Risk factors for endosseous dental implant failure

Review of Antimicrobial Nanocoatings in Medicine and Dentistry: Mechanisms of Action, Biocompatibility Performance, Safety, and Benefits Compared to Antibiotics

This review discusses topics relevant to the development of antimicrobial nanocoatings and nanoscale surface modifications for medical and dental applications. Nanomaterials have unique properties compared to their micro- and macro-scale counterparts and can be used to reduce or inhibit bacterial growth, surface colonization and biofilm development. Generally, nanocoatings exert their antimicrobial effects through biochemical reactions, production of reactive oxygen species or ionic release, while modified nanotopographies create a physically hostile surface for bacteria, killing cells via biomechanical damage. Nanocoatings may consist of metal nanoparticles including silver, copper, gold, zinc, titanium, and aluminum, while nonmetallic compounds used in nanocoatings may be carbon-based in the form of graphene or carbon nanotubes, or composed of silica or chitosan. Surface nanotopography can be modified by the inclusion of nanoprotrusions or black silicon. Two or more nanomaterials can be combined to form nanocomposites with distinct chemical or physical characteristics, allowing combination of different properties such as antimicrobial activity, biocompatibility, strength, and durability. Despite their wide range of applications in medical engineering, questions have been raised regarding potential toxicity and hazards. Current legal frameworks do not effectively regulate antimicrobial nanocoatings in matters of safety, with open questions remaining about risk analysis and occupational exposure limits not considering coating-based approaches. Bacterial resistance to nanomaterials is also a concern, especially where it may affect wider antimicrobial resistance. Nanocoatings have excellent potential for future use, but safe development of antimicrobials requires careful consideration of the "One Health" agenda, appropriate legislation, and risk assessment.

The Use of the Diode Laser against the Microbiome on Composites Closing the Screw Access Hall (Sah) in the Reconstruction of Dental Implants: Ex Vivo Studies

Patients undergoing implant treatment are at risk of peri-implant bone loss, which is most often caused by the adverse effects of microorganisms, but there are few proven procedures for their reduction. The aim of the research was to identify the microorganisms inhabiting the composites used to close the screw access hole (SAH), compare them numerically with those present on the surface of crowns and teeth, and optimize the doses of the diode laser, which will reduce microorganisms and will not deteriorate the roughness of polished composites. Patients were swabbed from the surface of SAH composites, from porcelain and zirconium restorations, and from teeth, and then the number of microorganisms was determined by using a culture technique. Microorganisms were identified by MALDI–TOF MS and NGS sequencing. The effectiveness of diode laser irradiation was achieved by using four variants of exposure. After polishing and laser irradiation, the surface roughness of the composites was studied by using optical profilometry. On the surface of SAH, 10⁶ to 10⁸ microorganisms were identified at 0.4 cm², including many pathogenic species. Among the materials used for the reconstruction of dental implants, the greatest microbiological contamination was found on the composites used to close the SAH. The diode laser with a wavelength of 810 nm with an average power of 3.84 W, during 60 s and 2 × 30 s, has a biocidal effect and does not significantly change the surface roughness of composites. The best reduction of microorganisms was achieved on a composite polished with a polishing rubber and then with a Sof-Lex™ Pre-Polishing Spiral beige (3M ESPE, Ave. St. Paul., MN, USA). Studies have shown that using the optimal laser dose can help treat periimplantitis. These studies provide important information on the possibility of the effective elimination of microorganisms by using a diode laser in the treatment of peri-implant bone loss.

A Novel Method for Digital Reconstruction of the Mucogingival Borderline in Optical Scans of Dental Plaster Casts

Adequate soft-tissue dimensions have been shown to be crucial for the long-term success of dental implants. To date, there is evidence that placement of dental implants should only be conducted in an area covered with attached gingiva. Modern implant planning software does not visualize soft-tissue dimensions. This study aims to calculate the course of the mucogingival borderline (MG-BL) using statistical shape models (SSM). Visualization of the MG-BL allows the practitioner to consider the soft tissue supply during implant planning. To deploy an SSM of the MG-BL, healthy individuals were examined and the intra-oral anatomy was captured using an intra-oral scanner (IOS). The empirical anatomical data was superimposed and analyzed by principal component analysis. Using a Leave-One-Out Cross Validation (LOOCV), the prediction of the SSM was compared with the original anatomy extracted from IOS. The median error for MG-BL reconstruction was 1.06 mm (0.49–2.15 mm) and 0.81 mm (0.38–1.54 mm) for the maxilla and mandible, respectively. While this method forgoes any technical work or additional patient examination, it represents an effective and digital method for the depiction of soft-tissue dimensions. To achieve clinical applicability, a higher number of datasets has to be implemented in the SSM.

