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PubMed2002

Risk factors affecting dental implant survival.

Given the predictability of dental implant success, the attention of the scientific community is moving from descriptions of implant success toward a more detailed analysis of factors associated with implant failure. The purposes of this study were (1) to estimate the 1- and 5-year survival of Bicon dental implants and (2) to identify risk factors associated with implant failure in an objective, statistically valid manner. To address the research purposes, we used a retrospective cohort study design and a study sample composed of patients who had one or more implants placed. The predictor variables were grouped into the following categories: demographic, health status, anatomic, implant fixture-specific, prosthetic, perioperative, and ancillary variables. The major outcome variable of interest was implant failure defined as implant removal. Overall implant survival was estimated using the Kaplan-Meier analysis. Risk factors for implant failure were identified using the Cox proportional hazard regression models. The study sample was composed of 677 patients who had 677 implants randomly selected for analysis. The overall 1- and 5-year survival of the Bicon implant system was 95.2% and 90.2%, respectively. After adjusting for other covariates in a multivariate model, both tobacco use (P = .0004) and single-stage implant placement (P = .01) were statistically associated with an increased risk for failure. The results of these analyses suggest that the overall survival of the Bicon dental implant is comparable with other current implant systems. In addition, after controlling for covariates, we identified 2 exposures associated with implant survival, tobacco use and implant staging. Of interest, both of these exposures are under the clinician's control.

Adolescent↗

PubMed1982

A model for the implant-bone interface characteristics of porous dental implants.

The use of computer-aided design techniques, such as finite element stress analysis, to evaluate implant designs requires that the mechanics at the interface between the implant and the bone be characterized. This problem is accentuated when implants designed to achieve stabilization by tissue growth into porous coatings are used. A model has been developed to represent the mechanical properties of the porous material-bone interface. The model, which accounts for the mechanics of bone tissue grown into a porous implant surface, was also developed so that it could be incorporated into a three-dimensional finite-element analysis. The analytical results from a three-dimensional finite-element model of a cylindrical porous rooted dental implant system incorporating the interface model were compared to the results of mechanical tests performed on similar implants which had resided in canines for two yr. The results from the finite element analysis using the interface model were found to be in better agreement with the experimental results than when a direct bone-to-porous-material interface was assumed.

Animals↗

PubMed2006

Soft and hard tissue response to zirconium dioxide dental implants--a clinical study in man.

Titanium dental implants have been used successfully in implantology for more than 40 years. Recent research, however, suggests that titanium might have more side effects than previously believed. Zirconia ceramics have been employed in orthopaedic surgery for approximately 30 years and were recently introduced into dentistry as a metal replacement for crown and bridge work as well as implant abutments. Zirconium dioxide has been shown in both in vitro and in vivo studies to have desirable osseointegrative properties. This clinical study shows that dental implants made from zirconia are a feasible alternative to titanium dental implants. In addition to excellent cosmetic results, zirconia implants allow a degree of osseointegration and soft tissue response that is superior to titanium dental implants.

Dental Implantation, Endosseous↗

PubMed2004

Effect of implant design on survival and success rates of titanium oral implants: a 10-year prospective cohort study of the ITI Dental Implant System.

