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Lin ZZ, Jiang ZT, Jia SR, Ding X. Analysis of risk factors related to early implant failure: A retrospective study. J Prosthet Dent 2024:S0022-3913(24)00304-4. [PMID: 38782608 DOI: 10.1016/j.prosdent.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
STATEMENT OF PROBLEM Factors influencing early implant failure (failure during the healing period) in the rehabilitation and restoration of oral function in partially edentulous patients are unclear. PURPOSE The purpose of this clinical study was to investigate several factors that may be associated with early implant failure. MATERIAL AND METHODS This retrospective study was conducted on 3247 implants in 2061 patients between 2009 and 2022. Patient-related and surgery-related factors, including smoking; sex; diabetes; bone grafting; implant length, diameter, and design; adjacent teeth; and insertion torque, were manually retrieved and analyzed. Using univariate and multivariate analyses, a generalized estimating equation (GEE) model with chi-squared tests was employed to evaluate factors related to early implant failure (the failure before restoration) (α=.05). RESULTS The mean ±standard deviation age of the study patients was 49.2 ±15.0 years (range 18 to 91). Ninety-nine implants (3.05%) failed during the healing period. Three factors were statistically significant regarding early implant failure: smoking (odds ratio [OR]=1.92, P=.008), implant design (tapered implants) (OR=1.84, P=.007), and implant length <10 mm (OR=2.98, P=.011). Factors including diabetes, bone grafting, anatomic location, adjacent teeth (endodontic therapy in the adjacent teeth and the distance between implant and adjacent teeth), healing method, and insertion torque did not exhibit a statistically significant higher early implant failure rate. Ninety-three sites with failed implants received new implants, and 6 of these 93 implants failed during the healing period. CONCLUSIONS Within the limitation of sample size, smokers, implant length (<10 mm), and implant design (tapered implant) exhibited higher risk of early implant failure in this retrospective study. Implant insertion torque, healing method, adjacent teeth, and diabetes did not significantly influence the risk of early implant failure.
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Affiliation(s)
- Zhe-Zhen Lin
- Resident, Department of Stomatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Zheng-Ting Jiang
- Resident, Department of Stomatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Sheng-Rui Jia
- Resident, Department of Stomatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Xi Ding
- Professor, Department of Stomatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China.
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Ruppin JM, Stimmelmayr M. High insertion torque versus regular insertion torque: early crestal bone changes on dental implants in relation to primary stability-a retrospective clinical study. Int J Implant Dent 2024; 10:22. [PMID: 38700739 PMCID: PMC11068710 DOI: 10.1186/s40729-024-00540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
The aim of the presented retrospective study was to evaluate the early crestal bone changes around an implant type designed for high primary stability. A total number of 111 implants placed clinically were evaluated regarding insertion torque, bone density, implant stability quotient (ISQ) and early crestal bone loss from standardized digital radiographs. The implants were allocated in two groups: the "regular torque " group contained all implants that achieved less than 50 Ncm as final insertion torque (n = 63) and the "high torque" group contained the implants that achieved 50-80 Ncm (n = 48). To avoid possible damage either to the implant´s inner connection or to the bone by application of excessive force, a limit of 80 Ncm was set for all surgeries. All implants underwent submerged healing for three months. ISQ measurements and standardized digital radiographs were taken at day of insertion and at day of second stage surgery. The bone loss was measured on the mesial and distal aspect of the implant. The data evaluation showed the following results: Mean bone loss was 0.27 ± 0.30 mm for the high torque group and 0.24 ± 0.27 mm for the regular torque group. The difference was not statistically significant (p = 0.552). In the two groups, no complications nor implant loss occurred. For the evaluated implant type, there was no significant difference in crestal bone changes and complication rate between high and regular insertion torque in the early healing period.
