Vol.18 / No.

1 Jul-Aug 2009

Dental Implant Summaries
and related areas of research



Nackaerts O. Huang H-L. no responsibility can be accepted for accuracy and readers should consult the original articles on matters of importance. Subscription rates for Vol. Journal of Oral and Maxillofacial Implants June 2009. Dr. stored in a retrieval system. Journal of Oral and Maxillofacial Implants August 2009. Lindström H. All rights reserved. Worthington H. 5 A rough surface implant neck with microthreads reduces the amount of marginal bone loss: A prospective study Clinical Oral Implants Research August 2009. resonance frequency measurements. Iezzi G. Bratu E. Tel +44 (0)20 7935-8687. Michael Norton Editorial Consultants: Dr. Molenderg A.com © Specialist Dental Summaries Ltd 2008/09. Zembic A. London. Schüpbach P. Aksoy U. Park K-H. Subramani K. Sieweke J. 13 Bone quality assessment based on cone beam computed tomography imaging Clinical Oral Implants Research August 2009. Stephen Jacobs.Dental Implant Summaries 1 A randomized prospective multicenter trial evaluating the platform-switching technique for the prevention of postrestorative crestal bone loss Int. Hua Y. 104 Harley Street. The rate is for 6 issues payable in advance and includes access to online edition. Managing Editors: Dr.com While every effort is made to ensure correctness of all summarised material. Manero J. Aparicio C. Berglundh T. Europe: EUR 120. Wennstrom J. Grusovin M. Fuh L-J. Moon I-S. 10 Influence of the height of the external hexagon and surface treatment on fatigue life of commercially pure titanium dental implants 11 Influence of early cover Int. Kia Rezavandi. Journal of Oral and Maxillofacial Implants August 2009. 3 Load fatigue performance of implant-ceramic abutment combinations Int. Gherlone E. 15 Extent of peri-implantitis associated bone loss Journal of Clinical Periodontology April 2009. W1G 7JD. Other: USD 160. Shapira L. Philip Friel Dr. Mark Atkinson. Duyck O. Kim C-K. Dr. Zarone F. Samuelsson E. photocopying or otherwise without written permission from Specialist Dental Summaries Ltd. 7 Biofilm on dental implants: A review of the literature Int. Students receive 25% discount (please include verification with order). Journal of Oral and Maxillofacial Implants August 2009. Journal of Oral and Maxillofacial Implants June 2009. Register online at www. Tomasi C. Eratalay K. Piattelli A. Rodriguez N. Shen Y-W. Prosper L. 12 Evaluation of nano- technology-modified zirconia oral implants: A study in rabbits Journal of Clinical Periodontology July 2009. 2009 . screw exposure on crestal bone loss around implants: Intraindividual comparison of bone level at exposed and non-exposed implants Journal of Periodontology June 2009. . 1 Jul-Aug 2009 2 Agreement of quantitative subjective evaluation of esthetic changes in implant dentistry by patients and practitioners Int. electronic.18. Dr.Jul 2010 UK: GBP 90. and histomorphometric evaluations of dental implant osteotomy sites Implant Dentistry August 2009. Tan K. Maes F. Overseas rates include Air Mail postage. Hsu J-T. Persson G. 8 Randomized-controlled clinical trial of customized zirconia and titanium implant abutments for single-tooth implants in canine and posterior regions Clinical Oral Implants Research August 2009. Fax +44 (0)20 7855-0282 Email dissales@dentalsummaries. Radaelli S. 14 Mechanical non-surgical treatment of peri-implantitis: A double blind randomized longitudinal clinical study Journal of Clinical Periodontology July 2009. Susin C. Jung R. Strocchi R. Padrós A. Degidi M. Lee J. Hämmerle C. Nicholls J. Nadeem Zafar Dental Implant Summaries (ISSN 0967-375X) Produced bi-monthly by Specialist Dental Summaries Ltd. Hammerle C. United Kingdom. Wikesjö U. Esposito M. 6 Bone strain and interfacial sliding analyses of platform switching and implant diameter on an immediately loaded implant Journal of Periodontology July 2009. Dr. Perrotti V. Max Suleiman. Lee D-W. 9 Is insertion torque correlated to bone-implant contact percentage in the early healing period? A histological and histomorphometrical evaluation of 17 human-retrieved implants Clinical Oral Implants Research August 2009. No part of this publication may be reproduced. Radaelli G.dentalsummaries. Nguyen H. Tandlich M. Fransson F. Gil F. Jung R-E. mechanical. Dr. Lindahl C. Lin D-J. Sailer I. Jacobs R. or transmitted in any form or by any means. Back issues GBP 18 or USD 35 per copy (subject to availability). Vol. Renvert S. 18 / No. Pasi M. Koray Feran. 4 The possible association among bone density values. Dr. Zaki Kanaan. Kim T-H. Tozum T. tactile sense.

abnormal occlusal loading. 4. Additional studies are needed to evaluate long term results of platform switching under various conditions. only small increases in CBL were seen for the standard implants in the SPS group (6. with a centralized abutment junction. Several etiological factors have been proposed for CBL such as: surgical trauma. Zarone F. Redaelli S. No other factors demonstrated any significant influence.1 A randomized prospective multicenter trial evaluating the platform-switching technique for the prevention of postrestorative crestal bone loss Crestal bone loss (CBL) has been an established criterion for long-term implant success. with their results being excluded from the analyses. Standard diameter implants in all groups exhibited more CBL than EP implants.007). Pasi M. Loris Prosper Via San Gottardo 84 20152 Monza Milan ITALY Material and Methods  78 patients were enrolled in this multicenter. 0. which was not significant.3.3. or included type 4 bone.5mm. non-smokers. randomized prospective study. The EP implants were more conical. with some implants incorporating this in their design.0006).5mm/3. 24 No. Data was grouped according to CBL values as follows: < 0mm. Both types of implant were randomly assigned to each group (CS. both within and between groups. and platform switching is one such factor.5mm and were slightly conical with spiral coils reducing in depth towards the implant neck resulting in an almost parallel implant. 100% of EP implants in the CS and SPS groups exhibited no bone loss over 2 years compared with 92% in the CNS group (P=0. 0. © Specialist Dental Summaries www.0mm).7% > 0 < 1. CNS and SPS). Bone quality was assessed by 2 to 4 examiners until agreement was reached. 2 pp 299-308 Correspondence to: Prof.com Vol. the conventional non-submerged (CNS) protocol and submerged implants with a platform-switched abutment design (SPS). with a similar progressive coil design and implant widths of 3.8mm) on the left was compared to a platform enlarged implant 4.dentalsummaries. Implants were restored after 3months in the mandible and 6 months in the maxilla and were assessed at insertion and followed up annually for 2 years with standard clinical and radiographic assessments.5mm but the implant necks were 3.1 Jul-Aug 2009 . Main inclusion criteria included: type 2 or 3 bone. Microtextured surface implants were used (Sandblasted and acid-etched.1-1. Results  Of the 78 patients recruited. sex. after the first year of function.18/ No. Journal of Oral and Maxillofacial Implants Vol. Conventionally.8 and 4. A further 6 patients experienced implant failures and another 2 withdrew.1-0. whereas the submerged implants were microtextured up to and including the neck. biologic width issues and host response to changes in bacterial flora.8. there is still a need for prospective studies to evaluate this phenomenon more objectively. implant-abutment junction variations.8 and 4. It can also be concluded that the use of an enlarged platform implant had a beneficial effect on maintenance of crestal bone levels irrespective of whether a one or two stage protocol was utilized and that it further enhanced the effects of platform switching. good oral hygiene with no periodontal disease and no clenching or bruxing habit. implants have been restored with matching diameter abutments with studies showing CBL of up to 2mm. 60 patients with 360 implants were included in the data. Dental Implant Summaries.6mm. 3.0001). Radaelli G.8mm on the right Discussion and Conclusion  There are several factors that have been shown to maintain crestal bone. Therefore. However. and this study corroborates this view demonstrating that it plays an important role in maintenance of crestal bone particularly for standard diameter implants. This study. Patients were excluded if agreement was less than 50%. London). 3. The control implant (3. bacterial colonization.5 and 5. Nonsubmerged implants had machined collars. Use of the platform switching concept has increased over the years. therefore aimed to establish whether implants placed posteriorly with an enlarged platform (EP) results in reduced CBL when compared to standard diameter implants using the conventional submerged (CS) protocol.0mm. Standard implants had diameters of 3. treatment protocol and any confounding variables.2mm respectively. Gherlone E.5mm and > 1. only 68 were included in the study. Although there have been some studies showing favorable bone level changes around platform switched implants. 1. Prosper L. but this was significantly different when compared to standard implants in the other 2 groups (p<0. with significant differences for CS and CNS groups (P=. Statistical tests were utilized to determine the influence of age.6-1. Winxix Ltd. June 2009 Int.

