A Positive Correlation Between Occlusal Trauma and Peri-implant Bone Loss: Literature Support

Effect of Integration Patterns Around Implant Neck on Stress Distribution in Peri-Implant Bone: A Finite Element Analysis

PURPOSE

To investigate the biomechanical performance of different osseointegration patterns between cortical bone and implants using finite element analysis.

MATERIALS AND METHODS

Fifteen finite element models were constructed of the mandibular fixed prosthesis supported by implants. Masticatory loads (200 N axial, 100 N oblique, 40 N horizontal) were applied. The cortical bone/implant interface was divided equally into four layers: upper, upper-middle, lower-middle, and lower. The bone stress and implant displacement were calculated for 5 degrees of uniform integration (0, 20%, 40%, 60%, and 100%) and 10 integration patterns.

RESULTS

The stress was concentrated in the bone margin and gradually decreased as osseointegration progressed, when the integrated and nonintegrated areas were alternated on the bone-implant surface. Compared with full integration, the integration of only the lower-middle layer or lower half layers significantly decreased von Mises, tensile, and compressive stresses in cortical bone under oblique and horizontal loads, and these patterns did not induce higher stress in the cancellous bone. For the integration of only the upper or upper-middle layer, stress in the cortical and cancellous bones significantly increased and was considerably higher than in the case of nonintegration. In addition, the maximum stress in the cortical bone was sensitive to the quantity of integrated nodes at the bone margin; lower quantity was associated with higher stress. There was no significant difference in the displacement of implants among 15 models.

CONCLUSIONS

Integration patterns of cortical bone significantly affect stress distribution in peri-implant bone. The integration of only the lower-middle or lower half layers helps to increase the load-bearing capacity of peri-implant bone and decrease the risk of overloading, while upper integration may further increase the risk of bone resorption.

Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques

PURPOSE

The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols.

MATERIALS AND METHODS

Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest.

RESULTS

Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels.

CONCLUSIONS

Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when planning implant-supported fixed prosthetic reconstructions.

Do Mobility and Occlusal Trauma Impact Periodontal Longevity?

The impact of tooth mobility and occlusal trauma (OT) on periodontal bone loss and need for therapy has been debated for many years. This paper summarizes the relevant literature reported in three Dental Clinics of North America articles in the late 1990s, and adds newer information from the 2000s. Principle findings indicate that strong evidence of mobility and OT impacting tooth longevity is lacking, but reducing inflammation in the surrounding periodontium remains a critical treatment. Occlusal therapy when mobility is increasing, comfort or function are compromised, or periodontal regeneration procedures are planned should be considered.

Use of an Intraoral Laser Scanner During the Prosthetic Phase of Implant Dentistry: A Pilot Study

The accuracy of a digital impression technique to fabricate the implant restoration and abutment for a dental implant using an intraoral laser scanner was evaluated in 36 patients who were missing a single posterior tooth in either the mandible or maxilla that was restored with a single implant. The spatial position of each integrated implant, including the surrounding anatomic hard and soft tissues of adjacent structures, was captured utilizing a special scanning abutment with an intraoral laser scanner. Data from the scanning protocol was then delivered via the Internet in the form of an STL file to the manufacturing site for the production of a custom computer-aided design abutment and crown. All 36 restorations and abutments were delivered to the patients and evaluated for marginal integrity, interproximal contact points, and occlusion. Of the 36 patients, 6 required contact adjustments, 7 required occlusal adjustments, and 3 required a gingivectomy around the implant to completely seat the restoration. Chair time for adjustments did not exceed 15 minutes. The findings suggest that an intraoral laser scanner can be used with confidence to obtain consistent and accurate digital impressions to fabricate custom restorations and abutments for dental implants.

