotropic material properties on the FEM predictions. Thirty-eight variables affecting the material properties, boundary conditions, and the geometry of a FEM of a human mandible, including two dental implants, were systematically changed, creating a number of FEMs of the mandible. The effects of the variations were quantified as differences in the principal strain magnitudes modeled by the original FEM (gold standard), prior to the sensitivity analyses, and those generated by the changed FEMs. The material properties that had the biggest impact on the predicted cortical principal strain were the shear moduli (up to 31% in difference from the unchanged state), and the absence of cancellous bone (up to 34%). Alterations to the geometry of the mandibular cross section, such as an increase in corpus dimensions, had the greatest effect on principal strain magnitudes (up to 16%). Changes in the cortical thickness in relation to the width of the corpus section modified strain more than alterations to the corpus depth (14% and 5%, respectively). The relatively small difference (up to 13.5%) between the predicted and measured interimplant distances indicates the accuracy of the FEM. Changes in geometry and orthotropic material properties could induce significant changes in strain patterns. These values must therefore be chosen with care when using finite element techniques for predicting stresses, strains, and displacements.

Dental Implantation, Endosseous↗
PubMed1996

Endosseous dental implants in orthodontic therapy.

This paper presents cases in which endosseous titanium implants are used in orthodontic treatment as an alternative method of providing anchorage, as well as solving prosthodontic problems, and shows that such an approach can be successful.

Anodontia↗
PubMedDate not supplied

Localized sinus elevation and osteocompression with single-stage tapered dental implants: technical note.

In the atrophic posterior maxilla, placement of longer (at least 10 mm) and wider diameter implants may significantly improve long-term results, but sinus grafting is often necessary to provide sufficient bone volume for implant support. The crestal approach to sinus augmentation requires penetration of the sinus floor with surgical instruments that are often difficult to control; there is a high risk of damaging the schneiderian membrane. Fabricating a round cutting rim at the apical end of a single-stage tapered implant can provide a controlled method of gently penetrating the sinus floor prior to grafting and placement of the definitive implant. In soft type 4 bone, the single-stage tapered implant design can help to enhance initial stabilization through lateral osteocondensation of the receptor site. Localized sinus elevation with osteocompression utilizing single-stage tapered implants may offer a simplified approach to the complex clinical challenge of successfully restoring the atrophic posterior maxilla.

Bone Density↗
PubMed2002

Porous-surfaced dental implants in the partially edentulous maxilla: assessment for subclinical mobility.

Fifty patients received 151 short, porous-surfaced implants in the partially edentulous maxilla. Periotest values (PTV) were recorded at baseline and after 6 months and 1 and 2 years. For this, prostheses were removed and a standard abutment attached and tightened (20-Ncm force) to each implant. Data analysis indicated significant relationships between time in function vs PTV and implant diameter (3.5, 4.1, or 5.0 mm) vs PTV There was no relationship between PTV and implant length. PTVs were more favorable in the posterior than anterior maxilla, and better PTVs were obtained with nonsplinted as opposed to splinted implants.

Alloys↗
PubMed1994

Bone grafting and guided bone regeneration for immediate dental implants in humans.

This study evaluated bone regeneration and osseointegration of hydroxyapatite (HA) coated and titanium plasma sprayed (TPS) implants placed in sockets immediately after extraction in 36 adults, mean age 55.2 years (range 26 to 81 years). Twelve TPS and 10 HA-coated implants in 20 patients were grafted with demineralized freeze-dried bone allograft (DFDBA), covered with a barrier material, and the facial flap coronally positioned to attain primary closure (experimental). The remaining 11 TPS and 10 HA-coated implants were placed similarly, except that no DFDBA was used (control). Osseous structures were measured at the initial placement and 6-month re-entry surgeries. At the 6-month re-entry, all implants placed were clinically osseointegrated. Bone resorption at the most coronal socket crest was -1.53 mm for the grafted group and -1.59 mm for the control group. Crestal bone apposition of 1.39 mm was noted at the most apical socket crest (ASC) for the grafted group, whereas crestal resorption of -0.11 mm was noted in the ungrafted control group (P < 0.02). Bone fill from the base of the deepest osseous defect was 5.68 mm for the grafted group and 3.18 mm for the control group (P < 0.04). Complete resolution of osseous defects occurred at 15 of 22 sites in the grafted group and at 9 of 21 sites in the control group. Clinical exposure of the barrier material and a subsequent inflammatory response at 27 of 43 sites, requires removal of the material prior to the 6-month re-entry and was associated with significantly more bone loss at the ASC sites (P < 0.01). There was no significant difference for any of the parameters when comparing the TPS with the HA-coated implants.

Adult↗
PubMed1999

Usefulness of dental implants in maxillofacial reconstruction.

Fabricating maxillofacial prosthesis can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in patients. This article provides clinical retrospective analysis of osseointegrated implants used for maxillofacial reconstruction. Patient charts and radiographs were reviewed to determine implant status, stability of prosthesis, and masticatory and speech function. Of the 104 implants placed, there were 4 implant failures. The overall survival rate for implants in this patient population was 96.1%. The stability of maxillofacial prostheses demonstrated significant improvement after anchorage to implants. Implant-borne maxillofacial prostheses are better stabilized and retained than non-implant-borne prostheses, providing an improved quality of life to patients requiring prosthesis rehabilitation of maxillofacial defects.