5 were fair. 2. 3. Although patients were generally in agreement. When intra-observer agreements were looked at. possibly due to the fact that the overall smile is what can be seen in everyday situations. very few trials have evaluated the esthetic outcome of implant treatment from both a patient and dentist perspective. This suggests that the patient may be better placed to give their subjective opinion in such studies. with varying degrees of reliability and ease of use. Newer indices (the implant crown aesthetic index. For the close up photos correct identification occurred for 83% at both tests. cases varied in the final result from poor to good. patients correctly identified preoperative photos in 83% of cases initially but this went up to 90% at the follow up test. they only assessed their own photos. It was found in this study that patients and practitioners saw the esthetic qualities of their treatment quite differently Discussion and Conclusion  This study is in agreement with previous studies which show that patients give better ratings for the esthetics than clinicians. Journal of Oral and Maxillofacial Implants Vol. Deciding whether the observer was pleased with the outcome.com Vol.dentalsummaries. the readings were 87-97% initially and 90-100% at second test.2 Agreement of quantitative subjective evaluation of esthetic changes in implant dentistry by patients and practitioners The ultimate goal of implant therapy is not only to provide function but to also have the best esthetic outcome. University of Manchester Higher Cambridge Street Manchester M15 6FH UK Material and Methods  Pre. June 2009 Int. allowing discrimination between cases. both on the VAS scale and categorical (kappa) scale. of Oral and Maxillofacial Surgery. giving 4 photos for each patient. In conclusion. Marco Esposito Dept. it is difficult to determine which group is more accurate in their judgments. Grusovin M. Data was subject to statistical analysis. Although a good esthetic outcome was achieved with most patients. this study showed that clinician and patient agreement was poor indicating that they perceive esthetics quite differently.and post-operative photos of 32 partially edentulous patients were selected. on both occasions. 4. For close up photos.1 Jul-Aug 2009 . It was also notable that using the smile images was more reliable than the close-up images. fair agreement for 5 clinicians. In contrast. the pink esthetic score and the California Dental Association criteria) have been developed. The remaining 2 patients acted as the test sample. However. It also set out to determine whether a similarity existed between the perception of esthetics between clinicians and patients. Photos were standardized as much as possible and included the full smile and close up views of the treated area. © Specialist Dental Summaries www. Clinicians fared better with the overall smile readings of 87-100% initially and 83-100% at the second test. One objective method of assessment was the Jemt Index or Papillary Score that was modified by others and formed the basis of many studies. Dental Implant Summaries. Rating the perception of esthetics on an ordinal scale (0=poor to 4=excellent). from a patient and clinician viewpoint. contralateral teeth and gingival height variations) may not be important to the patient. 2 pp 309-315 Correspondence to: Prof. Both patients and clinicians gave very high esthetic satisfaction ratings for all before and after photos preventing a meaningful kappa statistic to be ascertained. Worthington H. The current study aimed to determine the reliability of a subjective quantitative method of assessing esthetic changes after implant therapy. Photos were assessed in the same order by everyone and repeated 14 days or more later. The overall Kappa values for comparison between clinicians were poor for magnified and distant photos. Rating treatment outcome on a (VAS) visual analogue scale (from 1=poor to 10=excellent).18/ No. The tasks included: 1. there was slight agreement for 3 clinicians. Written instruction was given to 10 clinicians and 30 patients who then assessed all photos. Several techniques have been suggested to improve implant esthetics ranging from simple gingival grafting to more complex grafting involving hard tissues. Due to the nature of subjective analyses. 24 No. Esposito M. it is clear that the parameters that clinicians consider important (soft tissues. moderate for 1 clinician and substantial for 1 clinician. there was less agreement between clinicians but this may have been due to them assessing photos of all patients. Poor patientpractitioner agreement as well as poor agreement between practitioners was observed on all levels. Identifying the pre-treatment photo. Results  For distant smile photos. One clinician gave slight agreement. Unfortunately. 2 were moderate and 2 were substantial. Two clinicians identified all photos correctly.

Tan Department of Restorative Dentistry.3mm) and wide (5. Tan K. Significant subsets in the 10 test groups were determined by oneway ANOVA and Tukey highly significant difference (HSD) post-hoc test at p<0.5mm). suggesting that their performance may be dependent on abutment dimensions and design characteristics. Nguyen H.1 Jul-Aug 2009 Four implants and their respective zirconia abutments were subjected to rotational load testing to examine comparative performance . This concurs with other finite element analysis studies. Again implant fracture also occurred at the thinnest aspect of the internal thread. There were significant differences between implant diameters but not between implant systems. Overall there were 7 implant fractures in narrow and regular platform Replace Select.0mm. Screw loosening was also observed in the Brånemark group prior to fracture. Implants were secured in the test apparatus and their respective abutments secured to the recommended torque value. and compared to alumina exhibit high strength and chemical resistance. 2. Interestingly when abutment screw fracture occurred these were at the first thread for all samples.0mm for 3i implants. Osseotite NT external connection (3i) and 4. but the most common cause of failure was abutment fracture. A customized brass crown was also cemented to each abutment (Panavia F). Data from the current study indicates that zirconia abutments are more prone to failure than their metal counterparts particularly on narrow and regular diameter implants. August 2009 Int. Screw fracture featured in all samples except the wide diameter implants from all systems. Osseotite Certain implants also exhibited abutment and screw fractures as well as separation of the titanium insert from the zirconia abutment. Three zirconia abutments failed after comparatively few cycles suggesting that there were pre-existing cracks. 24 No.3mm. 4.1mm and 5. The failure rate in this study was 58%. with the system and diameter being the independent variables and the number of fatigue cycles to failure the dependent variable. Disadvantages include brittleness under tensile forces. Dental Implant Summaries.0mm diameter 3i samples or for one 4. biocompatible. with scratches indicating screw loosening prior to failure. This resulted in 10 groups. This in-vitro study aimed to determine the load-fatigue performance of 4 implant systems and their respective zirconia abutments. It was notable that there was no damage to the zirconia/abutment interface when there was a titanium insert.0mm) for Nobel Biocare implants and 4. There were 2 gold screw fractures in the Osseotite NT group and one combined implant and screw fracture. Replace Select internal-connection (Nobel Biocare).1mm 3i sample. with 5 samples in each. Brånemark Mark III external-connection (Nobel Biocare). Procera Zirconia abutments (Nobel Biocare) were standardized to match those of the preformed ZiReal Osseotite (3i) abutments.dentalsummaries. Journal of Oral and Maxillofacial Implants Vol.1 diameter Osseotite NT implants. Light and scanning electron microscopy was used to analyze the fractured surfaces.05. Densely sintered yttrium-stabilized zirconium dioxide (Y-TZP) abutments have the advantage of being tooth colored. 3. 5 Lower Kent Ridge Road Singapore 119074 REPUBLIC OF SINGAPORE Material and Methods  The 4 implant systems with their corresponding zirconia abutments tested were: 1. No failures were recorded for any of the 5. Faculty of Dentistry National University of Singapore. © Specialist Dental Summaries www. Previous studies on titanium abutments using similar testing methods yielded failure rates of 20% and 30%. they have not been subjected to rotational load testing. Results  58% of all samples failed with 36% exhibiting abutment fracture. Fatigue testing was carried out at 45˚ to the long axis of the sample with a 21N load at 10Hz. Two way analysis of variance (ANOVA) was used. as well as 4.3 Load fatigue performance of implant-ceramic abutment combinations In pursuit of enhanced esthetic outcomes in implant therapy there has been an increase in the use of ceramic abutments to avoid grey “shine-through” in the peri-implant tissues. Discussion and Conclusion  Implant fractures were seen at the thinnest part of the internal tri-channel of 5 Replace Select implants. Keson B. 4 pp 636-646 Correspondence to: Dr. regular (4. Diameters ranged from narrow (3. Osseotite NT Certain internal-connection (3i). While previous studies have shown that zirconia abutments were twice as resistant to fracture as alumina abutments.18/ No.com Vol. Nicholls J. 3. All samples were checked for concentricity during cyclic loading with a limit of 5 million cycles.