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Affiliation(s)
| | - Michael Stimmelmayr
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
- , Cham, Germany
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LOW INSERTIONAL TORQUE AND EARLY DENTAL IMPLANT FAILURE. J Oral Maxillofac Surg 2022; 80:1069-1077. [DOI: 10.1016/j.joms.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022]
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Atieh MA, Baqain ZH, Tawse-Smith A, Ma S, Almoselli M, Lin L, Alsabeeha NHM. The influence of insertion torque values on the failure and complication rates of dental implants: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2021; 23:341-360. [PMID: 33764648 DOI: 10.1111/cid.12993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The influence of using different insertion torque values on clinical and radiographic outcomes of implant therapy is unclear in the current literature. The aim of this systematic review and meta-analysis was to evaluate the implant outcomes and complications rates using high insertion torque values compared with those using regular insertion torque value levels. METHODS Randomized controlled trials (RCTs), nonrandomized controlled clinical trials (NRCCTs), prospective and retrospective cohorts were searched for in electronic databases and complemented by hand searching relevant dental journals. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized and nonrandomized studies. Data were analyzed using a statistical software. RESULTS A total of 718 studies were identified, of which, nine studies were included with 1229 dental implants in 684 participants. The meta-analysis of RCTs showed that the overall implant failure rate was not notably in favor of any insertion torque value and the difference between the two groups was not statistically significant (risk ratio 0.85; 95% confidence interval 0.07-10.52; P = 0.90). None of the RCTs was registered. The secondary analyses of non-RCTs did not either show any statistically significant difference. Overall meta-analysis did not show any significant differences in peri-implant marginal bone loss or biological/technical complications between high (≥50 Ncm) and regular insertion torque (<50 Ncm). CONCLUSIONS There is insufficient evidence to support the use of high or regular insertion torque even with immediate implant restoration/loading. The short-term implant failure rates, changes in marginal bone level and complication rates were comparable when high or regular insertion torques were used for implant placement. The wide confidence interval indicated that results cannot be interpreted with clinically meaningful benefit for using either high or regular insertion torque.
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Affiliation(s)
- Momen A Atieh
- Chair of Oral Diagnostic and Surgical Sciences, Associate Professor of Periodontology, Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates.,Honorary Associate Professor, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Zaid H Baqain
- Provost and Professor of Oral and Maxillofacial Surgery, Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Andrew Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sunyoung Ma
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Mohamed Almoselli
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine Dubai Healthcare City, Dubai, United Arab Emirates
| | - Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | - Nabeel H M Alsabeeha
- Ras Al-Khaimah Dental Center, Ministry of Health and Prevention, Ras Al-Khaimah, United Arab Emirates
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Lemos CAA, Verri FR, de Oliveira Neto OB, Cruz RS, Luna Gomes JM, da Silva Casado BG, Pellizzer EP. Clinical effect of the high insertion torque on dental implants: A systematic review and meta-analysis. J Prosthet Dent 2020; 126:490-496. [PMID: 32917400 DOI: 10.1016/j.prosdent.2020.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/29/2022]
Abstract
STATEMENT OF PROBLEM A consensus on the clinical performance in dental implants placed with different insertion torques is lacking. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the effect of high insertion torque compared with regular or low torques during dental implant placement in terms of implant survival rate and marginal bone loss. MATERIAL AND METHODS Two independent reviewers searched electronic databases for studies published until April 2019. The population, intervention, comparison, outcome (PICO) question was "Do patients who receive implants with a high torque (equal or higher than 50 Ncm) show similar implant survival rates and marginal bone loss as compared with those who receive implants with a regular or low torque (less than 50 Ncm)?". The meta-analysis was based on the Mantel-Haenszel (MH) and the inverse variance (IV) methods (α=.05). RESULTS The search yielded 6 articles, which included 389 patients (mean age: 55.28 years) who had received 651 dental implants (437 with high torque and 214 with low or regular torque). Most studies evaluated delayed loading, except 1 study that evaluated immediate implant loading (n=50 for each group). Low or regular insertion torque had a high failure rate (4.2%) compared with high insertion torque (1.1%), chiefly because of immediate loading. However, the meta-analysis indicated no significant difference between high- and regular- or low-torque implant placement in implant survival rate (P=.52, risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.06-4.06) and marginal bone loss (P=.30, mean difference [MD]: 0.15, 95% CI: -0.14 to 0.44). CONCLUSIONS A high insertion torque during implant placement does not affect implant survival rate or marginal bone loss. However, further research is recommended to reassess this clinical performance.
