Tooth-Implant connection : a bibliographic review

The aim of this study was to carry out a bibliographic review of all available literature addressing the issue of whether or not the connection of teeth to implants by means of a prosthesis is a viable treatment alternative. Twenty articles from a variety of sources were analyzed and classified in order to draw conclusions. Articles were classified by type and an analysis was made of the different variables considered in each study, obtaining percentages of implant survival ranging from 84.4% to 100%, prosthetic complications ranging from 80% to 90%, and the incidence of dental intrusion ranging from 0 to 5.6%. Biomechanical studies: Some articles studied models in order to assess different connections subjected to force, in which varying results were obtained. Rigid connections appeared to produce the most stress to the natural tooth, periodontal ligament and peri-implant bone; non-rigid connections reduced the stress to the bone, but increased stress to the prosthesis. Clinical studies: The results obtained were disparate. Studies in the medium or short-term show this as a viable treatment alternative, whereas some studies point to a greater risk of complications, although the use of rigid connection decreases the percentage of intrusion. Other bibliographic reviews have concluded that there is a need for more longitudinal studies on the viability of tooth-implant connection, also concluding that complications are greater when this is the chosen treatment. As a viable alternative with an acceptable success rate, this course of treatment is always associated with rigid connection rather than non-rigid connection. Although intrusion is avoided with rigid connection, this nevertheless remains inadvisable as the primary treatment choice

Ensanchamiento y elevación del suelo sinusal maxilar con osteotomos compresivos

Objetivo: El objetivo de este artículo es evaluar la eficacia de la técnica del ensanchamiento alveolar posterior y elevación del reborde alveolar del maxilar superior mediante el uso de los osteótomos compresivos ( Quirurgical Bontempi, España) especialmente diseñados para los implantes Osseotite NT y Osseotite NT Certain de 3i ( Implants Innovations, USA). Material y métodos: En el estudio se incluyeron 24 pacientes (16 mujeres y 8 hombres) siguiendo los criterios de inclusión y exclusión de Albrektsson, que presentaban un déficit óseo en anchura y altura del maxilar superior. Se colocaron 48 implantes Osseotite ( cuatro Osseotite Standard, seis Ossoetite NT y treinta y ocho NT Certain (3i, Implantes Innovations, CA, USA). El diámetro de los implantes fueron 44 de 4 mm y 4 de 5 mm con longitudes que variaban entre 11.5 (n=4) y 13 mm (n= 44). La cresta alveolar inicial tenía una anchura que variaba de 1.5mm a 5 mm y una altura que oscilaba entre 5 mm y 13 mm en los 24 pacientes. Resultados: Los datos obtenidos fueron analizados con el programa SPSS 11.0. En los 48 sitios tratados donde se colocaron los implantes inmediatos se obtuvo un aumento de altura ósea de 6.75 mm ± 1.25 mm. En el ensanchamiento alveolar de los 48 sitios implantados la media fue de 3.2 mm ± 0.15 mm. Conclusiones: La técnica de ensanchamiento y elevación alveolar del maxilar superior con osteótomos compresivos permite obtener un porcentaje de éxito de un 100 % a los 9 meses de seguimiento en los implantes y prótesis colocadas. Es un procedimiento quirúrgico con alta predictibilidad y además permite la colocación los implantes en el mismo acto quirúrgico reduciendo el número de cirugías, devolviendo la estética y función del paciente perdidas.Aim: The aim of this article is to assess the efficiency of the technique for the posterior alveolar expansion and elevation of the upper maxillary alveolar ridge through the use of compressive osteotomes (Quirurgical Bontempi, España) which have been specifically designed for Osseotite NT and Osseotite NT Certain of 3i implants (Implants Innovations, USA). Materials and Methods: 24 adult patients (16 female and 12 male), who were selected according to Albrektsson's inclusion and exclusion criteria, took part in the study. All the patients presented bone deficiency in the width and height of the upper maxilla. 48 Osseotite implants were performed (four Osseotite Standard; six Osseotite NT; 38 NT Certain (3i, Implants Innovations, CA, USA)). Implant diameters were 4 mm in 44 cases and 5 mm in 4 cases with lengths varying between 11.5 (n = 4) and 13 mm. (n = 44). The alveolar ridges of the 24 patients had initial widths from 1.5 mm to 5 mm and heights between 5 and 13mm. Results: The data obtained were analysed using the SPSS 11.0 program. In the 48 areas treated with immediate implants, an increase in bone height of 6.75 mm ± 1.25 mm. was achieved. In the case of the alveolar expansion for the 48 implants, the average was 3.2 mm. ± 0.15 mm. Conclusions: The technique for alveolar expansion and elevation of the upper maxilla with compressive osseotomes can lead to a 100% success rate after a 9-month follow-up of the implants and insertion of prostheses. It is a highly predictable surgical procedure which allows implants to be performed at the same time as surgery, thus reducing the number of such interventions while recovering aesthetic and functional losses in the patient