Comparative Analysis of Stress and Deformation between One-Fenced and Three-Fenced Dental Implants Using Finite Element Analysis

Finite element analysis (FEA) has always been an important tool in studying the influences of stress and deformation due to various loads on implants to the surrounding jaws. This study assessed the influence of two different types of dental implant model on stress dissipation in adjoining jaws and on the implant itself by utilizing FEA. This analysis aimed to examine the effects of increasing the number of fences along the implant and to compare the resulting stress distribution and deformation with surrounding bones. When a vertical force of 100 N was applied, the largest displacements found in the three-fenced and single-fenced models were 1.7469 and 2.5267, respectively, showing a drop of 30.8623%. The maximum stress found in the three-fenced and one-fenced models was 13.518 and 22.365 MPa, respectively, showing a drop of 39.557%. Moreover, when an oblique force at 35° was applied, a significant increase in deformation and stress was observed. However, the three-fenced model still had less stress and deformation compared with the single-fenced model. The FEA results suggested that as the number of fences increases, the stress dissipation increases, whereas deformation decreases considerably.

Factors affecting the decision to rehabilitate the posterior maxilla following surgical closure of oroantral communications/fistulae - A cohort study

BACKGROUND

Search of the English literature yielded no studies assessing the chosen dental treatment following surgical closure of oroantral communication/oroantral fistula (OAC/OAF). The purpose of the present study was to assess factors affecting the decision to rehabilitate the posterior maxilla following surgical closure of OAC/OAF.

METHODS

Consecutive patients at a single center. A structured form served to collect the data. The differences between groups (cases with versus cases without restoration) were assessed statistically.

RESULTS

A total of 58/121 responding individuals (62.1% men). Average age 51.57 years. Average waiting time prior to restoration 10.34 months. Most (51.7%) healthy. Most had a dental etiology (60.3%). Thirty-nine (67.2%) patients had a restoration of the posterior maxilla. Most of the patients responded that the reason not to do any restoration is the fear of failure (65.5%). Most of the patients completed the restoration procedure in a private clinic (87.2%). Only one patient (2.6%) reported a complication. Approximately half of the patients had implant supported prosthesis (ISP) following sinus augmentation (48.3%) with delayed implant placement. Most of the patients responded that the reason not to have ISP was the fear of failure (72.7%), and the rest responded because of financial issues (27.3%). For tooth supported restoration, most of the patients responded removable (90.9%).

CONCLUSIONS

Surgeons generally wait 6-12 months following surgical treatment of OAC/OAF prior to reconstruction with ISP. The chance for complications is low. Healthy women after dental induced OAC/OAF have the highest chances to seek for ISP in such circumstances.

Investigation of the Long-Term Antibacterial Properties of Titanium by Two-Step Micro-Arc Oxidation Treatment

Recently, biofilm formation caused by bacterial adhesion and colonization has been recognized as the major cause of failure in orthopedic and dental implant surgeries. In this study, a customized micro-arc oxidation (MAO) treatment technique was developed to obtain desirable antibacterial properties on Ti surfaces. The two-step MAO treatment was applied in the fabrication of specimens with Ag and with/without Zn in their surface oxide layer. In order to simulate practical usage, surface analyses and immersion tests were performed to evaluate the incorporation of Ag and Zn into the resulting oxide layer and ion release behavior, respectively. Additionally, the antibacterial properties of the specimens after long-term immersion in physiological saline were evaluated using Gram-negative facultative anaerobic bacteria. The MAO-treated specimens containing Ag and Zn exhibited excellent antibacterial properties against Escherichia coli, which were sustained even after 6 months of immersion in physiological saline to simulate practical usage. Moreover, the Ag ions released from the surface oxide indicate the antibacterial properties of the specimen in the early stage, while the release of the corrosion products of Zn demonstrates its antibacterial properties in the later stage.

Modeling of Symbiotic Bacterial Biofilm Growth with an Example of the Streptococcus-Veillonella sp. System

We present a multi-dimensional continuum mathematical model for modeling the growth of a symbiotic biofilm system. We take a dual-species namely, the Streptococcus-Veillonella sp. biofilm system as an example for numerical investigations. The presented model describes both the cooperation and competition between these species of bacteria. The coupled partial differential equations are solved by using an integrative finite element numerical strategy. Numerical examples are carried out for studying the evolution and distribution of the bio-components. The results demonstrate that the presented model is capable of describing the symbiotic behavior of the biofilm system. However, homogenized numerical solutions are observed locally. To study the homogenization behavior of the model, numerical investigations regarding on how random initial biomass distribution influences the homogenization process are carried out. We found that a smaller correlation length of the initial biomass distribution leads to faster homogenization of the solution globally, however, shows more fluctuated biomass profiles along the biofilm thickness direction. More realistic scenarios with bacteria in patches are also investigated numerically in this study.

Enhancement of antibacterial property of titanium by two-step micro arc oxidation treatment

A customized micro arc oxidation (MAO) treatment technique was developed to obtain desirable antibacterial properties on titanium surfaces. The two-step MAO treatment was applied to fabricate a specimen containing both Ag and Zn in its surface oxide layer. Surface analyses and metal-ion release tests were performed to evaluate the presence of Ag and Zn and the ion release behavior for simulating practical usage, respectively. Additionally, the antibacterial properties of the specimens were also evaluated using gram-negative facultative anaerobic bacteria. The MAO-treated specimens containing both Ag and Zn showed excellent antibacterial properties against Escherichia coli, and the properties were sustained even after 28 days of immersion in physiological saline to simulate the living environment.

