Effects of magnesium intake deficiency on bone metabolism and bone tissue around osseointegrated implants

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation of Patients' Perceptions of Alterations After Chin Bone Graft Harvesting

Objective: To evaluate patients' perceptions of alterations occurring after chin bone harvesting.Materials and Methods: Thirty patients were evaluated subjectively by visual analog scale-related sensitivity, facial aesthetics, eating, speaking, and lower lip movement, during 12 months. Objective analysis used the static light touch neurosensorial test. The statistical analysis was executed with Friedman test with P < 0.05 for both samples.Results: Subjective analysis revealed no alterations (1) to facial aesthetics, eating, speaking or lower lip movement but sensitivity of the mental region went from a lot of alteration initially (5) to little at the end of the study (3). Objective analysis results showed normal sensitivity (1) in the region after 12 months.Conclusion: The discrepancy between subjective and objective analyses may be indicative of the limited precision of clinical testing for subjective impressions assessment. (Implant Dent 2012;21:411-414)

Fresh-frozen human bone allograft in vertical ridge augmentation: clinical and tomographic evaluation of bone formation and resorption

The aim of the current study is to evaluate fresh-frozen human bone allografts (FHBAs) used in vertical ridge augmentation clinically and by computed tomography, and to analyze the resulting bone formation and graft resorption. Sixteen FHBAs were grafted in the maxillae and mandibles of 9 patients. The FHBAs, which were provided by the Musculoskeletal Tissue Bank of Marilia Hospital (Unioss), were frozen at -80A degrees C. After 7 months, dental implants were placed and bone parameters were evaluated. Vertical bone formation was measured by computerized tomography before (T0) and at 7 months (T1) after the surgical procedure. Bone graft resorption was measured clinically from a landmark screw head using a periodontal probe. The results were analyzed by Student's t-test. Significant differences existed in the bone formation values at T0 and T1, with an average change of 4.03 +/- A 1.69 mm. Bone graft resorption values were 1.0 +/- A 0.82 mm (20%). Implants were placed with varying insertion torque values (35-45 Ncm), and achieved primary stability. This study demonstrates that FHBAs promote satisfactory vertical bone formation with a low resorption rates, good density, and primary implant stability.

Vertical Bone Augmentation Using a Polytetrafluoroethylene Nonporous Barrier for Osseointegrated Implants Partially Inserted in Tibiae of Rabbits

Purpose: The aim of this study was to evaluate the possibility of obtaining guided bone regeneration using a poly-tetrafluoroethylene (PTFE) nonporous barrier for 2 endosseous implants, partially inserted in tibiae of rabbits.Materials and Methods: Histologic characteristics of the interface between titanium implants (one group with titanium plasma-coated implants and the other group with acid-treated surfaces) and of the regenerated bone were also studied. Twenty screw-vent implants were placed in tibiae of 5 male New Zealand rabbits, 2 at the right side and 2 at the left side, protruding 3 mm from the bone level, to create a horizontal bone defect. At the experimental group the implants were with a PTFE nonporous barrier, whereas no barriers were used in contralateral implants. Animals were sacrificed 3 months after surgery and biopsy specimens were evaluated histologically and histomorphometrically under light microscopy. Student's t test was used for statistical analysis.Results: The histologic measurements showed a mean gain in bone height of 2.15 and 2.42 mm for the barrier group and 1.95 and 0.43 mm for the control group, for the titanium plasma-spray and acid-treated implant surfaces, respectively.Conclusion: The results of the investigation revealed that the placement of implants protruding 3 nun from crestal bone defects may result in vertical bone augmentation using a nonporous PTFE barrier. (Implant Dent 2009;18:182-191)

BONE SPREADER TECHNIQUE: A PRELIMINARY 3-YEAR STUDY

The purpose of this study was to observe the clinical outcome of bone spreading and standardized dilation of horizontally resorbed bone during immediate implant placement using a "screw-type" configuration of expansion and threadformers. Fifty-three patients were included in this study, and 41 edentulous areas in anterior and posterior maxillas were treated. Sixty-eight implants were placed using an insertion torque of at least 40 Ncm. Abutments were delivered 4 to 6 months after implant placement. The overall failure percentage was 4.41% (3 failures). A retrieved analysis of I implant removed at 3 years after placement demonstrated bone resorption down to the level of the third thread. The bone spreader technique is different from Summers' osteotome, both in clinical use and in armamentarium. The main advantage of the crest-expanding technique is that it is a less invasive procedure; the facial wall expands after the medullary bone is compressed against the cortical wall. Within the limits of this preliminary study, the cumulative survival rate for this method of implant placement is 95.58% at 3 years. This study confirms that a bone spreader used in the maxilla shows an unusually low failure rate after 3 years.

