A study of histological responses from Ti-6Al-7Nb alloy dental implants with and without plasma-sprayed hydroxyapatite coating in dogs

Titanium alloys are hoped to be used much more for applications as implant materials in the medical and dental fields because of their basic properties, such as biocompatibility, corrosion resistance and specific strength compared with other metallic implant materials. Thus, the Ti-6Al-7Nb alloy that has recently been developed for biomedical use, that is, primarily developed for orthopaedic use, is to be studied in this paper, for application in dental implants. The biocompatibility test in vivo was carried out in dogs and the osseointegration was verified through histological analysis of the samples of the Ti-6Al-7Nb alloy with and without hydroxyapatite coating that were inserted in the alveoli. Within the controlled conditions the samples did not show any toxic effects on the cells. (C) 2001 Kluwer Academic Publishers.

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.

Effect of 17 beta-estradiol and alendronate on the removal torque of osseointegrated titanium implants in ovariectomized rats

Background: This study investigated the influence of estrogen deficiency and its treatment with estrogen and alendronate on the removal torque of osseointegrated titanium implants.Methods: Fifty-eight female Wistar rats received a titanium implant in the tibia metaphysis. After 60 days, which was needed for implant osseointegration, the animals were randomly divided into five groups: control (CTLE; N = 10), sham surgery (SHAM; N = 12), ovariectomy (OVX; N = 12), ovariectomy followed by hormone replacement (EST; N = 12), and ovariectomy followed by treatment with alendronate (ALE; N = 12). The CTLE group was sacrificed to confirm osseointegration, whereas the remaining groups were submitted to sham surgery or ovariectomy according to their designations. After 90 days, these animals were also sacrificed. Densitometry of femur and lumbar vertebrae was performed by dual-energy x-ray absorptiometry (DXA) to confirm systemic impairment of the animals. All implants were subjected to removal torque.Results: Densitometric analysis of the femur and lumbar vertebrae confirmed a systemic impairment of the animals, disclosing lower values of bone mineral density for OVX. Analysis of the removal torque of the implants showed statistically lower values (P <0.05) for the OVX group in relation to the other groups. However, the group treated with alendronate (ALE group) presented significantly higher torque values compared to the others.Conclusion: According to this study, estrogen deficiency was observed to have a negative influence on the removal torque of osseointegrated implants, whereas treatment with alendronate

Surface modification of Ti dental implants by Nd: YVO4 laser irradiation

Surface modifications have been applied in endosteal bone devices in order to improve the osseointegration through direct contact between neoformed bone and the implant without an intervening soft tissue layer. Surface characteristics of titanium implants have been modified by addictive methods, such as metallic titanium, titanium oxide and hydroxyapatite powder plasma spray, as well as by subtractive methods, such as acid etching, acid etching associated with sandblasting by either AlO2 or TiO2, and recently by laser ablation. Surface modification for dental and medical implants can be obtained by using laser irradiation technique where its parameters like repetition rate, pulse energy, scanning speed and fluency must be taken into accounting to the appropriate surface topography. Surfaces of commercially pure Ti (cpTi) were modified by laser Nd:YVO4 in nine different parameters configurations, all under normal atmosphere. The samples were characterized by SEM and XRD refined by Rietveld method. The crystalline phases alpha Ti, beta Ti, Ti6O, Ti3O and TiO were formed by the melting and fast cooling processes during irradiation. The resulting phases on the irradiated surface were correlated with the laser beam parameters: the aim of the present work was to control titanium oxides formations in order to improve implants osseointegration by using a laser irradiation technique which is of great importance to biomaterial devices due to being a clean and reproducible process. (c) 2007 Elsevier B.V. All rights reserved.

Use of carbon dioxide (CO2) laser radiation in exposure of implants (stage II): A metallography evaluation in dogs

In this study we analyzed possible damages that vaporization from laser radiation could cause to implant material. Fifteen standard titanium implants, measuring 3.75 mm in diameter by 7 mm in length, were placed into the upper and lower jaws of three dogs according to Branemark's system. After osseointegration, all implants were exposed. In group I (control) conventional exposure with a punch was used; in group II, a CO2 laser with 2 W (power density: 256 W/cm(2); fluency: 0.077 J/cm(2), and a pulse mode of 0.30 ms) was used, and in group III 4 W (power density: 512 W/cm(2), fluency: 0.154 J/cm(2), and a pulse mode of 0.30 ms) was used. After vaporization, the cover screws were removed and sent for metallographic examination. The results showed that cover screws irradiated with 2 and 4 W power caused no superficial or microstructural alteration. The results also showed that the prescribed power densities, fluencies, and the use of the pulse mode were suitable for exposing implants without damage to tissue or implant material. (C) 2002 Laser Institute of America.

