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A natural tooth's stress distribution in occlusion with a dental implant.

The loss of one or more teeth is normally treated with conventional fixed or removable partial dentures or with implant supported fixed or removable dentures. This study investigated stresses formed around the implant and the antagonist natural tooth under occlusal force in the substitution of a missing lower first molar with a rigid or resilient IMZ (Intra Mobil Zylinder) implant, using the finite element stress analysis method. The results indicate that a bite force of 143 N resulted in high compressive stresses around the roots of a natural tooth opposing a restoration supported by an IMZ implant with rigid type abutment. It is speculated that these high compressive stresses may contribute to intrusion of the tooth.

Bite Force↗

[Dental implants following trauma in young adults].

Various statistics have shown that avulsion (total displacement of tooth out of its socket) following traumatic injuries is relatively infrequent, ranging from 0.5 to 16% of traumatic injuries in the permanent dentition. The maxillary central incisors are the most frequently avulsed teeth. Avulsion of teeth occurs most often in children from 7 to 9 years of age, when the permanent incisors are erupting. Most frequently, avulsion involves a single tooth; but multiple avulsion are occasionally encountered. Fractures of the alveolar socket wall are often associate with avulsion. After the tooth is lost, an almost certain sequelae is the rapid resorption of alveolar bone. In many cases, only a very thin crestal bony lamella remains after healing of the alveolus, with clinically obvious horizontal and vertical depressions. In a young patient missing an anterior tooth, the operator may find implant insertion, in the proper anatomical position, difficult or impossible, because of inadequate bone volume. This situation aggravates with time because of continuous resorption and relative growth of the adjacent alveolar bone around the teeth. New and predictable bone augmentation techniques allow compensation for bone reduction while waiting for completion of growth. In cases of localized ridge augmentation, the amount of initial bone volume and its shape dictate whether implant insertion and bone augmentation will be performed simultaneously. The indications for this approach are: sufficient bone volume to achieve initial implant stability and a predictably high success rate for the augmentation. When bone volume and shape do not allow for initial stability, there is indication for a staged approach, in which the bone is initially augmented, the results are evaluated and the implant is then inserted. The first stage, the bone regeneration phase, may last between 8-10 months. The second, the implant integration period, may take an additional 6-8 months. The effect of growth on the augmented bone is not quite clear and there is only a paucity of information concerning the use of bone regeneration procedures in growing patients. Clinical decision when to start implant treatment after avulsion is dependent not only on the timing of implant insertion, but also on bone regeneration procedures. When most of horizontal and vertical bony walls of the extraction site is lost, augmentation procedure as a measure to reduce the deficiency, may be considered even in preadolescents. Three cases describing different clinical situations following avulsion, tooth replacement, resorption, regeneration treatment and implant insertion are discussed.

Adolescent↗

Five-year prospective follow-up report of the Astra tech standard dental implant in clinical treatment.

Between 1994 and 1999, 515 Astra standard implants were placed and documented prospectively in 107 patients. Of these implants, 364 were placed in original jawbone, 38 in areas augmented with local osteoplasty, and 113 in bone grafts from the iliac crest. The main indications for implantation were an atrophic edentulous alveolar crest (n = 361) and a shortened dental arch (n = 113). Single-tooth implants were excluded. In a special clinical examination, 56 patients with 258 implants were investigated. The average in situ time of the implants was 34.2 months. Failing osseointegration (n = 10), peri-implantitis (n = 10), and implant fracture (n = 1) in 15 patients resulted in the failure of 21 implants (4.1%). Three patients with 8 implants died from malignant tumor. Currently, 27 implants have been lost to follow-up, and 488 implants remain in situ (95.9%). Under analyses with different implant success criteria, the success rate decreased to 85%. Based on the results in this patient population, this implant was found to be a useful alternative to established implant systems for the indications analyzed.

Alveolar Bone Loss↗

Bovine hydroxyapatite for maxillary sinus augmentation: analysis of interfacial bond strength of dental implants using pull-out tests.

This study examines the effect of sinus lift surgery using bovine hydroxyapatite on the bone anchorage of titanium plasma flame-spray-coated cylindrical implants. A total of 54 implants were placed in the lateral bony antral walls of 27 mountain sheep. Host site augmentation was done simultaneously using bovine hydroxyapatite and autogenous cancellous bone from the iliac crest in 18 sinuses each. The bone walls of the remaining 18 sinuses received no augmentation. Pull-out tests were carried out at 12, 16, and 26 weeks, revealing a significant influence of the implants' residence time on pull-out strength (P = 0.004). The implants of the non-augmented group and those of the group augmented using cancellous bone showed a linear increase in pull-out strength to 169.8 N and 523.7 N, respectively, until the 26th week. The implants of the group augmented with bovine hydroxyapatite exhibited the highest initial pull-out strength (325.1 N) that further increased to 521.8 N until the 26th week. All in all, this group showed a significantly greater pull-out strength tan did the negative control group (P = 0.03).