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Affiliation(s)
- Cleidiel A A Lemos
- Professor, Department of Dentistry (Division of Prosthodontics), Federal University of Juiz de Fora (UFJF-GV), Governador Valadres, MG, Brazil.
| | - Fellippo R Verri
- Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Olavo B de Oliveira Neto
- Postgraduate student, Institute of Health and Biological Sciences, Federal University of Alagoas, Maceió, AL, Brazil
| | - Ronaldo S Cruz
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | - Jéssica M Luna Gomes
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | | | - Eduardo P Pellizzer
- Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, SP, Brazil
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Wang J, Lerman G, Bittner N, Fan W, Lalla E, Papapanou PN. Immediate versus delayed temporization at posterior single implant sites: A randomized controlled trial. J Clin Periodontol 2020; 47:1281-1291. [PMID: 32757387 DOI: 10.1111/jcpe.13354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
AIMS We conducted a randomized controlled trial to assess the clinical outcomes of two loading protocols involving either immediate or delayed prosthetic temporization of single implants placed at posterior, healed sites. MATERIALS AND METHODS Forty-nine patients in need of single implants at premolar or molar sites were randomized to receive a temporary crown either immediately after implant placement or 3 months later. Randomization was stratified by sex, implant location (premolar/molar) and arch (maxilla/mandible). Final implant screw-retained zirconia crowns with angulated screw channels were delivered at 5 months after surgery. Radiographic bone levels (primary outcome), peri-implant mucosal margin levels and peri-implant probing depths were recorded at baseline, 6 and 12 months after surgery. RESULTS Both treatment arms showed similar patterns of soft tissue and bone re-modelling from the implant platform over 12 months [mean bone level change 1.6 mm (SD 1.0 mm) in the delayed, and 1.2 mm (SD 1.3 mm) in the immediate temporization group], with the majority of changes occurring within the first 6 months. CONCLUSIONS Immediate or delayed temporization of single implants placed at posterior healed sites resulted in largely similar 1-year outcomes with respect to peri-implant bone levels and soft tissue changes.
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Affiliation(s)
- Joseph Wang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, New York, NY, USA
| | - Gila Lerman
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, New York, NY, USA
| | - Nurit Bittner
- Division of Prosthodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, New York, NY, USA
| | - Weijia Fan
- Department of Biostatistics, Mailman School of Public Health Columbia University, New York, NY, USA
| | - Evanthia Lalla
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, New York, NY, USA
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, New York, NY, USA
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The interplay between bone healing and remodeling around dental implants. Sci Rep 2020; 10:4335. [PMID: 32152332 PMCID: PMC7063044 DOI: 10.1038/s41598-020-60735-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/12/2020] [Indexed: 01/08/2023] Open
Abstract
Long-term bone healing/adaptation after a dental implant treatment starts with diffusion of mesenchymal stem cells to the wounded region and their subsequent differentiation. The healing phase is followed by the bone-remodeling phase. In this work, a mechano-regulatory cellular differentiation model was used to simulate tissue healing around an immediately loaded dental implant. All tissue types were modeled as poroelastic in the healing phase. Material properties of the healing region were updated after each loading cycle for 30 cycles (days). The tissue distribution in the healed state was then used as the initial condition for the remodeling phase during which regions healed into bone adapt their apparent density with respect to a homeostatic remodeling stimulus. The short- (bone healing) and long-term (bone remodeling) effects of initial implant micromotion during the healing phase were studied. Development of soft tissue was observed both in the coronal region due to high fluid velocity, and on the vertical sides of the healing-gap due to high shear stress. In cases with small implant micromotion, tissue between the implant threads differentiated into bone during the healing phase but resorbed during remodeling. In cases with large implant micromotion, higher percentage of the healing region differentiated into soft tissue resulting in smaller volume of bone tissue available for remodeling. However, the remaining bone region developed higher density bone tissue. It was concluded that an optimal range of initial implant micromotion could be designed for a specific patient in order to achieve the desired long-term functional properties.