Design of dental implants at materials level: An overview

Due to the excellent restoration of masticatory function, satisfaction on aesthetics and other superiorities, dental implants represent an effective method to resolve tooth losing and damaging. Current dental implant systems still have problems waiting to be addressed, and problems are centralized on the materials of implant bodies. This review aims to summarize major developments in the field of dental implant materials, starting with an overview on structures, procedures of dental implants and challenges of implant materials. Next, implant materials are examined in three categories, that is, metals, ceramics, and polymers, their mechanical properties, biocompatibility, and bioactivity are summarized. And as an important aspect, strategies of surface modification are also reviewed, along with some finite element analysis to guiding the research direction of implant materials. Finally, the conclusive remarks are outlined to provide an outlook on the future research directions and prospects of dental implants.

Attitude and treatment options in implant-supported prosthetics: A survey among a cohort of German dentists

PURPOSE

The aim of the current study was to analyze treatment concepts of a cohort of German dentists for planning, fabrication, and maintenance of implant-supported fixed and removable restorations.

MATERIALS AND METHODS

A questionnaire including queries about experiences with implant-supported restorations as well as prosthetic and maintenance treatment concepts for supplying patients with fixed and removable implant-supported prosthetic restorations was developed and sent to 350 dental offices registered in the municipal area of Leipzig, Germany.

RESULTS

An overall total of 62 returned questionnaires were included in the analyses, which relates to a response rate of 17.7%. Participating dentists were more involved in the prosthetic aspects of implant dentistry rather than surgery, while prosthetic concepts such as backward planning, digital processing, and application of all-ceramic materials were not commonly performed. Simple attachments were preferred over complex retention systems in removable implant-supported restorations. Tooth/implant-supported fixed denture prostheses as well as removable denture prostheses with supporting posterior implants were not regarded as a favorable treatment option.

CONCLUSION

Within the limitations of the study, the data indicate that dentists favor simple and conventional treatment approaches in implant prosthetics. Prosthetic aspects in the planning of implant-supported restorations are often neglected. Prosthetic treatment guidelines and aspects should commonly be considered in the planning phase of implant-supported prosthetic restorations, and awareness should be increased in postgraduate education.

Antibacterial activity and biofilm inhibition by surface modified titanium alloy medical implants following application of silver, titanium dioxide and hydroxyapatite nanocoatings

One of the most common causes of implant failure is peri-implantitis, which is caused by bacterial biofilm formation on the surfaces of dental implants. Modification of the surface nanotopography has been suggested to affect bacterial adherence to implants. Silver nanoparticles are also known for their antibacterial properties. In this study, titanium alloy implants were surface modified following silver plating, anodisation and sintering techniques to create a combination of silver, titanium dioxide and hydroxyapatite (HA) nanocoatings. Their antibacterial performance was quantitatively assessed by measuring the growth of Streptococcus sanguinis, proportion of live/dead cells and lactate production by the microbes over 24 h. Application of a dual layered silver-HA nanocoating to the surface of implants successfully inhibited bacterial growth in the surrounding media (100% mortality), whereas the formation of bacterial biofilm on the implant surfaces was reduced by 97.5%. Uncoated controls and titanium dioxide nanocoatings showed no antibacterial effect. Both silver and HA nanocoatings were found to be very stable in biological fluids with material loss, as a result of dissolution, to be less than 0.07% for the silver nanocoatings after 24 h in a modified Krebs-Ringer bicarbonate buffer. No dissolution was detected for the HA nanocoatings. Thus, application of a dual layered silver-HA nanocoating to titanium alloy implants creates a surface with antibiofilm properties without compromising the HA biocompatibility required for successful osseointegration and accelerated bone healing.

Development of a flow chamber system for the reproducible in vitro analysis of biofilm formation on implant materials

Since the introduction of modern dental implants in the 1980s, the number of inserted implants has steadily increased. Implant systems have become more sophisticated and have enormously enhanced patients’ quality of life. Although there has been tremendous development in implant materials and clinical methods, bacterial infections are still one of the major causes of implant failure. These infections involve the formation of sessile microbial communities, called biofilms. Biofilms possess unique physical and biochemical properties and are hard to treat conventionally. There is a great demand for innovative methods to functionalize surfaces antibacterially, which could be used as the basis of new implant technologies. Present, there are few test systems to evaluate bacterial growth on these surfaces under physiological flow conditions. We developed a flow chamber model optimized for the assessment of dental implant materials. As a result it could be shown that biofilms of the five important oral bacteria Streptococcus gordonii, Streptococcus oralis, Streptococcus salivarius, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans, can be reproducibly formed on the surface of titanium, a frequent implant material. This system can be run automatically in combination with an appropriate microscopic device and is a promising approach for testing the antibacterial effect of innovative dental materials.

TiO2nanotubes enriched with calcium, phosphorous and zinc: promising bio-selective functional surfaces for osseointegrated titanium implants

TiO₂nanotubes enriched with Ca, P, and Zn by reverse polarization anodization, are promising bio-selective functional structures for osseointegrated titanium implants.