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.

Electrochemical impedance spectroscopy characterization of passive film formed on implant Ti-6Al-7Nb alloy in Hank's solution

The influence of potential on electrochemical behavior of Ti-6Al-7Nb alloy under simulate physiological conditions was investigated by electrochemical impedance spectroscopy (EIS). The experimental results were compared with those obtained by potentiodynamic polarization curves. All measurements were carried out in Hank's aerated solution at 25degreesC, at pH 7.8 and at different potentials (corrosion potential, 0 mV(SCE), 1000 mV(SCE), and 2000 mV(SCE)). The EIS spectra exhibited a two-step or a two-time constant system, suggesting the formation of a two-layer oxide film on the metal surface. The high corrosion resistance, displayed by this alloy in electrochemical polarization tests, is due to the dense inner layer, while its osseointegration ability can be ascribed to the presence of the outer porous layer. (C) 2004 Kluwer Academic Publishers.

Hyperbaric Oxygen: Therapy for Patients With Maxillofacial Implants?

Osseointegration was an innovative treatment in dentistry during the last 3 decades. The success of osseointegration is related to factors such as material biocompatibility, adequate quality of bone tissue that allows implantation, surgical technique, and macrostructure and microstructure of implant. The osseointegrated implants are successfully applied in dental clinic including oral and facial rehabilitations mainly for patients submitted to mutilating surgeries. However, patients submitted to radiation therapy present risks to treatment with implants owing to adverse effects on bone tissue. Nowadays, the literature suggests different therapies to improve the success of osseointegration such as hyperbaric oxygen therapy that aims to prepare bone and adjacent tissues to receive the implant. Therefore, the purpose of this study was to present a literature review concerning indications, contraindications, successes, and difficulties with hyperbaric oxygen therapy associated to maxillofacial implants.

Short implants (6 mm) installed immediately into extraction sockets: An experimental study in dogs

Aim: To evaluate the effect of implant length (6 mm vs. 11 mm) on osseointegration (bone-toimplant contact) of implants installed into sockets immediately after tooth extraction.Material and methods: In six Labrador dogs, the pulp tissue of the mesial roots of P-3(3) was removed and the root canals were filled. Flaps were elevated bilaterally, the premolars hemisectioned and the distal roots removed. Recipient sites were prepared in the distal alveolus and a 6 mm or an 11 mm long implant was installed at the test and control sites, respectively. Non-submerged healing was allowed. After 4 months of healing, block sections of the implant sites were obtained for histological processing and peri-implant tissue assessment.Results: No statistically significant differences were found between test and control sites both for hard and soft tissue parameters. The bone-to-implant contact evaluated at the apical region of the implants was similar as well. Although not statistically significant, the location of the top of the bony crest at the buccal aspect was more apical in relation to the implant shoulder at the test compared with the control sites (2.0 +/- 1.4 and 1.2 +/- 1.1 mm, respectively).Conclusions: Shorter implants (6 mm) present with equal osseointegration than do longer implants (11 mm).

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.

Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs

ObjectivesTo evaluate the influence of implant size and configuration on osseointegration in implants immediately placed into extraction sockets.Material and methodsImplants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, cylindrical transmucosal implants (3.3 mm diameter) were installed, while in the test sites, larger and conical (root formed, 5 mm diameter) implants were installed. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically.ResultsWith one exception, all implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test implants. This resorption was more pronounced at the buccal aspects and significantly greater at the test (2.7 +/- 0.4 mm) than at the control implants (1.5 +/- 0.6 mm). However, the control implants were associated with residual defects that were deeper at the lingual than at the buccal aspects, while these defects were virtually absent at test implants.ConclusionsThe installment of root formed wide implants immediately into extraction sockets will not prevent the resorption of the alveolar crest. In contrast, this resorption is more marked both at the buccal and lingual aspects of root formed wide than at standard cylindrical implants.To cite this article:Caneva M, Salata LA, de Souza SS, Bressan E, Botticelli D, Lang NP. Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs.Clin. Oral Impl. Res. 21, 2010; 885-895.doi: 10.1111/j.1600-0501.2010.01931.x.