Mini-implant and Nance button for initial retraction of maxillary canines: a prospective study in cast models

OBJETIVO: a ancoragem óssea é fundamental para o sucesso do tratamento de algumas más oclusões, pois permite a aplicação de forças contínuas, diminui o tempo de tratamento e independe da colaboração do paciente. MÉTODOS: o propósito desse trabalho foi comparar, por meio de modelos dentários, a perda de ancoragem após a retração inicial de caninos superiores entre dois grupos. O grupo A utilizou o mini-implante enquanto o grupo B utilizou o Botão de Nance. Para todos os pacientes foram realizados dois modelos (M1 e M2). Os primeiros modelos foram realizados ao início (M1), e os outros ao final da retração inicial de canino (M2). RESULTADOS: todas as medidas foram tabuladas e submetidas à análise estatística. Para verificar o erro sistemático intraexaminador foi utilizado o teste t pareado. Na determinação do erro casual utilizou-se o cálculo de erro proposto por Dahlberg. Para comparação entre as fases Início e Após, foi utilizado o teste t pareado. Para a comparação entre os grupos de mini-implante e Botão de Nance, foi utilizado o teste t de Student para medidas independentes. em todos os testes foi adotado nível de significância de 5% (p<0,05). CONCLUSÃO: ao se medir e comparar em modelos dentários a perda de ancoragem dos molares após a retração inicial de canino utilizando-se dois sistemas de ancoragem distintos (Mini-implante e Botão de Nance), pôde-se observar a inexistência de diferença estatisticamente significativa entre os dois grupos.

The influence of cyclosporin a on mechanical retention of dental implants previously integrated to the bone: A study in rabbits

Background: Immunosuppressive agents may induce severe changes on bone metabolism and may impair the osseointegration process during the implant healing. No data are available concerning the influence of cyclosporin A on dental implants previously integrated to the bone. The aim of this study was to evaluate the influence of cyclosporin A administration on the mechanical retention of bone previously integrated to dental implants.Methods: Eighteen female New Zealand rabbits were submitted to an implant surgery. Each animal received one commercial dental implant of 10 x 3.75 mm. After 12 weeks of an undisturbed healing period, six animals were randomly sacrificed and the removal torque test was performed (group A). In addition, six animals were submitted to a daily injection of cyclosporin A in a dosage of 10 mg/kg (group C), and six animals received saline solution as a control (group B). After 12 weeks of cyclosporin A administration, groups B and C were sacrificed and submitted to a removal torque test in which higher values can be interpreted as higher mechanical bone retention to the implant surface or higher osseointegration.Results: the removal torque results were 30.5 (+/- 9.8) Ncm for group A, 50.17 (+/- 17.5) Ncm for group B, and 26 (+/- 7.8) Ncm for group C. The statistical analysis showed significant differences between groups A and B (P < 0.05) and groups B and C (P < 0.01).Conclusion: Cyclosporin A administration may impair the mechanical retention of dental implants previously integrated to the bone.

Infrared laser photobiomodulation (lambda 830 nm) on bone tissue around dental implants: A Raman spectroscopy and scanning electronic microscopy study in rabbits

Objective: the aim of this study was to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA; similar to 960 cm(-1)), and scanning electron microscopy (SEM), the bone quality on the healing bone around dental implants after laser photobiomodulation ( lambda 830 nm). Background Data: Laser photobiomodulation has been successfully used to improve bone quality around dental implants, allowing early wearing of prostheses. Methods: Fourteen rabbits received a titanium implant on the tibia; eight of them were irradiated with lambda 830 nm laser ( seven sessions at 48-h intervals, 21.5 J/cm(2) per point, 10 mW, phi similar to 0.0028 cm(2), 86 J per session), and six acted as control. The animals were sacrificed 15, 30, and 45 days after surgery. Specimens were routinely prepared for Raman spectroscopy and SEM. Eight readings were taken on the bone around the implant. Results: the results showed significant differences on the concentration of CHA on irradiated and control specimens at both 30 and 45 days after surgery ( p < 0.001). Conclusion: It is concluded that infrared laser photobiomodulation does improve bone healing, and this may be safely assessed by Raman spectroscopy or SEM.

