Flap vs. ""flapless"" surgical approach at immediate implants: a histomorphometric study in dogs

Aim To compare the remodeling of the alveolar process at implants installed immediately into extraction sockets by applying a flap or a ""flapless"" surgical approach in a dog model. Material and methods Implants were installed immediately into the distal alveoli of the second mandibular premolars of six Labrador dogs. In one side of the mandible, a full-thickness mucoperiosteal flap was elevated (control site), while contra-laterally, the mucosa was gently dislocated, but not elevated (test site) to disclose the alveolar crest. After 4 months of healing, the animals were sacrificed, ground sections were obtained and a histomorphometric analysis was performed. Results After 4 months of healing, all implants were integrated (n=6). Both at the test and at the control sites, bone resorption occurred with similar outcomes. The buccal bony crest resorption was 1.7 and 1.5 mm at the control and the test sites, respectively. Conclusions ""Flapless"" implant placement into extraction sockets did not result in the prevention of alveolar bone resorption and did not affect the dimensional changes of the alveolar process following tooth extraction when compared with the usual placement of implants raising mucoperiosteal flaps. To cite this article:Caneva M, Botticelli D, Salata LA, Souza SLS, Bressan E, Lang NP. Flap vs. ""flapless"" surgical approach at immediate implants: a histomorphometric study in dogs.Clin. Oral Impl. Res. 21, 2010; 1314-1319.doi: 10.1111/j.1600-0501.2009.01959.x.

The Effects of Different Loading Times on the Bone Response Around Dental Implants: A Histomorphometric Study in Dogs

Purpose: The aim of this study was to evaluate, through histomorphometric analysis, the effect that different loading times would have on the bone response around implants. Materials and Methods: Three Replace Select implants were placed on each side of the mandible in eight dogs (n = 48 implants). One pair of implants was selected for an immediate loading protocol (IL). After 7 days, the second pair of implants received prostheses for an early loading protocol (EL). Fourteen days after implant placement, the third pair of implants received prostheses for advanced early loading (AEL). Following 12 weeks of prosthetics, counted following the positioning of the metallic crowns for the AEL group, the animals were sacrificed and the specimens were prepared for histomorphometric analysis. The differences between loading time in the following parameters were evaluated through analysis of variance: bone-to-implant contact, bone density, and crestal bone loss. Results: The mean percentage of bone-to-implant contact for IL was 77.9% +/- 1.71%, for EL it was 79.25% +/- 2.11%, and for AEL it was 79.42% +/- 1.49%. The mean percentage of bone density for IL was 69.97% +/- 3.81%, for EL it was 69.23% +/- 5.68%, and for AEL it was 69.19% +/- 2.90%. Mean crestal bone loss was 1.57 +/- 0.22 mm for IL, 1.23 +/- 0.19 mm for EL, and 1.17 +/- 0.32 mm for AEL. There was no statistical difference for any of the parameters evaluated (P > .05). Conclusion: Different early loading times did not seem to significantly affect the bone response around dental implants. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:473-481

A Prospective Follow-up Study of 44 Mandibular Immediately Loaded Implants Using Resonance Frequency Analysis: Preliminary 1-Year Results

Purpose: This clinical study aimed to evaluate initial, 4-months, and 1-year stability of immediately loaded dental implants inserted according to a protocol of lower rehabilitation with prefabricated bars. Materials and Methods: The sample was composed of 11 edentulous patients. In each patient, 4 interforaminal implants were inserted. Immediately after implant installation, resonance frequency analysis (RFA) for each fixation was registered as well as after 4 months and 1 year with the prosthetic bar removed as it is a screwed system. Results: The clinical implant survival rate was 100%. The RFA showed an increase in stability after 4 months from 64.09 +/- 648 to 64.31 +/- 4.96 and I year, 67.11 +/- 4.37. The analysis of variance showed a statistically significant result (P = 0.015) among implant stability quotient values for the different periods evaluated. Tukey test results showed statistically significant differences between 1-year results and the initial periods but there was no statistically significant difference between initial and 4-month results (P > 0.05). Conclusion: These preliminary 1-year results indicate that immediate loading of mandibular dental implants using the studied prefabricated bars protocol is a reliable treatment as it is in accordance with the results described in the literature for other similar techniques. (Implant Dent 2009; 18:530-538)

Bone growth around silicon nitride implants - An evaluation by scanning electron microscopy

Silicon nitride has demonstrated to be a potential candidate for clinical applications because it is a non-cytotoxic material and has satisfactory fracture toughness, high wear resistance and low friction coefficient. In this paper, samples of silicon nitride, which were kept into rabbits` tibias for 8 weeks, and the adjacentbone tissue were analysed by scanning electron microscopy in order to verify the bone growth around the implants and the interaction between the implant and the bone. Bone growth occurred mainly in the cortical areas, although it has been observed that the newly bone tends to grow toward the marrow cavity. Differences were observed between the implants installed into distal and proximal regions. In the first region, where the distance between the implant and the cortical bone is greater than in the proximal region, the osteoconduction process was evidenced by the presence of a bridge bone formation toward the implant surface. The results showed that silicon nitride can be used as biomaterial since the newly bone grew around the implants. (c) 2007 Elsevier Inc. All rights reserved.