AIM: The aim of this 10-year study (observation time 8-12 years, mean: 10 years) was to compare the survival rates, success rates and incidences of biological complications using three different implant designs of the ITI Dental Implant System. MATERIAL AND METHODS: In 89 dental patients treated comprehensively, a total of 112 hollow screw (HS), 49 hollow cylinder (HC) and 18 angulated hollow cylinder (AHC) implants were installed depending on the available bone volume and according to prosthetic needs. One and 10 years after surgical placement, clinical and radiographic parameters were assessed. The incidences of peri-implantitis according to various thresholds were registered over 10 years of maintenance. RESULTS: Success criteria at 10 years were set at: pocket probing depth (PPD)< or =5 mm, bleeding on probing (BoP)-, bone loss < 0.2 mm annually. The survival rate for HS was 95.4%, for HC 85.7% and for AHC 91.7%. Ninety percent of all the HS, 71% of the HC and 88% of the AHC did not present with an incidence of peri-implantitis over the 10 years, HC having significantly higher incidence of peri-implantitis than HS (P< 0.004). With the success criteria set above, a success rate for HS of 74%, for HC of 63% and for AHC of 61% was identified at 10 years. However, including a definition of PPD< or =6 mm, BoP - and bone loss < 0.2 mm annually for success, the rates for HS were 78%, for HC 65% and for AHC 67%, respectively. Basing success criteria purely on clinical parameters (without radiographic analysis), such as: PPD< or =5 mm and BoP-, the success rates increased to 90%, 76% and 89%, respectively. With PPD< or =6 mm and BoP - as success criteria chosen, the respective rates were 94%, 82% and 94% for HS, HC and AHC implants, respectively. CONCLUSIONS: A significantly higher survival rate as well as a significantly lower incidence of peri-implantitis was identified for hollow screw design ITI Dental Implants after 10 years of service when compared to hollow cylinder design ITI Dental Implants (95.4% vs. 85.7%; 10% vs. 29%). Depending on the setting of the threshold criteria for success, success rates are highly variable and hence, reporting of success rates with elaboration on the criteria set appears crucial for comparison of different studies.

Adult↗

PubMed1992

Treatment of failing dental implants.

Recent studies show that the bacterial flora in adult periodontitis and peri-implantitis are identical, but there could be a more pathogenic flora (gram-negative bacteria, spirochetes) in the partially edentulous implant case than in the fully edentulous implant case. These data indicate a possible seeding mechanism from the natural tooth pocket to the implant crevice and may place the implant in the partially edentulous case more at risk. Also, understanding of the importance of loading in a progressive sense to prevent retrograde peri-implantitis involving the dental implant has increased; the density of bone must be evaluated more fully to determine the time frame necessary to gain a compact bone capable of withstanding occlusal forces at the bone-implant interface.

Animals↗

PubMed2006

[Dental implant treatment to osteoporosis patients].

Prosthetic treatment with dental implant is currently reliable. Since dental implant treatment can yield much satisfaction to patients compared to other treatments, such as bridge or removable denture, number of patients, who desire to be treated with dental implant, is increasing. Cortical bone of female mandible is thin compared to that of male mandible and postmenopausal condition decreases bone density of the cancerous bone. Furthermore, estrogen-deficiency delays implant and bone connection. Thus, it is necessary to treat osteoporotic patients with dental implants carefully compared to usual patients.

Dental Implantation, Endosseous↗

PubMed2005

[Experimental study of tissue engineered bone loaded with osteointergrated dental implants].

OBJECTIVE: To investigate osteogenesis and integration of osteointergrated dental implants with marrow stromal osteoblast and cancellous bone matrix compound artificial bone (MCCAB) when embedded subcutaneously. METHODS: Osteointergrated dental implants (3 mm in diameter) were inserted into cancellous bone matrix (CBM) columns (5 mm in diameter). Marrow stromal osteoblast (MSO) were cultured and expanded in the column and on the surface. The osteointergrated dental implants loaded MSO-Alginate-CBM compound was formatted. This compound was then implanted subcutaneously in nude mice, and the osteointergrated dental implants loaded Alginate-CBM compounds were implanted as control. The compound was in the mice for 4 to 8 weeks and then harvested and assessed by means of gross observation, X-ray examination, histologic observation and computerized histomorphometry for evaluation of bone formation. RESULTS: The osteogenesis of the osteointergrated dental implants loaded MSO-Alginate-CBM compound was better than that of the the osteointergrated dental implants loaded Alginate-CBM compound. Both intramembranous and cartilaginous osteogenesis was seen but the former was predominant. A large amount of new bone formed around the implant and integrated well with the implant. In the control, only slight cartilage osteogenesis was seen and no integration was found. CONCLUSIONS: The results suggest that the new bone forms in the scaffolds and on the surface of the implant, and integration between the implant and artificial bone also occurs when they are implanted in the nude mice.

