A histological comparison in the dog of porous-coated vs. threaded dental implants

An optimization approach for studying the effect of lattice unit cell's design-based factors on additively manufactured poly methyl methacrylate cranio-implant

In craniomaxillofacial surgery the inclusion of lattice structure on the Cranio-implants for the surgical procedure of cranial defects is difficult. Additive manufacturing open ups a huge space for the development of intricate profiles for complex surgical practices. Designing lattice structures with various design topologies has gained more interest in the medical community for reducing the weight of the implants in the cranial region. This research proposes the mimicking of cranial defective portion concerning bone-like porous structure by means of Poly methyl methacrylate (PMMA) material via 3D printing technology. The experiments were optimized by incorporating square-type porous lattice structure in the development of cranial implants. The design-based factors of the unit cell were enhanced with the aid of the Design of experiments (DOE) technique. L₉ orthogonal array is developed by incorporating various design-based factors of the lattice unit cell like unit cell size (mm), skewing angle (°), wall thickness (mm), and unit cell orientation (°). The experiments are optimized with respect to obtaining better compressive strength and compressive strength/density of the prepared lattice structure incorporated polymeric samples. The result shows that for obtaining the maximum compressive strength in the porous square lattice-structured PMMA compression samples will be a lower cell size of 2 mm, a higher skewing angle of 30°, a higher wall thickness of 1 mm, and a unit cell orientation of 90°. The experimental optimized condition results of the design-based factors achieve the maximum compressive strength and compressive strength/density of 83.37 MPa and 189.73 MPa/g mm^-3. The lattice structure orientated with 90° has a significant contribution towards reducing the development of structural deviations of incorporating square lattice structure on the PMMA polymeric material. Therefore, the topologically modified square lattice structure incorporated 3D printed PMMA material has a potential scope for the replacement of conventional maxillofacial cranial implants.

Biocompatibility and osseointegration of nanostructured titanium dental implants in minipigs

OBJECTIVES

It is well known that surface treatments of dental implants have a great impact on their rate of osseointegration. The aim of this study was to compare the biocompatibility and the bone-implant contact (BIC) of titanium dental implants with different surface treatments.

MATERIAL AND METHODS

Test implants (Biotech Dental) had a nanostructured surface and control implants (Anthogyr) were grit-blasted with biphasic calcium phosphate and acid-etched surface. Both titanium implants were inserted in mandible and maxillary bones of 6 Yucatan minipigs for 4 and 12 weeks (n = 10 implants/group). Biocompatibility and osseointegration were evaluated by non-decalcified histology and back-scattered electron microscopy images.

RESULTS

The reading of histology sections by an antomo-pathologist indicated that the test implants were considered non-irritating to the surrounding tissues and thus biocompatible compared with control implants. The BIC values were higher for test than for control dental implants at both 4 and 12 weeks.

CONCLUSIONS

In summary, the new nanostructured titanium dental implant is considered biocompatible and showed a better osseointegration than the control implant at both 4 and 12 weeks.

Direct Contact Test for Evaluating Bacterial Growth on Machined and Rough Surface Implants: An In Vitro Study

OBJECTIVE

To use a modified direct contact test (DCT) to evaluate the bacterial growth on 3 commercially available implants.

MATERIALS AND METHODS

Streptococcus salivarius growth was tested on 1 machined surface and 2 commercial rough surface implants. Seven implants from each group were fixed to the cover of a 96-well microtiter plate. Bacterial suspension was placed on each implant, and the plate was incubated at 37°C for 1 hour to allow the suspension fluid to evaporate. Fresh medium was added to 7 corresponding wells in the microtiter plate, and the cover holding the implants was placed on the plate to enable immersion of the implant. Noncontaminated implant samples served as control. Bacterial growth was monitored spectrophotometrically at 650 nm for 24 hours.

RESULTS

There was a significant S. salivarius growth in all groups of test implants compared with the control. There was no significant difference between bacterial growth kinetics on treated and nontreated implant surfaces (P = 0.241).

CONCLUSION

Using the DCT, we found no difference in bacterial growth between machined and rough surface implants.

Influence of macroporosity on NIH/3T3 adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 over bio-functionalized highly porous titanium implant material

Highly porous Ti implant materials are being used in order to overcome the stress shielding effect on orthopedic implants. However, the lack of bioactivity on Ti surfaces is still a major concern regarding the osseointegration process. It is known that the rapid recruitment of osteoblasts in bone defects is an essential prerequisite for efficient bone repair. Conventionally, osteoblast recruitment to bone defects and subsequent bone repair has been achieved using growth factors. Thus, in this study highly porous Ti samples were processed by powder metallurgy using space holder technique followed by the bio-functionalization through microarc oxidation using a Ca- and P-rich electrolyte. The biological response in terms of early cell response, namely, adhesion, spreading, viability, and proliferation of the novel biofunctionalized highly porous Ti was carried out with NIH/3T3 fibroblasts and MC3T3-E1 preosteoblasts in terms of viability, adhesion, proliferation, and alkaline phosphatase activity. Results showed that bio-functionalization did not affect the cell viability. However, bio-functionalized highly porous Ti (22% porosity) enhanced the cell proliferation and activity. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 73-85, 2019.

New bone formation and trabecular bone microarchitecture of highly porous tantalum compared to titanium implant threads: A pilot canine study

Aim

This study evaluated new bone formation activities and trabecular bone microarchitecture within the highly porous region of Trabecular Metal™ Dental Implants (TM) and between the threads of Tapered Screw‐Vent® Dental Implants (TSV) in fresh canine extraction sockets.

Materials and methods

Eight partially edentulated dogs received four implants (4.1 mmD × 13 mmL) bilaterally in mandibular fresh extraction sockets (32 TM, 32 TSV implants), and allowed to heal for 2, 4, 8, and 12 weeks. Calcein was administered to label mineralizing bone at 11 and 4 days before euthanasia for dogs undergoing all four healing periods. Biopsies taken at each time interval were examined histologically. Histomorphometric assay was conducted for 64 unstained and 64 stained slides at the region of interest (ROI) (6 mm long × 0.35 mm deep) in the midsections of the implants. Topographical and chemical analyses were also performed.

Results

Histomorphometry revealed significantly more new bone in the TM than in the TSV implants at each healing time (p = .0014, .0084, .0218, and .0251). Calcein‐labeled data showed more newly mineralized bone in the TM group than in the TSV group at 2, 8, and 12 weeks (p = .045, .028, .002, respectively) but not at 4 weeks (p = .081). Histologically TM implants exhibited more bone growth and dominant new immature woven bone at an earlier time point than TSV implants. The parameters representing trabecular bone microarchitecture corroborated faster new bone formation in the TM implants when compared to the TSV implants. TM exhibited an irregular faceted topography compared to a relatively uniform microtextured surface for TSV. Chemical analysis showed peaks associated with each implant's composition material, and TSV also showed peaks reflecting the elements of the calcium phosphate blasting media.