and stability measurements using RFA.045 HU. this preliminary clinical study was carried out in order to determine if a relationship exists between CT values.030). this study. Results  All implants were restored successfully. RFA values. Dental Implant Summaries. Zimmer Dental.046) compared with mandibular sites. or at the time of implant placement is considered useful as a prognostic indicator for implant success. A more specific analysis would be achieved using histology to determine the actual percentage of trabecular bone by volume (TBV) in the region where the implant is to be placed.87±302.1 Jul-Aug 2009 . Patients were reviewed at 7-10 days and restorations placed after 6 months. tactile measurements. Eratalay K. While some correlations were evident.042). probe version 2. P=0. Analysis by gender revealed that male subjects showed correlation between RFA and tactile sensation (r=-0. the TBV values in the mandible were higher than those in the maxilla. August 2009 Implant Dentistry Vol.017± 12. non-smoking patients received a total of 11 posterior mandibular and 12 posterior maxillary implants. Sweden) to evaluate the implant stability quotient (ISQ) for each of the 23 implants. However. Aksoy U. of Periodontology Faculty of Dentistry Hacettepe University Sihhiye.52. tactile sense.com Vol. Carlsbad. a healing abutment was placed and flaps sutured.552% respectively. r=0. Biopsies were prepared for histomorphometric evaluation of TBV. © Specialist Dental Summaries www. The only significant correlation found for all implants in all patients was between tactile sensation and CT values (r=-0. tactile sense and TBV using the Spearman’s correlation coefficient. a correlation between CT and TBV was only apparent in females. The average bone density from all the sites was 554.009). Statistical analysis was carried out to assess the presence or absence of a correlation between CT values (HU). was unable to demonstrate a correlation between ISQ and CT values. histological TBV. CT scans provide quantifiable bone density measurements which may relate to actual bone quality found at the time of surgery using non-invasive techniques such as tactile sense. and histomorphometric evaluations of dental implant osteotomy sites: A preliminary study The ability to determine bone quality (density) in a quantitative manner. A measurement in Hounsfield units (HU) was made to give a value of bone density at each of the proposed implant sites as indicated by markers placed into custom scanning guides. 18 No. which represented the percentage of trabecular bone present in the area of the specimen. as with previous studies. prior to.194 ISQ and 41.756.008). An important limitation which may affect the significance was the small sample making it clear that further studies with larger sample sizes are required. While males had a higher mean CT value than females this was not significant. Tozum Dept. while females showed correlation between CT values and TBV (r=0. Tozum T. At the same time a measurement of tactile sensation was made according to the Misch classification for bone quality (D1 to D4). At the time of placement an initial trephine bur 2mm x 5mm was used to remove a core biopsy. the use of CT measurements has been proposed as providing a pre-operative evaluation which is directly related to histological values for bone density and non-invasive tactile measurements. Thereafter.015). Yet RFA values were lower in the mandible compared to the maxilla. Discussion and Conclusion  Bone quality classifications have given practitioners the ability to make assessments at the time of surgery. and although not significant. If this measurement could be shown to correlate to CT or to other non-invasive analyses then it might be possible to predict outcome in relation to bone density.dentalsummaries. CA) were inserted via a crestal incision. As the surgeon in the present study was experienced a correlation was shown between tactile sensation and CT values. After implant insertion RFA was performed (Osstell Mentor.015) and tactile sense (r=-0. The implants (SwissPlus.011) than males but significantly lower TBV values (P=0. P=0. T. TR-06100 Ankara TURKEY Material and Methods  10 healthy. P=0. and between RFA (r=0. However. All patients had a basic clinical and conventional radiographic examination followed by a CT scan for pre-operative planning. Maxillary sites yielded significantly lower CT values (P=0.53.4 The possible association among bone density values. The mean RFA and TBV were 72. P=0.807. resonance frequency measurements. Females had significantly higher RFA values (P=0. 4 pp 316-21 Reprint requests to: Dr. Consequently. insertion torque and resonance frequency analysis (RFA).28±6.810.18/ No.

05). PTR values improved for both groups between insertion and final readings (P<0. August 2009 Clinical Oral Implants Research Vol. and after 6 and 12 months of functional loading. of Periodontology Faculty of Dental Medicine Hadassah Medical Centre PO Box 12272 Jerusalem ISRAEL Material and Methods  Two tapered.47 (0.56 (0. There was no correlation between size of implant and PTR value.001) but were significantly better (more negative) in the M group. Since the chemical composition and neck dimensions of the implant pairs in each site were identical. implants that varied in their neck design and surface topography exhibited statistically significant differences in the degree of marginal bone remodeling after abutment connection and up to one year in function. right with the same surface The P group lost significantly more bone than the M group (p<0. All implants were inserted to depth such that the necks of the implants were placed at the bone crest. A PerioTest (Medizintechnik Gulden) reading (PTR) was used to assess stability at implant insertion and at prosthetic connection after 4 months. © Specialist Dental Summaries www. using the shoulder of the implant as a reference and a baseline value of zero since the shoulder was leveled with the bone crest. MBR was measured on dental panoramic tomograms at baseline (prosthesis connection). early (after uncovery and abutment connection) and late (during the rest of the life of the implant). and this warrants further investigation. One of each implant matched for identical size (10 or 11. Discussion and Conclusion  In the current study.77 (0. Dehiscences during healing occurred in both groups (P: n=8. no micro-grooves. Shapira Dept. Tandlich M. All implants lost statistically significant amounts of marginal The implant on the left had bone (P<0.46) and 0. Machined implant necks tend to exacerbate MBR whereas roughened and micro-threaded necks tend to retain more bone over time. Bratu E. However. Dental Implant Summaries. All prosthetic treatment was carried out after the same time period (4 months) using a cemented crown over a standard milled abutment. Any occurrence of premature dehiscence during healing was noted but not treated further. This was compared to an implant on the 1.1 Jul-Aug 2009 .44) and 0. Thus 48 pairs of implants were inserted with 8 patients receiving bilateral pairs but only having one side analyzed.05) but had no impact on the M group of implants at any time in the study.25) at 1 year respectively.21 (0.05. threaded implant designs from the same company (MIS-Implants Inc. Dehiscence led to a treatment but with microgrooves and no polished collar statistically significantly increase in MBR in the P group (P<0. The comparative a 1mm polished collar and values of MBR (mm ± SD) for P and M groups were 0. M: n=4) but all implants osseointegrated.19) at 4 months..dentalsummaries.5 A rough surface implant neck with microthreads reduces the amount of marginal bone loss: A prospective study All implants display some degree of marginal bone remodeling (MBR) after insertion.23) at 6 months and 1. MBR around each implant at each time point and PTR results were subjected to statistical analysis with significance set at P=0. One had a 1mm polished collar (P) and one a microthreaded moderately rough collar (M).4) and 0. Results  2 patients were lost to follow up and thus only 46 pairs of implants in 46 patients were analyzed.2mm Ø) was inserted as a pair (P mesially and M distally) utilizing a two-stage standardized protocol in to the posterior mandibles of 48 patients (ages 23 .65) seeking replacement of missing posterior teeth.2 (0. L. Shapira L. This tends to occur in 2 phases. The latter is regarded as having an inflammatory and possibly overloading etiology. while PTR values. The objective of this study was to compare MBR in two similarly designed tapered implant systems and compare MBR and the initial stability of the implants due to the thread design and the influence this may have on MBR during early implant function. Israel) were used. MBR was evaluated as the primary variable.05) with more loss evident in the first 6 months of function. Implant dimensions were identical though threads patterns varied. this study could not determine whether the surface roughness or the microthread design enabled better bone retention in the M group.18/ No. 8 pp 827-832 Reprint requests to: Dr.69 (0.5mm length and 3. 20 No. incidence of premature exposure and associated bone loss were secondary variables.com Vol. this study supports previous investigations that show that polished implant collars are less successful at retaining marginal bone than roughened collars. Early MBR is attributed to re-establishment of the biologic width apical to the implant / abutment connection and can be influenced to a certain extent by implant design.75 or 4.