Effect of the Parafunctional Occlusal Loading and Crown Height on Stress Distribution

The aim of this study was to assess, by the three-dimensional finite element method, the influence of crown-to-implant ratio and parafunctional occlusal loading on stress distribution in single external hexagon implant-supported prosthesis. Computer-aided design software was used to confection three models. Each model was composed of a block bone and an external hexagon implant (5x10.0 mm) with screw-retained implant prostheses, varying the height crown: 10, 12.5 and 15 mm. Finite element analysis software was used to generate the finite element mesh and to establish the loading and boundary conditions. Normal (200 N axial and 100 N oblique load) and parafunctional forces (1,000 N axial and 500 N oblique load) were applied. The results were visualized by von Mises and maximum principal stress. In comparison with the normal occlusal force, the parafunctional occlusal force induced an increase in stress concentration and magnitude on implant (platform and first threads) and screw (neck). The cortical bone showed the highest tensile stress under parafunctional force (oblique load). The stress concentration increased as the crown height increased. It was concluded that: increasing the C/I increased stress concentration in both implant components and cortical bone; parafunctional loading increased between 4-5 times the value of stresses in bone tissue compared with functional loading; the type of loading variation factor is more influential than the crown-to-implant factor.

A histological and biomechanical study of bone stress and bone remodeling around immediately loaded implants

Immediate loading (IL) increases the risk of marginal bone loss. The present study investigated the biomechanical response of peri-implant bone in rabbits after IL, aiming at optimizing load management. Ninety-six implants were installed bilaterally into femurs of 48 rabbits. Test implants on the left side created the maximal initial stress of 6.9 and 13.4 MPa in peri-implant bone and unloaded implants on the contralateral side were controls. Bone morphology and bone-implant interface strength were measured with histological examination and push-out testing during a 12-week observation period. Additionally, the animal data were incorporated into finite element (FE) models to calculate the bone stress distribution at different levels of osseointegration. Results showed that the stress was concentrated in the bone margin and the bone stress gradually decreased as osseointegration proceeded. A stress of about 2.0 MPa in peri-implant bone had a positive effect on new bone formation, osseointegration and bone-implant interface strength. Bone loss was observed in some specimens with stress exceeding 4.0 MPa. Data indicate that IL significantly increases bone stress during the early postoperative period, but the load-bearing capacity of peri-implant bone increases rapidly with an increase of bone-implant contact. Favorable bone responses may be continually promoted when the stress in peri-implant bone is maintained at a definite level. Accordingly, the progressive loading mode is recommended for IL implants.

Should oral implants be splinted in a mandibular implant-supported fixed complete denture? A 3-dimensional-model finite element analysis

STATEMENT OF PROBLEM

The design of a mandibular fixed complete denture can influence periimplant bone loss. However, the design that transfers the greatest stress to the periimplant bone is not well documented.

PURPOSE

The purpose of this study was to assess the stress distribution associated with splinted and nonsplinted implant-supported mandibular fixed complete denture designs.

MATERIAL AND METHODS

Three-dimensional finite element models simulating 6 osseointegrated implants were created in the mandible to support a cobalt-chromium alloy and feldspathic porcelain veneering framework. One model simulated a 1-piece framework, and the other models simulated 2-piece and 3-piece frameworks. Axial and oblique loads were applied to the frameworks.

RESULTS

For all the models, the greatest stress values were recorded in the periimplant bone of posterior implants, with differences between the left and right sides. The axial load transferred greater stress values to the periimplant bone than did the oblique load. The lowest periimplant bone stress values were observed in the 3-piece framework model at all implant locations, with the exception of implants placed in the canine region.

CONCLUSIONS

A framework separated into 3 pieces transfers the least stress to the periimplant bone.

The effect of placement depth of platform-switched implants on periimplant cortical bone stress: a 3-dimensional finite element analysis

PURPOSE

The purpose of this study was to evaluate periimplant bone stress distribution for platform-switched implants placed at different depths relative to the bone crest, maintaining the occlusal plane at the same level.

