Evaluation of Impression Accuracy for Implant at Various Angulations

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

A comparison of profilometer and AutoCAD software techniques in evaluation of implant angulation in vitro

Purpose: The aim of this study was to compare 2 different methods of assessment of implants at different inclinations (90 degrees and 65 degrees)-with a profilometer and AutoCAD software. Materials and Methods: Impressions (n = 5) of a metal matrix containing 2 implants, 1 at 90 degrees to the surface and 1 at 65 degrees to the surface, were obtained with square impression copings joined together with dental floss splinting covered with autopolymerizing acrylic resin, an open custom tray, and vinyl polysiloxane impression material. Measurement of the angles (in degrees) of the implant analogs were assessed by the same blinded operator with a profilometer and through analysis of digitized images by AutoCAD software. For each implant analog, 3 readings were performed with each method. The results were subjected to a nonparametric Kruskal-Wallis test, with P <= .05 considered significant. Results: For implants perpendicular to the horizontal surface of the specimen (90 degrees), there were no significant differences between the mean measurements obtained with the profilometer (90.04 degrees) and AutoCAD (89.95 degrees; P=.9142). In the analyses of the angled implants at 65 degrees in relation to the horizontal surface of the specimen, significant differences were observed (P=.0472) between the mean readings with the profilometer (65.73 degrees) and AutoCAD (66.25 degrees). Conclusions: The degrees of accuracy of implant angulation recording vary among the techniques available and may vary depending on the angle of the implant. Further investigation is needed to determine the best test conditions and the best measuring technique for determination of the angle of the implant in vitro.

Accuracy of Impression Techniques for Impants. Part 2-Comparison of Splinting Techniques

Purpose: The aim of this study was to compare splinting techniques for impression copings of osseointegrated implants with different angulations.Materials and Methods: Replicas (N = 24) of a metal matrix (control) containing two implants at 90 degrees and 65 degrees in relation to the horizontal surface were obtained by using four impression techniques: Technique 1 (T1), direct technique with square copings without union in open trays; Technique 2 (T2), square copings splinted with dental floss and autopolymerizing acrylic resin; Technique 3 (T3), square copings splinted with dental floss and autopolymerizing acrylic resin, sectioned and splinted again with autopolymerizing acrylic resin; Technique 4 (T4), square copings splinted with prefabricated acrylic resin bar. The impression material was polyether. The replicas were individually scanned to capture the images, which were assessed in a graphic computation program. The program allowed the angulation between the bases of the replicas and the reading screws to be measured. The images of the replicas were compared with the matrix image (control), and the differences in angulations from the control image were calculated. The analysis of variance and the Tukey test for comparisons (p < 0.05) were used for statistical analysis.Results: All groups showed significant differences in the implant angulations in comparison with the control group (p < 0.05). Group T1 showed the highest difference (1.019 degrees) followed by groups T2 (0.747 degrees), T3 (0.516 degrees), and T4 (0.325 degrees), which showed the lowest angular alteration compared to the control group. There were significant differences between inclined and straight implants in all the groups, except in group T4.Conclusions: Based on the results, the splinting of pick-up impression copings is indicated for osseointegrated implant impressions. The square copings splinted with a prefabricated acrylic resin bar presented the best results among the pick-up impression techniques evaluated in this study.

Biomechanical evaluation of internal and external hexagon platform switched implant-abutment connections: An in vitro laboratory and three-dimensional finite element analysis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Care Required When Using Bisphosphonates in Dental Surgical Practice

Bisphosphonates are pharmacologic compounds characterized by high tropism to bone tissue. They affect bone metabolism by inhibition of osteoclast recruitment, proliferation, differentiation, and function. Because they can reduce bone resorption, bisphosphonates are used mainly for the treatment of osteometabolic conditions. However, the use of bisphosphonates has been associated with the onset of osteonecrosis of the jaws and indication of dental implants. As a result of this, the aim of this study was to present the risks and the care that health professionals should take in cases of surgical procedures such as placement of dental implants in patients who make use of bisphosphonates.

What is the role of lipopolysaccharide on the tribocorrosive behavior of titanium?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evaluation of the influence of location of osseointegrated implants associated with mandibular removable partial dentures

