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- Albrektsson, Tomas, 1945, et al.
(författare)
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Bone loss around oral and orthopedic implants: An immunologically based condition
- 2019
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Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 21:4, s. 786-795
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Tidskriftsartikel (refereegranskat)abstract
- Background Marginal bone resorption has by some been identified as a "disease" whereas in reality it generally represents a condition. Purpose The present article is a comparison between oral and orthopedic implants, as previously preferred comparisons between oral implants and teeth seem meaningless. Materials and Methods The article is a narrative review on reasons for marginal bone loss. Results and Conclusions The pathology of an oral implant is as little related to a tooth as is pathology of a hip arthroplasty to a normally functioning, pristine hip joint. Oral as well as orthopedic implants are recognized as foreign bodies by the immune system and bone is formed, either in contact or distance osteogenesis, to shield off the foreign materials from remaining tissues. A mild immune reaction coupled to a chronic state of inflammation around the implant serve to protect implants from bacterial attacks. Having said this, an overreaction of the immune system may lead to clinical problems. Marginal bone loss around oral and orthopedic implants is generally not dependent on disease, but represents an immunologically driven rejection mechanism that, if continuous, will threaten implant survival. The immune system may be activated by various combined patient and clinical factors or, if rarely, by microbes. However, the great majority of cases with marginal bone loss represents a temporary immune overreaction only and will not lead to implant failure due to various defense mechanisms.
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- Albrektsson, Tomas, 1945, et al.
(författare)
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Crestal Bone Loss and Oral Implants
- 2012
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Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 14:6, s. 783-791
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Tidskriftsartikel (refereegranskat)abstract
- Background: A consensus meeting was arranged to critically analyze whether the high figures of peri-implantitis at machined implants that recently have been reported in the literature are valid also for modern implants. Purpose: The aims of this paper were to present the outcomes from the consensus meeting and to evaluate recent long-term clinical studies on modern implants with regard to frequency of peri-implant infection. Materials and Methods: Ten different studies of three modern implant brands of moderately rough surfaces with 10-year or longer follow-up times were found through a PubMed and manual search. Results: It was concluded that bleeding on probing or probing depths are weak indicators of crestal bone loss (CBL); that CBL occurs for many other reasons than infection; that implant-, clinician-, and patient-related factors contribute to CBL; and that modern oral implants outperform older devices. Based on a literature search, the frequency of implants with reported peri-implant infection and significant bone loss leading to implant removal or other surgical intervention was on average 2.7% during 7 to 16 years of function. Conclusion: The summed frequency of peri-implantitis and implant failure is commonly less than 5% over 10 years of follow-up for modern implants when using established protocols.
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- Albrektsson, Tomas, 1945, et al.
(författare)
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Direct bone anchorage of oral implants: clinical and experimental considerations of the concept of osseointegration.
- 1990
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Ingår i: The International journal of prosthodontics. - 0893-2174. ; 3:1, s. 30-41
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Forskningsöversikt (refereegranskat)abstract
- The term osseointegration is analyzed in relation to its theoretical and clinical definitions, and comparisons are made to other implant modalities. The term osseointegration has a clear clinical meaning, but there is doubt about its precise usage in an experimental setting. Clinically, an implant can be described as osseointegrated if there is no discernable movement when force is applied to the fixture. This is in contrast to implants surrounded by fibrous connective tissue, which move within soft tissue. Newly developed laboratory techniques may be used in the future to precisely characterize osseointegration in the laboratory.
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- Albrektsson, Tomas, 1945, et al.
(författare)
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Histologic investigations on 33 retrieved Nobelpharma implants.
- 1993
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Ingår i: Clinical materials. - 0267-6605. ; 12:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Thirty Nobelpharma implants were retrieved from 17 patients despite a remaining clinical stability, after between 1 and 16 years of clinical function. The reasons for implant removal were bone resorption in combination with soft tissue disorders, psychological causes, implant fracture and post mortem cases. When measured at the cortical passage, there was an average of 84.9% direct bone-to-implant contact and 81.8% average surface bone area in individual threads as evaluated in a computerized morphometric system at the light microscopic level.