MATERIALS AND METHODS

Sections of posterior mandibular bone blocks comprising cortical and cancellous bones were simulated in a computer-aided design software. A platform-switched implant was simulated and placed at 1.0 mm supracrestal to 1.8 mm subcrestal positions at 0.1 mm intervals. All bone and implant materials were presumed to be homogenous and isotropic. Conical gold crowns were designed for each model, maintaining the occlusal plane at the same level. Models were analyzed under axial and nonaxial loads.

RESULTS

Cortical bone stress increased only slightly from equicrestal to 0.8 mm subcrestal positions, whereas supracrestal and deeper subcrestal positions resulted in higher stress values. Subcrestal positions showed maximum stress concentration away from crestal bone.

CONCLUSION

It can be concluded that shallow subcrestal placement of 2-stage platform-switched implants only slightly increases the stress within the cortical bone.

Effect of lateral static load on immediately restored implants: histologic and radiographic evaluation in dogs

OBJECTIVES

The aim of this study was to evaluate the effect of lateral static load in immediately restored implants in the canine mandible.

MATERIAL AND METHODS

In 7 mongrel dogs, all premolars and the first molars were extracted bilaterally in the mandible. Two months after the extractions, 6 implants with sandblasted acid-etched surfaces were placed in each animal, 3 on each side. Randomly, two implants per side were immediately restored with an orthodontic expansion device that promoted lateral excessive static load (test group) or load (control) while the third implant of each side, remained submerged (unloaded group). These loaded devices were cleaned daily with chlorhexidine 0.12%, during the 4 months of study, when the animals were sacrificed and biopsies removed for histometric study. Intra-oral periapicals were made using positioners at the beginning and at the end of the study.

RESULTS

Five implants from test group were lost in 3 dogs. Radiographically, there was a marginal bone loss of 3.68 ± 0.74 mm for the test group, 1.63 ± 0.2 mm for the control group and 0.45 ± 0.5 mm for the unloaded group. Histometrically, the percentage of bone-to-implant contact (BIC%) was 35.52 ± 7.32%, for the test group, 63.16 ± 5.16% for the control group and 42.33 ± 2.14% for the unloaded group.

CONCLUSION

In conclusion, the excessive lateral static load negatively affected the behavior of peri-implant bone around immediate restored implants.

Comportamento biomecânico do sistema prótese/implante em região anterior de maxila: análise pelo método de ciclagem mecânica

INTRODUÇÃO : O adequado posicionamento tridimensional dos implantes é indispensável para garantir a previsibilidade no tratamento com implantes dentários. OBJETIVO : Analisar comparativamente o comportamento mecânico do sistema prótese/implante em região anterior de maxila, diferindo os sistemas de encaixe e posicionamento dos implantes. MATERIAL E MÉTODO : Utilizando um modelo prototipado de maxila, as situações estudadas foram: Grupo IC - implantes nos incisivos centrais e cantilever nos incisivos laterais; Grupo IL - implantes nos incisivos laterais e pônticos nos incisivos centrais; Grupo ICIL - implantes no incisivo central e no incisivo lateral, intercalados com elementos suspensos. Para cada situação estudada, foram utilizadas as três conexões protéticas: hexágono externo, hexágono interno e cone-Morse. O ensaio de ciclagem mecânica foi realizado com a aplicação de 100 N de carga e frequência de 15 Hz no cíngulo dos incisivos a 45° com o longo eixo do dente, para simular o movimento mastigatório. RESULTADO : No ensaio de ciclagem mecânica, todos os modelos de todos os grupos com os três tipos de conexões protéticas atingiram um milhão de ciclos sem que ocorresse ruptura do parafuso, do componente protético ou da estrutura metálica. CONCLUSÃO : Com a metodologia e as condições empregadas, pode-se concluir que o comportamento mecânico das reabilitações implantossuportadas foi semelhante para os diferentes posicionamentos dos implantes e diferentes conexões protéticas.