Collagen membranes at immediate implants: a histomorphometric study in dogs

AimTo evaluate the influence of resorbable membranes on hard tissue alterations and osseointegration at implants placed into extraction sockets in a dog model.Material and methodsIn the mandibular premolar region, implants were installed immediately into the extraction sockets of six Labrador dogs. Collagen-resorbable membranes were placed at the test sites, while the control sites were left uncovered. Implants were intended to heal in a submerged mode. After 4 months of healing, the animals were sacrificed, and ground sections were obtained for histomorphometric evaluation.ResultsAfter 4 months of healing, a control implant was not integrated (n=5). Both at the test and at the control sites, bone resorption occurred. While the most coronal bone-to-implant contact was similar between the test and the control sites, the alveolar bone crest outline was maintained to a higher degree at the buccal aspect of the test sites (loss: 1.7 mm) compared with the control sites (loss: 2.2 mm).ConclusionsThe use of collagen-resorbable membranes at implants immediately placed into extraction sockets contributed to a partial (23%) preservation of the buccal outline of the alveolar process.To cite this article:Caneva M, Botticelli D, Salata LA, Souza SLS, Carvalho Cardoso L, Lang NP. Collagen membranes at immediate implants: a histomorphometric study in dogs.Clin. Oral Impl. Res. 21, 2010; 891-897.doi: 10.1111/j.1600-0501.2010.01946.x.

Deproteinized bovine bone mineral in marginal defects at implants installed immediately into extraction sockets: an experimental study in dogs

Aim: To evaluate the influence of deproteinized bovine bone mineral (DBBM) particles concomitant with the placement of a collagen membrane on alveolar ridge preservation and on osseointegration of implants placed into alveolar sockets immediately after tooth extraction. Material and methods: The pulp tissue of the mesial roots of 3P3 was removed in six Labrador dogs and the root canals were filled. Flaps were elevated in the right side of the mandible, and the buccal and lingual alveolar bony plates were exposed. The third premolar was hemi-sectioned and the distal root was removed. A recipient site was prepared and an implant was placed lingually. After implant installation, defects of about 0.6mm wide and 3.1mm depth resulted at the buccal aspects of the implant, both at the test and at the control sites. The same surgical procedures and measurements were performed on the left side of the mandible. However, DBBM particles with a size of 0.25-1mm were placed into the remaining defect concomitant with the placement of a collagen membrane. Results: All implants were integrated into mature bone. No residual DBBM particles were detected at the test sites after 4 months of healing. Both the test and the control sites showed buccal alveolar bone resorption, 1.8 +/- 1.1 and 2.1 +/- 1mm, respectively. The most coronal bone-to-implant contact at the buccal aspect was 2 +/- 1.1 an 2.8 +/- 1.3mm, at the test and the control sites, respectively. This difference in the distance was statistically significant. Conclusion: The application of DBBM concomitant with a collagen membrane to fill the marginal defects around implants placed into the alveolus immediately after tooth extraction contributed to improved bone regeneration in the defects. However, with regard to buccal bony crest preservation, a limited contribution of DBBM particles was achieved.

Bone healing pattern in surgically created circumferential defects around submerged implants: an experimental study in dog

Objective: To describe the healing of marginal defects below or above 1 mm of dimension around submerged implants in a dog model.Material and methods: In 12 Labrador dogs, all mandibular premolars and first molars were extracted bilaterally. After 3 months of healing, full-thickness flaps were elevated in the edentulous region of the right side of the mandible. Two recipient sites were prepared and the marginal 5mm were widened to such an extent to obtain, after implant installation, a marginal gap of 0.5mm at the mesial site (small defect) and of 1.25mm at the distal site (large defect). Titanium healing caps were affixed to the implants and the flaps were sutured allowing a fully submerged healing. The experimental procedures were subsequently performed in the left side of the mandible. The timing of the experiments and sacrifices were planned in such a way to obtain biopsies representing the healing after 5, 10, 20 and 30 days. Ground sections were prepared and histomorphometrically analyzed.Results: The filling of the defect with newly formed bone was incomplete after 1 month of healing in all specimens. Bone formation occurred from the base and the lateral walls of the defects. A larger volume of new bone was formed in the large compared with the small defects. Most of the new bone at the large defect was formed between the 10- and the 20-day period of healing. After 1 month of healing, the outline of the newly formed bone was, however, located at a similar distance from the implant surface (about 0.4mm) at both defect types. Only minor newly formed bone in contact with the implant, starting from the base of the defects, was seen at the large defects (about 0.8mm) while a larger amount was detected at the small defects (about 2.2 mm).Conclusion: Marginal defects around titanium implants appeared to regenerate in 20-30 days by means of a distance osteogenesis. The bone fill of the defects was, however, incomplete after 1 month.