Purpose: The aim of this research was to assess, by means of, the bi-dimensional finite element method, the best implant location in the alveolar edge, through stress distribution and support structure displacement of a distal extension removable partial denture associated with an osseointegrated implant of 10.0 x .75 mm, acting as abutment for the denture base.Methods and Materials: Five models in sagittal cut were used to represent: model A-hemi arch containing natural tooth 33 and the distal alveolar edge; model B-similar to model A, but with a conventional removable partial denture to replace the absent teeth; model C (MC)-similar to the previous one, with an implant in the distal region of the edge under the denture base; model D-similar to MC, with the implant in the central region of the edge; model E-similar to MC, with an implant in the mesial region of the edge. With the aid of the finite element program ANSYS 8.0, the models were loaded with strictly vertical forces of 50 N on each cusp tip. Displacement and von Mises Maps were plotted for visualization of results.Results: The introduction of implant diminished the tendency of intrusion of the removable partial denture in all situations. The maximum stress was observed on implant in all situations. Approximating implant in direction of support teeth was benefit for stress distribution.Conclusion: Model D presented the lowest value for maximum tendency to displacement when compared with those found in the other models; model E demonstrated better relief with regard to demand from the abutment tooth; locating the implant near of the abutment tooth influenced positively the distribution of stresses on the analyzed structures.

Effect of Smoking on Early Bone Healing Around Oxidized Surfaces: A Prospective, Controlled Study in Human Jaws

Background: This prospective and controlled histologic study evaluates the impact of smoking on bone-to-implant contact, the bone density in the threaded area, and the bone density outside the threaded area around microimplants with anodized surface retrieved from human jaws.Methods: A total of 24 subjects (mean age 51.32 +/- 7.5 years) were divided in two groups: smokers (n = 13 subjects) and non-smokers (n = 11 subjects). Each subject received one microimplant with oxidized surface during conventional mandible or maxilla implant surgery. After 8 weeks, the microimplants and the surrounding tissue were removed and prepared for histomorphometric analysis.Results: Three microimplants placed in smokers showed no osseointegration. The newly formed bone showed early stages of maturation, mainly in the non-smokers. Marginal bone loss, gap, and fibrous tissue were present around implants retrieved from smokers. Histometric evaluation indicated that the mean bone-to-implant contact ranged between 25.97% +/- 9.02% and 40.01% +/- 12.98% for smokers and non-smokers, respectively (P <0.001). Smokers presented 28.17% +/- 10.32% of bone density in the threaded area, whereas non-smokers showed 46.34% +/- 19.12%. The mean of bone density outside the threaded area ranged between 18.76% and 25.11% for smokers and non-smokers, respectively (P>0.05).Conclusion: The present data obtained in human subjects confirm that smoking has a detrimental effect on early bone tissue response around oxidized implant surfaces. J Periodontol 2010;81:575-583.

Progression of experimental chronic peri-implantitis in dogs: Clinical and radiographic evaluation

Background: the aim of this study was to evaluate the progression of experimental peri-implantitis in dogs using implants with different surface coatings.Methods: Thirty-six dental implants with four different surface coatings, commercially pure titanium (cpTi), titanium plasma-sprayed (TPS), hydroxyapatite (HA), and acid-etched (AE), were placed in six mongrel dogs. Five months after implantation, peri-implantitis was induced by cotton ligatures to facilitate plaque accumulation for 60 days. After 60 days, the ligatures were removed and supragingival plaque control was initiated for 12 months. Probing depth (PD), clinical attachment level (CAL), vertical bone level (VBL), horizontal bone level (HBL), and mobility were obtained at baseline, and 20, 40, 60 (acute phase), and 425 days (chronic phase) after ligature removal.Results: PD and CAL changed around all implant surfaces after ligature placement (P < 0.0001). However, the means of PD and CAL were not statistically significant among the different surfaces (P > 0.05). The range of CAL variation, calculated between baseline and 60 days (acute phase) and between 60 and 425 days (chronic phase), decreased (P < 0.05). Bone loss increased during the entire experiment (P < 0.0001). The HA surface showed the greatest bone loss measurement (5.06 +/- 0.38 mm) and the TPS showed the smallest bone loss (4.27 +/- 0.62 mm). However, statistical significance was not assessed for different coatings (P > 0.05).Conclusions: the clinical data at the initial phase showed rapid and severe peri-implant tissue breakdown. However, removal of ligatures did not convert the acute destructive peri-implant phase to a non-aggressive lesion and the progression of peri-implantitis was observed at chronic phase. The,experimental peri-implantitis in dogs may be a useful model to evaluate the progression of peri-implantitis.

A survey of radiographic prescription in dental implant assessment

Objectives: To survey the current radiographic prescriptions in dental implant assessment amongst dentists in Brazil.Methods: Sixty-nine dentists were interviewed during a dental implant meeting by two calibrated graduate students, using a 19-question questionnaire, considering imaging modality options both for pre-operative implant site assessment and for follow-up, particularly with respect to cost, patient radiation dose, and broad coverage of facial bones and teeth. Epi-Info 6.04 software was used to analyse the database file.Results: Approximately 63.8% of the dentists prescribed only panoramic radiography for dental implant assessment and 28.9% ordered panoramic radiography plus periapical radiography and/or conventional tomography and/or computed tomography (CT). Only 7.2% of the dentists ordered conventional tomography or CT as a single examination, although 10.1% ordered it in combination with other imaging modalities. The main reasons given for prescribing panoramic radiography were broad coverage and cost (86.4%).Conclusions: This study has shown that most of the dentists in this study prescribe panoramic radiographs in dental implant assessment based on broad coverage and cost. They are not following the American Academy of Oral and Maxillofacial Radiology recommendations regarding cross-sectional imaging.