Conclusions and clinical implications

Results suggest that the healing pathway associated with the highly porous midsection of TM dental implant could enable faster and stronger secondary implant stability than conventional osseointegration alone; however, prospective clinical studies are needed to confirm these potential benefits in patients with low bone density, compromised healing, or prior implant failure.

Porous titanium and Ti-35Nb alloy: effects on gene expression of osteoblastic cells derived from human alveolar bone

Tests on titanium alloys that possess low elastic modulus, corrosion resistance and minimal potential toxicity are ongoing. This study aimed to evaluate the behavior of human osteoblastic cells cultured on dense and porous Titanium (Ti) samples comparing to dense and porous Ti-35 Niobium (Ti-35Nb) samples, using gene expression analysis. Scanning electronic microscopy confirmed surface porosity and pore interconnectivity and X-ray diffraction showed titanium beta-phase stabilization in Ti-35Nb alloy. There were no differences in expression of transforming growth factor-β, integrin-β1, alkaline phosphatase, osteopontin, macrophage colony stimulating factor, prostaglandin E synthase, and apolipoprotein E regarding the type of alloy, porosity and experimental period. The experimental period was a significant factor for the markers: bone sialoprotein II and interleukin 6, with expression increasing over time. Porosity diminished Runt-related transcription factor-2 (Runx-2) expression. Cells adhering to the Ti-35Nb alloy showed statistically similar expression to those adhering to commercially pure Ti grade II, for all the markers tested. In conclusion, the molecular mechanisms of interaction between human osteoblasts and the Ti-35Nb alloy follow the principal routes of osseointegration of commercially pure Ti grade II. Porosity impaired the route of transcription factor Runx-2.

Peri-implant conditions around sintered porous-surfaced (SPS) implants. A 36-month prospective cohort study

OBJECTIVES

The specific aim of this study was to assess sintered porous-surfaced (SPS) implant system from a biological point of view, through a prospective study of the health status and the evolution of the peri-implant tissues over time and analysis of the changes observed in the various peri-implant parameters.

MATERIAL AND METHODS

Hundred and fifty-one patients were treated consecutively from 2005 to 2007 using 280 SPS implants, which were restored with a single crown or a partial fixed denture. To accurately monitor the health and biological evolution of peri-implant soft and hard tissues, a number of clinical parameters were adopted, such as the modified Plaque Index (mPI), the modified sulcus Bleeding Index (mBI), Peri-implant Probing Depth (PPD), and Crestal Bone Level (CBL). Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol generally applied to determine implant success rates and Peri-implant Bone Loss (PBL). Statistical analysis was used to determine any significant differences or correlations (P = 0.05).

RESULTS

A total of 259 SPS implants in 136 patients were followed up for 36 months. According to Buser's success criteria, the overall implant-based success rate was 98.1% and the mean PBL was 0.48 ± 0.29 mm. MBI and mPI mean values showed statistically significant differences between baseline and follow-up analyses (P < 0.001). No statistically significant differences in mean PPD values were found between baseline and control analyses (P = 0.060).

CONCLUSION

This prospective cohort study revealed that the biological behavior of SPS implant system was characterized by high tissue stability during the observation period, both as regards soft and hard tissues. In particular, the crestal bone remodeling pattern was very similar to that reported in other studies, confirming that the bone loss around SPS implants, at least at 36 months, seems to be predictable.

Micromotions and combined damages at the dental implant/bone interface

Micromotion and fretting damages at the dental implant/bone interface are neglected for the limitation of check methods, but it is particularly important for the initial success of osseointegration and the life time of dental implant. This review article describes the scientific documentation of micromotion and fretting damages on the dental implant/bone interface. The fretting amplitude is less than 30 µm in vitro and the damage in the interface is acceptable. While in vivo, the micromotion's effect is the combination of damage in tissue level and the real biological reaction.

Synthetic peptide-conjugated titanium alloy for enhanced bone formation in vivo

There are growing demands for bioactive titanium implants that could shorten the healing period, promote faster rehabilitation, and thereby increase the success rate of treating patients with poor bone quality. A synthetic receptor-binding peptide mimicking bone morphogenetic protein-2 (BMP-2) was covalently linked to a titanium alloy with two types of topography--machined (TiMA) and rough (TiGB)--by using a chemical conjugation process. In vivo osseointegration capacity was evaluated chronologically using histomorphometric analysis at 2, 4, and 8 weeks after implantation in the distal femurs of rabbits. In the histologic examinations, peri-implant bone formation was more active around TiGB than TiMA. Compared to the control groups (nonconjugated TiMA and TiGB) at 2, 4, and 8 weeks, the peptide-conjugated groups (TiMA-P and TiGB-P) had more mature new bone, thicker trabeculae, more rapid bone maturation, and higher affinity index (percentage of new bone contact length) in histomorphometric analysis. Particularly, differences in the affinity index between the peptide-conjugated and nonconjugated groups were more pronounced at the early phase of peri-implant healing (2 and 4 weeks). However, at 8 weeks, enhanced bone formation was less prominent according to peptide conjugation, especially in specimens with a rough surface. The titanium alloys in the rabbit femurs led to a significant increase of bone growth when modified with bioactive peptides, especially during the early phase of bone healing. These results confirm that biochemical modifications of titanium surfaces can enhance the rate of bone healing compared with that of untreated titanium surfaces.

Surface modification of biomedical and dental implants and the processes of inflammation, wound healing and bone formation

Bone adaptation or integration of an implant is characterized by a series of biological reactions that start with bone turnover at the interface (a process of localized necrosis), followed by rapid repair. The wound healing response is guided by a complex activation of macrophages leading to tissue turnover and new osteoblast differentiation on the implant surface. The complex role of implant surface topography and impact on healing response plays a role in biological criteria that can guide the design and development of future tissue-implant surface interfaces.

Histomorphometric analysis of pure titanium implants with porous surface versus rough surface

The purpose of this study was to analyze the bone repair around commercially pure titanium implants with rough and porous surface, fabricated using powder metallurgy technique, after their insertion in tibiae of rabbits. Seven male rabbits were used. Each animal received 3 porous-surface implants in the left tibia and 3 rough-surface implants in the right tibia. The rabbits were sacrificed 4 weeks after surgery and fragments of the tibiae containing the implants were submitted to histological and histomorphometric analyses to evaluate new bone formation at the implant-bone interface. Means (%) of bone neoformation obtained in the histomorphometric analysis were compared by Student's t-test for paired samples at 5% significance level.. The results of the histological analysis showed that osseointegration occurred for both types of implants with similar quality of bone tissue. The histomorphometric analysis revealed means of new bone formation at implant-bone interface of 79.69 ± 1.00% and 65.05 ± 1.23% for the porous- and rough-surface implants, respectively. Statistically significant difference was observed between the two types of implants with respect to the amount new bone formation (p<0.05). In conclusion, the porous-surface implants contributed to the osseointegration because they provide a larger contact area at implant-bone interface.