One-Year Prospective Study of 7-mm-Long Implants in the Mandible: Installation Technique and Crown/Implant Ratio of 1.5 or Less

This study prospectively evaluated the clinical prognoses of short implants (7-mm long) in the mandible. We investigated the clinical prognosis of short implants in 20 patients (46 implants) according to the installation technique (submerged or nonsubmerged), installation depth (5.5-mm depth, 7-mm depth), and crown/implant ratio. We investigated the marginal bone loss and peri-implant soft-tissue index 12 months after the final prosthetic delivery. Twelve months after prosthetic delivery, no statistically significant differences were observed in bone loss in relation to the type of installation technique, installation depth, or crown/implant ratio. The plaque index and pocket depth indexes were not influenced by the installation technique, installation depth, or crown/implant ratio. We observed marginal bone loss of 3.3 mm in 1 implant from the nonsubmerged group. The total 1-year success rate was 97.83%. Based on this 1-year success rate, short implants had a good clinical prognosis, regardless of the installation technique, installation depth, or crown/implant ratio.

Evaluation of heat conduction in dental implants after exposure to hot beverages

STATEMENT OF PROBLEM

It is unknown if the consumption of hot beverages after implant placement poses a danger of overheating at the bone-implant interface.

PURPOSE

The purpose of this study was to investigate the effect of simulated consumption of hot beverages on the heat transfer to different dental implant types, implant sizes, and the presence of an interim restoration.

MATERIAL AND METHODS

A model that consisted of 2 plastic containers was constructed to simulate the oral cavity and endosseous region of the jaw. One-piece and 2-piece implants with abutments were placed into a block of bovine mandibular bone without any healing tissue, surrounded by water maintained at 37°C in the lower compartment. The abutments, which extended into the upper container, were covered with water heated to 60°C to simulate consumption of a hot substance and then were cooled down spontaneously to 37°C during 100 to 600 seconds. Five thermocouple electrodes with an accuracy of ±0.1°C were attached to each test specimen and to a computer with data recording and analysis software to record temperature changes. Repeated measures ANOVA (α=.05)was performed to determine the effect of each major factor.

RESULTS

Heat conduction from the abutment exposed to hot liquid was significantly higher in the cervical as opposed to the apical areas of the implants. Implant type (1 piece), diameter (wider), and the absence of an interim coping had a significant effect on the maximum temperature measured and on the temperature change rate.

CONCLUSIONS

Abutment exposure to hot liquids resulted in heat conduction to the cervical region of the implant, which could be biologically harmful in healing tissues. Heat conduction was mitigated by implant design and diameter, and by the presence of an interim prosthesis. Results may differ in clinical models.

Tilted and short implants supporting fixed prosthesis in an atrophic maxilla: a 3D-FEA biomechanical evaluation

PURPOSE

This study compared the biomechanical behavior of tilted long implant and vertical short implants to support fixed prosthesis in an atrophic maxilla.

MATERIALS AND METHODS

The maxilla model was built based on a tomographic image of the patient. Implant models were based on micro-computer tomography imaging of implants. The different configurations considered were M4S, four vertical anterior implants; M4T, two mesial vertical implants and two distal tilted (45°) implants in the anterior region of the maxilla; and M6S, four vertical anterior implants and two vertical posterior implants. Numerical simulation was carried out under bilateral 150 N loads applied in the cantilever region in axial (L1) and oblique (45°) (L2) direction. Bone was analyzed using the maximum and minimum principal stress (σmax and σmin ), and von Mises stress (σvM ) assessments. Implants were analyzed using the σvM .

RESULTS

The higher σmax was observed at: M4T, followed by M6S/L1, M6S/L2, M4S/L2, and M4S/L1 and the higher σvM : M4T/L1, M4T/L2 and M4S/L2, M6S/L2, M4S/L1, and M6S/L1.

CONCLUSIONS

The presence of distal tilted (all-on-four) and distal short implants (all-on-six) resulted in higher stresses in both situations in the maxillary bone in comparison to the presence of vertical implants (all-on-four).

