Histomorphometrical and molecular evaluation of endosseous dental implants sites in humans: Correlation with clinical and radiographic aspects

Objective: To evaluate the correlations between clinical-radiographical aspects and histomorphometric-molecular parameters of endosseous dental implant sites in humans. Material and methods: The study sample consisted of bone implant sites from the jawbones of 32 volunteers, which were classified according to two different systems: (1) based only on periapical and panoramic images (PP); (2) as proposed by Lekholm & Zarb (L&Z). Bone biopsies were removed using trephine during the first drilling for implant placement. Samples were stained with haematoxylin-eosin (HE), and histomorphometric analysis was performed to obtain the following parameters: trabecular thickness (Tb.Th), trabecular number, bone volume density (BV/TV), bone specific surface (BS/BV), bone surface density and trabecular separation (Tb.Sp). In addition, immunohistochemistry analysis was performed on bone tissue samples for the proteins, Receptor activator of nuclear factor kappa-B (RANK), RANK ligand (RANKL), osteoprotegerin (OPG) and Osteocalcin (OC). Also, the determination of the relative levels of gene expression was performed using Reverse transcription-real-time Polymerase Chain Reaction (RT-PCR). Results: PP and L&Z classification systems revealed a moderate correlation with BV/TV, BS/BV, Tb.Th and Tb.Sp. L&Z's system identified differences among bone types when BV/TV, BS/BV, Tb.Th and Tb.Sp were compared. A weak correlation between PP/L&Z classifications and the expression of bone metabolism regulators (RANK, RANKL, OPG e OC) was found. The analysis of mRNA expression showed no difference between the bone types evaluated. Conclusions: Our results suggest that PP and L&Z subjective bone-type classification systems are related to histomorphometric aspects. These data may contribute to the validation of these classifications. Bone remodelling regulatory molecules do not seem to influence morphological aspects of the jawbone © 2011 John Wiley & Sons A/S.

Regular and switching platform: Bone stress analysis with varying implant diameter

The aim of this study was to evaluate stress distribution of the peri-implant bone by simulating the biomechanical influence of implants with different diameters of regular or platform switched connections by means of 3-dimensional finite element analysis. Five mathematical models of an implant-supported central incisor were created by varying the diameter (5.5 and 4.5 mm, internal hexagon) and abutment platform (regular and platform switched). For the cortical bone, the highest stress values (rmax and rvm) were observed in situation R1, followed by situations S1, R2, S3, and S2. For the trabecular bone, the highest stress values (rmax) were observed in situation S3, followed by situations R1, S1, R2, and S2. The influence of platform switching was more evident for cortical bone than for trabecular bone and was mainly seen in large platform diameter reduction.

Comparison of the accuracy for three dental impression techniques and index: An in vitro study

Objectives: This in vitro study compared the dimensional accuracy of stone index (I) and three impression techniques: tapered impression copings (T), squared impression copings (S) and modified squared impression copings (MS) for implant-supported prostheses. Methods: A master cast, with four parallel implant abutment analogs and a passive framework, were fabricated. Vinyl polysiloxane impression material was used for all impressions with two metal stock trays (open and closed tray). Four groups (I, T, S and MS) were tested (n = 5). A metallic framework was seated on each of the casts, one abutment screw was tightened, and the gap between the analog of implant and the framework was measured with a stereomicroscope. The groups' measurements (80 gap values) were analyzed using software (LeicaQWin - Leica Imaging Systems Ltd.) that received the images of a video camera coupled to a Leica stereomicroscope at 100× magnification. The results were statistically analyzed with Kruskal-Wallis One Way ANOVA on Ranks test followed by Dunn's Method, 0.05. Results: The mean values of abutment/framework interface gaps were: Master Cast = 32 μm (SD 2); Group I = 45 μm (SD 3); Group T = 78 μm (SD 25); Group S = 134 μm (SD 30); Group MS = 143 μm (SD 27). No significant difference was detected among Index and Master Cast (P = .05). Conclusion: Under the limitations of this study, it could be suggested that a more accurate working cast is possible using tapered impression copings techniques and stone index. © 2013 Japan Prosthodontic Society.