Impact of Physical Chemical Characteristics of Abutment Implant Surfaces on Bacteria Adhesion

Surface attachment is the first step in biofilm formation, and the ability of bacteria to adhere to surfaces and develop a biofilm is directly influenced by electrostatic interactions between the bacteria and the chemical composition of material surfaces. Here, we investigated the influence of physical and chemical characteristics of titanium (Ti) and zirconia (ZrO2) as implant abutment surfaces on the bacterial adhesion phase and compared the results to bovine enamel (BE) simulating a human tooth. To achieve this goal, we used 2 common pathogens of the oral cavity, Streptococcus mutans UA140 and Porphyromonas gingivalis 33277. To investigate the influence of material surfaces on bacterial adhesion, we studied the surface free energy as well as the topography by atomic force microscopy, and the chemical elements composition by scanning electron microscopy equipped with an energy dispersive X-ray spectroscope. Our results indicated a hydrophobic characteristic for all of the materials; however, the presence of polar and nonpolar components could aid in understanding why greater numbers of bacteria had adhered to BE compared to the other surfaces. Our confocal microscopy data support the proposition that electrostatic interactions, indeed, affected the initial adhesion phase. Within the limitations of a laboratory study, the results revealed bacterial adhered on BE and no bacteria could be observed by confocal images on Ti and ZrO2 implant abutment surfaces.

Mussel-inspired silver-nanoparticle coating on porous titanium surfaces to promote mineralization

Porous titanium surfaces modified with mussel-inspired silver-nanoparticles for inhibiting bacterial adhesion and promoting mineralization and then improving osteoblast-biocompatibility.

Analysis of the Factors Affecting Surgical Success of Implants Placed in Iranian Warfare Victims

OBJECTIVE

The aim was to evaluate the survival time and success rates of dental implants in warfare victims and factors that affect implant success.

SUBJECTS AND METHODS

This retrospective study involved 250 Iranian warfare victims who received dental implants from 2003 to 2013. Patients' demographic characteristics, as well as the brand, diameter, length, location and failure rate of the implants were retrieved from patients' dental records and radiographs. The associations between these data and the survival rate were analyzed. Statistical analysis was carried out with χ2 and log-rank tests.

RESULTS

Overall, out of the 1,533 dental implants, 61 (4%) failed. The maxillary canine area had the highest failure rate [9 of 132 implants (6.8%)], while the mandibular incisor region had the least number of failures [3 of 147 implants (2.0%)] and the longest survival time (approximately 3,182 days). Maxillary canine areas had the shortest survival (about 2,996 days). The longest survival time was observed in implants with 11 mm length (3,179.72 ± 30.139 days) and 3.75-4 mm diameter (3,131.161 ± 35.96 days), and the shortest survival was found in implants with 11.5 mm length (2,317.79 ± 18.71 days) and 6.5 mm diameter (2,241.45 ± 182.21 days). Moreover, implants with 10 mm length (10.7%) and 5.5-6 mm diameter (22.2%) had the highest failure rate; however, the least failure rate occurred when the implants were 11.5 mm in length (1.9%) and 3-3.5 mm in diameter (3.1%).

CONCLUSIONS

The brand, length and diameter of implants affected the survival time, failure rate and time to failure. The location of the implant was not statistically significant regarding the mentioned factors, although it has clinical significance.

Presurgical implant-site assessment and restoratively driven digital planning

Cone-beam computed tomography imaging and 3-dimensional (3D) computer software allows for greatly enhanced visualization of bone, critical anatomy, and restorative plans. These systems allow clinicians to digitally process 3D images and restorative templates, facilitating dental implant planning. This article highlights the use of contemporary methods of digital assessment combined with traditional restorative philosophies to allow the clinician to plan implant positions based on "crown-down" clinical requirements. This approach permits clinicians to have more control over the implant treatment plan by creating ideal, virtual restorations and managing implant positions based on the virtual plan with simplified, cost-effective techniques.

Lactotransferrin Gene (LTF) Polymorphisms and Dental Implant Loss: A Case-Control Association Study

BACKGROUND

Dental implants have been widely used to replace missing teeth, accomplishing aesthetics and function. Due to its large use worldwide, the small percentage of implant loss becomes significant in number of cases. Lactotransferrin (LTF) is a pleiotropic protein, expressed in various body tissues and fluids, which modulates the host immune-inflammatory response and bone metabolism, and might be involved in dental implant osseointegration. Recently, a few studies have been investigating genetic aspects underlying dental implant failure.

PURPOSE

This case-control study aimed to investigate the association of genetic markers (tag SNPs) in LTF gene and clinical parameters with dental implant loss.

MATERIAL AND METHODS

278 patients, both sexes, mean age 51 years old, divided into 184 without and 94 with implant loss, were genotyped for sixteen tag SNPs, representative of the whole LTF gene. Also, clinical oral and systemic parameters were analyzed. Univariate and Multivariate Logistic Regression model were used to analyze the results (p < .05).

RESULTS

No association was found between the tag SNPs and implant loss in the study population. Clinical association was found with medical treatment, hormonal reposition, edentulism, number of placed implants, plaque, calculus, and mobility.

CONCLUSION

Clinical variables, but not LTF gene polymorphisms, were associated with implant loss.

