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

Influence of implant diameter on surrounding bone

Objectives : Implant osseointegration is dependent upon various factors, such as bone quality and type of implant surface. It is also subject to adaptation in response to changes in bone metabolism or transmission of masticatory forces. Understanding of long-term physiologic adjustment is critical to prevention of potential loss of osseointegration, especially because excessive occlusal forces lead to failure. To address this issue, wide-diameter implants were introduced in part with the hope that greater total implant surface would offer mechanical resistance. Yet, there is little evidence that variation in diameter translates into a different bone response in the implant vicinity. Therefore, this study aimed at comparing the impact of implant diameter on surrounding bone. Material and methods : Twenty standard (3.75 mm) and 20 wide (5 mm) implants were placed using an animal model. Histomorphometry was performed to establish initial bone density (IBD), bone to implant contact (BIC) and adjacent bone density (ABD). Results : BIC was 71% and 73%, whereas ABD was 65% and 52%, for standard and wide implants, respectively. These differences were not statistically different ( P >0.05). Correlation with IBD was then investigated. BIC was not correlated with IBD. ABD was not correlated to IBD for standard implants ( r 2 =0.126), but it was correlated with wide implants ( r 2 =0.82). In addition, a 1 : 1 ratio between IBD and ABD was found for wide implants. It can be concluded, within the limits of this study, that ABD may be influenced by implant diameter, perhaps due to differences in force dissipation. To cite this article: Brink J, Meraw SJ, Sarment DP. Influence of implant diameter on surrounding bone. Clin. Oral Impl. Res. 18 , 2007; 563–568 doi: 10.1111/j.1600-0501.2007.01283.xPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75089/1/j.1600-0501.2007.01283.x.pd

Evaluation of Micromovements and Stresses around Single Wide-Diameter and Double Implants for Replacing Mandibular Molar: A Three-Dimensional FEA

Purpose. The purpose of this finite element study was to compare stresses, strains, and displacements of double versus single implant, in immediate loading for replacing mandibular molar. Materials and Methods. Two 3D FEM models were made to simulate implant designs. The first model used 6 mm wide-diameter implant to support a single molar crown. The second model used 3.75-3.75 double implant design. Each model was analyzed with a single force magnitude of 70 N in oblique axis in three locations. Results. This FEM study suggested that micromotion can be well controlled by both double implants and 6 mm single wide-diameter implant. The Von Mises stress for double implant had 31%–43% stress reduction compared to the 6 mm implant. Conclusion. Within the limitations of the paper, when the mesiodistal space for artificial tooth is more than 12.5 mm, under immediate loading, the double implant support should be considered

Mandibular Fracture in Conjunction with Bicortical Penetration, Using Wide-Diameter Endosseous Dental Implants

Prosthodontic rehabilitation of a patient with an atrophic edentulous mandible presents a significant challenge in restoring esthetics and function. The purpose of this clinical report is to describe fracture of an atrophic edentulous mandible opposing maxillary natural dentition in association with endosseous dental implants. The patient received two wide-diameter implants in the anterior mandible for an implant-assisted mandibular overdenture, in which the implants penetrated the inferior border of the mandible for bicortical stabilization. Three months following implant placement surgery, the patient experienced pain, swelling, and intraoral purulent drainage around the right implant. Panoramic radiograph revealed a fracture of the mandible through the right implant site and signs of infection around the left implant. The implants were removed surgically, and open reduction and fixation of the fracture site were undertaken using a titanium bone fixation plate. This clinical report demonstrates that placement of wide-diameter implants in conjunction with bicortical penetration in a severely atrophic edentulous mandible can risk fracture of the mandible.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79058/1/j.1532-849X.2010.00646.x.pd

Finite element analysis of narrow dental implants

Narrow-diameter implants (NDIs) traditionally have been associated to higher rates of failure in comparison with regular-diameter implants (RDIs) and wide-diameter implants (WDIs), since they generate a more unfavorable stress distribution in peri-implant bone. However, it is well known that the load sharing effect associated with prostheses supported by multiple implants (also called splinted prostheses) affords mechanical benefits. The present study involves finite element analysis (FEA) to determine whether the risks linked to NDIs could be mitigated by the mechanical advantages afforded by the splinting concept. For this purpose, a three-dimensional (3D) model of a real maxilla was reconstructed from computed tomography (CT) images, and different implants (NDIs, RDIs and WDIs) and prostheses were created using computer-aided design (CAD) tools. Biting forces were simulated on the prostheses corresponding to three different rehabilitation solutions: single-implant restoration, three-unit bridge and all-on-four treatment. Stress distribution around the implants was calculated, and overloading in bone was quantified within peri-implant volumes enclosed by cylinders with a diameter 0.1 mm greater than that of each implant. The mechanical benefits of the splinting concept were confirmed: the peri-implant overloaded volume around NDIs splinted by means of the three-unit bridge was significantly reduced in comparison with the nonsplinted condition and, most importantly, proved even smaller than that around nonsplinted implants with a larger diameter (RDIs). However, splinted NDIs supporting the all-on-four prosthesis led to the highest risk of overloading found in the study, due to the increase in compressive stress generated around the tilted implant when loading the cantilevered molar.Peer ReviewedPostprint (author's final draft

Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology.