Surface modifications of dental implants

Dental implant surface technologies have been evolving rapidly to enhance a more rapid bone formation on their surface and hold a potential to increase the predictability of expedited implant therapy. While implant outcomes have become highly predictable, there are sites and conditions that result in elevated implant loss. This paper reviews the impact of macro-retentive features which includes approaches to surface oxide modification, thread design, press-fit and sintered-bead technologies to increase predictability of outcomes. Implant designs that lead to controlled lateral compression of the bone can improve primary stability as long as the stress does not exceed the localized yield strength of the cortical bone. Some implant designs have reduced crestal bone loss by use of multiple cutting threads that are closely spaced, smoothed on the tip but designed to create a hoop-stress stability of the implant as it is completely seated in the osteotomy. Following the placement of the implant, there is a predictable sequence of bone turnover and replacement at the interface that allows the newly formed bone to adapt to microscopic roughness on the implant surface, and on some surfaces, a nanotopography (<10(-9) m scale) that has been shown to preferably influence the formation of bone. Newly emerging studies show that bone cells are exquisitely sensitive to these topographical features and will upregulate the expression of bone related genes for new bone formation when grown on these surfaces. We live in an exciting time of rapid changes in the modalities we can offer patients for tooth replacement therapy. Given this, it is our responsibility to be critical when claims are made, incorporate into our practice what is proven and worthwhile, and to continue to support and provide the best patient care possible.

Design of dental implants, influence on the osteogenesis and fixation

The fixation and the bone ingrowth at the interface of porous cylindrical implants (total porosity of 37% and average pores diameter of 480 microm) were compared in vivo to rough cylindrical implants (R (a) = 5.3 microm), both of commercially pure titanium, made by powder metallurgy. The implants were inserted into the tibias of 20 rabbits and the animals were sacrificed 4 and 8 weeks after surgery. The percentage of bone-implant contact observed in porous implant was significantly larger than in the rough ones for all of sacrifice periods, respectively, 57% vs. 46% after 4 weeks, and 59% vs. 50% after 8 weeks. The mechanical tests showed a significant increase in the shear strength of the porous implants for the two analyzed periods, 4 and 8 weeks (14 and 20 MPa), when compared with rough ones (4 and 13 MPa). These results suggest that porous implants improve the contact at the implant-bone interface and increase the fixation to the bone, improving the osseointegration. Thus, the porous implant might be an alternative to dental implant in less favorable conditions, and appear to be better fixed to bone, offering promising alternatives.

Immediate loading of the grafted maxillary sinus using platelet rich plasma and autogenous bone: a preliminary study with histologic and histomorphometric analysis

OBJECTIVE

The goal of this clinical study was to evaluate dental implant survival rates using the concept of a nonfunctional, immediate loading protocol with nonsplinted dental implants in the grafted maxillary sinus during a 52-week period. Random histomorphological and histomorphometric analysis was completed to evaluate the early healing effect of platelet rich plasma (PRP) and 50% autogenous bone combined with 3 different substitute graft materials.

MATERIALS

Four to 8 months after grafting the sinus with PRP sprayed autogenous bone combined with 3 different substitute graft materials in a 50:50 composite ratio, 27 hydroxyapatite- coated dental implants were surgically placed in 41 patients and immediately loaded between 48 hours and 5 days later with custom titanium abutments and acrylic provisional restorations placed out of functional occlusion. Six months later, definitive ceramometal restorations were cemented on to the custom abutments.

RESULTS

During a 52-week observation period, no implants were lost. Between 4 and 8 months of graft healing time, histologic and histomorphometric analysis revealed formation of new vital bone in different graft specimens ranging from 77% to 100%.

CONCLUSION

The preliminary results of this clinical study indicate that immediate nonfunctional loading using PRP and 50% autogenous bone combined with different substitute graft materials is a predictable protocol in the grafted maxillary sinus as early as 4 months of postgrafting. The high implant survival rate is due to the early formation of large percentages of new vital bone as confirmed by using histologic and histomorphometric analysis.

Histomorphometric evaluation of implants coated with enamel or dentine derived fluoride-substituted apatite

OBJECTIVES

The aim of this study was to compare osseous healing characteristics of titanium implants coated with enamel-derived fluoride-substituted apatite (EFSA) or dentin-derived fluoride-substituted apatite (DFSA).

METHODS

Fluoride-substituted apatite was derived from extracted human teeth with calcination method at 850 degrees C. DFSA and EFSA were separated and carefully ground with a blade grinder. Twenty-four titanium implants were prepared from a 99.99% pure titanium bar. EFSA and DFSA powders were sprayed separately on implants. As control group, unsprayed and sandblasted pure titanium implants were used. Eight adult rams were used in the study. One EFSA coated, 1 DFSA coated and 1 control implants were placed into right tibia of each rams. The rams were sacrificed after 6 months of healing. Undecalcified sections were prepared according to Donath's method and histomorphometric evaluation of implants was made.

RESULTS

The mean bone contact percentage of DFSA-coated, EFSA-coated and control implants was 89.88%+/-2.34, 70.19%+/-13.11 and 53.12%+/-5.76 respectively. This study suggests that DFSA-coated implants achieved better bone contact than EFSA-coated implants (P<0.05). Also study groups presented better bone contact than control group (P<0.05).

CONCLUSIONS

The results of this study show that although DFSA-coated implants achieved better bone contact, both DFSA and EFSA can be considered as appropriate coating materials.

Influence of different implant surfaces on peri-implant osteogenesis: histomorphometric analysis in sheep

BACKGROUND

The present study investigated peri-implant osteogenesis and implant biologic fixation in different zirconia sandblasted endosseous titanium surfaces (SLA-60 and SLA-120) and a turned titanium surface (T) 2 and 4 weeks after surgery.

METHODS

Seventy-two implant screws were implanted in tibia of six sheep. Histologic sections of implants (2 and 4 weeks after surgery) were analyzed with light microscopy for histomorphometric analysis of bone-to-implant contact (BIC), bone ingrowth (BI), and bone surface (BS/BV). Histologic blocks were used to perform bone microhardness studies next to the implants. Some implants were also observed with scanning electron microscopy (SEM) and transmission electron microscopy (TEM).

