Sequential healing at implants with different configuration and modified surfaces: an experimental study in the dog

To evaluate the peri-implant soft and hard tissue adaptation at implants with different modified surfaces and configurations. Six Beagle dogs were used. Mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness flaps were elevated, and two different types of trans-mucosal implants (ICX-Gold®, Medentis Medical GmbH, Dernau, Germany and SLActive®, Institute Straumann, Bern, Switzerland) and two different surfaces were randomly installed in the distal regions of one side of the mandible. Abutments were applied, and a nonsubmerged healing was allowed. After 1 month, the procedures were performed in the other side of the mandible, and after a further month, the animals were sacrificed, biopsies were collected, and ground sections prepared for histological examination. Similar results in marginal bone and soft tissues dimensions were observed after 1 month of healing at the two implant systems used, and no major changes could be observed after 2 months of healing. After 1 month, the percentage of new bone was 69.0% and 68.8% at ICX-Gold and SLActive surfaces, respectively. After 2 months, the percentage of new bone was 67.8% and 71.9% at ICX-Gold Medentis and SLActive surfaces, respectively. No statistically significant differences in osseointegration were found. The two implant systems used resulted in similar osseointegration after 1 and 2 months of healing.

Posterior partially edentulous jaws, planning a rehabilitation with dental implants

To discuss important characteristics of the use of dental implants in posterior quadrants and the rehabilitation planning. An electronic search of English articles was conducted on MEDLINE (PubMed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations (bone quantity and density), radiographic techniques, implant selection (number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.

Analysis of the biomechanical behavior of short implants: the photo-elasticity method

The aim of this study was to analyze the stress distribution of short implants supporting single unit or splinted crowns by the photo-elasticity method. Four photo-elastic models were produced: A (3.75×7mm); B (3.75×7mm, 3.75×7mm and 3.75×7mm); C (3.75×10mm, 3.75×7mm and 3.75×7mm); D (3.75×13mm, 3.75×7mm and 3.75×7mm). The prostheses were made with Ni-Cr alloy. A load of 100N in the axial and oblique directions was applied, totaling 380 applications, individually capturing their images in each model. The data were randomized and analyzed qualitatively and quantitatively by 2 examiners. The oblique loading was significantly more damaging. The increase in length was favorable for stress distribution (p<0.05). The splinting was beneficial for the transmission of stresses mainly (p<0.05). The splinting of the crowns, as well as increasing the length of the first implant and axial loading was most beneficial in the stress distribution. Short splinted implants behaved better than single unit implants. Increasing of the length of the first implant significantly improved the stress distribution in all analyzed situations.

Titanium-35niobium alloy as a potential material for biomedical implants: in vitro study

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Supratarsal approach to treatment of zygomatic complex fractures

Many incisions have been described for approaches to zygomatic fractures. Precise repositioning of zygomatic complex fractures is difficult. The traditional approach is through an eyebrow incision, but it can produce a scar that causes aesthetic and psychological problems for the patient. We describe the supratarsal fold approach to expose the frontozygomatic suture and to reduce small displacements of frontal sinus anterior wall; it gives good access and excellent aesthetic results.

Intraoral approach to zygomatic fracture

Abstract: The intraoral approach to zygomatic fracture treatment was introduced by Keen in 1909. This technique allows both an adequate visualization of the zygomaticomaxillary buttress and intraoral reduction of zygomatic arch fractures. Similar techniques have been published over the last 30 years. The aim of this study was to describe a modification of the Keen technique that promotes adequate visualization of the infraorbital rim and permits reduction and fixation of this region in cases of zygomatic fractures. The present technique has several advantages such as that (a) only 1 incision is necessary to approach the zygomaticomaxillary buttress and infraorbital rim, (b) it optimizes surgical time, and (c) it avoids periorbital scars. Fracture of the zygomatic complex is one of the most common facial traumas and has been extensively described in the literature.1 However, there are several controversies as regards the best technique and treatment of these fractures, such as closed versus open reduction; sequence of reduction and fixation in open techniques; complications; and morbidity rates of each technique. Currently, the intraoral approach for surgical treatment of zygomatic complex fractures has received special attention. It was first described by Keen in 1909, using the upper sulcus technique. Later, other studies showed different variations of this technique to reach the zygomatic arch and buttress.3,4 However, in most cases, infraorbital margin fixation was still performed through the subtarsal, subciliary, or transconjunctival approach. The purpose of this article was to describe the modifications made to the intraoral approach to allow reduction and fixation of the infraorbital rim in zygomatic fractures.