Esthetic failure in implant dentistry

The definition of failure for dental implants has evolved from lack of osseointegration to increased concern for other aspects, such as esthetics. However, esthetic failure in implant dentistry has not been well defined. Although multiple esthetic indices have been validated for objectively evaluating clinical outcomes, including failure of an implant-supported crown, only one author has determined a failure threshold. On the basis of objective indices, esthetic failures in implant dentistry can be categorized as pink-tissue failures and white-tissue failures. This article discusses esthetic failures, the factors involved in these failures, and their prevention and treatment.

Current trends in dental implants

Tooth loss is very a very common problem; therefore, the use of dental implants is also a common practice. Although research on dental implant designs, materials and techniques has increased in the past few years and is expected to expand in the future, there is still a lot of work involved in the use of better biomaterials, implant design, surface modification and functionalization of surfaces to improve the long-term outcomes of the treatment. This paper provides a brief history and evolution of dental implants. It also describes the types of implants that have been developed, and the parameters that are presently used in the design of dental implants. Finally, it describes the trends that are employed to improve dental implant surfaces, and current technologies used for the analysis and design of the implants.

Modified Titanium Surface-Mediated Effects on Human Bone Marrow Stromal Cell Response

Surface modification of titanium implants is used to enhance osseointegration. The study objective was to evaluate five modified titanium surfaces in terms of cytocompatibility and pro-osteogenic/pro-angiogenic properties for human mesenchymal stromal cells: amorphous microporous silica (AMS), bone morphogenetic protein-2 immobilized on AMS (AMS + BMP), bio-active glass (BAG) and two titanium coatings with different porosity (T1; T2). Four surfaces served as controls: uncoated Ti (Ti), Ti functionalized with BMP-2 (Ti + BMP), Ti surface with a thickened titanium oxide layer (TiO₂) and a tissue culture polystyrene surface (TCPS). The proliferation of eGFP-fLuc (enhanced green fluorescence protein-firefly luciferase) transfected cells was tracked non-invasively by fluorescence microscopy and bio-luminescence imaging. The implant surface-mediated effects on cell differentiation potential was tracked by determination of osteogenic and angiogenic parameters [alkaline phosphatase (ALP); osteocalcin (OC); osteoprotegerin (OPG); vascular endothelial growth factor-A (VEGF-A)]. Unrestrained cell proliferation was observed on (un)functionalized Ti and AMS surfaces, whereas BAG and porous titanium coatings T1 and T2 did not support cell proliferation. An important pro-osteogenic and pro-angiogenic potential of the AMS + BMP surface was observed. In contrast, coating the Ti surface with BMP did not affect the osteogenic differentiation of the progenitor cells. A significantly slower BMP-2 release from AMS compared to Ti supports these findings. In the unfunctionalized state, Ti was found to be superior to AMS in terms of OPG and VEGF-A production. AMS is suggested to be a promising implant coating material for bioactive agents delivery.

Inhibition of biofilm formation and antibacterial properties of a silver nano-coating on human dentine

The survival of pathogenic bacteria in the oral cavity depends on their successful adhesion to dental surfaces and their ability to develop into biofilms, known as dental plaque. Bacteria from the dental plaque are responsible for the development of dental caries, gingivitis, periodontitis, stomatitis and peri-implantitis. Certain metal nanoparticles have been suggested for infection control and the management of the oral biofilm. Here, it is shown that application of a silver nano-coating directly on dentine can successfully prevent the biofilm formation on dentine surfaces as well as inhibit bacterial growth in the surrounding media. This silver nano-coating was found to be stable (>98.8%) and to maintain its integrity in biological fluids. Its antibacterial activity was compared to silver nitrate and the widely used clinical antiseptic, chlorhexidine. The bacterial growth and cell viability were quantitatively assessed by measuring the turbidity, proportion of live and dead cells and lactate production. All three bioassays showed that silver nanoparticles and silver nitrate dentine coatings were equally highly bactericidal (>99.5%), while inhibiting bacterial adhesion. However, the latter caused significant dentine discolouration (ΔE* = 50.3). The chlorhexidine coating showed no antibacterial effect. Thus, silver nanoparticles may be a viable alternative to both chlorhexidine and silver nitrate, protecting from dental plaque and secondary caries when applied as a dentine coating, while they may provide the platform for creating anti-biofilm surfaces in medical devices and other biomedical applications.

Osteonecrosis of the jaw after implant surgery in patients treated with bisphosphonates--a presentation of six consecutive cases

BACKGROUND

Osteonecrosis of the jaws in patients treated with bisphosphonates is mostly associated with intravenous bisphosphonates while the incidence associated with oral bisphosphonates is not significant.

PURPOSE

The purpose of this paper is to describe a series of cases of jaw osteonecrosis that may be associated with dental implant placement in patients who had taken nitrogen containing bisphosphonates via oral and/or intravenous route.

PATIENTS

Six female patients were treated for osteonecrosis of the jaw after implant placement. An average age was 71.8 ± 6.5 years old and they had a history of bisphosphonate use. Two patients suffered from cancer and the other patients had osteoporosis. Two osteoporosis patients had taken only oral bisphosphonate and the other patients received intravenous bisphosphonates.

RESULTS

Resection of necrotized bone, implant removal, and primary closure were performed in five patients and four patients showed uneventful healing. One patient presented recurrence at the maxilla and underwent further extraction and resection. One patient presented with an exposure of the bone after implant placement was treated with an advanced flap closure, and the implants were preserved.