RESULTS

In general, the highest values of BIC, BI, BS/BV, and Vickers hardness number (HV) were measured in SLA-60 samples, followed by SLA-120 and T implants. Two weeks after surgery, all the implants appeared biologically fixed by a newly formed woven bone arranged in thin bone trabeculae and filling the gap between implant and host bone. Four weeks after implantation, the thickness of the woven bone trabeculae had increased, especially around the SLA-60 and SLA-120 implants by a gradual deposition of parallel-fiber bone.

CONCLUSIONS

Our results suggest that, in the early period of peri-implant healing, the implant surface morphology that seemed to influence the increase of peri-implant osteogenesis, bone turnover, and peri-implant bone maturation was SLA-60. We suggest that this surface, characterized by moderately deep titanium cavities very similar to the osteocyte lacunae, could act as a microscopic scaffold for mesenchymal and/or osteoblast-like cells adhesion.

Cytokines and Growth Factors Involved in the Osseointegration of Oral Titanium Implants Positioned Using Piezoelectric Bone Surgery Versus a Drill Technique: A Pilot Study in Minipigs

BACKGROUND

Most dental implants are positioned using a drilling surgery technique. However, dentistry recently experienced the implementation of piezoelectric surgery. This technique was introduced to overcome some of the limitations involving rotating instruments in bone surgery. This study used biomolecular and histologic analyses to compare the osseointegration of porous implants positioned using traditional drills versus the piezoelectric bone surgery technique.

METHODS

Porous titanium implants were inserted into minipig tibias. Histomorphology and levels of bone morphogenetic protein (BMP)-4, transforming growth factor (TGF)-beta2, tumor necrosis factor-alpha, and interleukin-1beta and -10 were evaluated in the peri-implant osseous samples.

RESULTS

Histomorphological analyses demonstrated that more inflammatory cells were present in samples from drilled sites. Also, neo-osteogenesis was consistently more active in bone samples from the implant sites that were prepared using piezoelectric bone surgery. Moreover, bone around the implants treated with the piezoelectric bone surgery technique showed an earlier increase in BMP-4 and TGF-beta2 proteins as well as a reduction in proinflammatory cytokines.

CONCLUSION

Piezoelectric bone surgery appears to be more efficient in the first phases of bone healing; it induced an earlier increase in BMPs, controlled the inflammatory process better, and stimulated bone remodeling as early as 56 days post-treatment.

Chemisch modifizierte, ultra-hydrophile Titanimplantatoberflächen

Recently, a chemically modified ultra-hydrophilic sand-blasted, large grit and acid-etched (modSLA) titanium surface has been introduced in order to enhance bone apposition. Indeed, preliminary preclinical and clinical data have indicated that modSLA implants may enhance bone apposition during early stages of wound healing. These positive effects on bone regeneration might be probably mainly due to the hydrophilic surface properties noted for modSLA which ensured a stabilization of the blood clot. The aim of the present review article is to evaluate, based on the currently available evidence, the potential impact of modSLA surfaces for implant dentistry.

Heterotopic Bone Formation Around Sintered Porous-Surfaced Ti-6Al-4V Implants Coated with Native Bone Morphogenetic Proteins

PURPOSE

Coating endosseous dental implants with growth factors such as bone morphogenetic proteins (BMPs) may be one way to accelerate and/or enhance the quality of osseointegration. The purpose of this study was to investigate in the murine muscle pouch model whether sintered porous-surfaced titanium alloy implants coated with BMPs would lead to heterotopic bone formation around and within the implant surface geometry.

MATERIALS

Porous-surfaced dental implants were coated with partially purified native human BMPs, with or without a carrier of Poloxamer 407 (BASF Corp., Parsippany, NJ), placed in gelatin capsules and implanted into the hindquarter muscles of mice. Mice were euthanized after 28 days. Sections of retrieved specimens were subsequently prepared for morphometric analysis of bone formation using backscatter electron microscopic images.

RESULTS

Human BMPs, either with or without the carrier of Poloxamer 407, led to bone formation within and outside of the sintered porous implant surface. When the sintered implant surface region was subdivided into inner and outer halves, similar levels of bone ingrowth and contact were seen in the 2 halves. Evidence of bone formation to the depth of the solid implant core (i.e., the deepest level possible) also was seen.

DISCUSSION AND CONCLUSIONS

Sintered porous-surfaced dental implants can be used as substrate for partially purified BMPs in the murine muscle pouch model. With the addition of these osteoinductive factors, the porous implant surface supported bone formation within the surface porosity provided, in some instances, all the way to the solid implant core. The addition of growth factors to a sintered porous surface may be an efficient method for altering locally the healing sequence and quality of bone associated with osseointegration of bone-interfacing implants.

Immediate Load Protocol for Anterior Maxilla With Cortical Bone From Mandibular Ramus

OBJECTIVE

To evaluate the concept of a nonfunctional immediate load protocol with single implants placed in the anterior maxilla that has been bone grafted with autogenous, block cortical grafts harvested from the ramus of the mandible.

METHODS

There were 19 hydroxyapatite-coated dental implants surgically placed in 19 patients, and immediately loaded between 48 hours and 3 days later with a custom acrylic provisional restoration that was placed out of functional occlusion. After 12 weeks, the definitive ceramo metal restoration was cemented to the custom abutment.

RESULTS

Over a 1-year observation period, all implants continue to function.

CONCLUSION

The preliminary results of this clinical study indicate that immediate, nonfunctional load with single implants is a predictable protocol in the bone grafted anterior maxilla in select cases.

Osteotome sinus elevation and simultaneous placement of porous-surfaced dental implants: a morphometric study in rabbits

The objective was to establish a model in rabbits in which to study the healing events associated with localized indirect osteotome-mediated maxillary sinus floor elevation in conjunction with simultaneous placement of sintered porous-surfaced dental implants. On one side of the maxilla of each of 28 rabbits, a sintered porous-surfaced titanium alloy press-fit implant was placed without the use of a bone graft material, while on the collateral side an implant was placed after first adding Bio-Oss graft particles to the osteotomy. Specimens were retrieved for morphometric assessment of bone contact and bone ingrowth of the porous implant surface after 2, 4, 6 and 8 weeks of healing. All implants became osseointegrated by bone ingrowth into the porous implant surface. While the addition of graft particles did not result in a statistically significant increase in the parameters measured, a trend for greater bone contact and particularly bone ingrowth at the apices of the implants was seen as healing time increased. The rabbit maxillary sinus can be used to study healing following placement of sintered porous-surfaced dental implants using the indirect sinus elevation procedure.

Peri-implant bone response to orthodontic loading: Part 1. A histomorphometric study of the effects of implant surface design

INTRODUCTION

Bone response to orthodontic loading was compared histomorphometrically around 2 different types of osseointegrated implants (porous surfaced and machined threaded) to determine their suitability for orthodontic anchorage.

