Showing papers on "Osseointegration published in 2006"

Impact of implant length and diameter on survival rates.

Abstract: Introduction: Despite the high success rates of endosseous oral implants, restrictions have been advocated to their placement with regard to the bone available in height and volume. The use of short or nonstandard-diameter implants could be one way to overcome this limitation. Material and methods: In order to explore the relationship between implant survival rates and their length and diameter, a Medline and a hand search was conducted covering the period 1990–2005. Papers were included which reported: (1) relevant data on implant length and diameter, (2) implant survival rates; either clearly indicated or calculable from data in the paper, (3) clearly defined criteria for implant failure, and in which (4) implants were placed in healed sites and (5) studies were in human subjects. Results: A total of 53 human studies fulfilled the inclusion criteria. Concerning implant length, a relatively high number of published studies (12) indicated an increased failure rate with short implants which was associated with operators' learning curves, a routine surgical preparation (independent of the bone density), the use of machined-surfaced implants, and the placement in sites with poor bone density. Recent publications (22) reporting an adapted surgical preparation and the use of textured-surfaced implants have indicated survival rates of short implants comparable with those obtained with longer ones.Considering implant diameter, a few publications on wide-diameter implants have reported an increased failure rate, which was mainly associated with the operators' learning curves, poor bone density, implant design and site preparation, and the use of a wide implant when primary stability had not been achieved with a standard-diameter implant. More recent publications with an adapted surgical preparation, new implant designs and adequate indications have demonstrated that implant survival rate and diameter have no relationship. Discussion: When surgical preparation is related to bone density, textured-surfaced implants are employed, operators' surgical skills are developed, and indications for implant treatment duly considered, the survival rates for short and for wide-diameter implants has been found to be comparable with those obtained with longer implants and those of a standard diameter. The use of a short or wide implant may be considered in sites thought unfavourable for implant success, such as those associated with bone resorption or previous injury and trauma. While in these situations implant failure rates may be increased, outcomes should be compared with those associated with advanced surgical procedure such as bone grafting, sinus lifting, and the transposition of the alveolar nerve.

Increased osteoblast and decreased Staphylococcus epidermidis functions on nanophase ZnO and TiO2.

Abstract: Many engineers and surgeons trace implant failure to poor osseointegration (or the bonding of an orthopedic implant to juxtaposed bone) and/or bacteria infection. By using novel nanotopographies, researchers have shown that nanostructured ceramics, carbon fibers, polymers, metals, and composites enhance osteoblast adhesion and calcium/phosphate mineral deposition. However, the function of bacteria on materials with nanostructured surfaces remains largely uninvestigated. This is despite the fact that during normal surgical insertion of an orthopedic implant, bacteria from the patient's own skin and/or mucosa enters the wound site. These bacteria (namely, Staphylococcus epidermidis) irreversibly adhere to an implant surface while various physiological stresses induce alterations in the bacterial growth rate leading to biofilm formation. Because of their integral role in determining the success of orthopedic implants, the objective of this in vitro study was to examine the functions of (i) S. epidermidis and (ii) osteoblasts (or bone-forming cells) on ZnO and titania (TiO(2)), which possess nanostructured compared to microstructured surface features. ZnO is a well-known antimicrobial agent and TiO(2) readily forms on titanium once implanted. Results of this study provided the first evidence of decreased S. epidermidis adhesion on ZnO and TiO(2) with nanostructured when compared with microstructured surface features. Moreover, compared with microphase formulations, results of this study showed increased osteoblast adhesion, alkaline phosphatase activity, and calcium mineral deposition on nanophase ZnO and TiO(2). In this manner, this study suggests that nanophase ZnO and TiO(2) may reduce S. epidermidis adhesion and increase osteoblast functions necessary to promote the efficacy of orthopedic implants.

Influence of forces on peri-implant bone.