Histologic and histometric evaluation of calvarial autogenous bone graft in reconstruction of atrophyc maxilla for dental implants

The calvarial bone is highlighted as a good donor area for large reconstructions of atrophic jaw for subsequent rehabilitation with implant-supported prosthesis. The aim of this study was to observe and measure through histological and histometric evaluation, the cellular events that occur at the interface of union from onlay parietal bone graft on the maxilla of 10 patients, after a period of 6 months of incorporation. The biopsies were performed at the time of installation of osseointegrated implants. The bone contact area represented 78.75% and connective contact 21.25%. The region of connective union between the bone graft to the maxillae presented new bone formation (41.26%), marrow bone (36.06%), osteoid tissue (15.86%) and connective tissue (6.80%). All samples had good graft incorporation to the receptor bed with osteogenic activity and absence of inflammatory cells.

Influence of morphological variables in photoelastic models with implants submitted to axial loading

Purpose: This study used 12 photoelastics models with different height and thickness to evaluate if the axial loading of 100N on implants changes the morphology of the photoelastic reflection. Methods: For the photoelastic analysis, the models were placed in a reflection polariscope for observation of the isochromatic fringes patterns. The formation of these fringes resulted from an axial load of 100N applied to the midpoint of the healing abutment attached to the implant with 10.0mm x 3.75mm (Conexão, Sistemas de Próteses, Brazil). The tension in each photoelastic model was monitored, photographed and observed using the software Phothoshop 7.0. For qualitative analysis, the area under the implant apex was measured including the green band of the second order fringe of each model using the software Image Tool. After comparison of the areas, the performance generated by each specimen was defined regarding the axial loading. Results: There were alterations in area with different height and thickness of the photoelastic models. It was observed that the group III (30mm in height) presented the smallest area. Conclusion: There was variation in the size of the areas analyzed for different height and thickness of the models and the morphology of the replica may directly influence the result in researches with photoelastic models.

Effect of smoking on the survival of dental implants

Background. Although the long-term success of implant treatment has been well- established, failures can still occur and the smoking habit has been reported as a risk factor for implant loss. A literature review on the effects of smoking on the survival of dental implants was undertaken. Methods and Results. Medline database was used to carry out the review with the keywords “osseointegration”, “smoking” and “bone healing”. The cigarette has more than 4,000 bioactive chemical components with potential toxic effects to human tissues including bone. Nicotine is the main component of the cigarette and it is frequently associated with bone healing failures. Since smoking negatively affects the osseointegration of dental implants, the main target is to quit the consumption of cigarettes. Conclusion. Nevertheless, the smoking habit should not be an absolute contraindication for implant treatment, but, patients should be advised that they are at a greater risk of implant failure.

Influence of crown-to-implant ratio, retention system, restorative material, and occlusal loading on stress concentrations in single short implants

Purpose: The aim of this study was to assess the contributions of some prosthetic parameters such as crown-to-implant (C/I) ratio, retention system, restorative material, and occlusal loading on stress concentrations within a single posterior crown supported by a short implant. Materials and Methods: Computer-aided design software was used to create 32 finite element models of an atrophic posterior partially edentulous mandible with a single external-hexagon implant (5 mm wide × 7 mm long) in the first molar region. Finite element analysis software with a convergence analysis of 5% to mesh refinement was used to evaluate the effects of C/I ratio (1:1; 1.5:1; 2:1, or 2.5:1), prosthetic retention system (cemented or screwed), and restorative material (metal-ceramic or all ceramic). The crowns were loaded with simulated normal or traumatic occlusal forces. The maximum principal stress (σmax) for cortical and cancellous bone and von Mises stress (σvM) for the implant and abutment screw were computed and analyzed. The percent contribution of each variable to the stress concentration was calculated from the sum of squares analysis. Results: Traumatic occlusion and a high C/I ratio increased stress concentrations. The C/I ratio was responsible for 11.45% of the total stress in the cortical bone, whereas occlusal loading contributed 70.92% to the total stress in the implant. The retention system contributed 0.91% of the total stress in the cortical bone. The restorative material was responsible for only 0.09% of the total stress in the cancellous bone. Conclusion: Occlusal loading was the most important stress concentration factor in the finite element model of a single posterior crown supported by a short implant.

Relation between bruxism and dental implants

OBJECTIVE: The aim of this study was to gather information and discuss the predictability of implant-supported prostheses in patients with bruxism by performing a literature review. METHODS: In order to select the studies included in this review, a detailed search was performed in PubMed and Medline databases, using the following key words: bruxism, dental implants, implant supported prosthesis, and dental restoration failure. Items that were included are: case reports, randomized controlled trials, in vitro studies, literature and systematic reviews, with or without meta-analysis, of the last 20 years that addressed the theme. Articles without abstracts, animal studies, articles in languages other than English and articles from journals unrelated to the dental field were excluded. RESULTS: after analysis according to inclusion and exclusion criteria, 28 articles were selected from a total of 54. It is known from the array of scientific articles which have assessed, either through retrospective, prospective or experimental studies, that the biomechanical and biological impact of bruxism on implant-supported prostheses is small, and that the literature has contributed little to exemplify the prosthetic limits of safety for the specialist from a clinical point of view. CONCLUSION: Although there is still no general consensus on this matter, most of the literature review articles do provide clinical guidelines that contribute to implant supported prostheses longevity and stability in patients with bruxism.