METHODS

Five beagles each received 3 implants of each design in contralateral mandibular locations. After a 6-week initial healing period, abutments were placed, and, 1 week later, the 2 mesial implants on each side were orthodontically loaded for 22 weeks. All implants remained osseointegrated throughout orthodontic loading except for 1 threaded implant that loosened. Light miscroscopy and back-scattered scanning electron microscopy were used to compare responses around the 2 implant designs.

RESULTS

Porous-surfaced implants had higher marginal bone levels (P +/- .025) and less relative implant displacement than threaded implants.

CONCLUSIONS

Differences in implant surface design can lead to differences in peri-implant bone height and bone-to-implant contact. Porous-surfaced implants might be successful as orthodontic anchorage units.

Calcium phosphate sol–gel-derived thin films on porous-surfaced implants for enhanced osteoconductivity. Part I: Synthesis and characterization

Thin sol-gel-formed calcium phosphate (Ca-P) films were formed on sintered porous-surfaced implants as an approach to increasing the rate of bone ingrowth. The films were prepared using either an inorganic precursor solution (with calcium nitrate tetrahydrate and ammonium dihydrogen phosphate) or an organic precursor solution (with calcium nitrate tetrahydrate and triethyl phosphite). We report on the formation and characteristics of the films so formed. Film characteristics were assessed by thin film X-ray diffraction, diffuse-reflectance infrared Fourier transform spectroscopy, X-ray photoelectron spectroscopy, and scanning electron microscopy. In addition, thin sections were prepared either across or parallel to the Ca-P/Ti6Al4V interface and examined by transmission electron microscopy. Both approaches resulted in the formation of nanocrystalline carbonated hydroxyapatite films but with different Ca/P ratios and structures, the Inorganic Route-formed film having a lower Ca/P ratio (1.46 cf 2.10 for the Organic Route-formed film) and having a more irregular topography. An interfacial reaction product (CaTi(2)O(5)) was identified by selected area electron diffraction with the Inorganic Route-formed film only.

Calcium phosphate sol–gel-derived thin films on porous-surfaced implants for enhanced osteoconductivity. Part II: Short-term in vivo studies

Osseointegration rates of porous-surfaced Ti6Al4V implants with control (unmodified sintered coatings) were compared to porous-surfaced implants modified through the addition of either an Inorganic or Organic Route-formed-Ca-P film. Implants were placed in distal femoral rabbit condyle sites and, following a 9-day healing period, implant fixation strength was evaluated using a pull-out test. Three groups of ten rabbits each were evaluated. Inorganic Route Ca-P-coated implants were compared with control implants in Group I. Organic Route Ca-P-coated implants with control implants in Group II, and Inorganic- with Organic Route-Ca-P-coated implants in Group III. Maximum pull-out force and interface stiffness were compared while selected extracted implants were examined by SEM to characterise failure surfaces. Both types of Ca-P coatings significantly enhanced the early rate of bone ingrowth and fixation as evidenced by higher pull-out force and interface stiffness compared with controls. However, there was no significant difference between Ca-P-coated implants prepared using the two different methods. The enhanced osteoconductivity observed with the Organic Route-formed films despite the absence of any obvious new surface topographic features introduced with the films suggests that the increased rate of bone ingrowth was due primarily to altered surface chemistry rather than changes in topography, at least for these sintered porous-surfaced implants.

Osteointegration of biomimetic apatite coating applied onto dense and porous metal implants in femurs of goats

Biomimetic calcium phosphate (Ca-P) coatings were applied onto dense titanium alloy (Ti6Al4V) and porous tantalum (Ta) cylinders by immersion into simulated body fluid at 37 degrees C and then at 50 degrees C for 24 h. As a result, a homogeneous bone-like carbonated apatitic (BCA) coating, 30 microm thick was deposited on the entire surface of the dense and porous implants. Noncoated and BCA-coated implants were press-fit implanted in the femoral diaphysis of 14 adult female goats. Bone contact was measured after implantation for 6, 12, and 24 weeks, and investigated by histology and backscattered electron microscopy (BSEM). After 6 weeks, bone contact of the BCA-coated Ti6Al4V implants was about 50%. After 12 and 24 weeks, bone contact was lower in comparison with the 6-week implantations at, respectively 24 and 39%. Regarding the BCA-coated porous Ta implants, bone contacts were 17, 30, and 18% after 6, 12, and 24 weeks, respectively. However, bone contact was always found significantly higher for BCA-coated dense Ti6Al4V and porous Ta cylinders than the corresponding noncoated implants. The results of this study show that the BCA coating enhances the bone integration as compared to the noncoated implants.

A Targeted Review of Study Outcomes With Short (≤7 mm) Endosseous Dental Implants Placed in Partially Edentulous Patients

BACKGROUND

Generally, threaded root-form endosseous dental implants are thought to perform poorly in short lengths (i.e., < 10 mm). However, whether modifications in implant surface geometry will improve performance of short threaded implants is less clear.

METHODS

The relationship between dental implant failure rates and their surface geometry, length, and location (maxilla versus mandible) was explored in the published literature. Using a MEDLINE search (1985 through 2001), studies were sought with the following criteria: 1) data suitable to calculate failure rates of implant lengths < or = 7 mm versus > 7 mm; 2) data separable into maxillary versus mandibular results; 3) criteria for "failure" clearly defined; and 4) minimal functional period of 2 years.

RESULTS

Twelve papers were identified as follows: eight with machined threaded implants, two with acid-treated threaded implants, and two with sintered porous-surfaced press-fit implants. The following results were found: 1) machined surface implants experienced greater failure rates than textured surface implants; 2) with the exception of sintered porous-surfaced implants, 7 mm long dental implants appear to have higher failure rates than those > 7 mm length; and 3) with textured surface implants, higher failure rates were more likely in the maxilla than in the mandible, but with machined surface implants there were no differences in failure rates between maxilla and mandible.

CONCLUSIONS

Dental implant surface geometry is a major determinant in how well these implants perform in short lengths, defined here as lengths of < or = 7 mm. While threaded implants show higher failure rates in short versus longer lengths, sintered porous-surfaced implants perform well in the defined "short" lengths. More studies are needed to better assess the performance of short, acid-washed threaded implants.

