The use of transitional implants to support provisional prostheses during the healing phase: a literature review

Objective: Transitional implants are indicated for cases in which immediate loading is counter-indicated because a healing period is necessary for osseointegration of the definitive implants. These provisional implants were developed to support an implant-supported fixed prosthesis or overdenture to provide retention, stability, and support. The aim of this article was to conduct a literature review on transitional implants to highlight the characteristics of the transitional implants and their advantages, indications, and contraindications, including the level of osseointegration of such implants according to the functional period. Method and Materials: The present literature review was based on the OldMedline and Medline databases from 1999 to 2010 using the key words "transitional implants" and "temporary implants." Fourteen articles were found: 11 clinical studies or techniques and three histologic and histomorphometric studies. Results: The transitional immediate prostheses were worn by completely and partially edentulous patients. Advantages of transitional implants include complete denture retention, stability, and support; maintenance of chewing, phonetics, and patient comfort; protection of bone grafts; vertical stop during healing period; easy and fast surgical and prosthetic procedures; lower cost in comparison to the definitive implant; and reestablishment of esthetics. The success of transitional implants as conservative treatment for conventional immediate loading is a reality if correctly indicated. Conclusion: Transitional implants are a provisional treatment alternative for completely and partially edentulous patients. However, additional studies are required to evaluate the level of remodeling and repair of the transitional implants under loading. (Quintessence Int 2011; 42: 19-24)

Prosthetic transfer impression accuracy evaluation for osseointegrated implants

Purpose: The objective of this study was to evaluate and compare 3 impression techniques for osseointegrated implant transfer procedures.Materials and Methods: (1) Group Splinted with Acrylic Resin (SAR), impression with square copings splinted with prefabricated autopolymerizing acrylic resin bar; (2) Group Splinted with Light-Curing Resin (SLR), impression, with square copings splinted with prefabricated light-curing composite resin bar; (3). Group Independent Air-abraded (IAA), impression with independent square coping aluminum oxide air-abraded. Impression procedures were performed with polyether material, and the data obtained was compared with a control group. These were characterized by metal matrix (MM) measurement values of the implants inclination positions at 90 and 05 degrees in relation to the matrix surface. Readings of analogs and implant inclinations were assessed randomly through graphic computation AutoCAD software. Experimental groups angular deviation with MM were submitted to analysis of variance and means were compared through Tukey's test (P < 0.05).Results: There was no statistical significant difference between SAR and SLR experimental groups and MM for vertical and angulated implants. Group IAA presented a statistically significant difference for angulated implants.Conclusion: It was concluded within the limitations of this study, that SAR and SLR produced more accurate casts than IAA technique, which presented inferior results.

Craniofacial Implants Success in Facial Rehabilitation

The use of craniofacial implants is an effective treatment for patients with deformities, burns, and cancer sequelae. The sites with the most successful implants are the auricular, nasal, and orbital regions. Furthermore, other factors can affect the implant longevity such as irradiated area, surgical technique, bone quality and quantity, macrostructure and microstructure of the implant, maintenance, and systemic factors.

Mobility, Aesthetic, Implants, and Satisfaction of the Ocular Prostheses Wearers

During the process of facial rehabilitation, the mobility of ocular prostheses must be considered. Whereas some factors depend exclusively on the dentist, such as molding techniques and selection of material for denture construction, regarding ocular rehabilitation, factors, such as type of surgery, whether to adopt implants, and the use of lubricants, deserve special attention owing to their integration and their association with other factors pertaining exclusively to the patient. To establish harmony, and with the intention of aiding the dentist, after a discerning evaluation, the authors of this study report the factors that provide greater or less mobility to ocular prostheses and conceal the prosthesis in a more natural way, thereby contributing toward achieving a favorable aesthetic result in rehabilitations.

Radiographic assessment of bone density around integrated titanium implants after ovariectomy in rats

Objectives:This study evaluated the influence of ovariectomy 8 weeks after implant placement on bone integrated to titanium implants.Materials and methods:Thirty-eight female rats were submitted to a titanium implant at the tibiae proximal methaphysis. After a healing period of 8 weeks the animals were randomly divided into three groups: control (CTL-10 animals), sham-operated (SHAM-14 animals) and ovariectomy (OVX-14 animals). The CTL group was then sacrificed in order to confirm integration of the implant. The SHAM group was submitted to fictitious surgery and the OVX group was submitted to bilateral ovariectomy. After 12 weeks post-implant placement, the SHAM and OVX groups were sacrificed. In order to confirm the systemic osteopenia in rats, a dual-energy X-ray absorptiometry (DXA) was performed. For the evaluation of bone density, digital radiographs were taken. The grey level of the bone adjacent to implant was measured using image software and the bone density was calculated at six points on both sides of the implant.Results:Densitometry measurements of the femur confirmed systemic bone mass loss in the OVX group. Individualized bone analyses of different regions surrounding the implant showed a significantly lower radiographic bone density (P < 0.05) in the cancellous region of the OVX group (77.48 +/- 23.39 grey levels) when compared with the CTL and SHAM groups (91.61 +/- 32.10 and 102.57 +/- 32.50 grey levels, respectively).Conclusions:The present study showed a decrease of the radiographic bone density in the cancellous region of bone around titanium implants placed 8 weeks before ovariectomy in rats.