Lethal photosensitization and guided bone regeneration in treatment of peri-implantitis: an experimental study in dogs

The purpose of this study was to evaluate the effect of lethal photosensitization and guided bone regeneration (GBR) on the treatment of ligature-induced peri-implantitis in different implant surfaces. The treatment outcome was evaluated by clinical and histometric methods. A total of 40 dental implants with four different surface coatings (10 commercially pure titanium surface (cpTi); 10 titanium plasma-sprayed (TPS); 10 acid-etched surface; 10 surface-oxide sandblasted) were inserted into five mongrel dogs. After 3 months, the animals with ligature-induced peri-implantitis were subjected to surgical treatment using a split-mouth design. The controls were treated by debridment and GBR, while the test side received an additional therapy with photosensitization, using a GaAlAs diode laser, with a wavelength of 830 nm and a power output of 50 mW for 80 s (4 J/cm(2)), and sensitized toluidine blue O (100 mu g/ml). The animals were sacrificed 5 months after therapy. The control sites presented an earlier exposition of the membranes on all coating surfaces, while the test group presented a higher bone height gain. Re-osseointegration ranged between 41.9% for the cpTi surface and 31.19% for the TPS surface in the test sites; however differences were not achieved between the surfaces. The lethal photosensitization associated with GBR allowed for better re-osseointegration at the area adjacent to the peri-implant defect regardless of the implant surface.

Effect of Severe Dietary Magnesium Deficiency on Systemic Bone Density and Removal Torque of Osseointegrated Implants

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

Implant image quality in dental radiographs recorded using a customized imaging guide or a standard film holder

Objective: To compare a customized imaging guide and a standard film holder for obtaining optimally projected intraoral radiographs of dental implants.Material and methods: Intraoral radiographs of four screw-type implants with different inclination placed in an upper or lower dental phantom model were recorded by 32 groups of examiners after a short instruction in the use of the RB-RB/LB-LB mnemonic rule. Half of the examiners recorded the images using a standard film holder and the other half used a customized imaging guide. Each radiograph was assessed under blinded conditions with regard to rendering of the implant threads and was assigned to one of four quality categories: (1) perfect, (2) not perfect, but clinically acceptable, (3) not acceptable, and (4) hopeless.Results: For the upper jaw, the same number of exposures per implant were made to achieve an acceptable image (P = 0.86) by the standard film holder method (median = 2) and the imaging guide method (median = 2). For the lower jaw, medians for the imaging guide method and the film holder method were 1 and 2, respectively (P = 0.004). For the imaging guide method, the first exposure was rated as perfect/acceptable in 62% of the cases and for the film holder method in 41% of the cases (P = 0.013). After <= 2 exposures, 78% (imaging guide method) and 69% (film holder method) of the implant images were perfect/acceptable (P=0.23). The implant inclination did not have a major influence on the outcomes.Conclusion: Perfect or acceptable images were achieved after two exposures with the same frequency either using a customized imaging guide method or a standard film holder method. However, the use of a customized imaging guide method was overall significantly superior to a standard film holder method in terms of obtaining perfect or acceptable images with only one exposure.

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)

Success rate of immediate nonfunctional loaded single-tooth implants: Immediate versus delayed implantation

Purpose: The aim of this study was to evaluate the success rate of maxillary immediate nonfunctional single-tooth loaded implants used into fresh extraction sites (immediate placement condition) or healed ridge (delayed placement condition).Materials and Methods: Eighty-two dental implants were placed in the maxilla of 64 consecutive patients from Private practice office and from a specialization course in Implantology. Forty-six implants were inserted under immediate placement condition, and 36 were inserted under delayed placement condition. The criteria used to evaluate success rate were those previously described by Albrektsson and Zarb (Int J Prosthodont 1993;6: 95-105), and follow-up period ranged from 18.0 to 39.7 months.Results: Seventy-nine implants fulfilled the success rate criteria (96.3%). Moreover, differences concerning implantation condition were not significant (P = 0.33, Qui-square test): three of the failed implants were from immediate placement group (success rate of 93.5%), and none was from delayed placement group (success rate of 100.0%).Conclusion: In the present sample, no statistically significant differences were detected for immediate nonfunctional single-tooth loaded implants under immediate placement condition in comparison with those inserted under delayed placement condition; both protocols had high success rate in maxillary incisors, canines, and premolars areas.