Tissue response around silicon nitride implants in rabbits

The chemical and dimensional stability associated with suitable fracture toughness and propitious tribological characteristics make silicon nitride-based ceramics potential candidates for biomedical applications, mainly as orthopedic implants. Considering this combination of properties, silicon nitride components were investigated in relation to their biocompatibility. For this study, two cylindrical implants were installed in each tibia of five rabbits and were kept in the animals for 8 weeks. During the healing time, tissue tracers were administrated in the animals so as to evaluate the bone growth around the implants. Eight weeks after the surgery, the animals were euthanized and histological analyses were performed. No adverse reactions were observed close to the implant. The osteogenesis process occurred during the entire period defined by the tracers. However, this process occurred more intensely 4 weeks after the surgery. In addition, the histological analyses showed that bone growth occurred preferentially in the cortical areas. Different kinds of tissue were identified on the implant surface, characterized by lamellar bone tissue containing osteocytes and osteons, by a noncalcified matrix containing osteoblasts, or by the presence of collagen III, which may change to collagen I or remain as a fibrous tissue. The results demonstrated that silicon nitride obtained according to the procedure proposed in this research is a biocompatible material. (c) 2007 Wiley Periodicals, Inc.

Stress distribution in orthodontic mini-implants

The objective of this study was to evaluate the stress distribution in the resin in contact with the spirals of cylindrical and conical mini-implants, when submitted to lateral load and insertion torsion. A photoelastic model was fabricated using transparent gelatin to simulate the alveolar bone. The model was observed with a plane polariscope and photographically recorded before and after activation of the two screws with a lateral force and torsion. The lateral force application caused bending moments on both mini-implants, with the uprising of fringes or isochromatics, characteristics of stresses, along the threads of the mini-implants and in the apex. When the torsion was exerted in the mini-implants, a great concentration of stress upraised close to the apex. The conclusion was that, comparing conical with cylindrical mini-implants under lateral load, the stresses were similar on the traction sides. The differences appear (1) on the apex, where the cylindrical mini-implant showed a greater concentration of stress, and (2) along the spirals, in the compression side, where the conical mini-implant showed a greater concentration of stress. The greater part of the stress produced by both mini-implants, after torsion load in insertion, were concentrated on the apex. With the cylindrical mini-implant, the greater concentration of tension was close to the apex, while with the conical one, the stresses were distributed along a greater amount of apical threads.

New material for orthopedic implants: Electrochemical study of nickel free P558 stainless steel in minimum essential medium

Nickel, a component of stainless steels (SS) applied in orthopedic implants may cause allergic processes in human tissues P558 nickel free SS was studied to verify its viability as a substitute for stainless steel containing nickel Its performance is compared to ISO 5832-9 and F138 most used nowadays grades in implants fabrications, in minimum essential medium. MEM, at 37 degrees C. Potentiodynamic polarization curves, electrochemical impedance spectroscopy (EIS), scanning electron microscopy (SEM) and ""in vitro"" cytotoxicity were used as techniques. From the electrochemical point of view P558 SS is comparable to ISO 5832-9 SS in MEM It remains passivated until the transpassivation potential, above which generalized corrosion occurs F138 presents pitting corrosion at 370 mV/SCE. The cytotoxicity results showed that P558. ISO 5832-9 and F138 do not present cytotoxic character Therefore, these results suggest that P558 SS can be applied in orthopedic implants (C) 2010 Elsevier BV All rights reserved

Implants of polyanionic collagen matrix in bone defects of ovariectomized rats

In recent years, there has been a great interest in the development of biomaterials that could be used in the repair of bone defects. Collagen matrix (CM) has the advantage that it can be modified chemically to improve its mechanical properties. The aim of the present study was to evaluate the effect of three-dimensional membranes of native or anionic (submitted to alkaline treatment for 48 or 96 h) collagen matrix on the consolidation of osteoporosis bone fractures resulting from the gonadal hormone alterations caused by ovariectomy in rats subjected to hormone replacement therapy. The animals received the implants 4 months after ovariectomy and were sacrificed 8 weeks after implantation of the membranes into 4-mm wide bone defects created in the distal third of the femur with a surgical bur. Macroscopic analysis revealed the absence of pathological alterations in the implanted areas, suggesting that the material was biocompatible. Microscopic analysis showed a lower amount of bone ingrowth in the areas receiving the native membrane compared to the bone defects filled with the anionic membranes. In ovariectomized animals receiving anionic membranes, a delay in bone regeneration was observed mainly in animals not subjected to hormone replacement therapy. We conclude that anionic membranes treated with alkaline solution for 48 and 96 h presented better results in terms of bone ingrowth.

