Unified Approach to the Biomechanics of Dental Implantology

The human need for safe and effective dental implants is well-recognized. Although many implant designs have been tested and are in use today, a large number have resulted in clinical failure. These failures appear to be due to biomechanical effects, as well as biocompatibility and surgical factors. A unified approach is proposed using multidisciplinary systems technology, for the study of the biomechanical interactions between dental implants and host tissues. The approach progresses from biomechanical modeling and analysis, supported by experimental investigations, through implant design development, clinical verification, and education of the dental practitioner. The result of the biomechanical modeling, analysis, and experimental phases would be the development of scientific design criteria for implants. Implant designs meeting these criteria would be generated, fabricated, and tested in animals. After design acceptance, these implants would be tested in humans, using efficient and safe surgical and restorative procedures. Finally, educational media and instructional courses would be developed for training dental practitioners in the use of the resulting implants

A review on the prevention of inflammatory periimplant diseases

Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; 'Clinical Trial,' 'Meta analysis,' 'Observational study,' 'Review,' and 'Validation study' were selected as article type filters. The following keywords were used in the searches: 'Peri implantitis prevention' and 'Dental implant failure prevention.'Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly

Implant Treatment in the Predoctoral Clinic: A Retrospective Database Study of 1091 Patients

Purpose: This retrospective study was conducted at the Marquette University School of Dentistry to (1) characterize the implant patient population in a predoctoral clinic, (2) describe the implants inserted, and (3) provide information on implant failures. Materials and Methods: The study cohort included 1091 patients who received 1918 dental implants between 2004 and 2012, and had their implants restored by a crown or a fixed dental prosthesis. Data were collected from patient records, entered in a database, and summarized in tables and figures. Contingency tables were prepared and analyzed by a chi-squared test. The cumulative survival probability of implants was described using a Kaplan-Meier survival curve. Univariate and multivariate frailty Cox regression models for clustered observations were computed to identify factors associated with implant failure. Results: Mean patient age (±1 SD) at implantation was 59.7 ± 15.3 years; 53.9% of patients were females, 73.5% were Caucasians. Noble Biocare was the most frequently used implant brand (65.0%). Most implants had a regular-size diameter (59.3%). More implants were inserted in posterior (79.0%) than in anterior jaw regions. Mandibular posterior was the most frequently restored site (43%); 87.8% of implants were restored using single implant crowns. The overall implant-based cumulative survival rate was 96.4%. The patient-based implant survival rate was 94.6%. Implant failure risk was greater among patients than within patients (p \u3c 0.05). Age (\u3e65 years; hazard ratio [HR] = 3.2, p = 0.02), implant staging (two-stage; HR = 4.0, p \u3c 0.001), and implant diameter (wide; HR = 0.4, p = 0.04) were statistically associated with implant failure. Conclusions: Treatment with dental implants in a supervised predoctoral clinic environment resulted in survival rates similar to published results obtained in private practice or research clinics. Older age and implant staging increased failure risk, while the selection of a wide implant diameter was associated with a lower failure risk

Oral Squamous Cell Carcinoma Associated with a Dental Implant: a case report and literature review

Objectives: Prosthodontic rehabilitation using dental implants has become a common practice in dentistry at the present time. Although severe complications related to dental osseointegrated implants are uncommon, in recent years several cases of oral squamous cell carcinoma adjacent to dental implants have been published. Study Design: A 67-year-old edentulous woman developed an oral squamous cell carcinoma around right mandibular implant about 12 months after receiving dental implants. The treatments involve chemotherapy, explantation of the implants and radiotherapy. Result and Conclusions: The use of endosseous implants has been associated with a low risk for the development of cancer. However, this case report serves as evidence to the importance of careful screening at routine dental examinations especially if the patient suffers from peri-implantitis, any mucosal erosion or discoloration, leukoplakia around implant, pain, implant loosening, bone loss around implant, mucosal erythema, and soft tissue inflammation

Survival of dental implants in patients with oral cancer treated by surgery and radiotherapy: a retrospective study

BACKGROUND: The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy. METHODS: We collected data for 34 subjects (22 females, 12 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone. RESULTS: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determinin

