Prospective clinical evaluation of 1920 Morse taper connection implants: results after 4 years of functional loading

Prospective evaluation of 2,549 Morse taper connection implants: 1- to 6-year data

BACKGROUND

The aim of this study is to evaluate the implant survival, the implant-crown success, and the prosthetic complications of 2,549 Morse taper interference-fit connection implants.

METHODS

A total of 2,549 Morse taper connection implants were inserted in 893 patients from January 2003 until December 2008. At each annual recall, clinical, radiographic, and prosthetic parameters were assessed. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility; an average distance between the implant shoulder and the first visible bone contact <2 mm from initial surgery; and the absence of prosthetic complications at the implant-abutment interface. Prosthetic restorations were fixed partial prostheses (462 units); fixed full-arch prostheses (60 units); single crowns (531 units); and overdentures (93 units).

RESULTS

The cumulative implant survival rate was 98.23% (97.25% maxilla, 99.05% mandible). The implant-crown success was 92.49%. A few prosthetic complications at implant-abutment interface were reported (0.37%). After 6 years, distance between the implant shoulder and the first visible bone contact was 1.10 mm (± 0.30 mm).

CONCLUSION

The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches.

Vital pulp therapy-current progress of dental pulp regeneration and revascularization

Pulp vitality is extremely important for the tooth viability, since it provides nutrition and acts as biosensor to detect pathogenic stimuli. In the dental clinic, most dental pulp infections are irreversible due to its anatomical position and organization. It is difficult for the body to eliminate the infection, which subsequently persists and worsens. The widely used strategy currently in the clinic is to partly or fully remove the contaminated pulp tissue, and fill and seal the void space with synthetic material. Over time, the pulpless tooth, now lacking proper blood supply and nervous system, becomes more vulnerable to injury. Recently, potential for successful pulp regeneration and revascularization therapies is increasing due to accumulated knowledge of stem cells, especially dental pulp stem cells. This paper will review current progress and feasible strategies for dental pulp regeneration and revascularization.

Histomorphologic and histomorphometric evaluation of various endosseous implant healing chamber configurations at early implantation times: a study in dogs

AIM

The objective of this study was to evaluate the early healing of endosseous implants presenting various healing chamber configurations in a beagle dog mandible model.

METHODS

The four premolars of 12 beagle dogs were extracted and allowed to heal for a period of 8 weeks. Implants allowing six different healing chamber configurations were placed in each dog (three per side, six configurations per dog). The animals were sacrificed after 3 and 5 weeks in vivo (n=6 per time in vivo), and the implants were non-decalcified processed to slides of approximately 30 microm thickness. Bone-to-implant contact (BIC) and bone area fraction occupied (BAFO) within the healing chamber were quantified. Statistical analysis was performed by a GLM ANOVA model at 5% significance level.

RESULTS

Osseointegration and healing with woven bone filling throughout all healing chambers was observed. Replacement of woven bone by lamellar bone showing primary osteonic structures was observed at 5 weeks. BIC was significantly affected by healing chamber configuration (P<0.001) and was not affected by time in vivo (P>0.42) at 3 and 5 weeks in vivo. BAFO was not affected by healing chamber configuration (P>0.14) however significantly increased over implantation time (P<0.001).

CONCLUSION

Regardless of healing chamber design and dimensions considered, healing allowed the devices osseointegration. However, healing chamber configuration significantly affected osseointegration measurable parameters such as BIC.

Influence of high insertion torque on implant placement: an anisotropic bone stress analysis

The aim of this study was to evaluate the influence of the high values of insertion torques on the stress and strain distribution in cortical and cancellous bones. Based on tomography imaging, a representative mathematical model of a partial maxilla was built using Mimics 11.11 and Solid Works 2010 softwares. Six models were built and each of them received an implant with one of the following insertion torques: 30, 40, 50, 60, 70 or 80 Ncm on the external hexagon. The cortical and cancellous bones were considered anisotropic. The bone/implant interface was considered perfectly bonded. The numerical analysis was carried out using Ansys Workbench 10.0. The convergence of analysis (6%) drove the mesh refinement. Maximum principal stress (σmax) and maximum principal strain (εmax) were obtained for cortical and cancellous bones around to implant. Pearson's correlation test was used to determine the correlation between insertion torque and stress concentration in the periimplant bone tissue, considering the significance level at 5%. The increase in the insertion torque generated an increase in the σmax and εmax values for cortical and cancellous bone. The σmax was smaller for the cancellous bone, with greater stress variation among the insertion torques. The εmax was higher in the cancellous bone in comparison to the cortical bone. According to the methodology used and the limits of this study, it can be concluded that higher insertion torques increased tensile and compressive stress concentrations in the periimplant bone tissue.

Preload loss and bacterial penetration on different implant-abutment connection systems

Preload loss can favor the occurrence of implant-abutment interface misfit, and bacterial colonization at this interface may lead to implant failure. The aim of this study was to evaluate the preload loss and bacterial penetration through the implant-abutment interface of conical and external hexagon connection systems subjected to thermal cycling and mechanical fatigue (TM). Four different implant-abutment connection systems were evaluated (n=6): external hexagon with universal post, Morse taper with universal post, Morse taper with universal post through bolt, and locking taper with standard abutment. The assemblies (implant-abutment) were subjected to a thermal cycling regimen (1,000 cycles of 5°C and 55°C) and to mechanical fatigue (1.0 million cycles, 1.0 Hz, 120 N). The assemblies were immersed in Tryptic Soy + Yeast Extract broth containing Streptococcus sanguinis and incubated at 37°C and 10% CO2 for 72 h. Detorque values were recorded. The bacterial penetration was assessed and the abutments were observed by scanning electron microscopy. The preload data were analyzed statistically by two-way ANOVA and Tukey’s test at 5% significance level. All screw abutment systems showed significantly higher (p<0.05) detorque values when subjected to TM and all conical systems presented bacterial penetration. The results show no relationship between the preload loss and the bacterial penetration.