Adult↗
PubMed1989

The interface between bone, soft tissue, and dental implants.

The normal healing responses of soft tissues and bone to injury, including the sequence of cellular activity, are presented. The nature of the attachment of the implant to the biological tissues may be either poorly differentiated fibrous tissue or direct anchorage in vital bone (preferred). Attachment by a highly differentiated periodontal ligament is presently not possible. The gingival seal has been found to be similar to that around the natural tooth. Commercially pure titanium is one of the best materials to use in terms of its biological compatibility with bone; polymers, carbons and controlled surface, i.e. active bioglasses, are also satisfactory. A porous low modulus coating is useful. Design of the implant and force transfer, as well as surgical treatment are among the important factors that determine how the interface will develop.

Alveolar Process↗
PubMed2001

Effect of early exposure on the integration of dental implants: Part 2--Clinical findings at 6 months postloading.

Implant exposure during initial healing after placement has been considered important in both implant integration and postloading effects. This study evaluated the effect of early implant exposure on the clinical findings prerestoration and 6 months postrestoration. Forty-eight implants (24 CPTi and 24 Ti-13-13) were placed in maxillary and mandibular posterior sites in six baboons. Implant exposure was evaluated for 24 of the submerged implants at placement and at each weekly visit for 3 weeks after implant placement. The crestal bone level at maxillary posterior sites was measured at 6-month uncovering, and mandibular sites were measured at 3-month uncovering. All sites were again measured 6 months after restoration placement. Periotest readings were recorded at implant uncovering and again 6 months postloading. Arbitrary groupings of the Periotest values were assigned as good = -7 to -1; guarded = 0 to +2; and poor = +3 to +27. At 6 months postloading, there were no statistical differences between CPTi and Ti-13-13 for change in crestal bone height in either arch. The mean change in maxillary crestal bone height varied from a 0.59- to 1.35-mm loss. The differences between the mean exposed and nonexposed changes were not statistically significant The mean change in mandibular crestal bone height varied from a 0.25- to 0.88-mm loss. Changes in crestal bone height for nonexposed sites from 3-month implant uncovering to 6 months postloading were statistically significant at the mesial, buccal, and lingual aspects. The mean change for the nonexposed distal aspect approached significance. The differences between the mean exposed and nonexposed changes were not statistically significant. The overall percentage of maxillary implants in the good category for nonexposed sites decreased by 41% from uncovering to 6 months after loading, while no change occurred for exposed sites; the percentage of implants in the good category was comparable for early exposed and nonexposed sites (57% and 59%, respectively). At 6 months after loading, the percentage of implants in the good category was more favorable for early exposed (88%) than nonexposed sites (50%). A one-stage implant approach should provide similar postloading clinical results as the two-stage surgical approach.

Alveolar Bone Loss↗
PubMed1998

Use of titanium dental implants as an integrated part of a CLP protocol.

The problem of edentulousness in the cleft area of patients with cleft lip and palate was formerly resolved with a conventional fixed bridge construction, but this approach did not always prove optimal. Nowadays, in these patients the bridge can be substituted by a crown on an osseointegrated titanium implant fixture. The concept of dental rehabilitation using titanium implants has gradually merged into our routine treatment for patients with cleft lip and palate. In this report we describe our surgical technique using osseointegrated titanium implants and evaluate our result in patients with cleft lip and palate. Sixteen patients with cleft lip and palate, 11 men and five women, were divided into two groups: group 1 consisted of six patients who did not need bone grafting prior to the fixture installation, and group 2 comprised 10 patients who had additional bone grafting three months before the fixture installation. Abutments were applied six months after fixture installation. Dental crowns and fixed bridges were then constructed. All patients were seen on regular follow-up visits. Routine roentgenograms were obtained preoperatively and when the abutments were applied. Photographs were taken at these occasions and also after the prosthodontic work was completed. Of a total of 31 fixtures, all except two were osseointegrated at the time of the abutment connection, and the remaining 29 have all been functional during the observation period, giving a success rate of 93%. In group 1 all fixtures (100%) were osseointegrated. The non-integrated fixtures were found in group 2 giving a success rate of 91% in this group. The mean follow-up time after fixture installation was six years and three months, and the mean observation time with loaded fixtures was five years and six months.

Adolescent↗
PubMed2007

Segmental osteotomy to reposition multiple osseointegrated dental implants in the anterior maxilla in a trauma patient.

A 16-year-old young man had severe loss of alveolar bone and lost four teeth in the anterior maxilla because of traumatic injury in a traffic accident. To overcome the surgically compromised condition for implant rehabilitation, the deficient ridge was augmented by autogenous bone graft from the mandibular symphysis. The augmented ridge had much improvement in width but less in vertical height. Four implants were placed to gain initial osseointegration. Segmental osteotomy was performed to occlusally reposition the implants and bone for 5-mm in the anterior maxilla. After 2 years of clinical follow-up, the rehabilitation outcome is satisfactory and stable.

Adolescent↗