Animals↗

PubMed1992

Plasminogen activator in human gingival tissue adjacent to dental implants.

The installment of endosseous dental implants has become an accepted treatment procedure, and the long-term clinical results appear excellent. The composition of the soft tissue environment, however, is different from that around natural teeth. One characteristic of original junctional epithelium is its association with plasminogen activator (PA) activity. In 11 patients with a total of 30 ITI hollow-screw titanium dental implants, 16 biopsies were taken. Histologic cryostat sections were assayed for the presence of PA in the junctional epithelium. The results demonstrated that junctional epithelium around titanium implants yields PA activity in a manner very similar to that of natural teeth. The ability to produce this enzyme activity is not related to the developmental origin of the junctional cells, but to their position and function at the base of the gingival sulcus.

Biopsy↗

PubMed1988

Future directions in surface preparation of dental implants.

Clean, intrinsically high-surface-energy dental implants are both safe and effective, but ambiguity remains with regard to the true surface qualities of many implant materials that have been sterilized and are about to be placed in properly instrumented host sites. Future dental implant requirements should include proper surface preparation and surface quality maintenance of the implants themselves. Recommended directions for research on dental implant materials include greater use of surface analytical techniques to identify, understand, and ultimately control common surface contaminants. Regulatory agencies should require specific reporting of critical surface parameters for all dental implant materials in their final, sterile states, including any changes from desirable initial values. Different implants demand different degrees of interaction with adjacent biological phases, for example, to promote or inhibit bioadhesion, and different surface preparations can assure these results.

Biocompatible Materials↗

PubMed2006

Lateral bone condensing and expansion for placement of endosseous dental implants: a new technique.

Placement of endosseous dental implants can be a problem due to bone resorption if the patient has been missing teeth for a considerable period of time. In the literature, bone-grafting techniques have shown variable results. Additionally, bone grafting requires a longer treatment time and a need for a second surgery, and it adds significant cost to the treatment. These factors often discourage patients from having dental-implant treatment. Another technique for placement of dental implants in narrow bone ridges is repositioning and remodeling of alveolar bone by condensing and expansion with the help of bone osteotomes. This article presents 2 cases, 1 in the maxilla and 1 in the mandible, for placement of endosseous dental implants with the use of a new bone-expansion osteotome kit that utilizes a screw-type configuration for bone condensing and expansion.

Alveolar Ridge Augmentation↗

PubMedDate not supplied

Patient selection for endosseous dental implants: oral and systemic considerations.

This paper reviews the literature and discusses patient selection for endosseous dental implants and the effect of systemic and local pathology on the success rate of dental implants. Endosseous dental implants may be preferable to conventional dentures in patients with compromised supporting bone or mucosa, xerostomia, allergy to denture materials, severe gag reflex, susceptibility to candidiasis, diseases affecting orofacial motor function or in patients who demand optimal bite force, esthetics, and phonetics. Conventional dentures or fixed partial prostheses may be preferable to endosseous dental implants in growing and epileptic patients and patients at risk of oral carcinoma, anaphylaxis, severe hemorrhage, steroid crisis, endocarditis, osteoradionecrosis, myocardial infarction, or peri-implantitis. A systematic approach to dental implant patient selection is outlined and centralized reporting of dental implant outcomes is recommended.

Animals↗

PubMed1981

The influence of implant elastic modulus on the stress distribution around LTI carbon and aluminum oxide dental implants.

A three-dimensional finite element analysis (FEA) has been used to determine the effect of implant elastic modulus on stresses in tissues around LTI carbon and aluminum oxide dental implants. The finite element model was constructed to represent a baboon mandible containing a blade type dental implant. A three unit fixed bridge was modeled connecting the dental implant to a natural molar. The results of the study indicate that stress levels of approximately a factor of 3 lower in the crestal region can be expected for aluminum oxide implants when compared to the LTI carbon implants. It was also observed that the use of LTI carbon and aluminum oxide dental implants as an abutment in a fixed bridge results in a reduction of stresses in tissues around the natural tooth when compared to normal physiological stress levels.