The implant-supported milled bar overdenture : a literature review

Purpose: This bibliographical review aims to determine the present situation of the implant-supported milled bar overdenture as a therapeutic option in implantology, as well as to set and compare the techniques and materials currently used for making them. Materials and methods: By searching the main electronic bibliographical data in indexed Medline articles, we obtained a total number of 20 articles that fulfilled the requirements of this bibliographical review. Results: The implant-supported milled bar overdenture offers excellent long-term successful results, although complication rates are higher in emergency cases of patients initially planned for a fixed prosthesis. Krenmair and collaborators found cumulative survival rates of implants on milled bars after 5 years, of 99% in mandible cases, and of 97.8% in maxilla cases. No detailed protocols specifying the necessary number of implants or their characteristics have been found, though they are never made with less than 4 implants in mandible or 4-6 in the maxilla. Milled bars are screwed, generally cast in a precious metal alloy, with a metal or acrylic suprastructure and include attachments that regulate the tightness. The suprastructure adjusts precisely and rigidly to the milled bar, and presents similar biomechanical movements to those of fixed prostheses. The overdenture is removable and its prophylaxis is simple. Conclusions: The implant supported milled bar overdenture is a very interesting option in the treatment of patients with moderate to severe reabsorbed maxilla problems. It offers both the advantages of removable prostheses as well as the stability and retention of a fixed prosthesis

Evaluation of the overdiagnosis in breast screening programmes using a Monte Carlo simulation tool: a study of the influence of the parameters defining the programme configuration

Objectives To build up and test a Monte Carlo simulation procedure for the investigation of overdiagnosis in breast screening programmes (BSPs). Design A Monte Carlo tool previously developed has been adapted for obtaining the quantities of interest in order to determine the overdiagnosis: the annual and cumulative number of cancers detected by screening, plus interval cancers, for a population following the BSP, and detected clinically for the same population in the absence of screening. Overdiagnosis is obtained by comparing these results in a direct way. Results Overdiagnosis between 7% and 20%, depending on the specific configuration of the programme, have been found. These range of values is in agreement with some of the results available for actual BSPs. In the cases analysed, a reduction of 11% at most has been found in the number of invasive tumours detected by screening in comparison to those clinically detected in the control population. It has been possible to establish that overdiagnosis is almost entirely linked to ductal carcinoma in situ tumours. Conclusions The use of Monte Carlo tools may facilitate the analysis of overdiagnosis in actual BSPs, permitting to address the role played by various quantities of relevance for them.Work partially supported by the Biomedical Research Networking Center- CIBER de Epidemiología y Salud Pública (CIBERESP), the Spanish Ministerio de Ciencia y Competitividad (FPA2015-67694), the European Regional Development Fund (ERDF) and the Junta de Andalucía (FQM0387)

Compressive osteotomes for expansion and maxilla sinus floor lifting

Aim: The aim of this article is to assess the efficiency of the technique for the posterior alveolar expansion and elevation of the upper maxillary alveolar ridge through the use of compressive osteotomes (Quirurgical Bontempi, España) which have been specifically designed for Osseotite NT and Osseotite NT Certain of 3i implants (Implants Innovations, USA). Materials and methods: 24 adult patients (16 female and 12 male), who were selected according to Albrektsson?s inclusion and exclusion criteria, took part in the study. All the patients presented bone deficiency in the width and height of the upper maxilla. 48 Osseotite implants were performed (four Osseotite Standard; six Osseotite NT; 38 NT Certain (3i, Implants Innovations, CA, USA)). Implant diameters were 4 mm in 44 cases and 5 mm in 4 cases with lengths varying between 11.5 (n = 4) and 13 mm (n = 44). The alveolar ridges of the 24 patients had initial widths from 1.5 mm to 5 mm and heights between 5 and 13 mm. Results: The data obtained were analysed using the SPSS 11.0 program. In the 48 areas treated with immediate implants, an increase in bone height of 6.75 mm ± 1.25 mm was achieved. In the case of the alveolar expansion for the 48 implants, the average was 3.2 mm ± 0.15 mm. Conclusions: The technique for alveolar expansion and elevation of the upper maxilla with compressive osseotomes can lead to a 100% success rate after a 9-month follow-up of the implants and insertion of prostheses. It is a highly predictable surgical procedure which allows implants to be performed at the same time as surgery, thus reducing the number of such interventions while recovering aesthetic and functional losses in the patien

Development of a Novel Nanotextured Titanium Implant. An Experimental Study in Rats.