Effects of an Er : YAG laser and the Vector® ultrasonic system on the biocompatibility of titanium implants in cultures of human osteoblast-like cells

The aim of the present study was to investigate the effects of an Er:YAG laser (ERL) and the Vector ultrasonic system (VS) on the biocompatibility of titanium implants in cultures of human osteoblast-like cells (SAOS-2). One hundred and sixty-eight titanium discs with four different surfaces (sand-blasted and acid-etched, titanium plasma-sprayed, machine-polished, and hydroxyapatite-coated) were used to evaluate cell attachment. The samples were equally and randomly assigned to the following groups: (1) an ERL at an energy level of 100 mJ/pulse and 10 Hz using a special application tip, (2) the VS using carbon fibre tips, or (3) untreated control (C). The discs were placed in culture plates, covered with a solution of SAOS-2 cells, and incubated for 7 days. The specimens were then washed with phosphate buffer to remove cells not attached to the surface, and the adherent cells were stained with hematoxilin-eosin. Cells were counted using a reflected light microscope and the cell density per mm2 was calculated. Additionally, cell morphology and surface alterations of the titanium discs after treatment were investigated using scanning electron microscopy (SEM). All titanium discs treated with ERL demonstrated nearly the same cell density per mm2 as the untreated C surfaces. There was a significant decrease in the number of cells that attached to the implant surfaces treated with VS. The SEM examination showed no visible differences between lased and C titanium surfaces. All surfaces treated with VS showed conspicuous surface damage and debris of the used carbon fibres. The results of the present study indicate that (i) ERL does not damage titanium surfaces and subsequently does not influence the attachment rate of SAOS-2 cells, and (ii) VS, used with this type of carbon fibre tip, does not seem to be suitable for the instrumentation of titanium surfaces.

Osteogenecity of octacalcium phosphate coatings applied on porous metal implants

The biomimetic route allows the homogeneous deposition of calcium phosphate (Ca-P) coatings on porous implants by immersion in simulated physiologic solution. In addition, various Ca-P phases, such as octacalcium phosphate (OCP) or bone-like carbonated apatite (BCA), which are stable only at low temperatures, can be deposited. In this pilot study, experiments were designed with a twofold-purpose: (1) to investigate the osteoinduction of OCP-coated and noncoated porous tantalum cylinders and of dense titanium alloy cylinders (5 mm in diameter and 10 mm in length) in the back muscle of goats at 12 and 24 weeks (n = 4); and (2) to compare the osteogenic potentials of BCA-coated, OCP-coated, and bare porous tantalum cylinders in a gap of 1 mm created in the femoral condyle of a goat at 12 weeks (n = 2). In the goat muscle, after 12 weeks the OCP-coated porous cylinder had induced ectopic bone as well as bone within the cavity of the OCP-coated dense titanium cylinder. In the femoral condyle, bone did not fill the gap in any of the porous implants. In contrast with the two other groups, OCP-coated porous cylinders exhibited bone formation in the center of the implant. The nature of the Ca-P coating, via its microstructure, its dissolution rate, and its specific interactions with body fluids, may influence the osteogenecity of the Ca-P biomaterial.

A systematic review of the survival of implants in bone sites augmented with barrier membranes (guided bone regeneration) in partially edentulous patients

The aim of the present systematic review was to assess the survival of implants in regenerated bone applying the method of guided bone regeneration (GBR) compared with the survival of implants in non-regenerated bone. Studies to be included in this review needed to provide at least 12-month results following prosthetic reconstruction of titanium implants in bone regenerated by GBR with or without membrane supporting materials. The outcome measures were implant survival described as presence of implant, implant success (according to the criteria in the respective study), absence of clinical implant mobility, absence of implant fracture, absence of progressive peri-implant crestal bone loss as assessed on radiographs without clinical signs of peri-implant infection, absence of peri-implant infection with suppuration. A MEDLINE search and a hand search of relevant scientific journals were conducted including studies from the year 1990 to May 2001. A total of 11 studies could be identified fulfilling the inclusion criteria. All studies except two had the characteristics of case series or cross-sectional surveys. The two different studies had both test and control implants included in their analysis and qualified as controlled clinical trials. Cumulative success or survival rates, respectively, for implants in regenerated bone ranged from 100% after 5 years to 79.4% after 5 years of function. Regarding survival data, no significant differences were found in the controlled clinical trials between implants in regenerated compared to implants in non-regenerated bone. Within the limits of this systematic review characterized by second and third levels of evidence, the following conclusions can be drawn: The survival rate of implants placed into sites with regenerated/augmented bone using barrier membranes varied between 79% and 100% with the majority of studies indicating more than 90% after at least one year of function. The survival rates obtained in the present systematic review are similar to those generally reported for implants placed conventionally into sites without the need for bone augmentation.

Ten-year results of a prospective study using porous-surfaced dental implants and a mandibular overdenture

BACKGROUND

Numerous investigators have used osseointegrated dental implants as retention for mandibular overdentures, but few have reported 10-year outcomes or incorporated carefully standardized radiographs to document crestal bone loss.

PURPOSE

The purpose of this study was to use a prospective clinical trial design to assess the performance of short sintered porous-surfaced dental implants with a mandibular complete overdenture when all patients in the trial had undergone 10 years of continuous function.

MATERIALS AND METHODS

Fifty-two fully edentulous patients, most with advanced alveolar ridge resorption, each received three free-standing Endopore implants (7-10 mm in length, mean length, 8.7 mm; Innova Corporation, Toronto, ON, Canada) in the mandibular symphysis region. After 10 weeks of submerged healing, these implants were used to support an overdenture. Carefully standardized radiographs, using a customized stainless steel filmholder attached to each implant and the x-ray tube, were collected at baseline, 3 months, 6 months, yearly to 5 years, and then again at 7and 10 years.

RESULTS

Life table analysis revealed a 10-year implant survival of 92.7% and a mean annual bone loss after year 1 of 0.03 mm.

CONCLUSION

Short free-standing dental implants with a sintered porous surface used for implant fixation are a predictable and effective means of retaining a mandibular overdenture in patients with advanced mandibular ridge resorption.

Osseous healing characteristics of three different implant types

The macroscopic and especially microscopic properties of implant surfaces play a major role in the osseous healing of dental implants. The aim of this study was to perform a histologic and histomorphometric comparison of the healing characteristics of anodically modified, machined and hydroxyapatite (HA)-coated implant types. A total of 24 machined surface implants (MSI), 24 HA-coated implants (HCI) and 24 anodized titanium surface implants (ASI) were inserted into the mandibles of 12 adult mini-pigs after extracting all mandibular premolars. Four animals each were killed after covered healing for 3, 6 and 12 weeks. Undecalcified ground sections were subjected to histologic and histomorphometric examinations. Primary effects and interactions were statistically evaluated and least square means (Tukey test) were compared. Histologic evaluations showed broad-based bone apposition to HA-coated and anodically roughened surfaces as well as narrow bone contacts to the machined surface. Localized resorption was only observed with the HA-coated implants. Overall, histomorphometric evaluation of bone-to-implant contact percentages for all observation periods showed significant differences between MSI (19.39% +/- 4.53) and HCI (39.05% +/- 4.53; P = 0.0092) and between MSI and ASI (42.72% +/- 4.20; P = 0.0011). In conclusion, the results of this study show that an anodically roughened implant may provide a similar rate of bone-to-implant contact as a HA-coated implant. In the presence of bone quality II to IV, according to Lekholm & Zarb (1985, in: Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago: Quintessence Publishing), this may be of particular benefit, possibly because of higher stability, in maintaining pre-implantation functional strength after implant healing.