PS did not influence peak bone strains under vertical loading.1% and 28.3% reduction under lateral loading.6 Bone strain and interfacial sliding analyses of platform switching and implant diameter on an immediately loaded implant: Experimental and 3-D finite element analyses The effect of platform switching and varying implant diameter on the stresses transmitted to bone during immediate loading are largely uninvestigated. B and C compared to D and E and these were concentrated mainly on the lingual aspect of each implant. A custom jig in a universal testing machine (JSU-H1000. Sliding and gap distances varied by less than 3µm between A.1 Jul-Aug 2009 . Bone strain under vertical and oblique loading for B and C (5mmØ implant) was 26. Japan Instrumentation Systems) was used to vertically and obliquely (45° buccal to lingual) load each abutment with 130N at 1mm/min. PS leads to a small but insignificant reduction of <10% in crestal bone strain. Most strain in the immediate loading model is seen where implant to bone contact occurs directly and is minimal in areas of no contact. Lin D-J. Dental Implant Summaries.6 was used to simulate sticking and sliding friction between implant and bone in the immediate loading scenario.0/SC/PS.4% lower respectively when compared to A (3. B and C. Peak tensile and compressive bone strains were recorded with rosette strain gauges cemented to the buccal and lingual aspects of each sample. 3i Biomet) was inserted into each model. the data suggest that a wider diameter implant reduces crestal bone strain.3% lower respectively in B when compared to A. 7 pp 1125-1132 Reprint requests to: Dr. Hsu J-T. Implant and bone nodes were merged to simulate osseointegration in the integrated implant scenario. The models and implants were tested to determine mechanical properties for FEA. D: 5/CA/PS and E: 5/CA/NPS. Heng-Li Huang School of Dentistry China Medical University 91 Hsueh-Shih Road 404 Taichung TAIWAN Material and Methods  Data from a CT scan of an edentulous mandible from a dried skull was used to construct 5 standardized resin impregnated powder models of the premolar and molar regions using rapid prototyping stereolithographic techniques. Peak compressive strain values exceeded peak tensile strain values in magnitude.5% and 30. The lingual and lower borders of the mandible were regarded as fixed. The implants were either 3. B: 5.75/SC/NPS. Compressive strains for B & D (PS samples) were 9% and 5% lower than those for C and E (NPS samples). Each reading was taken 3 times and analyzed using standardized software. Shen Y-W. 80 No. Peak compressive and tensile strains in bone are higher in immediately loaded implants than in integrated implants.05) noted in bone strain values between models with and without PS.75mm or 5mm diameter and were passively screwed into the models (SC) or cemented with cynoacrylate (CA) to represent either an immediately placed implant or an osseointegrated implant respectively. PS led to concentration of stress in the abutment/external hex interface but bone strain distribution did not differ significantly between PS samples and NPS samples. Peak compressive strain values under vertical and oblique loads were 7% and 8.dentalsummaries. This study uses a combination of load testing on standardized lithographic models and 3-D finite element analysis (FEA) to compare effects on bone strain at the implant-bone interface (IBI) of varing implant diameters and platform switching (PS). C: 5 /SC/NPS. Micromovement of <3µm is well below the 50-150µm of movement traditionally quoted as being necessary for prevention of integration. July 2009 Journal of Periodontology Vol. Vertical and lateral loading forces were examined on FE models in order to compare standard and wide body implants with platform switching on the latter as shown above Discussion and Conclusion  Within the constraints of this study (static load and relatively homogeneous materials).75mmØ implant). However. Bone strains were higher in A. One implant (13mm long. PS does not significantly influence crestal bone strain or micromovement. Results  There were no significant differences (p>0. Fuh L-J.8% higher compressive and tensile strains under vertical loading when compared to D and E respectively. An abutment of either 4mm or 5mm Ø was then attached to each implant to give 5 samples with (PS) or without a platform switch (NPS): A: 3. external hex ICE. C exhibited a 90% increase in bone strain under vertical load when compared to A but a 48. Huang H-L.com Vol.18/ No. A frictional coefficient of 0. It is speculated that this may lead to overload or atrophic resorption respectively though more clinical data is required. © Specialist Dental Summaries www. FEA showed that C had 28. and a 54% higher compressive strain under oblique loading.

Therefore optimizing implant abutment design as well as provision of easily cleansable restorations would reduce the likelihood of plaque accumulation. However. Dental Material Science Center for Dental and Oral Medicine and CranioMaxillofacial Surgery.7 Biofilm on dental implants: A review of the literature Subramani K. rough abutments and over contoured restorations can lead to increased plaque accumulation. Journal of Oral and Maxillofacial Implants Vol. an increase in surface free energy of implants and abutments together with surface physicochemical characteristics of the colonizing bacteria also affects the rate of biofilm formation.dentalsummaries.18/ No. reducing roughness below a threshold Ra of 0. and design of implants and abutments on biofilm formation and its sequelae. In addition the presence of a microgap and over contouring of restorations aids biofilm formation. some data has been presented supporting the antimicrobial properties of titanium oxide which forms on implant surfaces in vivo. Molenderg A. It has been reported that titanium with a low roughness average of (Ra)≤0. The presence of a microgap at the implant-abutment junction is also known to be associated with bacterial colonization and has been implicated as a risk factor for bone loss. August 2009 Int. Biofilm formation on different implant surfaces and implant designs was compared in this literature review Discussion and Conclusion  This literature review suggests that rough implant and abutment surfaces increase bacterial adhesion and speed of biofilm formation as well as sheltering bacteria against shear forces in the oral environment. as has a vancomycin-modified titanium surface. the difference being that the surface properties of implants have an impact on early microbial adhesion. Since these articles were mostly descriptive it was not possible to perform a comprehensive meta-analysis on this topic. A number of in vitro and in vivo studies have confirmed that surface roughness of the implant encourages bacterial attachment. There are conflicting data regarding the bacteriostatic effect of titanium on oral microflora. Dental Implant Summaries. The purpose of the present review article was to discuss biofilm formation on dental implant surfaces and the influence of surface characteristics.1 Jul-Aug 2009 . Results  Biofilm formation on teeth and implants follows the same initiation and maturation process. are more readily colonized. Hence.com Vol. By contrast titanium surfaces that are hydrophobic. Hard coating implants with titanium or zirconium nitride can reduce bacterial adhesion. 4 pp 616-626 Correspondence to: Dr. 24. material. Furthermore it has been reported that a higher prevalence of anaerobic bacteria is associated with cement-retained prostheses compared with screw-retained prostheses. which has been shown to limit bacterial colonization in vitro and to be stable. however. In fact rough abutments have been reported to harbour 25 times more sub-gingival bacteria than pristine abutments.2µm has not been shown to have an impact on biofilm formation in the long-term. and the influence of implant surface characteristics on biofilm formation.088µm strongly inhibits plaque accumulation and maturation after 24 hours. the initial colonizers provide a favorable environment for the growth of periodontopathic microorganisms that can lead to periodontitis and peri-implantitis. Their presence can lead to inflammation of the marginal tissues that may ultimately result in peri-implantitis and bone loss. The early bacterial colonizers. Hämmerle C. Jung R. Subramani Department of Fixed and Removable Prosthodontics. K. namely streptococci give way to a diverse flora of gram-ve anaerobes and filamentous species which form over a 2–4 week period. the effects of these in vivo on osteoblasts and cells from the periodontium is unclear and requires further investigation. due to the adhesion of impurities following repeated dry sterilization. Fifty three in vitro and in vivo articles were identified. In addition to the above. as well as the effect of implant and abutment design. Furthermore. University of Zurich Zurich SWITZERLAND Oral biofilms that form on transmucosal implant components are composed of a complex microbial flora that is supported by an extracellular matrix of bacterial and salivary origin. This has been shown to lead to reduced staphylococcal colonization and increased osteoblast adhesion. These included studies on biofilm formation on teeth and implants. Material and Methods  A MEDLINE literature search was performed of studies published over a 40 year period up to 2007. © Specialist Dental Summaries www. Although some data on silver and vancomycinmodified surfaces in available. Silver-coated titanium surfaces have also been examined showing antimicrobial activity without any adverse effects on osteoblast and epithelial cells. No.