Abstract: Occlusal forces affect an oral implant and the surrounding bone. According to bone physiology theories, bones carrying mechanical loads adapt their strength to the load applied on it by bone modeling/remodeling. This also applies to bone surrounding an oral implant. The response to an increased mechanical stress below a certain threshold will be a strengthening of the bone by increasing the bone density or apposition of bone. On the other hand, fatigue micro-damage resulting in bone resorption may be the result of mechanical stress beyond this threshold. In the present paper literature dealing with the relationship between forces on oral implants and the surrounding bone is reviewed. Randomized controlled as well as prospective cohorts studies were not found. Although the results are conflicting, animal experimental studies have shown that occlusal load might result in marginal bone loss around oral implants or complete loss of osseointegration. In clinical studies an association between the loading conditions and marginal bone loss around oral implants or complete loss of osseointegration has been stated, but a causative relationship has not been shown.

Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation

Abstract: Objective: To determine whether the reduction of the alveolar ridge that occurs following tooth extraction and implant placement is influenced by the size of the hard tissue walls of the socket. Material and methods: Six beagle dogs were used. The third premolar and first molar in both quadrants of the mandible were used. Mucoperiostal flaps were elevated and the distal roots were removed. Implants were installed in the fresh extraction socket in one side of the mandible. The flaps were replaced to allow a semi-submerged healing. The procedure was repeated in the contra later side of the mandible after 2 months. The animals were sacrificed 1 month after the final implant installation. The mandibles were dissected, and each implant site was removed and processed for ground sectioning. Results: Marked hard tissue alterations occurred during healing following tooth extraction and implant installation in the socket. The marginal gap that was present between the implant and the walls of the socket at implantation disappeared as a result of bone fill and resorption of the bone crest. The modeling in the marginal defect region was accompanied by marked attenuation of the dimensions of both the delicate buccal and the wider lingual bone wall. Bone loss at molar sites was more pronounced than at the premolar locations. Conclusion: Implant placement failed to preserve the hard tissue dimension of the ridge following tooth extraction. The buccal as well as the lingual bone walls were resorbed. At the buccal aspect, this resulted in some marginal loss of osseointegration.

Nine- to fourteen-year follow-up of implant treatment. Part I: implant loss and associations to various factors.

Abstract: OBJECTIVES: The aim of the present study was to evaluate the long-term result of implant therapy, using implant loss as outcome variable.MATERIAL AND METHOD: Two hundred and ninty-four patients had received implant therapy (Branemark System) during the years of 1988-1992 in Kristianstad County, Sweden. The patients were recalled to the speciality clinic 1 and 5 years after placement of the suprastructure. Between 2000 and 2002, 9-14 years after implant placements, the patients were again called in for a complete clinical and radiographic examination.RESULTS: Two hundred and eighteen patients treated with 1057 implants were examined. Twenty-two patients had lost 46 implants and 12 implants were considered "sleeping implants". The overall survival rate was 95.7%. Implant loss appeared in a cluster in a few patients and early failures were most common. Eight patients lost more than one fixture. A significant relationship was observed between implant loss and periodontal bone loss of the remaining teeth at implant placement. Maxillary, as opposed to mandibulary implants, showed more implant loss if many implants were placed in the jaw. A significant relationship between smoking habits and implant loss was not found.CONCLUSION: A history of periodontitis seems to be related to implant loss.

Bone healing and graft resorption of autograft, anorganic bovine bone and beta-tricalcium phosphate. A histologic and histomorphometric study in the mandibles of minipigs.

Abstract: OBJECTIVE: The purpose was to qualitatively and quantitatively compare the bone formation and graft resorption of two different bone substitutes used in both orthopedic and oral surgery, with autogenous bone as a positive control. MATERIALS AND METHODS: Three standardized bone defects were prepared in both mandibular angles of 12 adult minipigs. The defects were grafted with either autograft, anorganic bovine bone (ABB), or synthetic beta-tricalcium phosphate (beta-TCP). Sacrifice was performed after 1, 2, 4, and 8 weeks for histologic and histomorphometric analysis. RESULTS: At 2 weeks, more new bone formation was seen in defects filled with autograft than with ABB (P approximately 0.0005) and beta-TCP (P approximately 0.002). After 4 weeks, there was no significant difference between beta-TCP and the two other materials. Defects grafted with ABB still exhibited less bone formation as compared with autograft (P approximately 0.004). At 8 weeks, more bone formation was observed in defects grafted with autograft (P approximately 0.003) and beta-TCP (P approximately 0.00004) than with ABB. No difference could be demonstrated between beta-TCP and autograft. beta-TCP resorbed almost completely over 8 weeks, whereas ABB remained stable. CONCLUSION: Both bone substitutes seemed to decelerate bone regeneration in the early healing phase as compared with autograft. All defects ultimately regenerated with newly formed bone and a developing bone marrow. The grafting materials showed complete osseous integration. Both bone substitutes may have a place in reconstructive surgery where different clinical indications require differences in biodegradability.