Release of Bone Markers in Immediately Loaded and Nonloaded Dental Implants: A Randomized Clinical Trial

The aim of this study was to compare the release of bone markers during osseointegration of immediately loaded and nonloaded implants. Forty patients who were indicated for rehabilitation with dental implants randomly received either implant and prosthesis placement within 72 hours (group IM) or implant insertion and no prosthesis placement (group NL). Peri-implant crevicular fluid was collected immediately after implant insertion and 7, 15, 30, 60, 90, and 120 days after surgery and levels of osteoprotegerin, transforming growth factors, osteocalcin, osteopontin, and parathyroid hormone were evaluated using Luminex assay. Bleeding index and peri-implantar sulcus depth were also evaluated. The data were compared using statistical tests ( = 5%). No statistical difference was found regarding demographic and clinical parameters (p > .05). Transforming growth factors, osteoprotegerin, osteopontin, and parathyroid hormone presented an earlier release peak in group IM than in NL group (p < .05). Osteocalcin achieved higher levels in group IM versus group NL between 7 and 30 days of evaluation (p < .05). It may be concluded that earlier loading positively modulates bone mediators release around immediately loaded implants when compared with nonloaded dental implants (ClinicalTrials.gov NCT01909999).

Photoelastic Analysis of Stress Distribution With Different Implant Systems

The aim of this study was to evaluate stress distribution with different implant systems through photoelasticity. Five models were fabricated with photoelastic resin PL-2. Each model was composed of a block of photoelastic resin (10 x 40 x 45 mm) with an implant and a healing abutment: model 1, internal hexagon implant (4.0 X 10 mm; Conect AR, Conexao, Sao Paulo, Brazil); model 2, Morse taper/internal octagon implant (4.1 x 10 mm; Standard, Straumann ITI, Andover, Mass); model 3, Morse taper implant (4.0 x 10 mm; AR Morse, Conexao); model 4, locking taper implant (4.0 x 11 mm; Bicon, Boston, Mass); model 5, external hexagon implant (4.0 x 10 mm; Master Screw, Conexao). Axial and oblique load (45) of 150 N were applied by a universal testing machine (EMIC-DL 3000), and a circular polariscope was used to visualize the stress. The results were photographed and analyzed qualitatively using Adobe Photoshop software. For the axial load, the greatest stress concentration was exhibited in the cervical and apical thirds. However, the highest number of isochromatic fringes was observed in the implant apex and in the cervical adjacent to the load direction in all models for the oblique load. Model 2 (Morse taper, internal octagon, Straumann ITI) presented the lowest stress concentration, while model 5 (external hexagon, Master Screw, Conexao) exhibited the greatest stress. It was concluded that Morse taper implants presented a more favorable stress distribution among the test groups. The external hexagon implant showed the highest stress concentration. Oblique load generated the highest stress in all models analyzed.

Influence of Tapered and External Hexagon Connections on Bone Stresses Around Tilted Dental Implants: Three-Dimensional Finite Element Method With Statistical Analysis

Background: The purpose of this study is to analyze the tension distribution on bone tissue around implants with different angulations (0 degrees, 17 degrees, and 30 degrees) and connections (external hexagon and tapered) through the use of three-dimensional finite element and statistical analyses.Methods: Twelve different configurations of three-dimensional finite element models, including three inclinations of the implants (0 degrees, 17 degrees, and 30 degrees), two connections (an external hexagon and a tapered), and two load applications (axial and oblique), were simulated. The maximum principal stress values for cortical bone were measured at the mesial, distal, buccal, and lingual regions around the implant for each analyzed situation, totaling 48 groups. Loads of 200 and 100 N were applied at the occlusal surface in the axial and oblique directions, respectively. Maximum principal stress values were measured at the bone crest and statistically analyzed using analysis of variance. Stress patterns in the bone tissue around the implant were analyzed qualitatively.Results: The results demonstrated that under the oblique loading process, the external hexagon connection showed significantly higher stress concentrations in the bone tissue (P < 0.05) compared with the tapered connection. Moreover, the buccal and mesial regions of the cortical bone concentrated significantly higher stress (P < 0.005) to the external hexagon implant type. Under the oblique loading direction, the increased external hexagon implant angulation induced a significantly higher stress concentration (P = 0.045).Conclusions: The study results show that: 1) the oblique load was more damaging to bone tissue, mainly when associated with external hexagon implants; and 2) there was a higher stress concentration on the buccal region in comparison to all other regions under oblique load.

Non-linear 3D finite element analysis of full-arch implant-supported fixed dentures

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

Are new TiNbZr alloys potential substitutes of the Ti6Al4V alloy for dental applications? An electrochemical corrosion study

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

Piezosurgery Applied to Implant Dentistry: Clinical and Biological Aspects

Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.