CONCLUSION

Unusual jaw necrosis after dental implant surgery might be related with oral and/or intravenous bisphosphonates. Wide resection of necrotic bone, collagen graft, and primary closure are key factors for successful healing.

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.

Biofilm and dental implant: The microbial link

Mouth provides a congenial environment for the growth of the microorganisms as compared to any other part of the human body by exhibiting an ideal nonshedding surface. Dental plaque happens to be a diverse community of the microorganisms found on the tooth surface. Periodontal disease and the peri-implant disease are specific infections that are originating from these resident microbial species when the balance between the host and the microbial pathogenicity gets disrupted. This review discusses the biofilms in relation to the peri-implant region, factors affecting its presence, and the associated treatment to manage this complex microbial colony. Search Methodology: Electronic search of the medline was done with the search words: Implants and biofilms/dental biofilm formation/microbiology at implant abutment interface/surface free energy/roughness and implant, periimplantitis/local drug delivery and dental implant. Hand search across the journals - clinical oral implant research, implant dentistry, journal of dental research, international journal of oral implantology, journal of prosthetic dentistry, perioodntology 2000, journal of periodontology were performed. The articles included in the review comprised of in vivo studies, in vivo (animal and human) studies, abstracts, review articles.

Contemporary concepts in treatment planning, reconstruction and rehabilitation of the maxillofacial region: an overview of methods used in practice

Treatment planning, reconstruction and rehabilitation of maxillofacial and dental defects have always been a challenge for a maxillofacial surgeon. Reconstruction of the oral cavity is often a difficult task as it involves the restoration of both the esthetic or cosmetic form as well as the preoperative function. Understanding the oral cavity anatomy as well the functional capacities of its various subunits is required to achieve good results. The recent advances in treatment planning, diagnostic imaging and reconstructive techniques, especially in the field of osseointegration, tissue expanders, perforator flaps, microvascular free tissue transfer and bone engineering, have yielded excellent functional and esthetic outcomes. This article provides a brief overview on various advanced reconstructive and rehabilitation techniques available in contemporary clinical practice.

Microflora around teeth and dental implants

Background:

When an implant is exposed to oral cavity, its surface gets colonized by micro-organisms. The aim of this study is to comparatively assess the microbiological parameters in sulci around the teeth and the crowns supported by dental implants.

Materials and Methods:

In this prospective, cross-sectional study, 34 partially edentulous patients aged between 40 and 50 years with total 50 anterior maxillary single implants with cemented crowns (depth of sulci <4 mm) and 34 similar teeth in the same jaw of the same patients were included. Excluded were the patients with compromised systemic and periodontal health and smoking habits. None of the patients had used any antimicrobial mouthwashes during at least two weeks before the study. All of the implants (ITI) were at least 6 months in place covered by definitive prostheses. Samples of gingival sulci were taken around teeth with paper cone and transported to Stuart transport medium. Samples were cultured and examined by a dark field microscope and eight laboratory tests were performed to determine the micro-organisms The data were evaluated statistically using Chi-square test (α=0.05).

Results:

Six anerobic bacteria found in teeth and implants sulci were Gram-positive cocci, Gram-negative cocci, Prevotella, Porphyromonas gingivalis, Bacteroid Fragilis and Fusobacterium. Gram-positive cocci and Gram-negative cocci had maximum and minimum percentage frequency in the two groups, respectively. There were no significant differences between the two groups (P value >0.05).

Conclusion:

The present study indicated that microflora in implant sulci is similar to the tooth sulci, when the depth of sulci is normal (<4 mm). As a result, implants’ susceptibility to inflammation is the same as teeth.

Biomimetic surface modification of titanium surfaces for early cell capture by advanced electrospinning

The time required for osseointegration with a metal implant having a smooth surface ranges from three to six months. We hypothesized that biomimetic coating surfaces with poly(lactic-co-glycolic acid) (PLGA)/collagen fibers and nano-hydroxyapatite (n-HA) on the implant would enhance the adhesion of mesenchymal stem cells. Therefore, this surface modification of dental and bone implants might enhance the process of osseointegration. In this study, we coated PLGA or PLGA/collagen (50:50 w/w ratio) fiber on Ti disks by modified electrospinning for 5 s to 2 min; after that, we further deposited n-HA on the fibers. PLGA fibers of fiber diameter 0.957 ± 0.357 µm had a contact angle of 9.9 ± 0.3° and PLGA/collagen fibers of fiber diameter 0.378 ± 0.068 µm had a contact angle of 0°. Upon n-HA incorporation, all the fibers had a contact angle of 0° owing to the hydrophilic nature of n-HA biomolecule. The cell attachment efficiency was tested on all the scaffolds for different intervals of time (10, 20, 30 and 60 min). The alkaline phosphatase activity, cell proliferation and mineralization were analyzed on all the implant surfaces on days 7, 14 and 21. Results of the cell adhesion study indicated that the cell adhesion was maximum on the implant surface coated with PLGA/collagen fibers deposited with n-HA compared to the other scaffolds. Within a short span of 60 min, 75% of the cells adhered onto the mineralized PLGA/collagen fibers. Similarly by day 21, the rate of cell proliferation was significantly higher (p ⩽ 0.05) on the mineralized PLGA/collagen fibers owing to enhanced cell adhesion on these fibers. This enhanced initial cell adhesion favored higher cell proliferation, differentiation and mineralization on the implant surface coated with mineralized PLGA/collagen fibers.