Influência da largura do septo inter-radicular sobre a estabilidade dos mini-implantes

OBJETIVO: este estudo teve como objetivo avaliar a influência da largura do septo inter-radicular no local de inserção de mini-implantes autoperfurantes sobre o grau de estabilidade desses dispositivos de ancoragem. MÉTODOS: a amostra consistiu de 40 mini-implantes inseridos entre as raízes do primeiro molar e segundo pré-molar superiores de 21 pacientes, com o intuito de fornecer ancoragem para retração anterior. A largura do septo no local de inserção (LSI) foi mensurada nas radiografias pós-cirúrgicas e, sob esse aspecto, os mini-implantes foram divididos em dois grupos: grupo 1 (áreas críticas, LSI<3mm) e grupo 2 (áreas não críticas, LSI>3mm). A estabilidade dos mini-implantes foi avaliada mensalmente pela quantificação do grau de mobilidade e a partir dessa variável foi calculada a proporção de sucesso. Avaliou-se também: a quantidade de placa, altura de inserção, grau de sensibilidade e período de observação. RESULTADOS: os resultados obtidos demonstraram que não houve diferença estatisticamente significativa para o grau de mobilidade e proporção de sucesso entre os mini-implantes inseridos em septos de largura mesiodistal crítica e não crítica. A proporção de sucesso total encontrada foi de 90% e nenhuma variável demonstrou estar relacionada ao insucesso dos mini-implantes. No entanto, observou-se maior sensibilidade nos pacientes cujos mini-implantes apresentavam mobilidade, e que a falha desses dispositivos de ancoragem ocorria logo após sua inserção. CONCLUSÃO: a largura do septo inter-radicular no local de inserção não interferiu na estabilidade dos mini-implantes autoperfurantes avaliados neste estudo.

Effect of cyclic load on vertical misfit of prefabricated and cast implant single abutment

OBJECTIVES: The purpose of this in vitro study was to evaluate misfit alterations at the implant/abutment interface of external and internal connection implant systems when subjected to cyclic loading. MATERIAL AND METHODS: Standard metal crowns were fabricated for 5 groups (n=10) of implant/abutment assemblies: Group 1, external hexagon implant and UCLA cast-on premachined abutment; Group 2, internal hexagon implant and premachined abutment; Group 3, internal octagon implant and prefabricated abutment; Group 4, external hexagon implant and UCLA cast-on premachined abutment; and Group 5, external hexagon implant and Ceraone abutment. For groups 1, 2, 3 and 5, the crowns were cemented on the abutments and in group 4 crowns were screwed directly on the implant. The specimens were subjected to 500,000 cycles at 19.1 Hz of frequency and non-axial load of 133 N in a MTS 810 machine. The vertical misfit (μm) at the implant/abutment interface was evaluated before (B) and after (A) application of the cyclic loading. Data were analyzed statistically by using two-away ANOVA and Tukey's post-hoc test (p<0.05). RESULTS: Before loading values showed no difference among groups 2 (4.33±3.13), 3 (4.79±3.43) and 5 (3.86±4.60); between groups 1 (12.88±6.43) and 4 (9.67±3.08), and among groups 2, 3 and 4. However, groups 1 and 4 were significantly different from groups 2, 3 and 5. After loading values of groups 1 (17.28±8.77) and 4 (17.78±10.99) were significantly different from those of groups 2 (4.83±4.50), 3 (8.07±4.31) and 5 (3.81±4.84). There was a significant increase in misfit values of groups 1, 3 and 4 after cyclic loading, but not for groups 2 and 5. CONCLUSIONS: The cyclic loading and type of implant/abutment connection may develop a role on the vertical misfit at the implant/abutment interface.

Validation of an experimental polyurethane model for biomechanical studies on implant supported prosthesis - tension tests

OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, frequently hinder the development of clinical trials. The purpose of this in vitro study was to determine the modulus of elasticity of a polyurethane isotropic experimental model via tension tests, comparing the results to those reported in the literature for mandibular bone, in order to validate the use of such a model in lieu of mandibular bone in biomechanical studies. MATERIAL AND METHODS: Forty-five polyurethane test specimens were divided into 3 groups of 15 specimens each, according to the ratio (A/B) of polyurethane reagents (PU-1: 1/0.5, PU-2: 1/1, PU-3: 1/1.5). RESULTS: Tension tests were performed in each experimental group and the modulus of elasticity values found were 192.98 MPa (SD=57.20) for PU-1, 347.90 MPa (SD=109.54) for PU-2 and 304.64 MPa (SD=25.48) for PU-3. CONCLUSION: The concentration of choice for building the experimental model was 1/1.