A 5-year retrospective study on postsurgical periimplant infection during initial bone healing period: clinical characteristics, management, and prognosis

PURPOSE

The aim of this 5-year evaluation was to assess the clinical characteristics, management, and prognosis of postsurgical periimplant infection during the initial bone healing period.

METHODS

Nine hundred twenty-five implants (514 patients) placed without bone augmentation procedures were assessed. Ten implants (1.08%) in 7 patients (1.36%) were diagnosed as postsurgical periimplant infection. Different management methods were adopted respectively.

RESULTS

All reported implant infections were diagnosed after 2 weeks from implant surgery. Among the infected cases, 7 implants (70%) in 4 patients (57%) were successfully treated and loaded. Three implants (30%) in 3 patients (43%) failed to achieve osseointegration.

CONCLUSIONS

It is suggested that surgeons should observe the patient closely to detect possible infection during at least 1 month from surgery. Most postsurgical periimplant infections could recover and achieve osseointegration after timely and effective management.

Orthodontic Considerations in Restorative Management of Hypodontia Patients With Endosseous Implants

The use of implant-supported restorations in patients with hypodontia remains challenging and requires a multistage treatment that begins in late mixed dentition and continues into late adolescence. The aim of this article is to review the role of orthodontics in endosseous implant rehabilitation of patients with hypodontia. The MEDLINE, Web of Science, Scopus, Cochrane databases, and necessary scientific textbooks were searched for relevant studies and reviews, and as far as possible, they were only included if they had been cited at least once in the literature. Dental implants are susceptible to overloading as the periodontal ligament is absent and the proprioceptive nerve endings are either lacking or very limited. Patients with hypodontia may present with skeletal features such as short and retrognathic maxilla, prognathic mandible, and shorter lower anterior facial height, and they sometimes need orthognathic correction as part of their overall treatment. Dental problems vary and include bimaxillary retroclination of incisors, spacing, centerline discrepancies, microdontia, hypoplastic enamels, ankylosis of the retained primary teeth, overeruptions, and volume deficiencies of alveolar ridges. The challenges mentioned, as well as bone volume deficiencies, compromise the successful placement of implants. Orthodontic strategies and techniques, such as uprighting mechanics, extrusion/intrusion, delayed space opening, and orthodontic implant site-switching, can be used to create, preserve, or augment the implant site. After orthodontic site development, the final planned position of the teeth should be maintained with a rigid bonded retainer; overlooking this stage may compromise the implant site and require orthodontic retreatment.

In vitro bone strain analysis of implant following occlusal overload

OBJECTIVES

To enumerate peri-implant bone strain pattern under quantified occlusal load and verify the bone response through comparison with the critical strain thresholds defined by Frost's bone mechanostat theory.

MATERIAL AND METHODS

Mandibular unilateral recipient sites in two greyhound dogs were established with posterior teeth extractions. After 6 weeks, four titanium implants were placed in each dog mandible. Following 12 weeks of healing, successfully osseointegrated implants were placed in supra-occlusal contact via screw-retained non-splinted metal crowns. Plaque control and a dental health enhancing diet were prescribed. A bite force detection device was used to quantify in vivo occlusal load as the dogs functioned with supra-occlusal contact. After 8 weeks, the dogs were sacrificed. In vitro peri-implant bone strain under quantified occlusal load was measured using bonded stacked rosette strain gauges.

RESULTS

The average and peak in vivo occlusal load measured were 434 and 795 newton (N). When individually and simultaneously loaded in vitro (≤476 N), absolute bone strains up to 1133 and 753 microstrains (με) were measured at implant apices, respectively. Bone strain reaching 229 με was recorded at distant sites. For bone strain to reach the pathological overload threshold defined by Frost's bone mechanostat theory (3000 με), an occlusal load of 1344 N (greater than peak measured in vivo) is required based on the simple linear regression model.