Bone tissue response to porous and functionalized titanium and silica based coatings

Background

Topography and presence of bio-mimetic coatings are known to improve osseointegration. The objective of this study was to evaluate the bone regeneration potential of porous and osteogenic coatings.

Methodology

Six-implants [Control (CTR); porous titanium coatings (T1, T2); thickened titanium (Ti) dioxide layer (TiO₂); Amorphous Microporous Silica (AMS) and Bio-active Glass (BAG)] were implanted randomly in tibiae of 20-New Zealand white rabbits. The animals were sacrificed after 2 or 4 weeks. The samples were analyzed histologically and histomorphometrically. In the initial bone-free areas (bone regeneration areas (BRAs)), the bone area fraction (BAF) was evaluated in the whole cavity (500 µm, BAF-500), in the implant vicinity (100 µm, BAF-100) and further away (100–500 µm, BAF-400) from the implant. Bone-to-implant contact (BIC-BAA) was measured in the areas where the implants were installed in contact to the host bone (bone adaptation areas (BAAs)) to understand and compare the bone adaptation. Mixed models were used for statistical analysis.

Principal Findings

After 2 weeks, the differences in BAF-500 for different surfaces were not significant (p>0.05). After 4 weeks, a higher BAF-500 was observed for BAG than CTR. BAF-100 for AMS was higher than BAG and BAF-400 for BAG was higher than CTR and AMS. For T1 and AMS, the bone regeneration was faster in the 100-µm compared to the 400-µm zone. BIC-BAA for AMS and BAG was lower after 4 than 2 weeks. After 4 weeks, BIC-BAA for BAG was lower than AMS and CTR.

Conclusions

BAG is highly osteogenic at a distance from the implant. The porous titanium coatings didn't stimulate bone regeneration but allowed bone growth into the pores. Although AMS didn't stimulate higher bone response, it has a potential of faster bone growth in the vicinity compared to further away from the surface. BIC-BAA data were inconclusive to understand the bone adaptation.

Effect of surgical guide design and surgeon's experience on the accuracy of implant placement

Implant position is a key determinant of esthetic and functional success. Achieving the goal of ideal implant position may be affected by case selection, prosthodontically driven treatment planning, site preparation, surgeon's experience and use of a surgical guide. The combined effect of surgical guide design, surgeon's experience, and size of the edentulous area on the accuracy of implant placement was evaluated in a simulated clinical setting. Twenty-one volunteers were recruited to participate in the study. They were divided evenly into 3 groups (novice, intermediate, and experienced). Each surgeon placed implants in single and double sites using 4 different surgical guide designs (no guide, tube, channel, and guided) and written instructions describing the ideal implant positions. A definitive typodont was constructed that had 3 implants in prosthetically determined ideal positions of single and double sites. The position and angulation of implants placed by the surgeons in the duplicate typodonts was measured using a computerized coordinate measuring machine and compared to the definitive typodont. The mean absolute positional error for all guides was 0.273, 0.340, 0.197 mm in mesial-distal, buccal-lingual, vertical positions, respectively, with an overall range of 0.00 to 1.81 mm. The mean absolute angle error for all guides was 1.61° and 2.39° in the mesial-distal and buccal-lingual angulations, respectively, with an overall range of 0.01° to 9.7°. Surgical guide design had a statistically significant effect on the accuracy of implant placement regardless of the surgeon's experience level. Experienced surgeons had significantly less error in buccal-lingual angulation. The size of the edentulous sites was found to affect both implant angle and position significantly. The magnitude of error in position and angulation caused by surgical guide design, surgeon's experience, and site size reported in this study are possibly not large enough to be clinically significant; however, it is likely that errors would be magnified in clinical practice. Future research is recommended to evaluate the effect of surgical guide design in vivo on implant angulation and position error.

Full mouth rehabilitation with implant-supported prostheses for severe periodontitis: a case report

Oral rehabilitation for a patient with severe loss of alveolar bone and soft tissue resulting from severe periodontitis presents a challenge to clinicians. Replacing loosening natural teeth with fixed prostheses supported by dental implants often requires either gingival surgery or bone grafting. The outcome of the bone grafting is sometimes unpredictable and requires longer healing time and/ or multiple surgeries. The presence of periodontal inflammation and periapical lesions often delay the placement of bone grafts as well as dental implants. Here we present a clinical case of a patient undergone full mouth reconstruction with implant-supported fixed prostheses. We demonstrated that early placement of implants (three weeks after extractions) with minimal bone grafting may be an alternative to conventional bone grafting followed by implant placement. We believe that primary stability during implant placement may contribute to our success. In addition, composite resin gingival material may be indicated in cases of large fixed implant prostheses as an alternative to pink porcelain.