Histomorphometrical analysis of bone formed after maxillary sinus floor augmentation by grafting with a combination of autogenous bone and demineralized freeze-dried bone allograft or hydroxyapatite

Background: Maxillary sinus floor augmentation procedures are currently the treatment of choice when the alveolar crest of the posterior maxilla is insufficient for dental implant anchorage. This procedure aims to obtain enough bone with biomaterial association with the autogenous bone graft to create volume and allow osteo conduction. The objective of this study was to histologically and histometrically evaluate the bone formed after maxillary sinus floor augmentation by grafting with a combination of autogenous bone, from the symphyseal area mixed with DFDBA or hydroxyapatite.Methods: Ten biopsies were taken from 10 patients 10 months after sinus floor augmentation using a combination of 50% autogenous bone plus 50% dernineralized freeze-dried bone allograft (DFDBA group) or 50% autogenous bone plus 50% hydroxyapatite (HA group). Routine histological processing and staining with hernatoxylin and eosin and Masson's trichrome were performed.Results: the histomorphometrical analysis indicated good regenerative results in both groups for the bone tissue mean in the grafted area (50.46 +/- 16.29% for the DFDBA group and 46.79 +/- 8.56% for the HA group). Histological evaluation revealed the presence of mature bone with compact and cancellous areas in both groups. The inflammatory infiltrate was on average nonsignificant and of mononuclear prevalence. Some biopsies showed blocks of the biomaterial in the medullary spaces close to the bone wall, with absence of osteogenic activity.Conclusions: the results indicated that both DFDBA and HA associated with an autogenous bone graft were biocompatible and promoted osteoconduction, acting as a matrix for bone formation. However, both materials were still present after 10 months.

Fibrin adhesive implant in wound healing repair of dental sockets with topical application of epsilon aminocaproic acid: Histological analysis

The aim of the study was to evaluate wound healing repair of dental sockets after topical application of 5% epsilon-aminocaproic acid (EACA) and the use of fibrin adhesive implant in rats under anticoagulant therapy with warfarin. Sixty Albinus wistar rats were used, divided into three groups of 20. In Group I, the animals were given 0.1 mL/100 mg of 0.9% saline solution per day, beginning 6 days before dental extraction and continuing throughout the experimental period. In Group II, the animals received 0.03 mL of sodium warfarin daily, beginning 6 days before the surgery and continuing until the day of sacrifice; after tooth extractions, the sockets were filled with fibrin adhesive material. In Group III the animals were treated as in Group II, and after extractions, the sockets were irrigated with 5 mL of 5% EACA and filled with the same fibrin adhesive material. All groups presented biological phases of wound healing repair, the differences being evident only in the chronology. The results obtained in Group III were very similar to those of Group I in the last period of wound repair, whereas Group II presented a late chronology compared to the other groups. © 2005 Wiley Periodicals, Inc.

Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: A preliminary histologic study in dogs

Background: the purpose of this pilot study was to evaluate the healing potential and reosseointegration in ligature-induced peri-implantitis defects adjacent to various dental implant surfaces following lethal photosensitization.Methods: A total of 36 dental implants with 4 different surface coatings (9 commercially pure titanium surface [CPTi]; 9 titanium plasma-sprayed [TPS]; 9 hydroxyapatite [HA]; and 9 acid-etched [AE]) were inserted in 6 male mongrel dogs 3 months after extraction of mandibular premolars. After a 2-month period of ligature-induced peri-implantitis and 12 months of natural peri-implantitis progression, only 19 dental implants remained. The dogs underwent surgical debridement of the remaining dental implant sites and lethal photosensitization by combination of toluidine blue O (100 mug/ml) and irradiation with diode laser. All exposed dental implant surfaces and bone craters were meticulously cleaned by mechanical means, submitted to photodynamic therapy, and guided bone regeneration (GBR) using expanded polytetrafluoroethylene (ePTFE) membranes. Five months later, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis.Results: the percentage of bone fill was HA: 48.28 +/- 15.00; TPS: 39.54 +/- 12.34; AE: 26.88 +/- 22.16; and CPTi: 26.70 +/- 16.50. The percentage of reosseointegration was TPS: 25.25 +/- 11.96; CPTi: 24.91 +/- 17.78; AE: 17.30 +/- 15.41; and HA: 15.83 +/- 9.64.Conclusion: These data suggest that lethal photosensitization may have potential in the treatment of peri-implantitis.