Analysis of failed commercially pure titanium dental implants: A scanning electron microscopy and energy-dispersive spectrometer X-ray study

Background: the failure of osseointegration in oral rehabilitation has gained importance in current literature and in clinical practice. The integration of titanium dental implants in alveolar bone has been partly ascribed to the biocompatibility of the implant surface oxide layer. The aim of this investigation was to analyze the surface topography and composition of failed titanium dental implants in order to determine possible causes of failure.Methods: Twenty-one commercially pure titanium (cpTi) implants were retrieved from 16 patients (mean age of 50.33 +/- 11.81 years). Fourteen implants were retrieved before loading (early failures), six after loading (late failures), and one because of mandibular canal damage. The failure criterion was lack of osseointegration characterized as dental implant mobility. Two unused implants were used as a control group. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) to element analysis. Evaluations were performed on several locations of the same implant.Results: SEM showed that the surface of all retrieved implants consisted of different degrees of organic residues, appearing mainly as dark stains. The surface topography presented as grooves and ridges along the machined surface similar to control group. Overall, foreign elements such as carbon, oxygen, sodium, calcium, silicon, and aluminum were detected in failed implants. The implants from control group presented no macroscopic contamination and clear signs of titanium.Conclusion: These preliminary results do not suggest any material-related cause for implant failures, although different element composition was assessed between failed implants and control implants.

Influence of cyclosporin A on quality of bone around integrated dental implants: a radiographic study in rabbits

To evaluate the influence of cyclosporin A (CsA) administration on bone around integrated dental implants assessed by a bone quality index and by quantitative subtraction radiography.A total of 36 machine surface commercial implants were placed in 18 adult rabbits. After a 3-month healing period without any disturbance, the animals were randomly divided into three groups of six animals each. Group A was sacrificed at this time. CsA was injected subcutaneously in an immunosuppressive dose of 10 mg/kg/day in a test group (Group T), and a Group B served as a control, receiving only vehicle. After 3 months of cyclosporin administration, the animals of both Groups B and T were sacrificed. Radiographs were obtained at implant surgery and at the day of sacrifice with a CMOS sensor. Bone quality around the implants was compared between the groups using a bone quality index and quantitative subtraction radiography.The bone analysis showed that in Group T, the bone quality changed dramatically from a dense cortical to a loose trabecular bone structure (P < 0.0001, chi(2) test) while in Groups A and B there were no significant differences. Quantitative digital subtraction radiography showed significantly (P < 0.05) lower gray shade values (radiographic density) in a region of bone formation around the implants in Group T (118 +/- 12) than in Groups A (161 +/- 6) and B (186 +/- 10).Within the limits of this study, CsA administration has a negative effect on the quality of bone around integrated dental implant.

Histomorphometric analysis of tissue responses to bioactive glass implants in critical defects in rat calvaria

The aim of this study was to evaluate the osteogenic behavior of two chemically similar bioactive glass products (Biogran (R) and Perioglas (R)) implanted in critical bone defects in rat calvaria. Thirty-six transfixed bone defects of 8 mm diameter were made surgically in adult male Wistar rats. The animals were distributed equally into three groups: Biogran (GI), Perioglas (GII) and without implant material (control; GIII). The morphology and composition of both bioactive glasses were analyzed by scanning electron microscopy and energy-dispersive spectrometry. Tissue specimens were analyzed at the biological time points of 15, 30 and 60 days by optical microscopy and morphometry, demonstrating biocompatibility for the tested materials with moderate chronic inflammation involving their particles. Bone neoformation resulted only as a reparative reaction to an intentionally produced defect and was limited to the defect's edges. No statistically significant differences among the groups were observed. At the scar interstice, abundant deposits of collagenous fibers enveloping the particles were noted. The present results indicated that the bioactive glasses, under the experimental conditions analyzed, did not show osteogenic behavior. Copyright (c) 2007 S. Karger AG, Basel.

Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants?

Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, an interdisciplinary approach should be observed during the diagnosis, prognosis, and treatment plan to provide a result with good predictability and meet the esthetic and functional expectations of the patient. The present study describes a case of a young patient with tooth agenesis of maxillary lateral incisors, which was conducted with an integrated planning. After 5-year follow-up of 2 fixed implant-supported prostheses, clinical and radiographic examination showed the treatment to be successful. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:e22-e28)

Gingival Papilla Dimensions in Anterosuperior Regions Adjacent to Single-Tooth Implants

This study compared the dimensions of gingival papillae in anterosuperior areas presenting at natural teeth (teeth sites) or single-tooth implants adjacent to natural teeth (implant-tooth sites) by analyzing determined distances. A total of 45 teeth and 46 implant-tooth sites were carefully selected. Clinical evaluation consisted of visual and quantitative analyses with millimeter grids on radiographs. Implant-tooth sites showed a smaller gingival papilla dimension than tooth sites (P < .01). Both evaluated distances (contact point to bone crest and between the roots of adjacent teeth or implant platform to root of adjacent tooth) in all groups significantly influenced the presence/absence of gingival papillae (P < .01). (Int J Periodontics Restorative Dent 2012;32:93-100.)

Influence of Implant Design on the Biomechanical Environment of Immediately Placed Implants: Computed Tomography-Based Nonlinear Three-Dimensional Finite Element Analysis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Early Bone Healing and Biomechanical Fixation of Dual Acid-Etched and As-Machined Implants with Healing Chambers: An Experimental Study in Dogs

Purpose: To evaluate the biomechanical fixation, bone-to-implant contact (BIC), and bone morphology of screw-type root-form implants with healing chambers with as-machined or dual acid-etched (DAE) surfaces in a canine model. Materials and Methods: The animal model included the placement of machined (n = 24) and DAE (n = 24) implants along the proximal tibiae of six mongrel dogs, which remained in place for 2 or 4 weeks. Following euthanasia, half of the specimens were subjected to biomechanical testing (torque to interface failure) and the other half were processed for histomorphologic and histomorphometric (%BIC) assessments. Statistical analyses were performed by one-way analysis of variance at the 95% confidence level and the Tukey post hoc test for multiple comparisons. Results: At 4 weeks, the DAE surface presented significantly higher mean values for torque to interface failure overall. A significant increase in %BIC values occurred for both groups over time. For both groups, bone formation through the classic appositional healing pathway was observed in regions where intimate contact between the implant and the osteotomy walls occurred immediately after implantation. Where contact-free spaces existed after implantation (healing chambers), an intramembranous-like healing mode with newly formed woven bone prevailed. Conclusions: In the present short-term evaluation, no differences were observed in BIC between groups; however, an increase in biomechanical fixation was seen from 2 to 4 weeks with the DAE surface. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:75-82

Influence of estrogen deficiency and its treatment with alendronate and estrogen on bone density around osseointegrated implants: radiographic study in female rats

Objective. This study evaluated the influence of estrogen deficiency and its treatment on bone density around integrated implants.Study design. Implants were placed in female rat tibiae. The animals were assigned to 5 groups: control, sham, ovariectomy, estrogen, and alendronate. The control group was humanely killed to confirm integration of the implant. The others were submitted to ovariectomy or sham surgery. Bone density was measured by digital radiographs at 6 points on sides of the implant.Results. The analysis of radiographic bone density revealed estrogen privation had a negative impact only in the cancellous bone. The estrogen group differed significantly ( P <.05) from the ovariectomy and alendronate groups. The alendronate group presented the highest density for all evaluated regions.Conclusion. Ovariectomy caused a decrease in the radiographic bone density in the cancellous region. Estrogen replacement therapy and alendronate were effective treatments in preventing bone mass loss around integrated implants.

Influence of homeopathic treatment with comfrey on bone density around titanium implants. A digital subtraction radiography study in rats

Objective: The objective of this study was to evaluate the influence of homeopathic treatment with comfrey (Shymphytum officinalis 6CH) on radiographic bone density and area around titanium implants.Material and methods: Forty-eight rats were divided into two groups of 24 animals each: a control group (C) and a test group (SO). Each animal received one titanium micro-implant placed in the tibia. The animals in Group SO were subjected to 10 drops of comfrey 6CH per day mixed into their drinking water until the day of sacrifice. Eight animals of each group were sacrificed at 7, 14 and 28 days post-surgery, respectively.Standardized digital radiographs were obtained on the day of implant installation (baseline images) and on the day of sacrifice (final images). Digital subtraction of the two corresponding images was performed to evaluate changes in bone density and the area related to change around the implant between baseline and final images.Results: Subtraction images demonstrated that a significant difference existed in mean shade of gray at 14 days post-surgery between Group SO (mean 175.3 +/- 14.4) and Group C (mean 146.2 +/- 5.2). Regarding the area in pixels corresponding to the bone gain in Group SO, the differences observed between the sacrifice periods and groups were only significant at 7 days sacrifice between Group SO (mean 171.2 +/- 21.9) and Group C (mean 64.5 +/- 60.4).Conclusion: Within the limits of this study, comfrey administration promotes an increase in radiographic bone density around titanium implants in the initial period of bone healing.