Effect of Passive Fit Absence in the Prosthesis/Implant/Retaining Screw System: A Two-Dimensional Finite Element Analysis

The misfit between prostheses and implants is a clinical reality, but the level that can be accepted without causing mechanical or biologic problem is not well defined. This study investigates the effect of different levels of unilateral angular misfit prostheses in the prosthesis/implant/retaining screw system and in the surrounding bone using finite element analysis. Four models of a two-dimensional finite element were constructed: group I (control), prosthesis that fit the implant; groups 2 to 4, prostheses with unilateral angular misfit of 50, 100, and 200 mu m, respectively. A load of 133 N was applied with a 30-degree angulation and off-axis at 2 mm from the long axis of the implant at the opposite direction of misfit on the models. Taking into account the increase of the angular misfit, the stress maps showed a gradual increase of prosthesis stress and uniform stress in the implant and trabecular bone. Concerning the displacement, an inclination of the system due to loading and misfit was observed. The decrease of the unilateral contact between prosthesis and implant leads to the displacement of the entire system, and distribution and magnitude alterations of the stress also occurred.

Publication Bias in Five Dental Implant Journals: An Observation from 2005 to 2009

Purpose: This study evaluated possible publication bias and its related factors in implant-related research over time. Materials and Methods: Articles published in Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, Journal of Oral Implantology, and The International Journal of Oral & Maxillofacial Implants between 2005 and 2009 were reviewed. Nonoriginal articles were excluded. For each article included, study outcome, extramural funding source, type of study, and geographic origin were recorded. Descriptive and analytic statistics (alpha = .05), including the chi-square test and logistic regression analysis, were performed where appropriate. Results: From a total of 2,085 articles, 1,503 met the inclusion criteria. of the articles analyzed, 1,226 (81.6%), 160 (10.6%), and 117 (7.8%) articles reported positive, negative, and neutral outcomes, respectively. In vitro studies, studies from Asia, and funded animal studies were more likely to report positive outcomes compared to others (P = .02, P < .0001, and P = .009, respectively). Industry-funded studies represented the lowest frequency of positive outcomes versus studies funded by other sources. Conclusions: There were a high number of implant-related studies reporting positive outcomes in the five selected journals. Some selected factors were associated with positive outcome bias. In general, funding was not associated with a positive outcome, except for animal studies. Industry-supported research did not show any association with the publication of positive outcomes. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:1024-1032

Comparison of stress distribution between complete denture and implant-retained overdenture-2D FEA

The aim of this study was to compare the stress distribution induced by posterior functional loads on conventional complete dentures and implant-retained overdentures with different attachment systems using a two-dimentional Finite Element Analysis (FEA-2D). Three models representative of edentulous mandible were constructed on AutoCAD software; Group A (control), a model of edentulous mandible supporting a complete denture; Group B, a model of edentulous mandible supporting an overdenture over two splinted implants connected with the bar-clip system; Group C, a model of edentuluos mandible supporting an overdenture over two unsplinted impants with the O-ring system. Evaluation was conducted on Ansys software, with a vertical force of 100 N applied on the mandibular left first molar. When the stress was evaluated in supporting tissues, groups B (51.0 MPa) and C (52.6 MPa) demonstrated higher stress values than group A (10.1 MPa). Within the limits of this study, it may be conclued that the use of an attachment system increased stress values; furthermore, the use of splinted implants associated with the bar-clip attachment system favoured a lower stress distribution over the supporting tissue than the unsplinted implants with an O-ring abutment to retain the manibular overdenture.

Platform Switching: Biomechanical Evaluation Using Three-Dimensional Finite Element Analysis

Purpose: The objective of this study was to evaluate, using three-dimensional finite element analysis (3D FEA), the stress distribution in peri-implant bone tissue, implants, and prosthetic components of implant-supported single crowns with the use of the platform-switching concept. Materials and Methods: Three 3D finite element models were created to replicate an external-hexagonal implant system with peri-implant bone tissue in which three different implant-abutment configurations were represented. In the regular platform (RP) group, a regular 4.1-mm-diameter abutment (UCLA) was connected to regular 4.1-mm-diameter implant. The platform-switching (PS) group was simulated by the connection of a wide implant (5.0 mm diameter) to a regular 4.1-mm-diameter UCLA abutment. In the wide-platform (WP) group, a 5.0-mm-diameter UCLA abutment was connected to a 5.0-mm-diameter implant. An occlusal load of 100 N was applied either axially or obliquely on the models using ANSYS software. Results: Both the increase in implant diameter and the use of platform switching played roles in stress reduction. The PS group presented lower stress values than the RP and WP groups for bone and implant. In the peri-implant area, cortical bone exhibited a higher stress concentration than the trabecular bone in all models and both loading situations. Under oblique loading, higher intensity and greater distribution of stress were observed than under axial loading. Platform switching reduced von Mises (17.5% and 9.3% for axial and oblique loads, respectively), minimum (compressive) (19.4% for axial load and 21.9% for oblique load), and maximum (tensile) principal stress values (46.6% for axial load and 26.7% for oblique load) in the peri-implant bone tissue. Conclusion: Platform switching led to improved biomechanical stress distribution in peri-implant bone tissue. Oblique loads resulted in higher stress concentrations than axial loads for all models. Wide-diameter implants had a large influence in reducing stress values in the implant system. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:482-491

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.