Significance of primary stability for osseointegration of dental implants

Abstract: Aim: To investigate the significance of the initial stability of dental implants for the establishment of osseointegration in an experimental capsule model for bone augmentation. Material and methods: Sixteen male rats were used in the study. In each rat, muscle-periosteal flaps were elevated on the lateral aspect of the mandibular ramus on both sides, resulting in exposure of the bone surface. Small perforations were then produced in the ramus. A rigid, hemispherical Teflon® capsule with a diameter of 6 mm and a height of 4 mm and with a hole in its middle portion, prepared to fit the circumference of an ITI® HC titanium implant of 2.8 mm in diameter, was fixed to the ramus using 4 mini-screws. On one side of the jaw, the implant was placed through the hole in such a way that its apex did not make contact with the mandibular ramus (test). This placement of the implant did not ensure primary stability. On the other side of the jaw, a similar implant was placed through the hole of the capsule in such a way that contact was made between the implant and the surface of the ramus (control). This provided primary stability of the implant. After placement of the implants, the soft tissues were repositioned over the capsules and sutured. After 1, 3, 6 and 9 months, four animals were sacrificed and subjected to histometric analysis. Results: The mean height of direct bone-to-implant contact of implants with primary stability was 38.8%, 52.9%, 64.6% and 81.3% of the implant length at 1, 3, 6 and 9 months, respectively. Of the bone adjacent to the implant surface, 28.1%, 28.9%, 52.6% and 69.6%, respectively, consisted of mineralized bone. At the test implants, no bone-to-implant contact was observed at any observation time or in any of these non-stabilized specimens. Conclusion: The findings of the present study indicate that primary implant stability is a prerequisite for successful osseointegration, and that implant instability results in fibrous encapsulation, thus confirming previously made clinical observations.

Tissue modeling following implant placement in fresh extraction sockets.

Abstract: Objective: To study whether osseointegration once established following implant placement in a fresh extraction socket may be lost as a result of tissue modeling. Material and methods: Seven beagle dogs were used. The third and fourth premolars in both quadrants of the mandible were used as experimental teeth. Buccal and lingual full-thickness flaps were elevated and distal roots were removed. Implants were installed in the fresh extraction socket. Semi-submerged healing of the implant sites was allowed. In five dogs, the experimental procedure was first performed in the right side of the mandible and 2 months later in the left mandible. These five animals were sacrificed 1 month after the final implant installation. In two dogs, the premolar sites on both sides of the mandible were treated in one surgical session and biopsies were obtained immediately after implant placement. All biopsies were processed for ground sectioning and stained. Results: The void that existed between the implant and the socket walls at surgery was filled at 4 weeks with woven bone that made contact with the SLA surface. In this interval, (i) the buccal and lingual bone walls underwent marked surface resorption and (ii) the height of the thin buccal hard tissue wall was reduced. The process of healing continued, and the buccal bone crest shifted further in the apical direction. After 12 weeks, the buccal crest was located>2 mm apical of the marginal border of the SLA surface. Conclusion: The bone-to-implant contact that was established during the early phase of socket healing following implant installation was in part lost when the buccal bone wall underwent continued resorption.

Bone density and primary stability in implant therapy.

Abstract: Introduction: To improve patient comfort, deviations from the very successful standard osseointegration protocol are being developed. To keep implant failure rates as low as possible, the most perfect treatment planning and a good patient selection are extremely important. Because bone density plays an important role in implant outcome, known relations of bone density could improve treatment planning. Material and methods: A Pubmed search revealed 66 manuscripts investigating and discussing bone density of human jawbone whether or not related to implant stability or outcome. Forty-five of these will be discussed in this review. Results and discussion: Many pre-operative methods of jawbone density assessment are available. Most of those techniques correlate well with one another. Some are more elaborate to use in clinical practice. Primary stability measurements show significant correlations with different bone densities and also with implant outcome; however, not many studies investigate both at the same time. Conclusion: To investigate the outcome of adaptation methods of the surgical protocol with regard to the jawbone density, an objective pre-surgical determination of bone density is necessary.