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Lombardi T, Berton F, Salgarello S, Barbalonga E, Rapani A, Piovesana F, Gregorio C, Barbati G, Di Lenarda R, Stacchi C. Factors Influencing Early Marginal Bone Loss around Dental Implants Positioned Subcrestally: A Multicenter Prospective Clinical Study. J Clin Med 2019; 8:jcm8081168. [PMID: 31382675 PMCID: PMC6723035 DOI: 10.3390/jcm8081168] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022] Open
Abstract
Early marginal bone loss (MBL) is a non-infective remodeling process of variable entity occurring within the first year after implant placement. It has a multifactorial etiology, being influenced by both surgical and prosthetic factors. Their impact remains a matter of debate, and controversial information is available, particularly regarding implants placed subcrestally. The present multicenter prospective clinical study aimed to correlate marginal bone loss around platform-switched implants with conical connection inserted subcrestally to general and local factors. Fifty-five patients were enrolled according to strict inclusion/exclusion criteria by four clinical centers. Single or multiple implants (AnyRidge, MegaGen, South Korea) were inserted in the posterior mandible with a one-stage protocol. Impressions were taken after two months of healing (T1), screwed metal-ceramic restorations were delivered three months after implant insertion (T2), and patients were recalled after six months (T3) and twelve months (T4) of prosthetic loading. Periapical radiographs were acquired at each time point. Bone levels were measured at each time point on both mesial and distal aspects of implants. Linear mixed models were fitted to the data to identify predictors associated with MBL. Fifty patients (25 male, 25 female; mean age 58.0 ± 12.8) with a total of 83 implants were included in the final analysis. The mean subcrestal position of the implant shoulder at baseline was 1.24 ± 0.57 mm, while at T4, it was 0.46 ± 0.59 mm under the bone level. Early marginal bone remodeling was significantly influenced by implant insertion depth and factors related to biological width establishment (vertical mucosal thickness, healing, and prosthetic abutment height). Deep implant insertion, thin peri-implant mucosa, and short abutments were associated with greater marginal bone loss up to six months after prosthetic loading. Peri-implant bone levels tended to stabilize after this time, and no further marginal bone resorption was recorded at twelve months after implant loading.
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Affiliation(s)
| | - Federico Berton
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Stefano Salgarello
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | | | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Francesca Piovesana
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | | | - Giulia Barbati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Roberto Di Lenarda
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy.
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Makary C, Menhall A, Zammarie C, Lombardi T, Lee SY, Stacchi C, Park KB. Primary Stability Optimization by Using Fixtures with Different Thread Depth According To Bone Density: A Clinical Prospective Study on Early Loaded Implants. MATERIALS 2019; 12:ma12152398. [PMID: 31357620 PMCID: PMC6696293 DOI: 10.3390/ma12152398] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.
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Affiliation(s)
- Christian Makary
- Department of Oral Surgery, St Joseph University, Beirut 17-5208, Lebanon.
| | - Abdallah Menhall
- Department of Oral Surgery, St Joseph University, Beirut 17-5208, Lebanon
| | | | | | | | - Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
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Effect of Primary Stability and Soft- and Hard-Tissue Thickness on Marginal Bone Loss: A Prospective Pilot Study. IMPLANT DENT 2019; 27:542-546. [PMID: 30188364 DOI: 10.1097/id.0000000000000810] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare prospectively the effect of different insertion torques (ITs) on marginal bone stability and study the effect of soft-tissue and buccal bone thickness as confounding factors while using a 3-dimensional radiographic evaluation. MATERIALS AND METHODS Thirty-nine implants were placed in 22 patients. IT, soft-tissue thickness, and buccal bone thickness were recorded at implant placement. Marginal bone loss was evaluated on individualized periapical radiographs and cone-beam computed tomography at 1 year after loading. RESULTS Three groups of implants emerged based on their IT: group I (<30 Ncm), group II (between 30-45 Ncm), and group III (>45 Ncm). Soft-tissue thickness was ≤2 mm in 10 implants (25.6% thin biotype) and more than 2 mm in 29 implants (74.4% thick biotype). No significant difference in marginal bone loss was found for different IT and different soft-tissue thickness. A significant correlation was found between initial buccal bone thickness (≥2 mm or <2 mm) and marginal bone loss at 1 year. CONCLUSIONS IT and mucosal tissue thickness did not influence marginal bone loss. Buccal bone thickness of ≥2 mm was associated with a minimal marginal bone remodeling.
