| 11. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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An Imbalance of the Immune System Instead of a Disease Behind Marginal Bone Loss Around Oral Implants: Position Paper
- 2020
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Ingår i: The International journal of oral & maxillofacial implants. - : Quintessence Publishing. - 1942-4434 .- 0882-2786. ; 35:3, s. 495-502
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this paper is to present evidence that supports the notion that the primary reason behind marginal bone loss and implant failure is immune-based and that bacterial actions in the great majority of problematic cases are of a secondary nature. MATERIALS AND METHODS: The paper is written as a narrative review. RESULTS: Evidence is presented that commercially pure titanium is not biologically inert, but instead activates the innate immune system of the body. For its function, the clinical implant is dependent on an immune/inflammatory defense against bacteria. Biologic models such as ligature studies have incorrectly assumed that the primary response causing marginal bone loss is due to bacterial action. In reality, bacterial actions are secondary to an imbalance of the innate immune system caused by the combination of titanium implants and ligatures, ie, nonself. This immunologic imbalance may lead to marginal bone resorption even in the absence of bacteria. CONCLUSION: Marginal bone loss and imminent oral implant failure cannot be properly analyzed without a clear understanding of immunologically caused tissue responses.
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| 12. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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On inflammation-immunological balance theory—A critical apprehension of disease concepts around implants: Mucositis and marginal bone loss may represent normal conditions and not necessarily a state of disease
- 2019
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Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 21:1, s. 183-189
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oral implants have displayed clinical survival results at the 95%-99% level for over 10 years of follow up. Nevertheless, some clinical researchers see implant disease as a most common phenomenon. Oral implants are regarded to display disease in the form of mucositis or peri-implantitis. One purpose of the present article is to investigate whether a state of disease is necessarily occurring when implants display soft tissue inflammation or partially lose their bony attachment. Another purpose of this article is to analyze the mode of defense for implants that are placed in a bacteria rich environment and to analyze when an obtained steady state between tissue and the foreign materials is disturbed. Materials and Methods: The present article is authored as a narrative review contribution. Results: Evidence is presented that further documents the fact that implants are but foreign bodies that elicit a foreign body response when placed in bone tissue. The foreign body response is characterized by a bony demarcation of implants in combination with a chronic inflammation in soft tissues. Oral implants survive in the bacteria-rich environments where they are placed due to a dual defense system in form of chronic inflammation coupled to immunological cellular actions. Clear evidence is presented that questions the automatic diagnostics of an oral implant disease based on the finding of so called mucositis that in many instances represents but a normal tissue response to foreign body implants instead of disease. Furthermore, neither is marginal bone loss around implants necessarily indicative of a disease; the challenge to the implant represented by bone resorption may be successfully counteracted by local defense mechanisms and a new tissue-implant steady state may evolve. Similar reactions including chronic inflammation occur in the interface of orthopedic implants that display similarly good long-term results as do oral implants, if mainly evaluated based on revision surgery in orthopedic cases. The most common mode of failure of orthopedic implants is aseptic loosening which has been found coupled to a reactivation of the inflammatory- immune system. Conclusions: Implants survive in the body due to balanced defense reactions in form of chronic inflammation and activation of the innate immune system. Ten year results of oral and hip /knee implants are hence in the 90+ percentage region. Clinical problems may occur with bone resorption that in most cases is successfully counterbalanced by the defense/healing systems. However, in certain instances implant failure will ensue characterized by bacterial attacks and/or by reactivation of the immune system that now will act to remove the foreign bodies from the tissues.
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| 13. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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On osseointegration in relation to implant surfaces
- 2019
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Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 21, s. 4-7
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Tidskriftsartikel (refereegranskat)abstract
- Background The understanding of mechanisms of osseointegration as well as applied knowledge about oral implant surfaces are of paramount importance for successful clinical results. Purpose The aim of the present article is to present an overview of osseointegration mechanisms and an introduction to surface innovations with relevance for osseointegration that will be published in the same supplement of Clinical Implant Dentistry and Related Research. Materials and Methods The present article is a narrative review of some osseointegration and implant surface-related details. Results and Conclusions Osseointegration has a changed definition since it is realized today that oral implants are but foreign bodies and that this fact explains osseointegration as a protection mechanism of the tissues. Given adequate stability, bone tissue is formed around titanium implants to shield them from the tissues. Oral implant surfaces may be characterized by microroughness and nanoroughness, by surface chemical composition and by physical and mechanical parameters. An isotropic, moderately rough implant surface such as seen on the TiUnite device has displayed improved clinical results compared to previously used minimally rough or rough surfaces. However, there is a lack of clinical evidence supporting any particular type of nanoroughness pattern that, at best, is documented with results from animal studies. It is possible, but as yet unproven, that clinical results may be supported by a certain chemical composition of the implant surface. The same can be said with respect to hydrophilicity of implant surfaces; positive animal data may suggest some promise, but there is a lack of clinical evidence that hydrophilic implants result in improved clinical outcome of more hydrophobic surfaces. With respect to mechanical properties, it seems obvious that those must be encompassing the loading of oral implants, but we need more research on the mechanically ideal implant surface from a clinical aspect.
