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Sökning: LAR1:gu > Tidskriftsartikel > Jemt Torsten 1950

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1.
  • Albrektsson, Tomas, 1945, et al. (författare)
  • Bone loss around oral and orthopedic implants: An immunologically based condition
  • 2019
  • Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 21:4, s. 786-795
  • 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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2.
  • Albrektsson, Tomas, et al. (författare)
  • Is Marginal Bone Loss around Oral Implants the Result of a Provoked Foreign Body Reaction?
  • 2014
  • Ingår i: Clinical Implant Dentistry and Related Research. - : John Wiley & Sons. - 1523-0899 .- 1708-8208. ; 16:2, s. 155-165
  • 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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3.
  • Albrektsson, Tomas, 1945, et al. (författare)
  • 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
  • Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 21:1, s. 183-189
  • 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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5.
  • Andersson, B., et al. (författare)
  • Long-Term Function of Single-Implant Restorations: A 17-to 19-Year Follow-Up Study on Implant Infraposition Related to the Shape of the Face and Patients' Satisfaction
  • 2013
  • Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899. ; 15:4, s. 471-480
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Various levels of infraposition of single-implant restorations have been observed in long-term follow-up studies, but little knowledge is available on the biological mechanism behind this pattern. Purpose: The primary aim of this study is to report the frequency and severeness of implant infraposition in the anterior single-implant application after 17 to 19 years in function and, secondly, to try to relate these observations to anatomical appearance of the shape of the face of the patient. Materials and Methods: The present study comprised of 57 patients who were provided with 65 CeraOne (TM) single-tooth restorations (Nobel Biocare AB, Gothenburg, Sweden) between 1989 and 1991. Altogether 46 of these patients were treated with single implants in the anterior region. Besides clinical and radiographic data, clinical photographs, study casts, and patient's assessment of the long-term aesthetic result (visual analog scale) was collected at the termination of the present study. The degree of implant crown infraposition was related to assessed facial shape and to patient and clinical assessment of the aesthetic result by means of Pearson's correlation test. To increase the numbers of patients, another group of 25 patients presented in another similar study were pooled with the present material for prevalence calculations. Results: Altogether 47 patients showed up for the final examination after an average of 18 years (82%). Two implants failed (18 years cumulative survival rates [CSR] - 96.8%) and eight original single-crown restorations were replaced (CSR 83.8%). Three of the replaced crowns were replaced because of infraposition of the crowns. About 40% of the patients showed signs of infraposition, similar in younger and older age groups, but more frequently observed in female patients at termination of the study (p < 0.05). There was a weak trend indicating an association between "long-face" appearance and infraposition of the crown restoration (p > 0.05), and patients were more satisfied with the aesthetic clinical result than the participating clinicians (p < 0.05). Conclusion: Single-implant restorations in the anterior upper jaw may present small degrees of infraposition in long-term perspectives. Female patients seem to be at a higher risk of infraposition (p < 0.05), but no clear relationship between age at implant placement or facial shape and degree of infraposition was possible to establish (p > 0.05). Patients were more satisfied with the aesthetic result, as compared with the clinicians (p < 0.05), and patients seemed to pay less attention to the degree of infraposition in their aesthetic assessments, as compared with most of the clinicians.
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6.
  • Antoun, H., et al. (författare)
  • A retrospective study on 1592 consecutively performed operations in one private referral clinic. Part I: Early inflammation and early implant failures
  • 2017
  • Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899. ; 19:3, s. 404-412
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundFew large-scale follow-up studies are reported on routine implant treatment. PurposeTo report retrospective data on early inflammatory and early implant failures in a large number of routine patients at one private referral clinic. Materials and MethodsA total of 1017 patients were consecutively provided with 3082 implants with an anodized surface (Nobel Biocare AB) at 1592 implant operations between 2000 and 2011. All patients reported with mucosa inflammation and bone loss and/or implant failures to the first annual examination were identified. A logistic multivariate data analysis was performed to identify possible factors with an association to the two events. ResultsAltogether 33 patients/operations presented early inflammation (2.1% operations). History of periodontitis (OR 3.91; 95% CI: 1.86-8.21), numbers of implants (OR1.33; 95% CI:1.07-1.67 per implant), two stage surgical technique (OR 3.70; 95% CI: 1.75-7.85), and lower jaw treatment (OR 4.73; 95% CI: 2.12-10.57) increased the risk for early mucositis with bone loss (P<.05). Highest risk for early inflammation was observed for patients at an age of 50-55 years at surgery (P<.05). Smoking habits (OR 2.08; 95% CI: 1.06-4.10) Immediate implant placement (OR 2.09; 95% CI: 1.23-3.54), and immediate grafting procedures (OR 2.09; 95% CI: 1.04-4.19) had a significant association to early implant failures (P<.05). Furthermore, risk for an early failure decreased with 22% per year of inclusion (2000 >2011; OR 1.22; 95% CI;1.08-1.39). ConclusionHistory of periodontitis and two-stage surgery protocols with bone grafts in the (posterior) lower jaw increased the risk for early inflammatory problems after surgery (P<.05), with the highest risk for mid-aged patients (P<.05). Preventable factors related to the patient (smoking) and experience of surgeon showed to have a significant association to early implant failures in routine clinical practice (P<.05).
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7.
  • Bergenblock, Sibel, 1973, et al. (författare)
  • Long-Term Follow-Up of CeraOne Single-Implant Restorations: An 18-Year Follow-Up Study Based on a Prospective Patient Cohort.
