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.

Effect of UV-photofunctionalization on oral bacterial attachment and biofilm formation to titanium implant material

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Esthetics in implant-supported prostheses: a literature review

Esthetics is important for success of implant-supported prostheses. This study aimed to review esthetics concepts for implant treatment. Research in the PubMed database included studies published from 1995 to 2010 with the keywords implant esthetics, implant-supported prostheses, and esthetics. Forty-five studies were evaluated regarding the presurgical planning, surgical phase, and temporary and final restoration phases. It was concluded that esthetics in implant-supported prostheses results from a multidisciplinary approach from planning until insertion of the final restoration.

Leakage of Saliva Through the Implant-Abutment Interface: In Vitro Evaluation of Three Different Implant Connections Under Unloaded and Loaded Conditions

Purpose: Bacterial leakage along the implant-abutment interface, with consequent species harboring the inner parts of two-part dental implant systems, has been reported in the literature. The aim of this in vitro study was to evaluate bacterial leakage from human saliva to the internal part of the implants along the implant-abutment interface under loaded and unloaded conditions using DNA Checkerboard. Materials and Methods: Sixty denial implants-20 each of external-hexagon, internal-hexagon, and Morse cone-connection designs-and their conical abutments were used in this study. Each group was subdivided into two groups of 10 loaded and 10 unloaded implants. The assemblies were immersed in human saliva and either (1) loaded with 500,000 cycles at 120 N (experimental group) or (2) incubated in static conditions for 7 days at 35 degrees C (unloaded control group). Results: Microorganisms were found in the internal surfaces of all types of connections. The Morse cone connection presented the lowest count of microorganisms in both the unloaded and loaded groups. Loaded implants presented with higher counts of microorganisms than unloaded implants for external- and internal-hex connections. Conclusion: Bacterial species from human saliva may penetrate along the implant-abutment interface under both unloaded and loaded conditions for all connections evaluated. Morse cone-connection implants showed the lowest counts of microorganisms for both conditions. External- and internal-hex implants showed a higher incidence of bacteria and higher bacterial counts after simulated loading. INT J ORAL MAXILLOFAC IMPLANTS 2012;27:551-560.

The effect of implant design on insertion torque and immediate micromotion

Objectives: To evaluate the effect of insertion torque on micromotion to a lateral force in three different implant designs. Material and methods: Thirty-six implants with identical thread design, but different cutting groove design were divided in three groups: (1) non-fluted (no cutting groove, solid screw-form); (2) fluted (901 cut at the apex, tap design); and (3) Blossomt (Patent pending) (non-fluted with engineered trimmed thread design). The implants were screwed into polyurethane foam blocks and the insertion torque was recorded after each turn of 901 by a digital torque gauge. Controlled lateral loads of 10N followed by increments of 5 up to 100N were sequentially applied by a digital force gauge on a titanium abutment. Statistical comparison was performed with two-way mixed model ANOVA that evaluated implant design group, linear effects of turns and displacement loads, and their interaction. Results: While insertion torque increased as a function of number of turns for each design, the slope and final values increased (Po0.001) progressively from the Blossomt to the fluted to the non-fluted design (M +/- standard deviation [SD] = 64.1 +/- 26.8, 139.4 +/- 17.2, and 205.23 +/- 24.3 Ncm, respectively). While a linear relationship between horizontal displacement and lateral force was observed for each design, the slope and maximal displacement increased (Po0.001) progressively from the Blossomt to the fluted to the non-fluted design (M +/- SD 530 +/- 57.7, 585.9 +/- 82.4, and 782.33 +/- 269.4 mm, respectively). There was negligible to moderate levels of association between insertion torque and lateral displacement in the Blossomt, fluted and non-fluted design groups, respectively. Conclusion: Insertion torque was reduced in implant macrodesigns that incorporated cutting edges, and lesser insertion torque was generally associated with decreased micromovement. However, insertion torque and micromotion were unrelated within implant designs, particularly for those designs showing the least insertion torque.

Mechanical analysis of conventional and small diameter conical implant abutments

PURPOSE. The aim of the present study was to evaluate if a smaller morse taper abutment has a negative effect on the fracture resistance of implant-abutment connections under oblique compressive loads compared to a conventional abutment MATERIALS AND METHODS. Twenty morse taper conventional abutments (4.8 mm diameter) and smaller abutments (3.8 mm diameter) were tightened (20 Ncm) to their respective implants (3.5 x 11 mm) and after a 10 minute interval, implant/abutment assemblies were subjected to static compressive test, performed in a universal test machine with 1 mm/min displacement, at 45 degrees inclination. The maximum deformation force was determined. Data were statistically analyzed by student t test. RESULTS. Maximum deformation force of 4.8 mm and 3.8 mm abutments was approximately 95.33 kgf and 95.25 kgf, respectively, but no fractures were noted after mechanical test. Statistical analysis demonstrated that the evaluated abutments were statistically similar (P=.230). CONCLUSION. Abutment measuring 3.8 mm in diameter (reduced) presented mechanical properties similar to 4.8 mm (conventional) abutments, enabling its clinical use as indicated. [J Adv Prosthodont 2012;4:158-61]

Implant Osseointegration in Circumferential Bone Defects Treated with Latex-Derived Proteins or Autogenous Bone in Dog's Mandible