There was little change in MBLs over the 3-year period for either group and the color evaluation revealed no significant difference between the test and control groups (ΔEZr=9. however. Titanium (Ti) is resistant to distortion and works well in all areas of the mouth. 2 MCCs in the control group exhibited minor chipping. Dental Materials Science Center for Dental and Oral Medicine. premolars and molars. or fractured abutments. 11 8032 Zurich SWITZERLAND Material and Methods  22 patients treated with 40 implants (Brånemark RP. However. Rely X. screw loosening. ACC) or control group (CG: titanium abutments + Metal Ceramic Crowns. although both materials induced a visible colour change compared to The clinical performance natural teeth. 20 No. The test group (n=20) consisted of 17 ACC and 1 MCC cemented onto the Zr abutments. 3M ESPE) and glass ionomer (Ketac Cem. which is similar to previous studies. Nobel Biocare) in the canine and posterior regions of the mouth. Soft-tissue thickness (using a size 20 endodontic file with a stopper) and the height of the papilla (mesially and distally) were also recorded. More recently high strength ceramics such as alumina and zirconia have been used in the esthetic zone but there remains concern over their brittleness. Furthermore. no significant differences were found between soft-tissue of single-tooth CAD/CAM designed zirconia and titanium thickness or papilla height between groups. 12. Jung R-E. Clinical and radiographic examinations were carried out at crown insertion and at 6.8±0. in addition a biological examination to assess probing depths (PD). There were no cases of de-cementation. or chipping of ceramic. which can cause a greyish discoloration of the gingival tissues.dentalsummaries. University of Zurich Plattenstr.18/ No. © Specialist Dental Summaries www. a 3-year period Discussion and Conclusion  Results demonstrate that there were no complications for either Zr or Ti abutments. Hammerle C. were randomly assigned to either a test group (TG: zirconia abutments + Procera All-Ceramic Crowns.5±0. Screw loosening was not observed in the present study probably due to the exceptional fit of both CAD/CAM abutments and the comparable biological parameters and esthetic evaluation reinforce the absence of clear differences between these two abutment materials over a 3-yerar period. Irina Sailer Department of Fixed and Removable Prosthodontics. although the soft-tissue thickness around the abutments was compared over implants (~1. and 36 months post-loading. break of cement seal. MCC). ΔETi=7). 18% molars). More randomized studies are required. Despite titanium’s colour.9mm). Only minor chipping of the MCCs was found on Ti abutments.8 Randomized-controlled clinical trial of customized zirconia and titanium implant abutments for single-tooth implants in canine and posterior regions: 3-year results Titanium and ceramic abutments are commonly used today. Nobel Biocare) for replacement of missing canines. plaque retention (PR) and bleeding on probing (BOP) at 4 points around each implant and control teeth was undertaken. abutment screw loosening/fracture. Sailer I.1 Jul-Aug 2009 . Resin (Panavia 21. Switzerland) to assess the colour of gingiva 1 mm below the gingival margin. Clinical examination involved assessment for material fractures of abutments or crowns. 3M ESPE) cements were used. Kuraray. and 2 screw-retained ACC crowns. MHT. Clinical parameters for both groups were very similar to each other and also to natural teeth. it is generally considered to be the ‘goldstandard’ for implant-borne reconstructions. Implants were placed using a 2-stage protocol with abutments connected 4-6 months after surgery and torqued to 32Ncm.7mm) was greater than at teeth (~1. Zembic A. although the PD values were higher at the implants. one must be cautious as it has been shown that Zr can decrease its fracture toughness by 50% over longer periods of time in a humid environment. 8 pp 802-808 Correspondence to: Dr. over a 3-year period. Finally an esthetic examination was performed using a spectrometer (Spectroshade. Mesial and distal marginal bone levels (MBL) were also recorded from digitized radiographs by 2 independent examiners. Dental Implant Summaries. Results  18 patients with 18 test and 10 control abutments were followed up to 36 months. The aim of this study was to assess the survival and complication rates between CAD/CAM customized zirconia (Zr) and titanium abutments (Procera. August 2009 Clinical Oral Implants Research Vol. This study exhibited excellent results for Zr abutments (68% premolars. The slightly worse value recorded for visible discoloration of the gingiva with Zr abutments was surprising. The data was analyzed using Student unpaired t-tests and Mann Whitney rank tests at 95% confidence levels.com Vol. The control group consisted of 20 Ti abutments with cemented MCC crowns.

bone density. SLActive. implant uniformity and removal time. where osteoid matrix was evident. Results were subject to statistical analysis using the Friedman test at a level of p < 0. however. Dental Implant Summaries. cadaver studies have demonstrated that the torque required for implant insertion and removal may vary irrespective of bone mass or density. Adriano Piattelli Via F. 20 No. Accurate histomorphometric assessment can be used to assess the bone-implant interface and primary stability of implants. regardless of the time of implant retrieval. with no radiographic bone loss.dentalsummaries. All implants (N=17) had a sand-blasted. The PIT value had been recorded for each implant and the value recorded in the patient’s records.com Vol. and sectioned longitudinally to a thickness of 30µm. implant geometry. nerve damage. Histological evaluation highlighted numerous cellular and structural markers of bone repair.18/ No. Reasons for retrieval included psychoses. were self tapping and had been placed according to the manufacturers instructions (Ankylos Plus and Xive. August 2009 Clinical Oral Implants Research Vol. it is known that increasing PIT values correlate to increasing bone density and quality. Piattelli A. A stable implant in dense bone allows optimal distribution of any loads placed upon the implant during the healing phase. percentage of bone to implant contact (%BIC).05 to assess correlation between %BIC and PIT. a significant relationship between PIT and %BIC has yet to be determined. Iezzi G.1 Jul-Aug 2009 . The implants were removed within an 8-week period of placement using a 5mm trephine bur. DentsplyFriadent. Given the importance of primary implant stability further controlled studies may be useful in understanding the precise relationship between primary implant stability.9 Is insertion torque correlated to bone-implant contact percentage in the early healing period? A histological and histomorphometrical evaluation of 17 human-retrieved implants In areas of good bone quality and quantity. the present study has many limitations with respect to sample size. restorative complications and hygiene. and surgical technique. The primary stability of a dental implant has been proposed as a good indicator for long term success and is related to bone structure and biomechanics. NanoTite. An established alternative method of assessing the primary stability of an implant is the peak insertion torque (PIT). PIT and %BIC. Results  All of the implants were osseointegrated and stable at the time of removal. healing and turnover with no evidence of inflammatory cell infiltrate. but likely to be multifactorial. Specimens were dehydrated. acid etched surface. Many marrow spaces were observed on the implant surface. Discussion and Conclusion  The benefits of high initial implant stability are well documented. © Specialist Dental Summaries www. There was no statistically significant correlation between PIT and %BIC for any of the implants. dental implants can expect to achieve high primary stability. Various placement protocols were utilized depending on the case requirements at the time of surgery and 7 of the implants had been immediately loaded. Histomorphometric analysis of %BIC was carried out under light microscopy using three slides for each implant and the results assessed using a histomorphometry software package. Despite numerous studies investigating the factors thought to be responsible and recording these parameters using a variety of techniques. 3i. Sciucchi 63 66100 Chieti ITALY Material and Methods  A retrospective evaluation of implants which had been placed and retrieved from the posterior mandible for various reasons was undertaken. Considering the likely multifactorial relationship between PIT and %BIC. but the exact level of insertion torque necessary to effect an adequate degree of primary stability remains undetermined and the principle mechanism of this early stability is as yet unclear. but requires destructive. Sections were stained with von Kossa and acid fuchsin and one section stained with silver nitrate and basic fuchsin. Perrotti V. Degidi M. This study aimed to compare the values for PIT and the %BIC in humans to determine the presence or absence of correlation. Whilst the precise relationship between PIT and primary stability is as yet undetermined. apical epithelial migration or dense connective tissue at the bone-implant interface. invasive implant removal and therefore cannot be used in clinical practice. 8 pp 778-781 Correspondence to: Prof. Straumann). Strocchi R. fixed.