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| 14. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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Oral Implant Surfaces 1
- 2005
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Ingår i: Perio & Implant Quarterly 2005. ; 1, s. 33-43
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Tidskriftsartikel (refereegranskat)
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| 15. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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Oral Implant Surfaces 11
- 2005
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Ingår i: Perio & Implant Quarterly 2005. ; 2, s. 22-49
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Tidskriftsartikel (refereegranskat)
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| 16. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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Oral implant surfaces: Part 1--review focusing on topographic and chemical properties of different surfaces and in vivo responses to them
- 2004
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Ingår i: Int J Prosthodont. ; 17:5, s. 536-43
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This article reviews the topographic and chemical properties of different oral implant surfaces and in vivo responses to them. MATERIALS AND METHODS: The article considers detailed mechanical, topographic, and physical characteristics of implant surfaces. Anchorage mechanisms such as biomechanical and biochemical bonding are examined. Osteoattraction and doped surfaces are discussed. RESULTS: Surface quality of an oral implant may be subdivided into mechanical, topographic, and physicochemical properties. Topographic properties are evaluated at the micrometer level of resolution. Moderately rough surfaces (Sa between 1.0 and 2.0 microm) show stronger bone responses than smoother or rougher surfaces. The majority of currently marketed implants are moderately rough. Oral implants permit bone ingrowth into minor surface irregularities-biomechanical bonding or osseointegration. Additional biochemical bonding seems possible with certain surfaces. Osteoattraction is a commercial term without precise biologic correspondence. Surfaces doped with biochemical agents such as bone growth factors have been developed. CONCLUSION: Moderately roughened surfaces seem to have some clinical advantages over smoother or rougher surfaces, but the differences are small and often not statistically significant. Bioactive implants may offer some promise.
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| 17. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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Oral implant surfaces: Part 2--review focusing on clinical knowledge of different surfaces
- 2004
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Ingår i: Int J Prosthodont. ; 17:5, s. 544-64
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This article reviews clinical knowledge of selected oral implant surfaces. MATERIALS AND METHODS: The surfaces most commonly used in clinical practice, marketed by the five largest oral implant companies, are identified; their clinical documentation was scrutinized following a strict protocol. Experimental knowledge of the surfaces is briefly summarized. Retrospective, prospective, and comparative clinical studies were analyzed separately, as were studies of implants in conjunction with bone grafts. RESULTS: TiUnite anodized surfaces are clinically documented in 1- to 2-year follow-up studies at best, with failures at about 3%. Sandblasted and acid-etched SLA surfaces are documented with good clinical results for up to 3 years. Osseotite dual acid-etched implants are documented with good clinical results for up to 5 years. Frialit-2 sandblasted and etched implants are positively documented for about 3 years in one study only. The Tioblast implant is the only design documented for survival over 10 years of follow-up and success over 7 years of follow-up. CONCLUSION: Generally, oral implants are introduced clinically without adequate clinical documentation. Implant companies initiate clinical documentation after product launch. The standards of clinical reporting have improved over the years. Proper long-term reports have been published for only one surface, Tioblast.
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| 18. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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State of the art of oral implants
- 2008
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Ingår i: Peridontology 2000. - : Wiley. - 1600-0757 .- 0906-6713. ; 47:1, s. 15-26
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Tidskriftsartikel (refereegranskat)
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| 19. |
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| 20. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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The impact of oral implants - past and future, 1966-2042
- 2005
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Ingår i: J Can Dent Assoc. - 1488-2159. ; 71:5
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Tidskriftsartikel (refereegranskat)abstract
- This paper traces the history of oral implants, beginning with their early undocumented use in the mid-1960s. Although early experimentation with the Branemark system of osseointegration was unsuccessful, significant improvements and scrupulous documentation of the 1970s led to their general acceptance. George Zarb spearheaded their introduction into North America and application of the osseointegration technique soon expanded to extraoral craniofacial prostheses and bone-anchored hearing aids.New possibilities, such as altered surface properties and the use of implants in grafted and irradiated bone are currently being explored, although commercial pressure to introduce new products before they are adequately tested is a cause for concern.The future will see bioactive surfaces and additives that stimulate bone growth. In fact, with the possibility of in vivo growth of new teeth, implants may become unnecessary.
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