Aluminum↗

PubMed2002

Immediate placement/immediate load: a single-tooth case study utilizing the ITI dental implant system.

For the past 35 years, endosseous dental implants have revolutionized the methods clinicians use to treat edentulous and partially edentulous patients. Initially recommended only to rehabilitate fully edentulous patients utilizing fixed prosthetics, endosseous dental implants were then shown to be effective to treat partial edentulism. Over the last decade, numerous studies have documented successful placement of endosseous dental implants in fresh extraction sites, and methods have been developed to provisionalize both full-arch and single-tooth implant cases at the time of surgery. This article describes the immediate placement/immediate load of a single ITI dental implant.

Crowns↗

PubMed2006

Comparison of clinical, radiographic and immunological parameters of teeth and different dental implant platforms.

A comparison between host response in teeth and dental implants was not made. Likewise, the association between host response and periodontal parameters has never been explored. The purpose of this study was to compare periodontal health around natural teeth and dental implants with different restorative platforms. Twenty-seven partially edentulous patients with dental implants, either external hex butt joint (n=28) or tapered Morse (n=45), were included in this study. Implants were in function for 1-6 years (mean 2.9). Plaque index (PI), gingival index (GI), probing depth (PD); and clinical attachment level (CAL), were recorded at final examination; alveolar bone loss (ABL) was measured at baseline and final examination using panoramic radiographs. Gingival crevicular fluid samples were obtained from the Ramfjord index teeth and all implants and assayed using enzyme-linked immunosorbent assay for prostaglandin E(2) (PGE(2)), interleukin-1 (IL-1) and tumour necrosis factor alpha (TNFalpha). Differences between teeth and implants and between the two implant platforms were compared using Student's t-test. Correlations between cytokines, ABL and clinical parameters were analyzed using Pearson's co-efficient test. PI and GI were significantly higher in teeth than dental implants (1.2+/-0.5 vs. 0.8+/-0.5, P=0.0018; 1.2+/-0.3 vs. 1.1+/-0.3, P=0.048). Conversely, PD was deeper in implants (2.66+/-0.6 vs. 3.66+/-0.9, P=0.001). GI and PD around teeth and implants were positively associated (R=0.561, P=0.0023; R=0.39, P=0.0452). Greater ABL was observed around dental implants (1.62+/-2.2 mm) compared with teeth (0.49+/-0.3 mm). A positive correlation was found between both IL-1 (R=0.73, P=0.0064; R=0.52, P=0.0081) and TNFalpha (R=0.64, P=0.0246; R=0.46, P=0.091) and ABL in teeth and implants. Both implant platforms were similar clinically and radiographically; however, TNFalpha (2.49+/-0.3 vs. 4.79+/-0.5, P=0.004) and IL-1 (24.52+/-7.3 vs. 45.41+/-9.9, P=0.095) were higher for the non-submerged implants. In conclusion, IL-1 and TNFalpha are sensitive markers of ABL around teeth and implants. The two dental implant platforms showed a similar clinical and radiographic response; however, the greater host response in the non-submerged implants might suggest future bone loss.

Aged↗

PubMed2005

Ultrastructural localization of laminin-5 (gamma2 chain) in the rat peri-implant oral mucosa around a titanium-dental implant by immuno-electron microscopy.