simulating the bone level with a degree of bone remodeling. This is the opposite of what was hypothesized. 1. Padrós A. Dental Implant Summaries. Poor prosthesis fit.2mm and 1.0001). group 4 had the larger HEX height but with an acid etched surface (AE3) and group 5 had a grit-blasted surface (GB3). The grit blasted implants showed the longest fatigue life of all (p<0. The first three groups had an electropolished surface with HEX heights of 0. 4 pp 583-590 Correspondence to: Dr.dentalsummaries.20µm for EP<2. Gil F.18/ No. where all the groups. In summary. The favorable osseointegration of acid etched implants as compared with smoother surfaces has been well established. except GB3. especially when combined with a grit blasted surface.8mm HEX (p<. It was shown that hydrogen from the acid solutions can diffuse into the surface and form metal hydrides. © Specialist Dental Summaries www. Discussion and Conclusion  The tolerance of fit at the implant/abutment interface was consistent amongst the groups in this study which necessitates the identification of other factors that might impact upon fatigue life. potentially leading to fracture. The number of force cycles necessary to cause implant deformation/fracture differed between the groups to a statistically significant degree with fatigue life ordered as follows: EP1<EP2<AE3<EP3<GB3. Journal of Oral and Maxillofacial Implants Vol. The factors predisposing to fracture can be classified into geometric design and the material properties of the implant. Logically it would seem that rougher surfaces would induce more surface cracks.6mm HEX causing internal abutment screw fracture and shearing of the HEX. which can also cause a greater degree of brittleness within commercially pure titanium. greater HEX sizes will increase fracture resistance of implants.6mm. Therefore the aim of this study was to compare different HEX heights and surface topographies of titanium implants on their fatigue resistance. August 2009 Int. this being explained by the area of contact between the implant and abutment which is proportional to the resistance to bending. Appearance and propagation of cracks was also of interest as the cracks were generally initiated on the surface of all the groups except the GB3 surface.com Vol. with the size of the HEX having been shown to influence the mechanical stability of the restoration. Av. which could propagate through the implant leading to fracture. had the cracks initiate at the surface. and an abutment connected at 25Ncm. whereas cracks in the GB3 group were at a depth of 20µm. EP2 and EP3 respectively).02).8mm (EP1. Manero J. where the goal will be to increase its fatigue resistance to prevent fracture in the implant body and the external hexagon (HEX). This is explained by the method of blasting where the particles contact the surface and compress the metal. 24 No. immersed in artificial saliva and a cyclical force applied at 10Hz between 10 and 225N at 30˚ to its long axis. with the remaining groups demonstrating fracture within the implant body.10 Influence of the height of the external hexagon and surface treatment on fatigue life of commercially pure titanium dental implants Dental implant fracture is a rare occurrence but can be catastrophic. Aparicio C. In addition the micro-geometry of the implant can also affect its fatigue resistance in that a rough surface topography would seem more prone to generate small cracks at centers of stress concentration. The mode of failure also differed with the 0. Each implant was clamped at a level of 3mm below the HEX. Francesco Gil Department of Materials Science and Metallurgical Engineering. The explanation lies in the analysis of the surface cracks. Cracks can only propagate from a tensile state and therefore this compressive area increases the resistance to cracking. and the potential dilemma arises because it has been established that these surfaces increase bone to implant contact and enhance osseointegration. Diagonal 647 08028 Barcelona SPAIN Material and Methods  5 groups with 7 implants in each group were created.29µm for GB. ETSEIB Technical University of Catalonia. where the cracks were initiated 20µm sub-surface. Results  Mean implant surface roughness measured 0. The deformed/fractured implants were examined by both scanning and transmission electron microscopy and an analysis of variance with the multiple comparison Fisher test used to compare the groups with regard to fatigue life and fracture resistance.1 Jul-Aug 2009 Various HEX heights were tested under 30 deg loading conditions until failure . peri-implant bone loss and too few implants for the required clinical situation are all factors that will contribute to increased stress along the body of an implant. but this study showed that they would be more prone to fractures under fatigue.1µm for AE<4. The fatigue life of the shorter HEX sizes was less than half that for the 1.

Initial placement was at or below the bone crest and no augmentation materials were used.40 ±0.dentalsummaries. These measurements were made by a single investigator whose results were subjected to calibration by an independant supervisor. A limitation of this study was that the exact period of time the cover screw was exposed for was not known and in any case it would be unethical to deliberately leave such exposures untreated. Ik-Sang Moon Dept. In all cases healing abutments were placed without raising a flap via a mini crestal incision and patients were asked to implement thorough hygiene maintenance.53mm (range -0. No brushing was permitted post-surgery and all patients rinsed 2x daily with an antiseptic mouth rinse until suture removal 10 days later.49mm when early exposure of implants was recorded. where a previously submerged implant becomes exposed spontaneously to the oral environment strict hygiene measures may not be in place creating the risk of marginal bone loss through plaque mediated infection and inflammation. Kim C-K.96mm compared to 0. It was assumed in this study that there would be no differences in marginal bone levels.15 to 2. Moon I-S. From this group it was found that 24 of them had developed spontaneous exposure for 28 of their implants. of Periodontology Gangam Severance Dental Hospital. however. (1999) and Tal (1999) have reported spontaneous exposure rates of between 5 and 15% for submerged implants. Mandibular implants were scheduled for exposure 3 months post-placement and after 6 months for maxillary implants. it was found there was a considerable elapse of time before the exposure was found and then treated with the placement of a healing abutment. However. range 34 to 82) it was also possible to compare on an intraindividual basis comparative bone loss between their exposed and their other nonexposed implants. mean age 54. Mean marginal bone levels were calculated from mesial and distal values collected from digitized radiographs to an accuracy of 0.10mm. Images showing a typical example of a spontaneous exposure before placement of a healing abutment Discussion and Conclusion  The additional crestal bone loss observed at spontaneously exposed implants.85mm). was mainly due to continuous plaque and food debris accumulation during the phase between occurrence and surgical placement of a cleansible healing abutment. 6 pp 933-939 Correspondence to: Dr.15mm) and for the non-exposed group was 0. (1981).05. Animal studies with deliberate untreated exposure may shed light on the rate of bone loss. 5 female. 19 patients (14 male.03-0. Van Assche et al. During this interval there was considerable potential for bone damage.02). Dental Implant Summaries. Results  Mean crestal bone loss for spontaneous/early exposed implants was 0. it is suggested. College of Dentistry Yonsei University Seoul KOREA Material and Methods  A total of 781 implants were placed in 355 medically healthy patients between 2000 and 2007. All patients were reviewed at 1. All implants had been placed more than 3 months after tooth extraction. All data was subjected to statistical analysis with P value significance set at 0. Final prostheses were placed 3 to 4 weeks after the planned healing periods of 3 and 6 months. 3 and 7 weeks post-placement. The difference between the groups was statistically significant (P=0.26mm (range -0. In the submerged protocol oral hygiene measures are unnecessary as the implant should not normally be exposed the oral environment and in the case of non-submerged protocols the design of the permucosal abutment allows a strict oral hygiene regimen to be implemented. Authors such as Adell et al. The aim of this study was to evaluate the influence of spontaneous early exposure of cover screws on crestal bone loss around dental implants. Toljanic et al.1 Jul-Aug 2009 .11 Influence of early cover screw exposure on crestal bone loss around implants: Intraindividual comparison of bone level at exposed and non-exposed implants Conventional placement of dental implants using a submerged (2-stage) or non-submerged (1-stage) protocol creates an ideal environment for the development of osseointegration and the maintenance of marginal bone tissues. Kim T-H. © Specialist Dental Summaries www. on the basis of this study the authors recommend regular post-surgical checks in order to minimise any deleterious impact of spontaneous exposure.18±0. however. (2008) reported bone loss of 1. Any implant that became spontaneously exposed was immediately provided with a healing abutment.com Vol. Park K-H. in their study unlike this one.18/ No. In a sub-set of this group. However. no attempt was made to place the healing abutments ahead of the planned healing interval. June 2009 Journal of Periodontology Vol. Lee D-W. 80 No.