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The impact of different torques for the insertion of immediately loaded implants on the peri-implant levels of angiogenesis- and bone-related markers. Int J Oral Maxillofac Surg 2018; 47:651-657. [DOI: 10.1016/j.ijom.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/31/2017] [Accepted: 11/03/2017] [Indexed: 11/23/2022]
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Schwitalla AD, Zimmermann T, Spintig T, Abou-Emara M, Lackmann J, Müller WD, Houshmand A. Maximum insertion torque of a novel implant-abutment-interface design for PEEK dental implants. J Mech Behav Biomed Mater 2017; 77:85-89. [PMID: 28898725 DOI: 10.1016/j.jmbbm.2017.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022]
Abstract
Frequent reports attest to the various advantages of tapered implant/abutment interfaces (IAIs) compared to other types of interfaces. For this reason, a conical IAI was designed as part of the development of a PEEK (polyetheretherketone)-based dental implant. This IAI is equipped with an apically displaced anti-rotation lock with minimal space requirements in the form of an internal spline. The objective of this study was the determination of the average insertion torque (IT) at failure of this design, so as to determine its suitability for immediate loading, which requires a minimum IT of 32Ncm. 10 implants each made of unfilled PEEK, carbon fiber reinforced ("CFR") PEEK (> 50vol% continuous axially parallel fibers) as well as of titanium were produced and tested in a torque test bench. The average IT values at failure of the unfilled PEEK implants were measured at 22.6 ± 0.5Ncm and were significantly higher than those of the CFR-Implants (20.2 ± 2.5Ncm). The average IT values at failure of the titanium specimens were significantly higher (92.6 ± 2.3Ncm) than those of the two PEEK variants. PEEK- and CFR-PEEK-implants in the present form cannot adequately withstand the insertion force needed to achieve primary stability for immediate loading. Nevertheless, the achievable torque resilience of the two PEEK-variants may be sufficient for a two-stage implantation procedure. To improve the torque resistance of the PEEK implant material the development of a new manufacturing procedure is necessary which reinforces the PEEK base with continuous multi-directional carbon fibers as opposed to the axially parallel fibers of the tested PEEK compound.
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Affiliation(s)
- Andreas Dominik Schwitalla
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Tycho Zimmermann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Tobias Spintig
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mohamed Abou-Emara
- Beuth University of Applied Sciences, Luxemburger Str. 10, 13353 Berlin, Germany
| | - Justus Lackmann
- Beuth University of Applied Sciences, Luxemburger Str. 10, 13353 Berlin, Germany
| | - Wolf-Dieter Müller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
| | - Alireza Houshmand
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
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Abstract
STATEMENT OF PROBLEM Dental implants are typically made of titanium. However, with the current systems on the market, the implant neck often shows through the gingival tissues as a black or dark gray line and/or as a grayish discoloration of the peri-implant soft tissue. PURPOSE The purpose of this in vitro study was to test a new implant design. The key component of this design is the ceramic shell that covers the polished collar of the tissue-level titanium implant and masks its dark color to mimic natural dentition. The main purpose was to determine the maximum torque for fracturing the ceramic shell and compare it with clinical implant insertion torque value. MATERIAL AND METHODS Type 4 commercially pure titanium endosseous implants of 3 different diameters (3.3, 4.1, and 4.8 mm) were used. Porcelain was applied in 0.5-mm thickness to the polished collar of each implant. An axial-torsional universal testing machine was used to twist the implants until failure. The data (n=10) were statistically analyzed by ANOVA and the Tukey honest significant difference test (α=.05). The maximum torque for each diameter group was also compared with the optimum clinical implant insertion torque value of 35 Ncm (control) using a 1-sample t test. RESULTS None of the tested groups had a fractured ceramic shell. Instead, the implant carriers fractured at the maximum torque levels. Therefore, the fracture of the implant carriers was selected as the maximum (failure) torque value. A statistical difference was found for the failure torque between the 3.3-mm diameter and the other 2 diameters (P<.001) although no statistical differences were found between the 4.1-mm and 4.8-mm diameters (P=.106). A statistically significant difference was found between the failure torque of any one of the tested groups and the clinical insertion torque (P<.001). CONCLUSIONS The ceramic shells did not fracture. Instead, the implant carriers fractured at certain torque levels. These levels were sufficiently higher than the clinical torque values.