Bone substitutes for peri-implant defects of postextraction implants

Placement of implants in fresh sockets is an alternative to try to reduce physiological resorption of alveolar ridge after tooth extraction. This surgery can be used to preserve the bone architecture and also accelerate the restorative procedure. However, the diastasis observed between bone and implant may influence osseointegration. So, autogenous bone graft and/or biomaterials have been used to fill this gap. Considering the importance of bone repair for treatment with implants placed immediately after tooth extraction, this study aimed to present a literature review about biomaterials surrounding immediate dental implants. The search included 56 articles published from 1969 to 2012. The results were based on data analysis and discussion. It was observed that implant fixation immediately after extraction is a reliable alternative to reduce the treatment length of prosthetic restoration. In general, the biomaterial should be used to increase bone/implant contact and enhance osseointegration.

Clinical and radiographic evaluation of surgical treatment of zygomatic fractures using 1.5 mm miniplates system

Fractures of the zygomaticomaxillary complex are among the most common face traumas. Based upon the complexity and great variety of reported diagnoses and treatments, the proposal of this study was to evaluate, clinically and radiographically, unilateral zygomatic fractures treated through internal rigid fixation with miniplates and screws of 1.5 mm. Material and Method: 15 patients with unilateral fractures of the zygomaticomaxillary complex were analyzed, and compared with 15 patients without fractures so that a comparative analysis of the area and the perimeter of the orbital cavities could be made, as well as the distance from the nasal point to the zygomatic prominence between both groups. Results: In the radiographic analysis, the both groups presented similarity in the perimeter and in the area of the orbital cavities. Concerning the distance from the nasal point to the zygomatic prominence, only the operated group showed a significant difference between the sides, even though clinically the observation of the asymmetry had been absent or discreet. Conclusions: The treatment of unilateral fractures of the zygomaticomaxillary complex with the use of plates and screws of the 1.5 mm system proved to be effective, showing good esthetic results and low complication rates.

Biocompatibility of experimental Ti-30Ta implants with compromised primary stability: effect of TEA

Purpose: Ti-Ta alloys have high potential for dental application due to a good balance between high strength and low modulus. Absence of primary anchoring may occur when dental implants are installed immediately after tooth extraction. Tranexamic acid (TEA) is used to reduce fibrin degradation and can prevent early blood clot breakdown. The aim of this study was to evaluate the biocompatibility of Ti-30Ta implants associated or not with tranexamic acid and installed with compromised primary stability. Methods and materials: Fabricated were 20 implants of titanium ASTM F67 (Grade 4) and 20 implants of Ti-30Ta alloy with dimensions of 2.1 mm × 2.8 mm Ø. They were divided (n = 10) into Group I (Ti machined), Group II (Ti machined/tranexamic acid), Group III (Ti-30Ta alloy) and Group IV (Ti-30Ta/tranexamic acid) and were implanted in tibia (defects with 2.5 mm × 3.2 mm Ø) of 40 male rats (250 g). The surgical sites were rinsed with 5% tranexamic acid solution in Groups II and IV. The animals were euthanized at 45 days postoperative. The pieces were processed in methyl methacrylate (Stevenel's blue/Alizarin red). The percentage of peri-implant tissue repair was analyzed via images obtained by an optical microscope coupled to a digital camera using Leica software and Adobe Photoshop QWin. Data were analyzed statistically with a significance level of 5%. Results: Histomorphometric results showed 97.16% of bone-implant contact for group IV, 89.78% of bone contact for group III, 70.89% for group II and 61.59% of bone contact for group I. The statistical analyses demonstrated significant differences (P < 0.05) among group I and other groups. Conclusion: The results suggest that (a) Ti-30Ta promoted an increase of bone healing and apposition around implant; (b) tranexamic acid favored the stabilization of blood clot and bone formation.

Measurement of buccal bone volume of dental implants by means of cone-beam computed tomography

Purpose: The aim of this study was to evaluate the accuracy of cone-beam computed tomography (CBCT) for measuring the buccal bone volume around dental implants. Materials and methods: Three to six implants were inserted into the anterior maxilla of eight skulls, depending on the availability of bone, and after this, the CBCT was performed. By means of CBCT image, measurements of the bone wall at three points of the implant were obtained, analyzed and compared with those obtained in the plaster skull casting. Results: The results showed that for the three points of the implants, no statistically significant difference in the measurements was obtained from the plaster model and CBCT images. Conclusions: CBCT can be a useful tool for assessing buccal bone volume along the implant. To cite this article:?Shiratori LN, Marotti J, Yamanouchi J, Chilvarquer I, Contin I, Tortamano-Neto P. Measurement of buccal bone volume of dental implants by means of cone-beam computed tomography.?Clin. Oral Impl. Res. 23, 2012; 797804.?doi: 10.1111/j.1600-0501.2011.02207.x