PurposeThree-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy.Material and methodsThree brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic.ResultsPatient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences.ConclusionsWe established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators

"All on short" prosthetic-implant supported rehabilitations

Objectives. Short implants are increasing their popularity among clinicians who want to fulfill the constant demanding of fixed prosthetic solutions in edentulous jaws. The aim of this report was to propose a new possibility to project and realize an occlusal guided implant cross-arch prosthesis supported by ultra-short implants, describing it presented an edentulous mandible case report. Methods. A 61-year-old, Caucasian, female patient who attended the dental clinic of the University of L’Aquila presented with edentulous posterior inferior jaw and periodontitis and periimplantitis processes in the anterior mandible. The remaining tooth and the affected implant were removed. Six 4-mm-long implants were placed to support a cross-arch metal-resin prosthesis. Results. At 1-year follow-up clinical and radiological assessment showed a good osseointegration of the fixtures and the patient was satisfied with the prosthesis solution. Conclusion. The method, even if it requires further validation, seems to be a valid aid in solving lower edentulous clinical cases, and appears less complex and with more indications of other proposals presented in the current clinical literature. Our case report differs from the current technique All-on-Four, which uses four implants in the mandible to support overdenture prosthesis, assuring a very promising clinical resul

Platform Switching of Implants May Decrease Bone Loss

Data sources: PubMed/Medline, Web of Science and the Cochrane Oral Health Group Trials Register, clinicaltrials.gov, www.centerwatch.com/clinical-trials, www.clinicalconnection.com supplemented by a manual search of dental implants-related journals. Study selection: Clinical studies, either randomised or not, comparing implant failure rates, marginal bone level (MBL) and/or postoperative infection in any group of patients receiving platform-switched implants or platform-matched implants were considered. Data extraction and synthesis: Study quality was assessed using the Newcastle-Ottawa scale (NOS).Only randomised clinical trials (RCTs) were considered for meta-analysis. Implant failure and postoperative infection were the dichotomous outcomes measures evaluated. Weighted mean differences were used for MBL. Results: Twenty-eight studies (18 RCTs, six CCTs and four retrospective analyses) were included. Twenty-six studies were considered to be of high quality. Twelve hundred and sixteen platform-switched implants were included with 16 failures (1.32%) and 1157 platform-matched implants and 13 failures (1.12%). Twenty studies had no implant failures. In a meta-analysis for the outcome MBL (18-RCTs) there was less MBL loss at implants with platform-switching than at implants with platform-matching (mean difference -0.29, 95% CI −0.38 to −0.19; P\u3c0.00001) Conclusions: The results of the present study suggest that there is a significantly less MBL loss at implants with platform-switching than on implants with platform-matching. The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them with short follow-up periods

Mechanical Behavior and Failure Analysis of Prosthetic Retaining Screws after Long‐term Use In Vivo. Part 3: Preload and Tensile Fracture Load Testing

Purpose: The aim of this study was to determine the preload and tensile fracture load values of prosthetic retaining screws after long‐term use in vivo compared to unused screws (controls). Additionally, the investigation addressed whether the preload and fracture load values of prosthetic retaining screws reported by the manufacturer become altered after long‐term use in vivo. Materials and Methods: For preload testing, 10 new screws (controls) from Nobel Biocare (NB) and 73 used retaining screws [58 from NB and 15 from Sterngold (SG)] were subjected to preload testing. For tensile testing, eight controls from NB and 58 used retaining screws (46 from NB and 12 from SG) were subjected to tensile testing. Used screws for both tests were in service for 18–120 months. A custom load frame, load cell, and torque wrench setup were used for preload testing. All 83 prosthetic screws were torqued once to 10 Ncm, and the produced preload value was recorded (N) using an X–Y plotter. Tensile testing was performed on a universal testing machine and the resulting tensile fracture load value was recorded (N). Preload and tensile fracture load values were analyzed with 2‐way ANOVA and Tukey post‐hoc tests. Results: There was a significant difference between preload values for screws from NB and screws from SG (p \u3c 0.001). The preload values for gold alloy screws from NB decreased as the number of years in service increased. There was a significant difference between tensile fracture values for the three groups (gold alloy screws from NB and SG and palladium alloy screws from NB) at p \u3c 0.001. The tensile fracture values for gold alloy screws from NB and SG decreased as the number of years in service increased. Conclusions: In fixed detachable hybrid prostheses, perhaps as a result of galling, the intended preload values of prosthetic retaining screws may decrease with increased in‐service time. The reduction of the fracture load value may be related to the increase of in‐service time; however, the actual determination of this relationship is not possible from this study alone