Short Dental Implants in Posterior Partial Edentulism: A Multicenter Retrospective 6‐Year Case Series Study

Abstract: Background: Implants <10 mm long in the posterior regions of partially edentulous patients have a higher failure rate in many clinical reports. The purpose of this case series study was to evaluate implant survival when a biomechanical approach was used to decrease stress to the bone-implant interface.Methods: A retrospective evaluation of 273 consecutive posterior partially edentulous patients treated with 745 implants, 7 or 9 mm long, supporting 338 restorations over a 1- to 5-year period was reviewed from four private offices. Implant survival data were collected relative to stage I to stage II healing, stage II to prosthesis delivery, and prosthesis delivery to as long as 6 years follow-up. A biomechanical approach to decrease stress to the posterior implants included splinting implants together with no cantilever load, restoring the patient with a mutually protected or canine guidance occlusion, and selecting an implant designed to increase bone-implant contact surface area.Results: Of the 745 implan...

Biomechanical evaluation of the interfacial strength of a chemically modified sandblasted and acid-etched titanium surface.

Abstract: The functional capacity of osseointegrated dental implants to bear load is largely dependent on the quality of the interface between the bone and implant. Sandblasted and acid-etched (SLA) surfaces have been previously shown to enhance bone apposition. In this study, the SLA has been compared with a chemically modified SLA (modSLA) surface. The increased wettability of the modSLA surface in a protein solution was verified by dynamic contact angle analysis. Using a well-established animal model with a split-mouth experimental design, implant removal torque testing was performed to determine the biomechanical properties of the bone-implant interface. All implants had an identical cylindrical shape with a standard thread configuration. Removal torque testing was performed after 2, 4, and 8 weeks of bone healing (n = 9 animals per healing period, three implants per surface type per animal) to evaluate the interfacial shear strength of each surface type. Results showed that the modSLA surface was more effective in enhancing the interfacial shear strength of implants in comparison with the conventional SLA surface during early stages of bone healing. Removal torque values of the modSLA-surfaced implants were 8-21% higher than those of the SLA implants (p = 0.003). The mean removal torque values for the modSLA implants were 1.485 N m at 2 weeks, 1.709 N m at 4 weeks, and 1.345 N m at 8 weeks; and correspondingly, 1.231 N m, 1.585 N m, and 1.143 N m for the SLA implants. The bone-implant interfacial stiffness calculated from the torque-rotation curve was on average 9-14% higher for the modSLA implants when compared with the SLA implants (p = 0.038). It can be concluded that the modSLA surface achieves a better bone anchorage during early stages of bone healing than the SLA surface; chemical modification of the standard SLA surface likely enhances bone apposition and this has a beneficial effect on the interfacial shear strength.

Degradable implantable medical devices

Abstract: Devices and methods are provided for an implantable medical device which is degradable over a clinically relevant period of time. The medical devices may have the form of implants, graft implants, vascular implants, non vascular implants, wound closure implants, sutures, drug delivery implants, biologic delivery implants, urinary tract implants, inter-uterine implants, organ implants, bone implants including bone plates, bone screws, dental implants, spinal disks, or the like. In preferred embodiments, the implantable medical device comprises an implantable luminal prosthesis, such as vascular and non-vascular stents and stents grafts.

Bone tissue formation adjacent to implants placed in fresh extraction sockets: an experimental study in dogs.