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Affiliation(s)
- Waleed Elshahawy
- Lecturer, Department of Fixed Prosthodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Raed Ajlouni
- Professor, Department of Restorative Science, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Khaldoun Ajlouni
- Professor, Department of Restorative Science, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Texas.
| | - Abdelfattah Sadakah
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Tanta, Egypt
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The Effects of High Insertion Torque Versus Low Insertion Torque on Marginal Bone Resorption and Implant Failure Rates: A Systematic Review With Meta-Analyses. IMPLANT DENT 2017; 25:532-40. [PMID: 27129002 DOI: 10.1097/id.0000000000000422] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The aim was to analyze the data about the effects on marginal bone resorption and implant failure rates between implants inserted with high or low insertion torque values. MATERIALS AND METHODS A systematic literature search until July 2015 was conducted. Data were summarized qualitatively in descriptive tables and quantitatively by performing random effects meta-analyses of effect sizes (ESs) for bone resorption and bone-to-implant contact (BIC) and relative risks (RRs) for implant failures. Risk of bias assessments were performed using the Cochrane tool for human studies and the SYRCLE's tool for animal studies. RESULTS Four studies in humans and 6 quasirandomized animal studies were included. A total of 591 implants were evaluated qualitatively: 348 installed with high insertion torque (>25 Ncm, up to 176 Ncm) and 243 implants inserted with low torque values (<30-35 Ncm). No significant differences were detected for bone resorption (ES, 0.13; 95% confidence interval [CI], -0.12 to 0.38 in human studies; ES predictive interval from 35.03 to 34.50 in animal studies), implant failure (RR, 0.39; 95% CI, 0.01-20.77 in human studies; RR, 2.05; 95% CI, 0.19-21.71 in animal studies), or BIC (ES predictive interval from -3.84 to 5.13 in animal studies). CONCLUSION The current review indicated that there is no significant difference in marginal bone resorption and implant failure rate between implants inserted with high or low insertion torque values.
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Jang TS, Jung HD, Kim S, Moon BS, Baek J, Park C, Song J, Kim HE. Multiscale porous titanium surfaces via a two-step etching process for improved mechanical and biological performance. Biomed Mater 2017; 12:025008. [DOI: 10.1088/1748-605x/aa5d74] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Effect of Implant Thread Geometry on Secondary Stability, Bone Density, and Bone-to-Implant Contact: A Biomechanical and Histological Analysis. IMPLANT DENT 2017; 24:384-91. [PMID: 25939083 DOI: 10.1097/id.0000000000000269] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated the effect of 2 different thread designs on secondary stability (micromotion) and osseointegration rate in dense and cancellous bones. MATERIALS AND METHODS Forty large threaded and 40 small threaded implants (Cortex) were placed in low- (iliac crest) and high-density (mandible) bone of sheep. Two months later, micromobility tests and histological analysis were performed to measure secondary stability, osseointegration (bone-to-implant contact percentage [%BIC]), and bone density (bone volume percentage [%BV]). The value of actual micromotion of implant is introduced as a new parameter to evaluate secondary stability. RESULTS Large threaded implants showed significantly higher %BIC and %BV than small threaded implants in low-density bone and statistically higher secondary stability in cancellous and cortical bones. CONCLUSIONS Implants in dense bone reach higher secondary stability than those in cancellous bone, despite the lower %BIC. Implant geometry and bone density play a key role in secondary stability. Large thread design improves bone anchorage mechanically and histologically as compared with small threaded implants.