CONCLUSION

Under the in vivo and in vitro conditions investigated in this study, peri-implant bone was not found to be under pathological overload following supra-occlusal contact function. Strain dissipation to distant sites appeared to be an effective mechanism by which implant overload was avoided.

Radiological and micro-computed tomography analysis of the bone at dental implants inserted 2, 3 and 4 mm apart in a minipig model with platform switching incorporated

BACKGROUND

The purpose of this study was to assess the effect of inter-implant distance on interproximal bone utilizing platform switching. Analysis of interproximal bone usually depends on traditional two-dimensional radiographic assessment. Although there has been increased reliability of current techniques, there has been an inability to track bone level changes over time and in three dimensions. Micro-CT has provided three-dimensional imaging that can be used in conjunction with traditional two-dimensional radiographic techniques.

METHODS

This study was performed on 24 female minipigs. Twelve animals received three implants with an inter-implant distance of 3 mm on one side of the mandible and another three implants on the contra-lateral side, where the implants were placed 2 mm apart creating a split mouth design. Twelve other animals received three implants with an inter-implant distance of 3 mm on one side of the mandible and another three implants on the contra-lateral side, where the implants were placed 4 mm apart creating a split mouth design too. The quantitative evaluation was performed comparatively on radiographs taken at t 0 (immediately after implantation) and at t 8 weeks (after termination). The samples were scanned by micro-computed tomography (μCT) to quantify the first bone to implant contact (fBIC) and bone volume/total volume (BV/TV). Mixed model regressions using the nonparametric Brunner-Langer method were used to determine the effect of inter-implant distance on the measured outcomes.

RESULTS

The change in bone level was determined using radiography and its mean was 0.05 mm for an inter-implant distance of 3 and 0.00 mm for a 2 mm distance (P = 0.7268). The mean of this outcome was 0.18 mm for the 3 mm and for 4 mm inter-implant distance (P = 0.9500). Micro-computed tomography showed that the fBIC was always located above the reference, 0.27 and 0.20 mm for the comparison of 2-3 mm (P = 0.4622) and 0.49 and 0.34 mm for the inter-implant distance of 3 and 4 mm (P = 0.1699). BV/TV inside the defined parallelepipedic masks reached 82.38% for the 2 mm inter-implant distance and 85.00% for 3 mm, P = 0.8432. For the comparison of the 3-4 mm inter-implant distance, the means were 84.69% and 84.38%, respectively, P = 0.8401. Non-inferiority tests for the smaller inter-implant distances for both comparisons showed similar differences and similar tolerance ranges.

CONCLUSION

The effect of a smaller interproximal distances between implants on bone level, fBIC and BV/TV assessed by two convergent investigation methods, radiology and μCT, was similar to that of larger distances. Implants can potentially be placed 2 mm apart instead of 3 mm and 3 mm apart instead of 4 mm when platform switching is utilized. Further research with a conventional platform is warranted.

A novel bionic design of dental implant for promoting its long-term success using nerve growth factor (NGF): utilizing nano-springs to construct a stress-cushioning structure inside the implant

The absence of periodontium causes masticatory load in excess of the self-repairing potential of peri-implant bone; peri-implant bone loss caused by occlusal overload is not uncommon in patients and greatly diminishes chances of long-term success. Regenerative treatments may be useful in inducing peri-implant bone regeneration, but are only stopgap solutions to the aftermaths caused by the imperfect biomechanical compatibility of the dental implant. Despite promising success, the tissue-engineered periodontal ligament still needs a period of time to be perfected before being clinically applied. Hence, we propose a novel design of dental implant that utilizes nano-springs to construct a stress-cushioning structure inside the implant. Many studies have shown that NGF, a neurotrophin, is effective for nerve regeneration in both animal and clinical studies. Moreover, NGF has the potential to accelerate bone healing in patients with fracture and fracture nonunion and improve osseointegration of the implant. The key point of the design is to reduce stress concentrated around peri-implant bone by cushioning masticatory forces and distributing them to all the peri-implant bone through nano-springs, and promote osseoperception and osseointegration by NGF-induced nerve regeneration and new bone formation. This design, which transfers the main biomechanical interface of the implant from outside to inside, if proven to be valid, may to some extent compensate for the functions of lost periodontium in stress cushioning and proprioception.