This animal study evaluated the osseointegration level of a new nanotextured titanium surface produced by anodization. Ti-cp micro-implants (1.5 mm diameter by 2.5 mm in length) divided into two groups: titanium nanotextured surface treatment (Test Group) and acid etched surface treatment (Control Group). Surface characterization included morphology analysis using scanning electron microscopy and wettability by measuring contact angle. Sixteen Wistar rats were submitted to two micro implants surgical placement procedures. In each rat, one type of micro implant placed in each tibia. The animals sacrificed after two (T1) and six weeks (T2) post-implantation. After the euthanasia, tibias processed for histomorphometric analysis, which allowed the evaluation of bone to implant contact (BIC) and the bone area fraction occupancy between the threads (BAFO). Our surface analysis data showed that the Control Group exhibited an irregular and non-homogenous topography while the Test Group showed a nanotextured surface. The Test Group showed higher wettability (contact angle = 5.1 ± 0.7°) than the Control Group (contact angle = 75.5 ± 4.6°). Concerning the histomorphometric analysis results for T1, Control and Test groups showed BIC percentages of 41.3 ± 15.2% and 63.1 ± 8.7% (p < 0.05), respectively, and for BAFO, 28.7 ± 13.7% and 54.8 ± 7.5%, respectively (p < 0.05). For T2, the histomorphometric analysis for Control and Test groups showed BIC percentages of 51.2 ± 11.4% and 64.8 ± 7.4% (p < 0.05), respectively and for BAFO, 36.4 ± 10.3% and 57.9 ± 9.3% (p < 0.05), respectively. The findings of the current study confirmed that the novel nanotextured surface exhibited superior wettability, improved peri-implant bone formation, and expedited osseointegration

Pharmacological interactions of anti-inflammatory-analgesics in odontology

In this second article we describe the more interesting pharmacological interactions in dental practice based on the prescription of analgesic narcotics, paracetamol and non-selective non-steroid anti-inflammatory drugs (NSAI) (which inhibit cyclooxigenase 1 ?COX 1- and cyclooxigenase 2 ?COX 2-) and selective NSAIs (COX 2 inhibitors). The importance of preventing the appearance of these pharmacological interactions is because these are medicaments prescribed daily in odontology for moderate pain treatment and inflammation in the oral cavity. Paracetamol can interact with warfarin and therefore care should be taken with chronic alcoholic patients. All NSAIs reduce renal blood flow and consequently are capable of reducing the efficacy of medicaments used for treating arterial hypertension, which act via a renal mechanism. Especial attention should be taken considering the risk of interaction between the antagonists of AT1 receptors of angiostensin II (ARAII) and the NSAIs

Pharmacological interactions of anti-microbial agents in odontology

In this third article we describe the pharmacological interactions resulting from the use of anti-microbial agents. Although the antimicrobials prescribed in odontology are generally safe they can produce interactions with other medicaments which can give rise to serious adverse reactions which are well documented in clinical studies. Antibiotics with grave and dangerous life threatening consequences are erythromycin, clarithromycin and metronidazol and the anti-fungal agents are ketoconazol and itraconazol. Regarding the capacity of the anti-microbials to reduce the efficacy of oral anti-contraceptives the clinical studies to date are inconclusive, however, it would be prudent for the oral cavity specialist to point out the risk of a possible interaction. Therefore the specialist should be aware of possible interactions as a consequence of administering an antibiotic together with other medicaments the patient may be taking

Immediate loading and immediate restoration in 105 expanded-platform implants via the Diem System after a 16-month follow-up period

Objective: The aim of this study was to report on our experience and outcomes with Certain Prevail Implants and immediate loading via the Diem System after a 16-month follow-up period. Materials and Methods: Over a 16- month period, 105 (14 maxilla, 91 mandible) expanded-platform implants were placed in 18 patients (15 females, 3 males; 55.97 ±7.25 SD years). Resonance frecuency analysis (RFA) was measured on the day of placement and at 3, 12 and 16 months. All prostheses were screw mounted on IOL DIEM standard abutments. The follow-up time varied between 3 up to 16 months. Results: One implant (0.9%) failed during final prothetic placement (3 months). The RFA (ISQ) measurements at 16 months evalution for 4 mm- and 5 mm diameter implants were: 76.13 ± 5.0 SD and 76 ±7.7 SD respectively. The RFA data related to mandible and maxilla, the day 0 mean was 76.47 ± 4.75 SD and 70.13 ± 1.35 SD, at 3 months 70.53 ± 4.0 SD and 66.07 ±2.9 SD, at 12 months 68.23± 3.6 SD and 66.40 ±2.7 SD and 16 months 68.23± 3.6 SD and 66.60 ± 2.5 SD respectively. The crestal bone resorption was 0.6 mm at 16 months in platform switching implants.Conclusions: The cumulative implant survival rate during the follow-up period was 99.1% Immediate loading on IOL Diem abutments is a reliable and effective technique for edentulous patients in the maxilla and mandible

Pharmacological interactions of vasoconstrictors

This article is the first of a series on pharmacological interactions involving medicaments commonly prescribed and/or used in odontology: vasoconstrictors in local anaesthetics and anti-inflammatory and anti-microbial analgesics. The necessity for the odontologist to be aware of adverse reactions as a result of the pharmacological interactions is due to the increase in medicament consumption by the general population. There is a demographic change with greater life expectancy and patients have increased chronic health problems and therefore have increased medicament intake. The presence of adrenaline (epinephrine) and other vasoconstrictors in local odontological anaesthetics is beneficial in relation to the duration and depth of anaesthesia and reduces bleeding and systemic toxicity of the local anaesthetic. However, it might produce pharmacological interactions between the injected vasoconstrictors and the local anaesthetic and adrenergic medicament administered exogenically which the odontologist should be aware of, especially because of the risk of consequent adverse reactions. Therefore the importance of conducting a detailed clinical history of the general state of health and include all medicaments, legal as well as illegal, taken by the patient