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17
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Silva RDO, Passador F, Caria PHF. Twist removal of healed vs. nonhealed implants-a mechanical and histological study in mini pigs. Int J Implant Dent 2016; 2:23. [PMID: 27888491 PMCID: PMC5124023 DOI: 10.1186/s40729-016-0059-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the effect of removal torque (reverse torque) of titanium implants in peri-implant bone. METHODS The P1-M1 teeth were extracted bilaterally of 6 mini pigs (BR-1). Each animal received 6 titanium implants, three for each side of mandible. On the right side of mandible, 3 implants reminded 9 months (9M) under masticatory activity and on the left side, other 3 implants were placed and immediately removed (IR). All 36 implants were removed by removal torque, and the recorded values were statistically analyzed. Animals were euthanized right after the removal torque and recording. Each third (cervical, medium, and apical) of peri-implant bone was extracted and analyzed histological and immunohistochemically. Student's t test was used to determine statistical differences in the values between the 9M and IR samples. Data were presented as means with standard deviations. The level of significance was set at 5% (P < 0.05). RESULTS Removal torque was higher in 9M experimental situation than in IR. Histological characteristics of mature bone were presented in the 9M experimental condition, and immature bone characteristics were presented in the IR experimental condition. Removal torque caused small fractures and rounding in the bone grooving. Immunohistochemical analysis reinforced the histological results; Student's t test provided statistically significant differences to osteocalcin expression in 9M samples and no statistically significant differences expression to collagen I in both experimental conditions (P < 0.05). CONCLUSIONS Removal torque caused microscopical fractures and smoothing in the peri-implant bone grooves, but it does not compromise the bone healing.
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Meloni SM, Tallarico M, Pisano M, Xhanari E, Canullo L. Immediate Loading of Fixed Complete Denture Prosthesis Supported by 4-8 Implants Placed Using Guided Surgery: A 5-Year Prospective Study on 66 Patients with 356 Implants. Clin Implant Dent Relat Res 2016; 19:195-206. [DOI: 10.1111/cid.12449] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nienkemper M, Santel N, Hönscheid R, Drescher D. Orthodontic mini-implant stability at different insertion depths : Sensitivity of three stability measurement methods. J Orofac Orthop 2016; 77:296-303. [PMID: 27272055 DOI: 10.1007/s00056-016-0036-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/30/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this work was to evaluate the influence of insertion depth on the stability of orthodontic mini-implants. Sensitivity of three different methods to measure implant stability based on differences in insertion depth were determined. METHODS A total of 82 mini-implants (2 × 9 mm) were inserted into pelvic bone of Swabian Hall pigs. Each implant was inserted stepwise to depths of 4, 5, 6, 7, and 8 mm. At each of these depths, three different methods were used to measure implant stability, including maximum insertion torque (MIT), resonance frequency analysis (RFA), and Periotest(®). Differences between the recorded values were statistically analyzed and the methods tested for correlations. RESULTS Almost linear changes from each insertion depth were measured with the values of RFA [implant stability quotient (ISQ) values range from 1-100], which increased from 6.95 ± 2.85 ISQ at 4 mm to 34.63 ± 5.51 ISQ at 8 mm, and with those of Periotest(®) [periotest values (PTV) range from -8 to 50], which decreased from 13.24 ± 4.03 PTV to -2.89 ± 1.87 PTV. Both methods were found to record highly significant (p < 0.0001) changes for each additional millimeter of insertion depth. The MIT increased significantly (p < 0.0001) from 153.67 ± 69.32 Nmm to 261 ± 103.73 Nmm between 4 and 5 mm of insertion depth but no further significant changes were observed as the implants were driven deeper. The RFA and Periotest(®) values were highly correlated (r = -0.907). CONCLUSIONS Mini-implant stability varies significantly with insertion depth. The RFA and the Periotest(®) yielded a linear relationship between stability and insertion depth. MIT does not appear to be an adequate method to determine implant stability based on insertion depth.