Bone apposition and surface treatment in dental implants: histomorphometric pilot evaluation in rabbits

The surface of dental implants is an important factor for osseointegration process and different methods of surface treatment have been described. Objective: To investigate the bone apposition in implant surface treated with sandblasting and acid-etching. Material and methods: Ten rabbits were selected and received one implant treated with method I in the left tibia and one implant treated with method II in the right tibia. Then, twenty implants were divided in two groups, according to methods of sandblasting and acid-etching (method I and method II). After 7, 14, 30, 45 and 60 days, tibias were retrieved and submitted to histotechnical procedures. The percentages of bone–implant contact (BIC) and bone area between threads (BABT) were determined throughout histomorphometric analysis and bone apposition was detected in implants of both groups. Results: In BABT measurements, an increase was observed after 45 and 60 days in the method II, compared to method I and no differences were found after 7, 14 and 30 days. In BIC measurements, an increase was detected with method II at 45 days when compared to method I. No differences between groups in BIC values were observed after 7, 14, 30 and 60 days. Conclusion: Our data demonstrated that implants treated with the method II presented increase in the contact between bone and implant after 45 days compared to method I. Moreover, with concern to bone area between threads, it was observed an increased in the method II after 45 and 60 days. However, both groups can be successfully used as a therapeutic strategy to rehabilitation of edentulous patients. Then, further experiments are needed to evaluate, in depth, the putative differential role of each surface treatment.

A combined approach for the treatment of resorbed fresh sockets allowing immediate implant restoration: a 2-year follow-up

Introduction: The demand for optimal esthetics has increased with the advance of the implant dentistry and with the desire for easier, safer and faster technique allowing predictable outcomes. Thus, the aim of this case report was to describe a combined approach for the treatment of a periodontally compromised tooth by means of atraumatic tooth extraction, immediate flapless implant placement, autogenous block and particulate bone graft followed by connective tissue graft and immediate provisionalization of the crown in the same operatory time. Case Report: A 27-year-old woman underwent the proposed surgical procedures for the treatment of her compromised maxillary right first premolar. The tooth was removed atraumatically with a periotome without incision. A dental implant was inserted 3 mm apical to the cement-enamel junction of the adjacent teeth enabling the ideal tridimensional implant position. An osteotomy was performed in the maxillary tuber for block bone graft harvesting that allowed the reconstruction of the alveolar buccal plate. Thereafter, an autogenous connective tissue graft was placed to increase both the horizontal and vertical dimensions of the alveolar socket reaching the patient functional and esthetic expectations. Conclusion: This treatment protocol was efficient to create a harmonious gingival architecture with sufficient width and thickness, maintaining the stability of the alveolar bone crest yielding excellent aesthetic results after 2-years of follow-up. We suggest that this approach can be considered a viable alternative for the treatment of periodontally compromised tooth in the maxillary esthetic area enhancing patient comfort and satisfaction.

An alternative technique for fabrication of frameworks in an immediate loading implant fixed mandibular prosthesis

The oral rehabilitation of edentulous patients with immediate loading has become a safe procedure with high predictability. The success is related to immediate fabrication of a passive fit framework to attach the implants. Based on these considerations, this case report shows an alternative technique for mandibular rehabilitation using implants immediately loaded, where the framework was fabricated using cylinders with internal reinforcement and precast pieces, electrowelding, and conventional welding providing esthetics and function to the patient in a short period of time.

Optimizing maxillary aesthetics of a severe compromised tooth through orthodontic movement and dental implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.

The fitness of copings constructed over UCLA abutments and the implant, constructed by different techniques: casting and casting with laser welding

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

Dynamic UCLA for single tilted implant in an aesthetic region

The aim of this paper was to present a rehabilitation of a patient with a dynamic universal castable long abutment (UCLA) for a single tilted implant in the anterior maxillary area. A 57-year-old male patient attended the dentistry college clinic complaining of a vertical fracture of a residual root of the dental element 22. The tooth extraction was indicated for the implant installation. Due to the socket buccal wall thickness, the implant was installed with an inclination to the palate. It was done in a two-stage surgical protocol, and an external hexagon implant (3.75×11.5mm) was placed. After a six-month healing period to correct the implant position, a dynamic UCLA was set in place, rectifying the implant emergence profile at 20°. The ceramic structure fitting was performed and, after the patient's consent, the prosthesis was finalized and installed. After a follow-up period of twenty months, no complications were observed. The installation of tilted implants with a dynamic UCLA may be a viable option, faster and less invasive than bone grafts.