Abstract: Objective To study the healing of marginal defects that occurred at implants placed in a healed ridge or in fresh extraction sockets. Material and methods Six dogs were used. The right side of the mandible was used in the first part of the study. The first, second premolars and first molars were extracted. After 3 months of healing the bone was prepared for implant installation in these premolar and molar sites. The marginal 5 mm of each recipient site was widened with a conical drill. Following implant installation a gap of varying dimension occurred around the titanium rod (artificial defect (A) sites). At this interval the third and fourth premolars were extracted and implants were installed in the distal socket of the two teeth (natural defect (N) sites). The flaps were sutured to allow non-submerged healing. After 2 months, the procedures were repeated in the left side. Two months later the animals were euthanized, and biopsies were obtained and prepared for histological examination. Results The length of the zone of de novo'bone-to-implant contact' in the defect region was longer at the A sites than at the N sites both at the 2- and the 4-month interval. Further, while after 4 months of healing the marginal bone crest at the A sites was located close to the abutment/fixture junction, at the N sites a marked reduction of the height of the bone crest was documented. Hence, most A site defects became completely resolved whereas healing of the N site defects was incomplete. Conclusion The process of bone modeling and remodeling at an implant placed in a fresh extraction socket differs from the resolution of marginal defects that may occur following implant installation in a healed ridge.

Indications for immediate loading of implants and implant success

Abstract: It was the aim of this review to compare the survival and success rates of immediately loaded dental implants with those of conventionally loaded dental implants, based on prospective controlled studies and prospective studies without controls. Studies on immediate loading were identified in the current literature by electronic and hand searches. Only clinical data on root-form or cylindrical threaded oral implants were included. For immediate loading of oral implants in the edentulous and partially dentate, mandible and maxilla controlled studies could be found. All of these studies were based on limited patient numbers. Therefore, definitive conclusions could not be drawn concerning survival and success rates of immediately loaded implants compared with conventionally loaded implants. The compilation of the current literature shows that prospective controlled studies as well as prospective studies without controls using several different approaches to immediate loading have demonstrated high implant survival and success rates. However, more high-level evidence-based studies are needed to demonstrate the relative merits of immediate loading compared with conventional loading in all potential applications.

Radiographic signs of osseointegration in porous-coated acetabular components.

Abstract: UNLABELLED There currently is no direct method to radiographically determine osseointegration of an uncemented, porous-coated acetabular component. We defined five radiographic signs for detecting acetabular osseointegration: (1) absence of radiolucent lines; (2) presence of a superolateral buttress; (3) medial stress-shielding; (4) radial trabeculae; and (5) an inferomedial buttress. We assessed their ability to predict acetabular osseointegration by reviewing the postprimary and prerevision radiographs from a series of 119 total hip arthroplasties that had revision surgery. Each sign had a high positive predictive value for the presence of bone ingrowth (range, 92.2-96.3%). The absence of radiolucent lines, presence of superolateral buttresses, and presence of medial stress-shielding were the most sensitive signs for indicating bone ingrowth. Ninety-seven percent of the cups with three to five signs were bone ingrown, whereas 83% of the cups with one or no signs were unstable. When three or more signs were present, the positive predictive value of the radio-graphic test was 96.9%, the sensitivity was 89.6%, and the specificity was 76.9%. The five signs of acetabular osseointegration reliably predicted osseointegration, especially when used in combination. They can be used as a tool for radio-graphically assessing the status of patients with porous-coated uncemented cups. LEVEL OF EVIDENCE Diagnostic study, Level III (Study of nonconsecutive patients; without consistently applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.

A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: case series.

Abstract: Background: The current investigation focuses on new implant designs for increased predictability in clinically demanding situations. Microtextured implant surfaces create favorable conditions for enhanced osseointegration of dental implants compared to implants with a smooth surface, and the macroscopic implant design may influence implant stability. Purpose: The aim of the present study was to retrospectively evaluate the clinical performance of a novel implant design in the rehabilitation of completely edentulous jaws and in combination with an immediate function protocol. Materials and Methods: Forty-six consecutive patients received 189 study implants (NobelSpeedyTM concept implant, Nobel Biocare AB, Goteborg, Sweden) supporting 53 full-arch all-acrylic prostheses (44 maxilla, 9 mandible). The majority (66%) of the reconstructions were supported by four implants, of which the two posterior implants were tilted. All patients were followed for a minimum of 1 year. Radiographic assessment of the marginal bone level was performed. Results: Two implants were lost in two patients, rendering a 1-year cumulative clinical survival rate of 98.9%. The marginal bone level was, on average, situated 1.2 ± 0.7 mm below the implant-abutment interface after 1 year of loading. Good soft tissue health and overall esthetic outcome was reported. Conclusions: The results of the present pilot study indicate that fully edentulous jaws with various types of bone can be treated with high success and good esthetics using immediately loaded implants with the presented design, and that favorable marginal bone levels can be maintained.