Background: In sites with diminished bone volume, the osseointegration of dental implants can be compromised. Innovative biomaterials have been developed to aid successful osseointegration outcomes. Purpose: The aim of this study was to evaluate the osteogenic potential of angiogenic latex proteins for improved bone formation and osseointegration of dental implants. Materials and Methods: Ten dogs were submitted to bilateral circumferential defects (5.0 x 6.3 mm) in the mandible. Dental implant (3.3 x 10.0 mm, TiUnite MK3 (TM), Nobel Biocare AB, Goteborg, Sweden) was installed in the center of the defects. The gap was filled either with coagulum (Cg), autogenous bone graft (BG), or latex angiogenic proteins pool (LPP). Five animals were sacrificed after 4 weeks and 12 weeks, respectively. Implant stability was evaluated using resonance frequency analysis (Osstell Mentor T, Osstell AB, Goteborg, Sweden), and bone formation was analyzed by histological and histometric analysis. Results: LPP showed bone regeneration similar to BG and Cg at 4 weeks and 12 weeks, respectively (p >= 3.05). Bone formation, osseointegration, and implant stability improved significantly from 4 to 12 weeks (p <= 2.05). Conclusion: Based on methodological limitations of this study, Cg alone delivers higher bone formation in the defect as compared with BG at 12 weeks; compared with Cg and BG, the treatment with LPP exhibits no advantage in terms of osteogenic potential in this experimental model, although overall osseointegration was not affected by the treatments employed in this study.

Implant Stability Measurements of Two Immediate Loading Protocols for the Edentulous Mandible: Rigid and Semi-rigid Splinting of the Implants

Aim: Primary and secondary stabilities of immediately loaded mandibular implants restored with fixed prostheses (FP) using rigid or semirigid splinting systems were clinically and radiographically evaluated. Methods: Fifteen edentulous patients were rehabilitated using hybrid FP; each had 5 implants placed between the mental foramens. Two groups were randomly divided: group 1-FP with the conventional rigid bar splinting the implants and group 2-semi-rigid cantilever extension system with titanium bars placed in the 2 distal abutment cylinders. Primary stability was evaluated using resonance frequency analysis after installation of the implant abutments. The measurements were made at 3 times: T0, at baseline; T1, 4 months after implant placement; and T2, 8 months after implant placement. Presence of mobility and inflammation in the implant surrounding regions were checked. Stability data were submitted to statistical analysis for comparison between groups (P, 0.05). Results: Implant survival rate for the implants was of 100% in both groups. No significant differences in the mean implant stability quotient values were found for both groups from baseline and after the 8-month follow-up. Conclusion: The immediate loading of the implants was satisfactory, and both splinting conditions (rigid and semi-rigid) can be successfully used for the restoration of edentulous mandibles. (Implant Dent 2012;21:486-490)

Fatigue Reliability of 3 Single-Unit Implant-Abutment Designs

Objectives: Because the mechanical behavior of the implant-abutment system is critical for the longevity of implant-supported reconstructions, this study evaluated the fatigue reliability of different implant-abutment systems used as single-unit crowns and their failure modes. Methods and Materials: Sixty-three Ti-6Al-4V implants were divided in 3 groups: Replace Select (RS); IC-IMP Osseotite; and Unitite were restored with their respective abutments. Anatomically correct central incisor metal crowns were cemented and subjected to separate single load to failure tests and step-stress accelerated life testing (n = 18). A master Weibull curve and reliability for a mission of 50,000 cycles at 200 N were calculated. Polarized-light and scanning electron microscopes were used for failure analyses. Results: The load at failure mean values during step-stress accelerated life testing were 348.14 N for RS, 324.07 N for Osseotite, and 321.29 N for the Unitite systems. No differences in reliability levels were detected between systems, and only the RS system mechanical failures were shown to be accelerated by damage accumulation. Failure modes differed between systems. Conclusions: The 3 evaluated systems did not present significantly different reliability; however, failure modes were different. (Implant Dent 2012;21:67-71)

Comparison of variable-thread tapered implant designs to a standard tapered implant design after immediate loading. A 3-year multicentre randomised controlled trial

This randomised, controlled multicentre trial aimed at comparing two versions of a variable-thread dental implant design to a standard tapered dental implant design in cases of immediate functional loading for 36 months after loading.

Morphogenesis of the peri-implant mucosa: an experimental study in dogs

PURPOSE: The objective of the present experiment was to study the morphogenesis of the mucosal attachment to implants made of c.p. titanium. MATERIAL AND METHODS: All mandibular premolars were extracted in 20 Labrador dogs. After a healing period of 3 months, four implants (ITI Dental Implant System) were placed in the right and left sides of the mandible. A non-submerged implant installation technique was used and the mucosal tissues were secured to the conical marginal portion of the implants with interrupted sutures. The sutures were removed after 2 weeks and a plaque control program including daily cleaning of the remaining teeth and the implants was initiated. The animals were sacrificed and biopsies were obtained at various intervals to provide healing periods extending from Day 0 (2 h) to 12 weeks. The mandibles were removed and placed in the fixative. The implant sites were dissected using a diamond saw and processed for histological analysis. RESULTS: Large numbers of neutrophils infiltrated and degraded the coagulum that occupied the compartment between the mucosa and the implant during the initial phase of healing. At 2 weeks after surgery, fibroblasts were the dominating cell population in the connective tissue interface but at 4 weeks the density of fibroblasts had decreased. Furthermore, the first signs of epithelial proliferation were observed in specimens representing 1-2 weeks of healing and a mature barrier epithelium occurred after 6-8 weeks of healing. The collagen fibers of the mucosa were organized after 4-6 weeks of healing. CONCLUSION: It is suggested that the soft-tissue attachment to implants placed using a non-submerged installation procedure is properly established after several weeks following surgery.