Dental implants in periodontal therapy

Over the past 30 years, research has validated the success of osseointegrated implants as a viable alternative to fixed or removable prosthetic restorations. Periodontists are extensively trained in surgical procedures to treat and maintain patients with edentulous and partially edentulous arches. They also have a primary role in treatment planning and maintenance therapy. Thus, periodontists routinely integrate endosseous implants into periodontal therapy. This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology and is intended to inform the dental profession regarding the utility of endosseous dental implants in the treatment of full and partial edentulism.

Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature

A significant no-load healing period is the generally accepted prerequisite for osseointegration in dental implantology. The aim of this article was to examine whether this no-load healing period is validated by the experimental literature. In vivo histological data was scrutinized to identify the effect of early loading protocols on the bone-implant interface. Several loading modes were identified. They were categorized into groups according to implant design and the type of prosthetic reconstruction, and by their ability to introduce a distinct magnitude of motion at the interface. Specific histologic responses of early loaded implants (i.e., fibrous repair or osseointegration) were suggested to be directly related to the specific combinations of the above parameters. Early loading per se was not found to be detrimental to osseointegration. Specifically, only excessive micromotion was directly implicated in the formation of fibrous encapsulation. The literature suggests that there is a critical threshold of micromotion above which fibrous encapsulation prevails over osseointegration. This critical level, however, was not zero micromotion as generally interpreted. Instead, the tolerated micromotion threshold was found to lie somewhere between 50 and 150 microns. Suggestions are made for the earliest loading time that achieves osseointegration.

A comparison of endosseous dental implant surfaces

Endosseous dental implants are available with various surface characteristics ranging from relatively smooth machined surfaces to more roughened surfaces created by coatings, blasting by various substances, by acid treatments, or by combinations of the treatments. Studies characterizing these implants and surfaces include in vitro experimentation, animal studies, and human clinical trials. Both descriptive and functional testing of the bone-implant interface includes histomorphometrics and biomechanical testing such as torque removal values and push out/pull out strength. Using these assays to evaluate and compare different surfaces, the data demonstrate that rough implant surfaces have increased bone-to-implant contact and require greater forces to break the bone-implant interface compared to more smooth surfaces. The objective of this report was to evaluate publications of human clinical experiences evaluating implant use in patients and to determine if differences existed in success rates of implants with relatively smooth surfaces compared to implants having roughened implant surfaces. Human trials were reviewed to determine the clinical efficacy of implants under various clinical indications. Synopsis tables were constructed and the experiences segregated by implant surface characteristics. Meta-analyses were performed on all implants in all locations, on implants placed only in the maxilla or the mandible, and, finally, on implants placed in the maxilla compared to implants placed in the mandible. Evaluation of the data revealed that predictably high success rates can be achieved for implants with both rough and smooth titanium surfaces and for hydroxyapatite-coated implants. When studies were clustered by specific indications or patient populations, rough surfaced implants had significantly higher success rates compared to implants with more smooth surfaces except in the case of single tooth replacements where the success rates were comparable. In general, implants placed in the mandible had significantly higher success rates than implants placed in the maxilla. However, in the partially edentulous patient group, titanium implants with a rough surface had significantly higher success rates in the maxilla compared to the mandible and, in cases of single tooth replacement, success rates were similar in the maxilla and in the mandible as was the case for hydroxyapatite-coated implants. The documented advantage of implants with a roughened surface in animal and in vitro experiments has been demonstrated in clinical cases when studies were compared in which specific indications or patients were treated. Additionally, implants placed in the mandible have, in general, higher success rates than implants placed in the maxilla, with only a few exceptions noted. These data from human clinical experiences support the documented advantage of implants with a roughened surface in animal and in vitro experimentation and indicate that the magnitude of the advantage is significant for patient care.

Osseointegration of sintered porous-surfaced and plasma spray-coated implants: An animal model study of early postimplantation healing response and mechanical stability

The osseointegration and long-term success of bone-interfacing implants are dependent on mechanical stability of the implant relative to host bone during the early healing period. The geometric design of an implant surface may play an important role in affecting early implant stabilization, possibly by influencing tissue healing dynamics. In this study, we compared the early tissue healing response and resulting implant stability for two surface designs by characterizing the histological and mechanical properties of the healing tissue around Ti6Al4V sintered porous-surfaced and Ti plasma-sprayed implants. The implants were inserted transversely in rabbit femoral condyles and evaluated at 0, 4, 8, and 16 days postimplantation. At 4 and 8 days after implantation, the early healing tissue (fibrin and collagenous matrix) was more extensively integrated with the three-dimensional interconnected structure of the sintered porous surface than with the irregular geometry of the plasma-sprayed coating. In addition, histological examination indicated that initial matrix mineralization leading to osseointegration occurred more rapidly with the porous-surfaced implants. The more extensive tissue integration and more rapid matrix mineralization with the porous-surfaced implants were reflected in the mechanical test data, which demonstrated greater attachment strength and interfacial stiffness for the porous-surfaced implants 4 and 8 days postimplantation (p <.05). Sixteen days after implantation, both implant designs were osseointegrated and had comparable attachment characteristics. These data demonstrate that appropriate surface design selection can improve early implant stability and induce an accelerated healing response, thereby improving the potential for implant osseointegration.

Overview of clinical trials on endosseous implants

Early history of clinical trials on endosseous implants revolved around anecdotal reports on predominantly blade implants in the U.S. The first criteria to define success or failure were established at the National Institutes of Health (NIH)-Harvard Conference in 1978. This was followed by the multi-center trials from the Branemark group which described round, metallic implants. At the 1988 NIH Conference, questions dealt with the following: 1) the effectiveness of dental implants for the long-term; 2) indications and contra-indications of various types of implants; 3) requirements for management of dental implants; 4) health risks of dental implants; and 5) future directions in research. In the ensuing 7 years since the second NIH Conference, most of the data generated have been from non-controlled case reports, which describe a 90% success rate in 5 years or more with many types of endosteal systems in both partially and fully edentulous patients. Therefore, it can be said that there is evidence that dental implants are effective for the long-term. The other questions posed at the 1988 NIH Conference have not been as well described and have led to many controversies and future research areas. Two areas which will have a special future impact are 1) the establishment of a standard of care and risk-benefit ratio for implants and 2) the use of various factors to accelerate bone formation to allow greater access to dental implants by patients.