Enhanced bone apposition around biofunctionalized sandblasted and acid-etched titanium implant surfaces. A histomorphometric study in miniature pigs.

Abstract: Microrough titanium (Ti) surfaces of dental implants have demonstrated more rapid and greater bone apposition when compared with machined Ti surfaces. However, further enhancement of osteoblastic activity and bone apposition by bio-functionalizing the implant surface with a monomolecular adsorbed layer of a co-polymer - i.e., poly(L-lysine)-graft-poly(ethylene glycol) (PLL-g-PEG) and its derivatives (PLL-g-PEG/PEG-peptide) - has never been investigated. The aim of the present study was to examine early bone apposition to a modified sandblasted and acid-etched (SLA) surface coated with an Arg-Gly-Asp (RGD)-peptide-modified polymer (PLL-g-PEG/PEG-RGD) in the maxillae of miniature pigs, and to compare it with the standard SLA surface. Test and control implants had the same microrough topography (SLA), but differed in their surface chemistry (polymer coatings). The following surfaces were examined histomorphometrically: (i) control - SLA without coating; (ii) (PLL-g-PEG); (iii) (PLL-g-PEG/PEG-RDG) (RDG, Arg-Asp-Gly); and (iv) (PLL-g-PEG/PEG-RGD). At 2 weeks, RGD-coated implants demonstrated significantly higher percentages of bone-to-implant contact as compared with controls (61.68% vs. 43.62%; P < 0.001). It can be concluded that the (PLL-g-PEG/PEG-RGD) coatings may promote enhanced bone apposition during the early stages of bone regeneration.

Harder and Stiffer Bone Osseointegrated to Roughened Titanium

Abstract: Mechanisms underlying the beneficial anchorage of roughened titanium implants have not been identified. We hypothesized that the implant surface roughness alters intrinsic biomechanical properties of bone integrated to titanium. Nano-indentation performed on two- and four-week post-implantation bone specimens of rats revealed that bone integrated to acid-etched titanium was approximately 3 times harder than that integrated to the machined titanium, both at the osseointegration interface and at the inner area of the peri-implant bone. The hardness of the acid-etched surface-associated bone was equivalent to that of untreated cortical bone at week 4, while the bone hardness around the machined surface was equivalent to that of the untreated trabecular bone. The elastic modulus of the integrated bone was 1.5 to 2.5 times greater around the acid-etched surface than around the machined surface. Analysis of the data suggests that the implant surface roughness affects the biomechanical quality of osseo-integrate...

Resonance frequency analysis and damping capacity assessment. Part I: an in vitro study on measurement reliability and a method of comparison in the determination of primary dental implant stability.

Abstract: Objectives The aims of this in vitro study were to evaluate reliability of the Osstell and Periotest devices in the assessment of implant stability and to perform a method comparison. Material and methods Commercial dental implants were inserted into bovine rib segments of different anatomical origins and densities. Repeated measurements were performed, varying (a) the torque-in force of the devices' attachment screw (the Osstell transducer and the ball attachment, insert for the Periotest device), (b) the insertion site bone quality, and (c) the thread exposure in simulated peri-implant bone defects. Results Both methods were comparably reliable and showed a strong association to each other in the classification of implant stability. As opposed to torque-forced screw attachment, the variations in bone composition, differences in inter-implant stability of adjacent implants, and peri-implant bone reduction were statistically significant for both methods. Conclusions Both non-invasive diagnostic devices seem to be useful in the long-term follow-up of implant integration.

Which surface properties enhance bone response to implants? Comparison of oxidized magnesium, TiUnite, and Osseotite implant surfaces.