Occlusal concepts application in resolving implant prosthetic failure: case report

The prosthetic management of a poor implant treatment is presented in this case report. The recommended occlusion concepts for implant-supported prostheses were applied for the resolution of the case. The rehabilitation of the posterior segments provided a mutually protected occlusion with adequate distribution of the axial and lateral bite forces with stable posterior occlusion. The clinical exam indicated the need for modification in the vertical dimension of occlusion. Sufficient interocclusal rest space was present to test the alteration in the vertical dimension. The aim was to achieve an occlusion scheme that followed four specific criteria: (1) centric contacts and centric relation of the jaw-to-jaw position; (2) anterior guidance only; (3) shallow anterior angle of tooth contact; and (4) vertical dimension of occlusion with acceptable tooth form and guidance. The success of an oral rehabilitation relies in following the aforementioned criteria, appropriate interaction between the dental laboratory technician and the clinician, careful elaboration of the provisional rehabilitation with all the desired details to be reproduced in the final prosthetic restoration and sufficient follow-up time of the provisional prostheses before placing the final restoration.

Influence of Clinically Relevant Factors on the Immediate Biomechanical Surrounding for a Series of Dental Implant Designs

The objective of the present study was to assess the influence of various clinically relevant scenarios on the strain distribution in the biomechanical surrounding of five different dental implant macrogeometries. The biomechanical environment surrounding an implant, i.e., the cortical and trabecular bone, was modeled along with the implant. These models included two different values of the study parameters including loading conditions, trabecular bone elastic modulus, cortical/trabecular bone thickness ratio, and bone loss for five implant designs. Finite element analysis was conducted on the models and strain in the bones surrounding the implant was calculated. Bone volumes having strains in four different windows of 0–200 με, 200–1000 με, 1000–3000 με, and >3000 με were measured and the effect of each biomechanical variable and their two-way interactions were statistically analyzed using the analysis of variance method. This study showed that all the parameters included in this study had an effect on the volume of bones in all strain windows, except the implant design, which affected only the 0–200 με and >3000 με windows. The two-way interaction results showed that interactions existed between implant design and bone loss, and loading condition, bone loss in the 200–1000 με window, and between implant design and loading condition in the 0–200 με window. Within the limitations of the present methodology, it can be concluded that although some unfavorable clinical scenarios demonstrated a higher volume of bone in deleterious strain levels, a tendency toward the biomechanical equilibrium was evidenced regardless of the implant design.

Stress distribution prevents ischaemia and bone resorption in residual ridge

OBJECTIVE

Intensive mechanical stress and/or inflammation are known to induce alveolar bone resorption. This study investigated whether a distribution of mechanical stress would reduce residual ridge resorption or improve ischaemia.

DESIGN

Thirty rats were divided into six experimental groups (n=5). The control group received no intentional stimulation, but rats in the experimental groups wore denture stimulators made of acrylic resin or a soft lining material. The stimulator transmitted masticatory pressure to the rats' palates for four weeks. The four types of soft lining materials investigated in this study dispersed the applied pressure, with compressive stress ranging from 20.8 to 90.8kPa. Volumes of blood flow and bone resorption of denture foundations were measured every week for 4 weeks. Statistical evaluation of these results was performed using two-way ANOVA and Holm-Sidak test within 5% error limits.

RESULTS

Non-viscoelastic material clearly induced bone resorption and ischaemia of denture foundations, while viscoelastic materials reduced these phenomena to different extents according to their viscoelastic properties. Ischaemia in the alveolar ridge preceded residual ridge resorption, because the amount of residual ridge resorption and blood flow rate showed a simple linear regression.