Simplifying the treatment of edentulism: a new type of implant

In this article, the authors describe the application of a new and unique root-form dental implant in a simplified approach to treating the completely edentulous mandible using an overdenture. The technique is supported by the results of a prospective clinical trial involving 52 patients that showed a three- to four-year success rate of 95 percent.

The three-dimensional bone interface of an osseointegrated implant. I: A morphometric evaluation in initial healing

Direct bone-implant interface as an indicator of endosseous implant success appears to have been overinterpreted because 100% bone apposition is not necessarily obtained at the surface of the endosseous dental implant. The purpose of this study was to obtain quantitative information about the three-dimensional bone structure around three hydroxyapatite-coated titanium alloy dental implants. Implants were placed in the mandible in three monkeys, and the surface bone contact ratio in the buccal, lingual, mesial, and distal directions was computed. Computer graphics were generated by the integration of data for serial ground surfaces obtained at 75 microm intervals of the tissue block involved with the implant. The bone contact ratio of the whole surface of each of the three implants was 80.8%, 68.1%, and 68.8%, and the bone contact ratio for each direction and portion varied with the conditions of implant placement. The bone volume ratios around the implant at the 0 to 300 microm zone were also calculated, and total ratios ranged from 58% to 81%. These results may provide useful quantitative information about the bone structure around the hydroxyapatite-coated implants and contribute to the development of realistic finite element analysis models based on the biologic bone structure around the implants.

Periodontal parameters around porous-coated dental implants after 3 to 4 years supporting overdentures

In this study, an assessment using modified periodontal indices was done on a group of 48 fully edentulous patients who had each been treated with 3 porous-coated (EndoPore) dental implants and a mandibular overdenture. Parameters assessed included plaque index (PI), sulcular bleeding index (SBI), pocket probing depth (PD), probing attachment level (PAL) and mobility (M) using a Periotest device. At the time of the assessment, all of the patients had passed 3 years of continuous function while 26 had passed 4 years. Approximately 50% of implant surfaces were plaque-free while 79% of surfaces showed no bleeding upon probing. There was no correlation between PI and SBI. The mean PD was 3.1 mm with 64% of sites < or = 3.5 mm. Mobility measurements taken with the Periotest device gave a mean PTV of (-4.35) with 96% of measurements (-0.5). No significant correlations were found between mobility and either PAL or implant length.

Finite element analysis of crestal bone loss around porous-coated dental implants

Crestal bone loss is observed around various designs of dental implants. A possible cause of this bone loss is related to the stresses acting on periimplant bone. To investigate the relationship between stress state and bone loss, two-dimensional finite element models corresponding to bucco-lingual and mesio-distal sections of canine mandibles with one of two designs of porous-coated dental implants were analyzed. A fully porous-coated design consisting of a solid Ti6A14V core had a porous coating over the entire outer surface of the implant component, while a partially porous-coated design had the porous coating over the apical two-thirds of the implant surface only. Occlusal forces with axial and transverse components were assumed to act on the implant with interface bonding and effective force transfer at all porous coat-bone interfaces and no bonding for the non-porous-coated regions. The results of the analysis indicated that at most implant aspects (buccal, lingual, mesial, and distal), the equivalent stresses in crestal bone adjacent to the coronal-most, non-porous-coated zone of the partially porous-coated implants were lower than around the most coronal region of the fully porous-coated implants. The region of lower stress around the partially porous-coated implants corresponded to observed areas of crestal bone loss in animal studies, suggesting that crestal bone loss in this case was due to bone disuse atrophy. A number of parameters of the finite element models were varied to determine the effect on the resulting stress fields and, therefore, possible long-term bone remodeling. Based on differences in observed bone structures by histological examination and results of finite element analyses with fully and partially porous-coated implants, an equivalent stress equal to 1.6 MPa was determined to be sufficient to avoid bone loss due to disuse atrophy in the canine mandibular premolar region.

Histological observations of coated and prestressed dental implants under flexible or rigid loading conditions

Hydroxyapatite-coated and hydroxyapatite-prestressed titanium implants were implanted under load-free, flexible-loaded and rigid-loaded conditions in dog mandibula in vivo. The bone response, bone contact and the quality of the coating were evaluated histologically and histometrically. Hydroxyapatite coating on titanium implants enhanced the bone apposition. The bone contact can still be present while the coating is resorbed. Gingiva contact with the coating led to a faster degradation of the coating. There was no significant difference in bone contact between hydroxyapatite-coated and -prestressed implants with regard to the loading systems: rigid, flexible and load-free. All three implants showed the highest amount of bone contact apically. Only at the mesial side of the implant did the flexible element show rather high amounts of bone contact compared to the rigid and load-free implants. The hydroxyapatite coating more or less degraded during the implantation period. The degree of degradation varied in the implant itself, between the implants and between the animals.

Light and transmission electron microscopy of the intact interfaces between non-submerged titanium-coated epoxy resin implants and bone or gingiva

This experiment was aimed at studying the intact tissue/implant interface of non-submerged dental implants with a titanium surface. Epoxy-resin replicas were fabricated from 3.05 x 8 mm cylindrical titanium implants with a plasma-sprayed apical portion and a smooth coronal collar. The replicas were coated with a 90-120-nm-thick layer of pure titanium and autoclaved. The coated replicas were inserted as non-submerged endosseous implants in the edentulous premolar region of dog mandibles and allowed to heal for three months. Jaw sections containing the implants were processed for light and electron microscopic study of the intact tissue/implant interface with and without prior demineralization. Gingival connective tissue fibers were closely adapted to the titanium layer, in an orientation more or less parallel to the implant surface. There was no evidence of any fiber insertions into the surface irregularities of the smooth or rough titanium surface. Undemineralized bone was intimately adapted to the titanium surface without any intervening space. In demineralized sections, the collagen fibers of the bone matrix tended to be somewhat thinner and occasionally less densely packed in the vicinity of the implant surface. However, they extended all the way to the titanium surface, without any intervening fibril-free layer.

The role of dental implants in the future

Osseointegration's documented success allowing bone and mucosal tissue to tolerate a titanium implant has dramatically expanded the possibilities of dental care. We can now replace extracted teeth. Maintaining implants is different, but simpler than tooth maintenance. There is much interest in quicker procedures, shorter healing times or other materials to see if they can be as successful as CP titanium. Some may prove to be so. In any case, osseointegration has had as much impact on 20th century dentistry as local anesthetics, fluorides and the air rotor. Our practices and curricula, are changing to remain contemporary and ready for the 21st century.