  • 2012
  • Ingår i: Clinical implant dentistry and related research. - : Wiley. - 1708-8208 .- 1523-0899. ; 14:4
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT Background: Knowledge on long-term clinical performance of more than 5 years on the single-implant CeraOne (Nobel Biocare AB, Gothenburg, Sweden) concept is limited. Purpose: The aim of this study is to report the long-term clinical performance of the first CeraOne single-implant restorations, installed 17 to 19 years ago. Materials and Methods: The group comprised 57 patients provided with 65 CeraOne single-tooth restorations. Sixty-two all-ceramic and three metal-ceramic crowns were cemented between 1989 and 1991. Patients were followed up clinically and with intraoral radiographs at placement, after 1, 5, and between 17 and 19 years after placement. Results: Data were available for altogether 48 patients, followed up on an average time of 18 years. Excluding deceased patients (n = 2) and failed implant patients (n = 2), only five patients were lost to follow-up (8.8%). Two implants failed, resulting in an 18-year implant cumulative success rate (CSR) of 96.8%, and altogether eight original single-crown restorations were replaced (CSR 83.8%). The most common reason for crown replacement was infra-position of the implant crown (n = 3). Many of the remaining original crowns showed various signs of implant crown infraposition at the termination of the study. In general, the soft tissue at the restorations was assessed to be healthy and comparable with the gingiva at the adjacent natural teeth. Bone levels were on an average stable with only few patients exhibiting bone loss of more than 2 mm during 18 years in function. Conclusion: This long-term follow-up study of single-implant restorations shows encouraging results with few implant failures and minimal bone loss over an 18-year period. Original single-crown restorations were replaced more frequently, because of, for example, implant crown infraposition and veneer fractures. The CeraOne concept proved to be a highly predictable and safe prosthodontic treatment.
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8.
  • Book, K, et al. (författare)
  • Functional adaptation to full-arch fixed prosthesis supported by osseointegrated implants in the edentulous mandible.
  • 1992
  • Ingår i: Clinical oral implants research. - 0905-7161. ; 3:1, s. 17-21
  • Tidskriftsartikel (refereegranskat)abstract
    • The objective of the present study was to assess possible adaptive functional changes in the masticatory system after insertion of fixed prostheses supported by osseointegrated implants in the edentulous mandible. Registrations of mandibular movement characteristics and maximal biteforce were performed at insertion and after 1 week, 3 months and 1 year after connection. The duration of the opening and closing phase decreased and maximal biteforce increased significantly (p < or = 0.05-0.001) from connection of the prostheses to the annual check-up. However, the process of functional adaptation implied 2 identified stages. An immediate phase that occurred within the 1st week, probably due to altered impact from mechano-sensitive receptors and a later more time-dependent phase, based on learning and new cortical engrams. Accordingly, the process of adaptation will continue over a long period of time.
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9.
  • Carlsson, Gunnar E, 1930, et al. (författare)
  • Long-term marginal periimplant bone loss in edentulous patients.
  • 2000
  • Ingår i: The International journal of prosthodontics. - 0893-2174. ; 13:4, s. 295-302
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim of this study was to examine the long-term periimplant bone loss in patients treated with implant-supported fixed prostheses in both jaws. MATERIALS AND METHODS: The participants comprised 44 edentulous patients who have been followed for a 15-year period after treatment with a fixed implant-supported prosthesis in the mandible. Thirteen of them also received an implant-supported fixed prosthesis in the maxilla, on average 4.5 years after the mandibular treatment. The periimplant bone level was measured on intraoral radiographs. RESULTS: The long-term results of the implant treatment were successful, and only 1% (3/273) of the implants were lost in the mandible and 7% (5/75) in the maxilla. All but one of the failures occurred before the connection of the prostheses. The mean marginal bone loss around the implants was small (less than 1 mm for a 10-year period after implant placement), and was of similar magnitude in both jaws. However, the individual variation was relatively great. There was no significant difference in marginal bone loss between those who had a maxillary complete denture during the entire observation period and those who had received a fixed implant-supported maxillary prosthesis. Smokers lost more periimplant bone than did the nonsmokers; the difference was significant in the mandible but small and nonsignificant in the maxilla. CONCLUSION: The long-term periimplant bone loss was small and of similar magnitude in the mandible and the maxilla in subjects who had received implant-supported fixed prostheses in both jaws. The prosthetic status in the maxilla, i.e., complete denture or fixed implant-supported prosthesis, had no significant influence on the mandibular periimplant bone loss.
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10.
  • Coli, Pierluigi, 1964, et al. (författare)
  • On marginal bone level changes around dental implants
  • 2021
  • Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 23:2, s. 159-69
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Peri-implant bone level values have been used as the clinical standard of reference to describe the status of a dental implant, despite the fact that their significance for the long-term survival of the implant has never been properly assessed. Purpose: To challenge the assumption that the natural course of peri-implant bone loss is the loss of the implant. Materials and methods: This article is a narrative review on reasons and interpretations of marginal bone level changes around dental implants. Results and conclusions: Different views regarding the pattern and progression of marginal bone loss depending on dental specialties have been identified. However, the present finding of a negative correlation between an increasing cumulative marginal bone loss and a decreasing risk of implant failures over time indicates that peri-implant marginal bone loss does not necessarily represent a condition of disease. Reduction of marginal bone levels may be observed in a majority of patients during follow-up time, with only a minority of those patients losing implants and implant-supported prostheses in the long term. Bone level changes seem often to occur as a consequence of physiological processes and/or as an adaptation to altered external as well as host response factors. Periodical radiological assessments of implant-restorations remain a valid diagnostic tool for the detection of potential implant fractures, loss of osseointegration, screws working loose and for the detection of the few cases with advanced, continuously progressing marginal bone loss during time. The detection of peri-implant marginal bone loss at one time point should not be immediately considered as a sign of ongoing pathology and of an increased risk of future loss of the implant in question.
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