Biological factors involved in implant-anchored orthodontics and in prosthetic-implant therapy: a literature review

During the past few years, the application of orthodontic miniscrews and dental implants has been expanded. However, failures have necessitated ongoing investigation of potential risk factors. The aim of this overview was to conduct an assessment of the immunological response following application of cortical temporary anchorage devices--titanium miniscrew implants--in orthodontic patients. A scrupulous search of the database revealed only two matching items; therefore studies evaluating the immune response subsequent to insertion of dental implants were reviewed. Thorough assessment revealed the following as factors associated with dental implant rejection: (1) correlation of the volume of gingival and peri-implant crevicular fluid and the amount of interleukin (IL)-1beta with mucosal inflammation, thus serving as a peri-implantitis evaluation index; (2) significantly more frequent marginal bone loss around implants in patients with IL-1B-511 2/2 genotype; (3) humoral response to Staphylococcus aureus. However, since there is almost no evidence-based evaluation of the allergic/inflammatory reaction either to orthodontic titanium miniscrews themselves or in adolescents and young adults, who comprise the largest group of orthodontic patients, this issue requires further investigation. It is essential in order to achieve successful, sophisticated and modern treatment of malocclusions.

Histopathologic findings in bone from edentulous alveolar ridges: a role in osteonecrosis of the jaws?

Bisphosphonate-related osteonecrosis of the jaws (BONJ) is characterized by a breach in the oral mucosa with exposure of necrotic bone. Although bisphosphonates impact multiple biologic processes, including bone turnover and vascularity, factors contributing to the pathogenesis of BONJ remain poorly understood. In this retrospective analysis, the histopathologic findings from 154 alveolar bone specimens obtained during osteotomy preparation for dental implant placement were reviewed from 147 consecutively treated patients [male (79); female (68); Caucasian (141); African-American (6)]. The alveolar ridge sites had been edentulous for 1 year or longer. None of the patients in this study had a history of bisphosphonate therapy or clinical evidence of BONJ. Two pathologists, masked, using predetermined criteria, reviewed and substantiated the pathology reports provided by the licensed pathology service. In selected cases, special stains had been conducted to help establish the presence of bacteria. The histopathologic findings for the core specimens were as follows: 76 viable bone (49.4%); 54 nonviable bone (35.0%); and 24 osteomyelitis (15.6%). These histopathologic findings indicate that the edentulous jaw can contain regions of nonviable bone and microbial biofilm formation for 1 year or more after tooth extraction and mucosal healing. Regions of necrotic bone and subclinical infection may contribute to the development of untoward clinical events, such BONJ and early implant failure.

The effect of smoking on early bone remodeling on surface modified Southern Implants®

INTRODUCTION

Smoking affects the survival of turned titanium implants. Although smoking has less impact on the failure rate of rough surface implants, the effect on bone loss on rough surface implants has not been studied yet and may be an important factor in biological stability.

AIM

To determine the effect of smoking on early implant failures and bone remodeling around moderately rough implants (Southern Implants®, Southern Implants, Irene, South Africa).

MATERIALS AND METHODS

Three hundred twenty-nine patient records, containing information on 712 installed implants, were scrutinized retrospectively and periapical radiographs were analyzed for interproximal bone level. Mann-Whitney U-test and Fisher's exact test were performed to compare bone level and implant survival in smokers and nonsmokers. Only implants with at least 6 months of function time were analyzed for bone level changes.

RESULTS

The overall survival rate was 98.3%. Implants in smokers had a threefold higher failure rate compared with nonsmokers (5/104 = 4.8% vs 7/608 = 1.2%). This was statistically significant on implant level (p = .007) but not on patient level (1/41 vs 7/288, p = .997). Readable radiographs from 363 implants in 169 patients were available with a mean follow-up of 12 months (SD 5.11; range 6-28). The mean interproximal bone level was 1.36 mm (n = 363; SD 0.41; range 0.48-3.70). Bone levels were independent of jaw location. Sixty implants from 21 smokers lost statistically significantly (p = .001) more bone (mean 1.56; SD 0.53; range 0.75-3.22) than the 303 implants in 148 nonsmokers (mean 1.32 mm; SD 0.38; range 0.48-3.7). The maxilla is especially prone to bone loss compared with the mandible (1.70 mm vs 1.26 mm, p < .001).

CONCLUSION

The Southern Implants® system demonstrated a high absolute survival rate. Although smokers are not more prone to implant loss, more pronounced peri-implant bone loss was observed, especially in the maxilla. Whether this affects future biological complications remains to be investigated in prospective long-term studies.

Applications of microscale technologies for regenerative dentistry

While widespread advances in tissue engineering have occurred over the past decade, many challenges remain in the context of tissue engineering and regeneration of the tooth. For example, although tooth development is the result of repeated temporal and spatial interactions between cells of ectoderm and mesoderm origin, most current tooth engineering systems cannot recreate such developmental processes. In this regard, microscale approaches that spatially pattern and support the development of different cell types in close proximity can be used to regulate the cellular microenvironment and, as such, are promising approaches for tooth development. Microscale technologies also present alternatives to conventional tissue engineering approaches in terms of scaffolds and the ability to direct stem cells. Furthermore, microscale techniques can be used to miniaturize many in vitro techniques and to facilitate high-throughput experimentation. In this review, we discuss the emerging microscale technologies for the in vitro evaluation of dental cells, dental tissue engineering, and tooth regeneration.