Abstract: Purpose This study compared the speed and strength of osseointegration and osteoconductivity between an oxidized experimental magnesium (Mg) implant, an oxidized commercially available TiUnite implant, and a dual acid-etched surface Osseotite implant. The aim was to investigate which surface properties enhance bone response to implants, and thereby to test a biochemical bonding theory. Materials and methods A total of 60 screw implants (20 of each design) were inserted through 1 cortex into the tibiae of 10 rabbits. Surface chemistry, oxide thickness, morphology, crystal structure, and surface roughness were evaluated. After healing times of 3 and 6 weeks, all bone implants were unscrewed with removal torque (RTQ) devices, and the bone specimens were subjected to histomorphometry. Results RTQ values for Mg, TiUnite, and Osseotite implants were 27.1, 21.3, and 15.4 Ncm, with new bone formation values of 29%, 18%, and 15%, respectively, at 3 weeks. At 6 weeks the RTQ values were 37.5, 36.4, and 21.5 Ncm, with new bone formation values of 39%, 31%, and 26%, respectively. Discussion Mg implants demonstrated significantly greater RTQ values (P = .008 and P = .0001) and more new bone formation (P = .031 and P = .030) than Osseotite at 3 and 6 weeks, respectively. Mg implants also showed higher RTQ values at 3 weeks and new bone formation at 6 weeks than TiUnite, but neither were significant (P > .05). TiUnite showed significantly higher RTQ values than Osseotite at 6 weeks (P = .001), but was not significant at 3 weeks (P > .05). Osseointegration rate (deltaRTQ/deltaweeks) was significantly faster for Mg (P = .011) and TiUnite (P = .001) implants between 3 and 6 weeks of healing time, but was not significant for Osseotite. Conclusions The results indicate that surface chemistry facilitated more rapid and stronger osseointegration of the Mg implants despite their minimal roughness compared to the moderately roughened TiUnite. This suggests potential advantages of Mg implants for reducing high implant failure rates in the early postimplantation stage and in compromised bone, making it possible to shorten bone healing time from surgery to functional loading, and enhancing the possibility of immediate/early loading.

Predictability of Simultaneous Implant Placement in the Severely Atrophic Posterior Maxilla: A 9-Year Longitudinal Experience Study of 2,132 Implants Placed into 731 Human Sinus Grafts

Abstract: Purpose: One-stage implant placement in the grafted maxillary sinus has traditionally been limited to patients with at least 5 mm of residual bone to ensure complete implant stabilization. The aim of this prospective study was to determine the long-term survival rates of implants with roughened surfaces placed immediately into maxillary sinus grafts in patients with 1 to 5 mm of residual bone. Materials and Methods: A total of 2,132 microtextured screw-type (n = 1,374) or hydroxyapatite-coated cylindertype (n = 758) implants were immediately placed into the grafted sinuses of 731 patients. The implants were restored and monitored for up to 9 years of clinical follow-up. Results: Cumulative survival at 9 years was 97.9% (n = 2,091 implants); 20.4% of the implants were placed in 1 to 2 mm of residual bone. Discussion: Initial implant stability and parallelism were achieved through a combination of meticulous condensation of the particulate bone graft material around the implants, the frictional interface of the roughened implant surfaces and the host tissues, and selection of an appropriate graft material. Conclusions: Simultaneous implant placement into sinus floor grafts can be a predictable treatment option for patients with at least 1 to 2 mm of vertical residual bone height when careful case planning and meticulous surgical techniques are used. (More than 50 references) INT J ORAL MAXILLOFAC IMPLANTS 2006;21:94–102

Tissue characteristics at microthreaded implants: an experimental study in dogs.

Abstract: Purpose: The aim of the present study was to analyze bone tissue reactions at implants with and without a microthread configuration. Materials and Methods: In six beagle dogs, one test and two control implants were installed in one side of the mandible. While both implant types had a similar dimension and surface roughness, the test implants were designed with a microthread configuration in the marginal portion. Abutment connection was performed after 3 months. Another 3 months later, fixed partial dentures (FPDs) were cemented to the maxillary canine and premolars and FPDs were connected to the implants in the mandible. Ten months later, the animals were sacrificed and biopsies from each implant region were processed for histological analysis. Radiographs were obtained at implant placement after FPD connection and at the termination of the experiment. Results: The radiographic examination revealed that the marginal bone level was well preserved at both test and control implants during the entire 16-month period. The degree of bone-implant contact within the marginal portion of the implants was significantly higher at the test (microthread) implants (81.8%) than at the control implants (72.8%). Conclusions: It was suggested that the microthread configuration offered improved conditions for osseointegration.