CONCLUSION

Animal model of this study suggested that a distribution or reduction of mechanical stress could improve blood flow and decrease alveolar ridge resorption.

Correlation between occlusal forces and marginal bone levels around implant-retained restorations: a clinico-radiological study

The study measured the maximal occlusal forces (MOFs) and marginal bone levels (MBLs) around single implant-retained restorations over a period of 1 year and studied the correlation between them. Results showed that there was no change in MOFs at the end of 1 year and that the MBLs were stabilized by the end of 1 year. There was no statistically significant correlation between MOFs and MBLs.

Evaluation of the stress distribution in CFR-PEEK dental implants by the three-dimensional finite element method

CFR-PEEK (carbon fiber reforced-poly ether ether ketone) has been demonstrated to be excellent substitute titanium in orthopedic applications and can be manufactured with many physical, mechanical, and surface properties, in several shapes. The aim of this study was to compare, using the three-dimensional finite element method, the stress distribution in the peri-implant support bone of distinct models composed of PEEK components and implants reinforced with 30% carbon fiber (30% CFR-PEEK) or titanium. In simulations with a perfect bonding between the bone and the implant, the 30% CFR-PEEK presented higher stress concentration in the implant neck and the adjacent bone, due to the decreased stiffness and higher deformation in relation to the titanium. However, 30% CFR-PEEK implants and components did not exhibit any advantages in relation to the stress distribution compared to the titanium implants and components.

Effect of implant surface microtopography on proliferation, neurotrophin secretion, and gene expression of Schwann cells

The purpose of this study was to evaluate the effect of different implant surface properties on the morphology, proliferation, neurotrophin secretion, and gene expression of Schwann cells. Four types of implant surfaces, including ground (smooth surface), sandblasted and acid-etched (SLA), hydroxyapatite-coated (HA), and titanium plasma spray (TPS) surfaces were fabricated and photographed by a scanning electron microscopy (SEM). Schwann cells derived from neonatal rats were cultured on the implant surfaces and assessed via SEM observation and methylthiazol tetrazolium (MTT) colorimetric assay. The secretions and mRNA levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay (ELISA) and quantitative real time RT-PCR, respectively, on days 3 and 7. Tissue culture plastic was used as a control. The results demonstrated that Schwann cells exhibited typical bipolar spindle morphology on various surfaces, and proliferated faster than the control. Neurotrophin secretion and gene expression of both BDNF and NGF were also increased by implant surfaces. This study suggests that the function of Schwann cells can be enhanced by implant implants.

Impact of implant number, distribution and prosthesis material on loading on implants supporting fixed prostheses

The purpose of this study is to evaluate axial forces and bending moments (BMs) on implants supporting a complete arch fixed implant supported prosthesis with respect to number and distribution of the implants and type of prosthesis material. Seven oral Brånemark implants with a diameter of 3.75 mm and a length of 13 and 7 mm (short distal implant) were placed in an edentulous composite mandible used as the experimental model. One all-acrylic, one fibre-reinforced acrylic, and one milled titanium framework prosthesis were made. A 50 N vertical load was applied on the extension 10 mm distal from the most posterior implant. Axial forces and BMs were measured by calculating signals from three strain gauges attached to each of the abutments. The load was measured using three different models with varying numbers of supporting implants (3, 4 and 5), three models with different implant distribution conditions (small, medium and large) and three models with different prosthesis materials (titanium, acrylic and fibre-reinforced acrylic). Maximum BMs were highest when prostheses were supported by three implants compared to four and five implants (P < 0.001). The BMs were significantly influenced by the implant distribution, in that the smallest distribution induced the highest BMs (P < 0.001). Maximum BMs were lowest with the titanium prosthesis (P < 0.01). The resultant forces on implants were significantly associated with the implant number and distribution and the prosthesis material.