Comparison of osseointegration in piezoimplants versus cylindrical implants

BACKGROUND: Dental implants have been successful for the restoration of edentulous areas, but current techniques are inadequate in areas lacking sufficient bone volume. Piezoelectric surgery has shown encouraging effects on both osseous healing. A new wedge-shaped titanium PiezoImplant requires piezoelectric osteotomy. This study compares PiezoImplants to conventional threaded cylindrical shaped implants by microcomputed tomography and histology to assess osseointegration, tissue response, and alveolar ridge changes. METHODS: After 3 months post-extraction, 18 conventional cylindrical implants and 18 wedge-shaped PiezoImplants were placed using a split-mouth design in 3 adult mini pigs. The cylindrical implant sites were prepared for osteotomy with rotary instrumentation while the PiezoImplant sites were prepared with piezoelectric surgical inserts. One animal was sacrificed at 4, 8, and 12 weeks post operation. Quantitative µCT and histological analysis evaluated bone volume, osseointegration, and post-operative cellular events. RESULTS: The results of a multivariable linear regression model demonstrated that the PiezoImplants, arch location, and time were significant factors on higher BV/TV percentage. Bone to implant contact (BIC) analysis by high resolution microscopy and histomorphometry indicated osseointegration though intimate contact between implants and adjacent alveolar bone in both groups. The tissue response displayed no evidence of abnormal healing and the PiezoImplant was classified as a non-irritant. CONCLUSION: The combination of piezoelectric osteotomy and newly designed PiezoImplants had favorable effects on wound healing and osseointegration compared to conventional cylindrical implants. These novel wedge-shaped implants may be beneficial for narrow ridge spaces without additional ridge augmentation. Further research is needed to establish clinical validity

Primary oral squamous cell carcinoma arising around dental osseointegrated implants mimicking peri-implantitis

Prosthodontic rehabilitation using dental implants has become a common practice in dentistry at the present time. The number of complications related to dental osseointegrated implants has increased according to the generalization of its use along the last decade. Among the most common of these complications are chronic inflammatory conditions affecting both hard and soft tissues around dental implants. Although severe complications are uncommon, in recent years several cases of oral squamous cell carcinoma adjacent to dental implants have been published. In this paper we present a new unusual case of primary oral squamous cell carcinoma arising around a dental fixed prosthesis over osseointegrated implants in a 76 male patient with no previous history of malignance and no risk factors related to oral cancer

Review Found Little Difference between Sandblasted and Acid-etched (SLA) Dental Implants and Modified Surface (SLActive) Implants

Data sources Medline, Embase, the Cochrane Oral Health Group\u27s Trials Register and OpenGREY databases were searched together with the reference lists of identified articles. Study selection Randomised controlled trials (RCTs) and prospective cohort studies of at least six month duration were included. Studies/case series in which there was only one implant surface (SLA or SLActive) and one loading protocol (immediate or early) were also considered. Data extraction and synthesis Two reviewers screened, selected and abstracted data, independently. RCTs were assessed for quality using the Cochrane risk of bias approach and observational studies using the Newcastle-Ottawa scale (NOS). The primary outcomes were changes from baseline to follow-up of clinical attachment level (CAL), probing depth (PD) and radiographic changes in the peri-implant bone level and number of implants lost. Cumulative survival rates (%) of each included study were calculated. Results Twenty-three articles reporting 19 studies (seven RCTs; 12 prospective observational studies) were included. The seven RCTs included 407 patients with 853 implants (8% titanium plasma-sprayed, 41.5% SLA and 50.5% SLActive). Only one RCT was considered to be at low risk of bias, the others were considered to be at unclear risk. The 12 observational studies included 1394 SLA and 145 SLActive implants and were considered to be of medium methodological quality based on the NOS. A narrative summary of the studies was undertaken owing to marked heterogeneity of the loading periods, types of implants described and lack of occurrence of the outcome of interest. There were no significant differences reported in the studies in relation to implant loss or clinical parameters between the immediate/early loading and delayed loading protocols. Overall, 95% of SLA and 97% of SLActive implants still survive at the end of follow-up. Conclusions Despite the positive findings achieved by the included studies, few RCTs were available for analysis for SLActive implants. Study heterogeneity, scarcity of data and the lack of pooled estimates represent a limitation between studies\u27 comparisons and should be considered when interpreting the present findings

Fracture Resistance of Zirconia Oral Implants In Vitro: A Systematic Review and Meta-Analysis

Various protocols are available to preclinically assess the fracture resistance of zirconia oral implants. The objective of the present review was to determine the impact of different treatments (dynamic loading, hydrothermal aging) and implant features (e.g., material, design or manufacturing) on the fracture resistance of zirconia implants. An electronic screening of two databases (MEDLINE/Pubmed, Embase) was performed. Investigations including > 5 screw-shaped implants providing information to calculate the bending moment at the time point of static loading to fracture were considered. Data was extracted and meta-analyses were conducted using multilevel mixed-effects generalized linear models (GLMs). The Šidák method was used to correct for multiple testing. The initial search resulted in 1864 articles, and finally 19 investigations loading 731 zirconia implants to fracture were analyzed. In general, fracture resistance was affected by the implant design (1-piece > 2-piece, p = 0.004), material (alumina-toughened zirconia/ATZ > yttria-stabilized tetragonal zirconia polycrystal/Y-TZP, p = 0.002) and abutment preparation (untouched > modified/grinded, p < 0.001). In case of 2-piece implants, the amount of dynamic loading cycles prior to static loading (p < 0.001) or anatomical crown supply (p < 0.001) negatively affected the outcome. No impact was found for hydrothermal aging. Heterogeneous findings of the present review highlight the importance of thoroughly and individually evaluating the fracture resistance of every zirconia implant system prior to market release