Effect of Metal-Ceramic or All-Ceramic Superstructure Materials on Stress Distribution in a Single Implant-Supported Prosthesis: Three-Dimensional Finite Element Analysis

Purpose: This three-dimensional finite element analysis study evaluated the effect of different material combinations on stress distribution within metal-ceramic and all-ceramic single implant-supported prostheses. Materials and Methods: Three-dimensional finite element models reproducing a segment of the maxilla with a missing left first premolar were created. Five groups were established to represent different superstructure materials: GP, porcelain fused to gold alloy; GR, modified composite resin fused to gold alloy; TP, porcelain fused to titanium; TR, modified composite resin fused to titanium; and ZP, porcelain fused to zirconia. A 100-N vertical force was applied to the contact points of the crowns. All models were fixed in the superior region of bone tissue and in the mesial and distal faces of the maxilla section. Stress maps were generated by processing with finite element software. Results: Stress distribution and stress values of supporting bone were similar for the GP, GR, TP, and ZP models (1,574.3 MPa, 1,574.3 MPa, 1,574.3 MPa, and 1,574.2 MPa, respectively) and different for the TR model (1,838.3 MPa). The ZP model transferred less stress to the retention screw (785 MPa) than the other groups (939 MPa for GP, 961 MPa for GR, 1,010 MPa for TP, and 1,037 MPa for TR). Conclusion: The use of different materials to fabricate a superstructure for a single implant-supported prosthesis did not affect the stress distribution in the supporting bone. The retention screw received less stress when a combination of porcelain and zirconia was used. Int J Oral Maxillofac Implants 2011;26:1202-1209

Evaluation of Stress Patterns Produced by Implant-Retained Overdentures and Implant-Retained Fixed Partial Denture

The purposes of this study were to photoelastically measure the biomechanical behavior of 4 implants retaining different cantilevered bar mandibular overdenture designs and to compare a fixed partial denture (FPD). A photoelastic model of a human edentulous mandible was fabricated, which contained 4 screw-type implants (3.75 x 10 mm) embedded in the parasymphyseal area. An FPD and 3 overdenture designs with the following attachments were evaluated: 3 plastic Hader clips, 1 Hader clip with 2 posterior resilient cap attachments, and 3 ball/O-ring attachments. Vertical occlusal forces of 100 N were applied between the central incisor and unilaterally to the right and left second premolars and second molars. Stresses that developed in the supporting structure were monitored photoelastically and recorded photographically. The results showed that the anterior loading, the overdenture with 3 plastic Hader clips, displayed the largest stress concentration at the medium implant. With premolar loading, the FPD and overdenture with 3 plastic Hader clips displayed the highest stresses to the ipsilateral terminal implant. With molar loading, the overdenture with 3 ball/O-ring attachments displayed the most uniform stress distribution in the posterior edentulous ridge, with less overloading in the terminal implant. It was concluded that vertical forces applied to the bar-clip overdenture and FPD created immediate stress patterns of greater magnitude and concentration on the ipsilateral implants, whereas the ball/O-ring attachments transferred minimal stress to the implants. The increased cantilever in the FPD caused the highest stresses to the terminal implant.

Implant Platform Switching: Biomechanical Approach Using Two-Dimensional Finite Element Analysis

In implant therapy, a peri-implant bone resorption has been noticed mainly in the first year after prosthesis insertion. This bone remodeling can sometimes jeopardize the outcome of the treatment, especially in areas in which short implants are used and also in aesthetic cases. To avoid this occurrence, the use of platform switching (PS) has been used. This study aimed to evaluate the biomechanical concept of PS with relation to stress distribution using two-dimensional finite element analysis. A regular matching diameter connection of abutment-implant (regular platform group [RPG]) and a PS connection (PS group [PSG]) were simulated by 2 two-dimensional finite element models that reproduced a 2-piece implant system with peri-implant bone tissue. A regular implant (prosthetic platform of 4.1 mm) and a wide implant (prosthetic platform of 5.0 mm) were used to represent the RPG and PSG, respectively, in which a regular prosthetic component of 4.1 mm was connected to represent the crown. A load of 100 N was applied on the models using ANSYS software. The RPG spreads the stress over a wider area in the peri-implant bone tissue (159 MPa) and the implant (1610 MPa), whereas the PSG seems to diminish the stress distribution on bone tissue (34 MPa) and implant (649 MPa). Within the limitation of the study, the PS presented better biomechanical behavior in relation to stress distribution on the implant but especially in the bone tissue (80% less). However, in the crown and retention screw, an increase in stress concentration was observed.

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.

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.

Effect of Superstructure Materials and Misfit on Stress Distribution in a Single Implant-Supported Prosthesis: A Finite Element Analysis

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

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.

Accuracy of zoomed digital image in the detection of periodontal bone defect: in vitro study

Objectives: (1) To evaluate the intraobserver agreement related to image interpretation and (2) to compare the accuracy of 100%, 200% and 400% zoomed digital images in the detection of simulated periodontal bone defects.Methods: Periodontal bone defects were created in 60 pig hemi-mandibles with slow-speed burs 0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm and 3.0 mm in diameter. 180 standardized digital radiographs were made using Schick sensor and evaluated at 100%, 200% and 400% zooming. The intraobserver agreement was estimated by Kappa statistic (kappa). For the evaluation of diagnostic accuracy receiver operating characteristic (ROC) analysis was performed followed by chi-square test to compare the areas under ROC curves according to each level of zooming.Results: For 100%, 200% and 400% zooming the intraobserver agreement was moderate (kappa = 0.48, kappa = 0.54 and kappa = 0.43, respectively) and there were similar performances in the discrimination capacity, with ROC areas of 0.8611 (95% CI: 0.7660-0.9562), 0.8600 (95% CI: 0.7659-0.9540), and 0.8368 (95% CI: 0.7346-0.9390), respectively, with no statistical significant differences (chi(2)-test; P = 0.8440).Conclusions: A moderate intraobserver agreement was observed in the classification of periodontal bone defects and the 100%, 200% and 400% zoomed digital images presented similar performances in the detection of periodontal bone defects.

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.