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Affiliation(s)
- Manuel Nienkemper
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Natascha Santel
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralf Hönscheid
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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20
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Yin X, Li J, Chen T, Mouraret S, Dhamdhere G, Brunski JB, Zou S, Helms JA. Rescuing failed oral implants via Wnt activation. J Clin Periodontol 2016; 43:180-92. [PMID: 26718012 DOI: 10.1111/jcpe.12503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 02/05/2023]
Abstract
AIM Implant osseointegration is not always guaranteed and once fibrous encapsulation occurs clinicians have few options other than implant removal. Our goal was to test whether a WNT protein therapeutic could rescue such failed implants. MATERIAL AND METHODS Titanium implants were placed in over-sized murine oral osteotomies. A lack of primary stability was verified by mechanical testing. Interfacial strains were estimated by finite element modelling and histology coupled with histomorphometry confirmed the lack of peri-implant bone. After fibrous encapsulation was established peri-implant injections of a liposomal formulation of WNT3A protein (L-WNT3A) or liposomal PBS (L-PBS) were then initiated. Quantitative assays were employed to analyse the effects of L-WNT3A treatment. RESULTS Implants in gap-type interfaces exhibited high interfacial strains and no primary stability. After verification of implant failure, L-WNT3A or L-PBS injections were initiated. L-WNT3A induced a rapid, significant increase in Wnt responsiveness in the peri-implant environment, cell proliferation and osteogenic protein expression. The amount of peri-implant bone and bone in contact with the implant were significantly higher in L-WNT3A cases. CONCLUSIONS These data demonstrate L-WNT3A can induce peri-implant bone formation even in cases where fibrous encapsulation predominates.
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Affiliation(s)
- Xing Yin
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Jingtao Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Tao Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Sylvain Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Girija Dhamdhere
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - John B Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Shujuan Zou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
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Cha JY, Pereira MD, Smith AA, Houschyar KS, Yin X, Mouraret S, Brunski JB, Helms JA. Multiscale analyses of the bone-implant interface. J Dent Res 2015; 94:482-90. [PMID: 25628271 DOI: 10.1177/0022034514566029] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Implants placed with high insertion torque (IT) typically exhibit primary stability, which enables early loading. Whether high IT has a negative impact on peri-implant bone health, however, remains to be determined. The purpose of this study was to ascertain how peri-implant bone responds to strains and stresses created when implants are placed with low and high IT. Titanium micro-implants were inserted into murine femurs with low and high IT using torque values that were scaled to approximate those used to place clinically sized implants. Torque created in peri-implant tissues a distribution and magnitude of strains, which were calculated through finite element modeling. Stiffness tests quantified primary and secondary implant stability. At multiple time points, molecular, cellular, and histomorphometric analyses were performed to quantitatively determine the effect of high and low strains on apoptosis, mineralization, resorption, and collagen matrix deposition in peri-implant bone. Preparation of an osteotomy results in a narrow zone of dead and dying osteocytes in peri-implant bone that is not significantly enlarged in response to implants placed with low IT. Placing implants with high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Using high IT to place an implant creates high interfacial stress and strain that are associated with damage to peri-implant bone and therefore should be avoided to best preserve the viability of this tissue.
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Affiliation(s)
- J Y Cha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA Orthodontic Department, College of Dentistry, Yonsei University, Seoul, South Korea
| | - M D Pereira
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - A A Smith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - K S Houschyar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - X Yin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - S Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - J B Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - J A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
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Dagorne C, Malet J, Bizouard G, Mora F, Rangé H, Bouchard P. Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study. Clin Oral Implants Res 2014; 26:307-13. [DOI: 10.1111/clr.12498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Cécile Dagorne
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP; Paris 7 - Denis Diderot University; U.F.R. of Odontology; Paris France
| | - Jacques Malet
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP; Paris 7 - Denis Diderot University; U.F.R. of Odontology; Paris France
| | | | - Francis Mora
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP; Paris 7 - Denis Diderot University; U.F.R. of Odontology; Paris France
| | - Hélène Rangé
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP; Paris 7 - Denis Diderot University; U.F.R. of Odontology; Paris France
| | - Philippe Bouchard
- Department of Periodontology; Service of Odontology; Rothschild Hospital; AP-HP; Paris 7 - Denis Diderot University; U.F.R. of Odontology; Paris France
- EA 2496; Paris Descartes University; France
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23
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Analysis and comparison of clutch techniques of two dental implants. J Mech Behav Biomed Mater 2014; 34:1-7. [DOI: 10.1016/j.jmbbm.2014.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 11/19/2022]
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