Analysis of Variance↗

A five year clinical evaluation showing optimum results in dental implants.

Implant dentistry has made great advances since its inception several decades ago. As a result, predictability and success have reached high levels. Nonetheless, efforts continue to further refine implant design, materials, and techniques to reduce even the small percentage of failures that still occur. As part of this effort, the authors for the past six years have conducted clinical trials of Steri-Oss threaded titanium implants and HA-coated implants. The results have been consistent with the body of implant research reported since the 1970s. Optimum implant performance is realized when a well-designed system such as those tested is utilized in association with astute clinical judgment.

Clinical Trials as Topic↗

A 6-year unloaded hydroxyapatite-coated dental implant placed into an extraction socket in conjunction with nonresorbable hydroxyapatite grafting material: histologic evaluation.

A submerged hydroxyapatite (HA)-coated implant placed into a fresh extraction socket in conjunction with a nonresorbable HA graft was harvested after 6 years of unloaded healing. The implant and surrounding bone were processed for histologic analysis. The HA coating appeared to be stable and homogenous. An excellent bone-to-implant contact could be found along the entire implant length. No signs of HA resorption or detachment were found. The HA graft was still recognizable histologically around the apical third of the implant. Light microscopy revealed a good osteoconductive ability of the HA particles, which did not show any signs of remodeling or resorption. These findings suggest that HA-coated implants may be able to maintain optimal osseointegration over time, even in the absence of loading.

Adult↗

Update in dental implant periapical surgery.

Implant periapical lesions are infectious-inflammatory alterations surrounding an implant apex, and can be caused by a number of situations--including contamination at instrumentation, overheating of bone, and the prior existence of bone pathology. The diagnosis is based on the clinical manifestations and radiological findings, where a radiotransparency can be seen at periapical level. The lesions are classified according to their evolutive stage as either acute (non-suppurated and suppurated) or chronic (or periapical abscess). The management of implant periapical lesions comprises periapical surgery with curettage and irrigation in the acute phase, or implant extraction when the bone surface is affected and/or primary fixation is lost (chronic phase).

Dental Implantation, Endosseous↗

Dental implants: materials and design considerations.

Although the biologic principles underlying successful clinical implants are still not completely understood, it is clear that both physical and chemical attributes of the material may influence the clinical outcome. Knowledge of the stresses and strains in an implant system and superstructure is still incomplete, but micromotion at the interface must be avoided for bone fixation. The composition and topography of the implant surface influence the cellular events at the bone-biomaterial interface. These surface parameters require definition to interpret the tissue response to a particular material. Hydroxyapatite-coated surfaces are an example of a variable implant modality that has resulted in variable clinical performance. The clinician should consider all the available information on material and design before embarking on extensive clinical trial.

Biocompatible Materials↗

Scanning electron microscopy evaluation of the interfacial fit of interchanged components of four dental implant systems.

The introduction of the original Swedish implant system (Brånemark) was followed by several alternative implant systems with implants and components that closely resembled the original design and treatment protocol. Some of these alternative systems may be interchangeable. Manufacturing variations can result in as much as 0.1 mm of space between the component parts. The implant/abutment interface fit was evaluated by scanning electron micrography for each of four implant systems, as well as interchanged components between the various systems. Results showed that certain implant system abutments are interchangeable, and that the accuracy of fit meets with or exceeds the criteria set by the original Swedish system.

Dental Abutments↗

A new custom-made abutment for dental implants: a technical note.

The restoration of four missing maxillary incisors with implants and custom-made abutments is described. Acetal was used to fabricate the custom-made abutments, instead of the conventional metals. This material is resistant to wear, and it is biocompatible and white in color. Acetal meets esthetic requirements, particularly when restoring the anterior region of the dental arches. The white post does not give a grayish appearance to the surrounding soft tissues, and the possible gingival recession around the post will not compromise esthetics. The presented case report indicates excellent esthetic and functional results.

Acetals↗

[Combined use of Ceros-80 an lyodura in dental implantations].

The histological examination plays an important role in the determination of the clinical use of hydroxylapatite ceramics (HA). In the presented case, the periodontally compromised tooth was removed and the alveolus filled with HA and covered by Lyodura. 20 months later a blade type of implant was inserted, which was surrounded with HA again. At the time of the operation a biopsy was taken, and the subsequent histological examination showed a complete osseous healing.

Adult↗