The nanosurfaces were prepared with a calcium phosphate (CaP) coating. bone density inside the threads (BDIT) and the percentage bone to implant contact (%BIC). Zirconia as an implant surface.05) but not significantly different to the ZiC group (70%). It shows a high level of osseointegration. all surfaces used in this study demonstrated high levels of osseointegration in a rabbit model. Results  Four animals were excluded from the study and replaced for various reasons. There was no statistical difference between the ZiC and the two test nano surfaces for %BIC but there were significant differences for both BDRT. mechanically strong and shows reduced microbial colonization. is biocompatible. leading to a lower risk of the problems previously observed with CaP on titanium implants. The control groups consisted of a regular zirconia surface (ZiUnite. backscatter scanning electron in this study were prepared microscopy has been shown to be an effective alternative to histometric analysis and hence with a CaP nano-layer coating a combination of both was used in this study. while the zirconia control implant had a pore-forming sintered surface (ZiC) and the titanium control implant had an anodized microtextured surface (TiC). and were subject to the same healing times. At 6 weeks. Wikesjö U. Susin C. Lindström H. Medical College of Georgia School of Dentistry 1120 15th Street AD 1432 Augusta Georgia 30912 USA Material and Methods  Forty male adult New Zealand white rabbits received one implant in each femoral condyle of their hind leg. The test Zirconia implants used Due to the difficulty in sectioning and preparing zirconia. Statistical analysis of variance at a level of p<0. Lee J.com Vol. sectioned. The implants were all removed.1 Jul-Aug 2009 . where the 3 and 6-week healing times would correlate to early and conventional loading in humans. using two differing methods (Zi/CaP1 and Zi/CaP2). One problem with the metallic implant materials currently used is that they can cause a grey hue in the cervical gingival tissue. Department of Periodontics and Oral Biology. Recently. © Specialist Dental Summaries www. The aim of this study was to combine nanotechnology with a zirconia implant. No such differences were noted between the ZiC and TiC control groups. Sieweke J. BDIT (p<0. However. CaP nanotechnology has been shown to accelerate bone healing and it is hypothesized that the CaP nano-coating used on the test implants in this study has not significantly altered the surface texture. The %BIC of control group TiC (77%) was significantly better than both test groups Zi/ CaP1 (65%) and Zi/CaP2 (62%) at 3 weeks (p<0. Rodriguez N. the current study shows that the addition of CaP nanotechnology does not seem to enhance the osteoconductivity of the test zirconia surfaces over conventional zirconia or titanium surfaces. Jaebum Lee Laboratory for Periodontal and Facial Regeneration. receiving ZiC and TiC were also split into two groups of ten.18/ No. where detachment from the implant surface led to failure. important for early loading strategies. Dental Implant Summaries. with photomicrographs produced using scanning electron microscopy. Two test groups received a zirconia implant with one of two surface modifications using nanotechnology. stained and prepared for histometric analysis. BDIT. The control animals. the application of nanotechnology has been claimed to enhance these surface properties further. BDRT. Discussion and Conclusion  From a histometric viewpoint. Schüpbach P. shows good osteoconductive properties. The animals were anesthetized and implants placed in a standardized technique with 20 animals receiving Zi/CaP1 and Zi/CaP2.12 Evaluation of nano-technology-modified zirconia oral implants: A study in rabbits The macro and micro-geometrical modifications of an implant surface are known to enhance its osteoconductivity. but just changed the composition of the zirconium surface. with the strength and bio-compatibility of zirconia being at the forefront. half of which were sacrificed at 3 weeks with the remainder at 6 weeks. Nobel Biocare) and a titanium implant (TiUnite. was used to evaluate the bone density remote from the threads (BDRT). to test osteoconductivity potential in the rabbit model. there were no differences in %BIC. July 2009 Journal of Clinical Periodontology Vol. and this has led workers to begin looking at alternative base materials to titanium. 7 pp 610-617 Correspondence to: Dr.dentalsummaries. Nobel Biocare). between any of the test or control groups.05).05. 36 No.

a reduction in FD was noted for corticocancellous samples but increases in FD observed for trabecular bone samples. can be used to determine fractal dimension (FD) and this has been shown to be useful in comparing normal and osteoporotic bone.5). Oral Pathology and Maxillofacial Surgery.05). As a result. Nackaerts O. Surface roughness (FD) was quantified using 2D fractal analysis (FD). correlation between BMD and MDV was not statistically significant (p>0. The aim of the current study was to assess the validity of other parameters such as fractal analysis or morphometry as indicators of bone quality assessment. A control group (CG) consisting of two samples. fractal analysis and bone area measurements would appear to demonstrate potential as parameters for bone quality assessment. Statistical analysis using Spearman’s ρ was applied to calculations of FD. Based on the results of this in vitro study.1 Jul-Aug 2009 . Regions of interest were divided into both cortico-cancellous samples or restricted to the trabecular bone. Fractal analysis. From a clinical viewpoint. an approach using texture. Osteoporosis can be an etiological factor in low or reduced bone quality. Group 1 (n=5) had artificial bone lesions of approximately 1–1. Faculty of Medicine Universiteit Leuven Kapucijnenvoer 7. Standard morphometric techniques were used to determine mean density value (MDV) using gray values and area of bone structure (ABS) based on image pixellation. measuring HU may not be an ideal method to assess bone mineral density when CBCT is used.18/ No.com Vol. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry (DXA). Reductions after modification were noted for ABS with increases in MDV. A statistically significant correlation existed between FD and BMD (p<0. Hua Y. The study found that 2D fractal analysis significantly related the data in this study to BMD with 3D fractal analysis allowing decalcification or the presence of bone lesions to be quantified. In Group 2 (n=12). Reinhilde Jacobs Oral Imaging Center School of Dentistry. the use of cone beam computed tomography (CBCT) has increased with widespread use in dentomaxillofacial radiology. BMD and MDV.05) as well as BMD and ABS (p<0. based on gray values and BMD (using DXA) would appear to be due to intensity inhomogeneity and may affect the ability for CBCT images to be used for such measurements. Dental Implant Summaries. However. Technical constraints of image datasets exist and CBCT data can be associated with larger amounts of scattered x-rays that can increase the noise in reconstructed images. CBCT images were obtained using an i-CAT scanner by placing the samples into a polystyrene container containing water in order to simulate soft tissue. Changes in FD and MDV were subjected to descriptive statistics. With 3D fractal analysis. The fact that FD increased for trabecular bone is contrary to expectations but has been shown before. Jacobs R.5mm created with a spoon excavator. Discussion and Conclusion  The current study used in vitro methods to attempt to Image showing the i-CAT cone validate and assess the accuracy of CBCT scans in determining the quality of bone and in beam CT scanner used to aquire particular osteoporotic bone. The significance of this is as yet unknown. spiral 3D CT scans can be used to provide Hounsfield units (HU) for regions of interest as a way of assessing bone mineral density.3000 Leuven BELGIUM Material and Methods  19 human mandibular dry bone specimens were divided into three groups. Nonetheless morphometric measurements confirmed decreases in bone area.13 Bone quality assessment based on cone beam computed tomography imaging Low bone quality has been identified as one of the potential factors related to biological failure of implants. Currently. The absence of correlation between density. In contrast. Results  All test specimens showed a reduction in weight after modification. It is also know that beam hardening in CBCT is a phenomenon that can affect the relative HU values for soft and hard tissues.dentalsummaries. CBCT does however. August 2009 Clinical Oral Implants Research Vol. 8 pp 767-771 Correspondence to: Dr. Maes F. © Specialist Dental Summaries www. 3D fractal analysis was carried out using similar methods. Duyck O. 20 No. Calculations of the mean FD for 2D fractal analysis showed that values decreased for Groups 1 and 2 after sample modification. there is some doubt as to the validity of density measurements using CBCT. Further studies are required to verify these findings. have certain limitations that can affect bone quality assessment. decalcification in order to simulate the osteoporotic condition was effected using a HCl solution.