Periosteum-Derived Cells as an Alternative to Bone Marrow Cells for Bone Tissue Engineering Around Dental Implants. A Histomorphometric Study in Beagle Dogs

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Bone regeneration at implants placed into extraction sockets of maxillary incisors in dogs

AimTo compare the influence of autologous or deproteinized bovine bone mineral as grafting material on healing of buccal dehiscence defects at implants installed immediately into the maxillary second incisor extraction socket in dogs.Material and methodsIn the maxillary second incisor sockets of 12 Labrador dogs, implants were installed immediately following tooth extraction. A standardized buccal defect was created and autologous bone particles or deproteinized bovine bone mineral were used to fill the defects. A collagen membrane was placed to cover the graft material, and the flaps were sutured to fully submerge the experimental areas. Six animals were sacrificed after 2 months, and six after 4 months of healing. Ground sections were obtained for histological evaluation.ResultsAfter 2 months of healing, all implants were osseointegrated. All buccal dehiscence defects were completely filled after 2 months irrespective of the augmentation material (autologous bone or Bio-Oss (R)) applied. Bone-to-implant contact (BIC) on the denuded implant surfaces was within a normal range of 30-40%. However, the newly formed tissue at 2 months was partially resorbed (> 50% of the area measurements) after 4 months.ConclusionsApplying either autologous bone or deproteinized bovine bone mineral to dehiscences at implants installed immediately into extraction sockets resulted in high degree of regeneration of the defects with satisfactory BIC on the denuded implant surface.To cite this article:De Santis E, Botticelli D, Pantani F, Pereira FP, Beolchini M, Lang NP. Bone regeneration at implants placed into extraction sockets of maxillary incisors in dogs.Clin. Oral Impl. Res. 22, 2011; 430-437.

Osseointegrated Implant Fracture: Causes and Treatment

Despite its high success rate, therapy with osseointegrated dental implants is not free of complications. Among the problems that may occur is fracture of implants, which, albeit a rare phenomenon, may lead to unpleasant clinical outcomes for the patient, as well as for the clinician. Thus, it is paramount to know the factors related to the biological processes involved in maintenance of osseointegration and biomechanics applied to dental implants to prevent such complications, as well as treatment options available to deal with the problem. Therefore, the objectives of this work were to investigate the literature to identify causative factors that may lead to fracture of dental implants and to discuss available procedures.

Inferior alveolar nerve transposition with involvement of the mental foramen for implant placement

Inferior Alveolar Nerve (IAN) transposition is an option for prosthetic rehabilitation in cases of moderate or even severe bone reabsorption for patients that do not tolerate removable dentures. The aim of the present report is to describe an inferior alveolar nerve transposition with involvement of the mental foramen for implant placement. The surgical procedure was performed under local anesthesia, by the inferior alveolar, lingual and buccal nerve blocking technique. Centripetal osteotomy was performed, and bone tissue was removed, leaving the nerve tissue free in the foramen area. After that, transsection of the incisor nerve was performed, and lateral osteotomy was started from the buccal direction, toward the trajectory of the IAN. The procedure was concluded, by making use of a delicate resin spatula to manipulate the vascular-nervous bundle. The drilling sequence for placing the dental implants was performed, and autogenous bone was harvested using a bone collector attached to the surgical suction appliance. After the implants were placed, the bone tissue previously collected during the osteotomies and drilling processes was placed in order to protect the IAN from contact with the implants. The surgical protocol for inferior alveolar nerve transposition, followed by implant placement presented excellent results, with complete recovery of the sensitivity, seven months after the surgical procedure.