Validation of an experimental polyurethane model for biomechanical studies on implant-supported prosthesis: compression tests

OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, most always hinder the performance of clinical trials. Thus, in vitro studies become an important source of information for the understanding of biomechanical events on implant-supported prostheses, although study results cannot be considered reliable unless validation studies are conducted. The purpose of this work was to validate an artificial experimental model based on its modulus of elasticity, to simulate the performance of human bone in vivo in biomechanical studies of implant-supported prostheses. MATERIAL AND METHODS: In this study, fast-curing polyurethane (F16 polyurethane, Axson) was used to build 40 specimens that were divided into five groups. The following reagent ratios (part A/part B) were used: Group A (0.5/1.0), Group B (0.8/1.0), Group C (1.0/1.0), Group D (1.2/1.0), and Group E (1.5/1.0). A universal testing machine (Kratos model K - 2000 MP) was used to measure modulus of elasticity values by compression. RESULTS: Mean modulus of elasticity values were: Group A - 389.72 MPa, Group B - 529.19 MPa, Group C - 571.11 MPa, Group D - 470.35 MPa, Group E - 437.36 MPa. CONCLUSION: The best mechanical characteristics and modulus of elasticity value comparable to that of human trabecular bone were obtained when A/B ratio was 1:1.

Effect of biofunctionalized implant surface on osseointegration: a histomorphometric study in dogs

Among the different properties that influence bone apposition around implants, the chemical or biochemical composition of implant surface may interfere on its acceptance by the surrounding bone. The aim of this study was to investigate if a biofunctionalization of implant surface influences the bone apposition in a dog model and to compare it with other surfaces, such as a microstructured created by the grit-blasting/acid-etching process. Eight young adult male mongrel dogs had the bilateral mandibular premolars extracted and each one received 6 implants after 12 weeks, totaling 48 implants in the experiment. Four groups of implants were formed with the same microrough topography with or without some kind of biofunctionalization treatment. After histomorphometric analysis, it was observed that the modified microstructured surface with a "low concentration of the bioactive peptide" provided a higher adjacent bone density (54.6%) when compared to the other groups (microstructured + HA coating = 46.0%, microstructured only = 45.3% and microstructured + "high concentration of the bioactive peptide" = 40.7%), but this difference was not statistically significant. In conclusion, biofunctionalization of the implant surface might interfere in the bone apposition around implants, especially in terms of bone density. Different concentrations of bioactive peptide lead to different results.

Influence of implant surfaces on osseointegration

The biological fixation between the dental implant surfaces and jaw bones should be considered a prerequisite for the long-term success of implant-supported prostheses. In this context, the implant surface modifications gained an important and decisive place in implant research over the last years. As the most investigated topic in, it aided the development of enhanced dental treatment modalities and the expansion of dental implant use. Nowadays, a large number of implant types with a great variety of surface properties and other features are commercially available and have to be treated with caution. Although surface modifications have been shown to enhance osseointegration at early implantation times, for example, the clinician should look for research evidence before selecting a dental implant for a specific use. This paper reviews the literature on dental implant surfaces by assessing in vitro and in vivo studies to show the current perspective of implant development. The review comprises quantitative and qualitative results on the analysis of bone-implant interface using micro and nano implant surface topographies. Furthermore, the perspective of incorporating biomimetic molecules (e.g.: peptides and bone morphogenetic proteins) to the implant surface and their effects on bone formation and remodeling around implants are discussed.

Bone response to biosilicates® with different crystal phases

The aim of this study was to investigate the histological and histomorphometrical bone response to three Biosilicates with different crystal phases comparing them to Bioglass®45S5 implants used as control. Ceramic glass Biosilicate and Bioglass®45S5 implants were bilaterally inserted in rabbit femurs and harvested after 8 and 12 weeks. Histological examination did not revealed persistent inflammation or foreign body reaction at implantation sites. Bone and a layer of soft tissue were observed in close contact with the implant surfaces in the medullary canal. The connective tissue presented few elongated cells and collagen fibers located parallel to implant surface. Cortical portion after 8 weeks was the only area that demonstrated significant difference between all tested materials, with Biosilicate 1F and Biosilicate 2F presenting higher bone formation than Bioglass®45S5 and Biosilicate® vitreo (p=0.02). All other areas and periods were statistically non-significant (p>0.05). In conclusion, all tested materials were considered biocompatible, demonstrating surface bone formation and a satisfactory behavior at biological environment.