It was also observed that although improvements in oral hygiene were noted. Reductions in peri-implantitis were also recorded with a mean difference of 27. In addition. Finland). the implants were subsequently polished with rubber cups and polishing paste. 36 No. but only at week 1. together with the morphology of the superstructure can hamper efforts to disturb and remove the biofilm. Oral hygiene instructions and clinical measurements were carried out at baseline. Dental Implant Summaries. The inclusion criteria were based on radiographic evidence of bone loss <2. 7 pp 604-609 Correspondence to: Prof.2%±7. Further studies using surgical intervention with or without adjunctive antimicrobial and/or antiinflammatory drugs would be of interest. 1. One possible explanation for the differences for bacterial counts at week 1 could be that hand instrumentation may be more aggressive. In both groups. ultrasonic debridement was undertaken using the Vector System equipped with an implant specific ultrasonic tip (LM Instruments. Discussion and Conclusion  The findings of this study would seem to confirm that no differences exist between hand and ultrasonic mechanical debridement of peri-implantitis sites.05) were noted between the two groups with relation to the study parameters. including 3 smokers. The aim of the current study was to compare the efficacy of two methods for mechanical debridement in the treatment of peri-implantitis.5mm±1. Lindahl C. No significant differences were noted for PPDs between baseline and six months for either group.5mm. Renvert Dept. Microbiological analysis revealed a significantly lower total bacterial count for Group 1 (p<0. with 2 smokers. Data was subject to appropriate statistical analysis.5. Measurements included presence of hyperplasia.18/ No. while in Group 2 (n=18). Merged data for the two groups comparing baseline with six month data showed a significant improvement in oral hygiene measures from a mean plaque index (PI) of 73% down to 53%. Mean bone loss around the implants at the commencement of the study was 1.05).2mm. S. During the course of the study mean PPD varied from 2. It is possible that the nature of implant design and surface. overall oral hygiene remained poor and this may have accounted for the results obtained.8 . Treatment protocols have developed from those relating to periodontitis with implant surface debridement seen as the prerequisite for treatment. PPDs and full mouth plaque scores. Persson G.5mm and a periodontal probing depth (PPD) of ≥ 4mm around one dental implant with bleeding and or pus on probing.1 Jul-Aug 2009 . Group 1 (n=19). They would also seem to suggest that mechanical debridement in early cases of peri-implantitis may not be clinically relevant. Patients with bone loss in excess of 2. on anti-inflammatory medication or antibiotic administration in the previous three months were excluded.01). Samuelsson E.5mm. The need therefore exists to have specific knowledge of adequate intervention methods for the treatment of these conditions around dental implants. Any existing periodontal lesions were treated and the subjects were subsequently randomly divided into two treatment groups. The results of this study demonstrate that no differences exist between hand and ultrasonic debridement methods. July 2009 Journal of Clinical Periodontology Vol. No statistically significant differences (p>0. neither treatment modality appeared to have an affect on the bacterial counts associated with diseased implant sites. © Specialist Dental Summaries www. Renvert S.dentalsummaries.14 Mechanical non-surgical treatment of peri-implantitis: A double blind randomized longitudinal clinical study 1: Clinical results The prevalence of implant mucositis has been reported as >60% with the potential for periimplantitis cited between 28-56%.9% as well as with a reduction in the mean BOP score (p<0.com Vol. bleeding on probing graded on extent (BOP). 3 and 6 months post-operatively. poorly controlled diabetes mellitus. Peri-implantitis appears to be related to the presence of biofilms and the management of these would seem to be important in the control of periimplant infections. inducing a host response of limited duration. Sterile paper points were used to gain microbiological samples at relevant intervals to calculate a total bacterial load. of Health Sciences Kristianstad University SE-29188 Kristianstad SWEDEN Material and Methods  In total 37 patients were enrolled into this double blind randomized longitudinal study. was treated with mechanical debridement using titanium curettes. Results  Data was obtained for 17 subjects in Group 1 and 14 in Group 2.

of Periodontology The Sahlgrenska Academy Göteburg University Box 450 S-405 30 Göteburg SWEDEN Peri-implantitis has been defined as an inflammatory process affecting the tissues around a functioning implant that results in the loss of supporting bone. Using a multilevel model (MLwiN2. The data collated in this study concurs with many previous studies and confirms that it is possible to suffer peri-implantitis at all locations in the oral cavity. the results were similar when comparing within the 2 types of prostheses (FAP: 43% vs 31% and PP:49 vs 35%).05. which was classified as either a full arch prosthesis (FAP) or partial prosthesis (PP). The purpose of this retrospective study was to assess the amount of peri-implantitis induced bone loss relative to implant position for a given patient population. UP (29%) and LP (25%). Results  The most popular site for implant placement was the first premolar region followed by the incisors. lower posterior (LP). In contrast peri-implant mucositis has been defined as reversible inflammatory changes of the peri-implant soft tissues without accompanying bone loss. Approximately 2 implants (42%) per patient were affected by peri-implantitis.1 Jul-Aug 2009 . 36 No. canines and the molars. with 52% of implants being classified as affected compared with UA (39%). On examination of the different prostheses the M positioned implants appeared to experience greater bone loss and could be deemed to be at a higher risk than implants placed as distal abutments (E). The number of M implants affected (44% where n=619) was significantly higher than for the E implants (32%. London. Christer Fransson Dept. and reported upon by Fransson 2005. © Specialist Dental Summaries www. upper anterior (UA). The range of implants presenting with bone loss varied from 30-52%. However.dentalsummaries. 2008) with a total of 1070 implants of which 39% (419 implants) exhibited peri-implantitis induced bone loss were analyzed in this study. Previous studies have stated that poor oral hygiene and smoking are major factors in peri-implantitis induced bone loss.18/ No. Wennstrom J. April 2009 Journal of Clinical Periodontology Vol. of which only a few were placed. the highest prevalence being in the LA region. Discussion and Conclusion  In the present study there was an even spread of anterior and posterior implants of which 42% exhibited bone loss due to peri-implantitis. p < 0.1. identified. 88% of patients had ≥1 affected implant in the LA region and this was the most frequent area for peri-implantitis. lower anterior (LA)) and also relative to their position within a fixed prosthesis (‘end’ implants (E) and those in between ‘mid’ (M) positions). The mean bone loss was calculated for each patient and was divided into 2 categories: a)<2mm. this result was not statistically significant. and UP (30%) respectively. Patient radiographs were analysed 1 year post-operatively (or 2 year post-op when the 1 year radiographs were absent) and at the end point (5 . 4 pp 357-363 Correspondence to: Dr. Berglundh T. However. Material and Methods  182 patients (previously treated. n=451). tooth cleansing and the length of the cantilever are of minor importance.15 Extent of peri-implantitis associated bone loss Fransson F. whereas occlusal load.com Vol. which is similar to findings published in other studies. b)≥2mm. In addition the highest frequency of ≥2mm bone loss was found in the LA region (37%) followed by UA (33%).1mm graded scale. Tomasi C.23 years) using a magnifying glass (x7) and a 0. The LA area was statistically more associated with the condition compared to the other areas. although this may be due to the larger number of FAP where the majority of implants were in the M position. The implant positions were noted relative to jaw position (upper posterior (UP). Statistical analyses included Fishers exact test (95% confidence levels) for the amount of bone loss between the different implant positions (within the jaw and the prostheses) as well as the distribution of affected and non-affected implants. UK) the influence of implant position and risk of peri-implantitis associated bone loss was evaluated. Dental Implant Summaries. LP (35%). but that perhaps the anatomy of the anterior mandible and a middle abutment position within a fixed prosthesis renders an implant more susceptible to peri-implant bone loss.