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| 7. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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Initial and long-term crestal bone responses to modern dental implants
- 2017
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Ingår i: Periodontology 2000. - : Wiley. - 0906-6713 .- 1600-0757. ; 73:1, s. 41-50
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Forskningsöversikt (refereegranskat)abstract
- Successful osseointegration is the result of a controlled foreign body reaction to dental implants. Osseointegrated implants have demonstrated excellent long-term survivability, although they may be subject to limited marginal bone loss. Marginal bone loss during the first few years after implant placement seldom represents disease, but is instead the result of an adaptive bone response to surgical trauma and implant loading. It is not uncommon for implants with early marginal bone loss to enter a long-lasting state of bone stability. Extensive bone resorption after the first year is generally due to an exacerbation of adverse body reactions caused by non-optimal implant components, adverse surgery or prosthodontics and/or compromised patient factors. Disease in the form of peri-implantitis is a late complication that affects some implants with suppuration and rapid loss of crestal bone, and is probably caused by bacterial pathogens and immunological reactions. Unfortunately, the literature is not consistent with respect to the type or magnitude of clinical implant problems, including how they are defined and diagnosed. If the peri-implantitis diagnosis is confined to cases with infection, suppuration and significant bone loss, the frequency of the disease is relatively low, which is in sharp contrast to the frequencies reported with unrealistic definitions of peri-implantitis. We suggest that when modern implants are placed by properly trained individuals, only 1–2% of implants show true peri-implantitis during follow-up periods of 10 years or more. Peri-implantitis must be separated from the initial and self-limiting marginal bone loss.
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| 8. |
- Albrektsson, Tomas, et al.
(författare)
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Is Marginal Bone Loss around Oral Implants the Result of a Provoked Foreign Body Reaction?
- 2014
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Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 16:2, s. 155-165
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Tidskriftsartikel (refereegranskat)abstract
- Background When a foreign body is placed in bone or soft tissue, an inflammatory reaction inevitably develops. Hence, osseointegration is but a foreign body response to the implant, which according to classic pathology is a chronic inflammatory response and characterized by bone embedding/separation of the implant from the body. Purpose The aim of this paper is to suggest an alternative way of looking at the reason for marginal bone loss as a complication to treatment rather than a disease process. Materials and Methods The present paper is authored as a narrative review contribution. Results The implant-enveloping bone has sparse blood circulation and is lacking proper innervation in clear contrast to natural teeth that are anchored in bone by a periodontal ligament rich in blood vessels and nerves. Fortunately, a balanced, steady state situation of the inevitable foreign body response will be established for the great majority of implants, seen as maintained osseointegration with no or only very little marginal bone loss. Marginal bone resorption around the implant is the result of different tissue reactions coupled to the foreign body response and is not primarily related to biofilm-mediated infectious processes as in the pathogenesis of periodontitis around teeth. This means that initial marginal bone resorption around implants represents a reaction to treatment and is not at all a disease process. There is clear evidence that the initial foreign body response to the implant can be sustained and aggravated by various factors related to implant hardware, patient characteristics, surgical and/or prosthodontic mishaps, which may lead to significant marginal bone loss and possibly to implant failure. Admittedly, once severe marginal bone loss has developed, a secondary biofilm-mediated infection may follow as a complication to the already established bone loss. Conclusions The present authors regard researchers seeing marginal bone loss as a periodontitis-like disease to be on the wrong track; the onset of marginal bone loss around oral implants depends in reality on a dis-balanced foreign body response.
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| 9. |
- Albrektsson, Tomas, 1945, et al.
(författare)
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State of the art in oral implants.
- 1991
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Ingår i: Journal of clinical periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 18:6, s. 474-81
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Forskningsöversikt (refereegranskat)abstract
- Uncontrolled oral implant devices are still being widely used. The documentation of most oral implant systems is poorly backed up or not followed up for an adequate time period. Success rates are being quoted without reference to any defined success criteria. Frequently used oral implant designs such as the Core-Vent, IMZ and Calcitek hydroxyapatite coated implants are in neither case supported by any adequate clinical reports from minimally 5-years of follow-up. Other implant systems such as the ITI, some subperiosteal designs and the Tübingen implant demonstrate well-controlled and acceptable 5-year data but are not followed up in a sufficient number or have demonstrated less good results in the 10-year evaluation. The Small transosteal staple has been adequately reported for more than 10 years of follow-up, whereas the Brånemark implant is the only endosseous design that has demonstrated acceptable 15-year success rates.
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| 10. |
- 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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