Laminin-5 (Ln-5) is an important molecule associated with epithelial cell adhesion and migration. In the gingiva around the tooth, Ln-5 localizes within basement membranes between the junctional epithelium (JE) and the tooth or connective tissue. Recently, we reported that in the oral mucosa around a dental implant, Ln-5 is expressed within the basement membranes at the implant-peri-implant epithelium (PIE) interface, and at the PIE-connective tissue interface. However, the ultrastructural localization of Ln-5 within or along the PIE has not yet been reported. Therefore, peri-implant oral mucosa was treated with anti-Ln-5 (gamma2 chain) antibody and examined using immuno-electron microscopy. Ln-5 was localized in the cells of the innermost-third layer and basal layer of the PIE. A 100-nm-wide Ln-5-positive internal basal lamina (basement membrane) and hemidesmosomes as adhesion structures were formed at the apical portion of the implant-PIE interface. However, at the upper-middle portion of the interface, these adhesion structures were not observed. Furthermore, at the PIE-connective tissue interface, the Ln-5-positive external basal lamina (basement membrane) and hemidesmosomes were partially deficient. Judging from these findings, we concluded that Ln-5 contributes to the attachment of the PIE to the titanium surface, and that PIE attached to titanium at the apical portion of the dental implant-PIE interface.

Animals↗

PubMed2005

Histologic and histomorphometric analysis of three types of dental implants following 18 months of occlusal loading: a preliminary study in baboons.

The purpose of this study was to determine the percentage of 'bone area' (BA) and 'bone-to-implant contact' (BIC) of dental implants with different designs and surface modifications after functional loading. Three types of dental implants with fixed partial dentures were placed in the posterior jaws of adult baboons (commercially pure titanium (CpTi) screws, grit-blasted acid-etched (GBAE) screws, and titanium plasma-sprayed (TPS) cylinders), three of the same design per quadrant. After 18 months of functional loading, all implants investigated were successfully integrated in the jawbone and histologic and histomorphometric analyses were carried out. Statistical evaluation was performed with a mixed model with data given as least-square means and standard errors of the mean (SEM). Histologically, direct BIC without connective tissue interposed between implant surfaces and peri-implant bone was seen. Analysis of BA within 1 mm around implants showed significant differences between CpTi (50.5%) and TPS (39.7%) (+/-2.72 SEM; P<0.01) in the maxilla. To account for the different implant designs, absolute BIC was calculated. Significant differences were found between CpTi (23.9 mm) and TPS (15.1 mm) and between GBAE (27.2 mm) and TPS (15.1 mm) (+/-1.05 SEM; P<0.01) in the maxilla and between GBAE (26.5 mm) and TPS (19.6 mm) (+/-1.42 SEM; P<0.01) in the mandible. Overall, the data indicate that, in the maxilla, screw-shaped implants showed more absolute BIC than cylindrical implants, which had less maxillary than mandibular absolute BIC after 18 months of functional loading.

Acid Etching, Dental↗

PubMedDate not supplied

Descending necrotizing mediastinitis: a complication of dental implant surgery.

BACKGROUND: The placement of osseointegrated dental implants is considered a minimally invasive procedure with a low complication rate. Reported complications include local trauma to neurovascular structures, mandible fractures, sinusitis, and localized gingivitis. Major life-threatening complications are extremely rare. Severe infection has not been reported in a review of the English literature. METHOD: Case study. RESULTS: We present a case of life-threatening deep neck space infection resulting in descending necrotizing mediastinitis following osseointegrated dental implant placement. Treatment included intravenous antibiotics, aggressive neck debridement, and removal of the infected dental implants. CONCLUSION: Severe infection can result from the placement of dental implants. Principles of treatment include antibiotics, surgical drainage and debridement, and careful assessment and removal of the involved implants.

Dental Implants↗

PubMed1998

Interactive CT diagnostics, planning and preparation for dental implants.

The insertion of dental implants is multifaceted. Adequate containment of the implant body requires not only a measurable volume of bone but also an acceptable density of this osseous foundation. Through interactive computerized axial tomography (CAT), not only are such measurements conveyed to the clinician, but vital structures that should be avoided or at least accounted for are portrayed in a three-dimensional manner. Predict-ability is enhanced, and the implants can be directed for prosthetic use in conjunction with surgical guides (templates).

Bone Density↗