| 1. |
- 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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| 2. |
- Aparicio, C., et al.
(författare)
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ORIS Criteria of Success for the Zygoma-Related Rehabilitation: The (Revisited) Zygoma Success Code
- 2020
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786 .- 1942-4434. ; 35:2, s. 366-378
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Tidskriftsartikel (refereegranskat)abstract
- Zygomatic-related implant rehabilitation differs from traditional implant treatment in biomechanics, clinical procedures, outcomes, and eventual complications such as soft tissue incompetence or recession that may lead to recurrent sinus/soft tissue complications. The extreme maxillary atrophy that indicates the use of zygomatic implants prevents use of conventional criteria to describe implant success/failure. Currently, results and complications of zygomatic implants reported in the literature are inconsistent and lack a standardized systematic review. Moreover, protocols for the rehabilitation of the atrophic maxilla using zygomatic implants have been in continuous evolution. The current zygomatic approach is relatively new, especially if the head of the zygomatic implant is located in an extramaxillary area with interrupted alveolar bone around its perimeter. Specific criteria to describe success/survival of zygomatic implants are necessary, both to write and to read scientific literature related to zygomatic implant-based oral rehabilitations. The aim of this article was to review the criteria of success used for traditional and zygomatic implants and to propose a revisited Zygomatic Success Code describing specific criteria to score the outcome of a rehabilitation anchored on zygomatic implants. The ORIS acronym is used to name four specific criteria to systematically describe the outcome of zygomatic implant rehabilitation: offset measurement as evaluation of prosthetic positioning; rhino-sinus status report based on a comparison of presurgical and postsurgical cone beam computed tomography in addition to a clinical questionnaire; infection permanence as evaluation of soft tissue status; and stability report, accepting as success some mobility until dis-osseointegration signs appear. Based on these criteria, the assessment of five possible conditions when evaluating zygomatic implants is possible.
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| 3. |
- de Souza, R. S., et al.
(författare)
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In Vitro Analysis of the Implant-Abutment Interface Connection and Bacterial Infiltration in Two Extraoral Implant Models
- 2020
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786. ; 35:1, s. 63-69
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the connection microgaps and the bacterial infiltration of implant-abutment interfaces of two extraoral implant models. Materials and Methods: Two implant models were used: the inner connection and the flush connection types. The implant-abutment microgaps of five sets of each extraoral implant were evaluated with scanning electron microscopy. Eleven additional sets of each model design were immersed in Staphylococcus aureus cultures for 24 hours, and samples were obtained from the external surface and from the implant's internal chamber to quantify the colony-forming units. Results: Scanning electron microscopy analysis showed that microgaps of the flush connection were smaller compared with the inner connection (P < .0001), and that bacterial counts were higher at the inner connection compared with the flush connection (P < .0001). Conclusion: Within the limitations of this experimental study, it can be concluded that the flush connection model presented a smaller microgap and fewer bacterial colonies compared with the inner connection model.
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| 4. |
- Duddeck, D. U., et al.
(författare)
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Quality Assessment of Five Randomly Chosen Ceramic Oral Implant Systems: Cleanliness, Surface Topography, and Clinical Documentation
- 2021
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786 .- 1942-4434. ; 36:5, s. 863-874
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: After some initial setbacks in the 1970s, ceramic implants seem to be a promising alternative to titanium implants. Since the surface of an implant system represents the interface to surrounding biologic structures, the study focuses on cleanliness and surface topography. Clinical documentation of the corresponding systems completes the picture and allows a better evaluation of zirconia implant systems. Materials and Methods: Five different ceramic implant systems were selected randomly and purchased via blind-shopping: Z5s (Z-Systems), ZiBone (COHO), W implant (TAVDental), ceramic. implant (vitaclinical), and BioWinI/Standard Zirkon Implantat (Champions-Implants/ZV3 system). Three samples of each implant system underwent scanning electron microscopy (SEM) imaging and elemental analysis (EDS). Where appropriate, subsequent Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) was performed to identify the chemical nature of impurities. Surface topography was evaluated, and a search for clinical trials in the PubMed database, on the websites and by written request to each dental implant manufacturer, was performed. Results: Surfaces of Champions implants (ZV3) and Z-Systems implants were relatively clean, whereas the other investigated surfaces of vitaclinical, TAV Dental, and ZiBone implants all displayed organic contaminations on their surfaces. Four of the investigated ceramic implants showed a moderately rough implant surface. Only the vitaclinical ceramic implant had minimal surface roughness. Three ceramic designs-vitaclinical, ZV3, and Z-Systems-had clinical trials documented with up to 3 years of follow-up and results varying between 82.5% and 100% survival. TAV Dental W and ZiBone implant systems lacked properly conducted clinical recording of results. Conclusion: The results of this study showed that it is technically possible to produce zirconia implants that are largely residue-free. On the other hand, the variety of significant residues found in this analysis raises concerns, as contamination may lead to undesirable biologic effects. The lack of clinical studies in peer-reviewed journals does not seem to be relevant for the approval of marketing, nor does the lack of surface cleanliness. In the authors' opinion, a critical analysis of these aspects should be included in a more stringent future analysis prior to the marketing of oral implant systems.
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| 5. |
- Jemt, Torsten, 1950, et al.
(författare)
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Bone Loss Before and After Peri-implantitis Surgery: A 7-Year Retrospective Observational Study
- 2021
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786. ; 36:6, s. 1199-1210
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to report changes in implant bone levels before and after peri-implantitis surgery (P-IS). Materials and Methods: Patients were treated with P-IS from 2003 to 2010 and thereafter followed up until the last available radiographic examination (study termination: October 2018). Bone loss was measured before and after P-IS, and the numbers of clinical examinations post-P-IS were determined. The Student t test was used to compare the bone loss between examinations and reference populations, and correlations between different variables were calculated using the Pearson correlation coefficient (r). Results: One hundred thirty-four consecutive patients (137 arches) underwent P-IS during the inclusion period (2.3%). A total of 122 patients (125 arches) were followed up fora mean period of 6.9 (SD: 5.54) and 7.3 (SD: 3.39) years from the first annual examination to before P-IS, and from the time of P-IS to after P-IS, respectively. The mean bone loss during the aforementioned durations was 0.18 (SD: 0.23) and 0.26 (SD: 0.28) mm/year, respectively (P < .05). Bone loss per year was also greater for unaffected implants after (0.29 [0.34] mm/year) compared with before P-IS (0.06 [0.10] mm/year; P < .05). No difference in bone loss was observed between peri-implantitis affected and unaffected implants or between implants with a turned or moderately rough surface after P-IS. A greater amount of bone loss was associated with increasing numbers of clinical examinations and shorter follow-up times after P-IS (P < .05). Conclusion: Average bone levels decreased from the time of prosthesis placement to termination of the study. Bone loss increased after P-IS in the total and unaffected group, and edentulous patients compared unfavorably with partially and single implant conditions. Increased bone loss was associated with higher numbers of clinical examinations per year of followup after P-IS (P < .05).
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| 6. |
- Jemt, Torsten, 1950, et al.
(författare)
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Could Age at Surgery Be Associated with Early Mortality After Implant Surgery? A Retrospective Study of 3,877 Edentulous Patients
- 2022
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786. ; 37:1, s. 128-134
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Knowledge of the early mortality patterns in edentulous implant patients is limited. This study aimed to report patient mortality within the first year after surgery and compare the cause of death with preexisting conditions reported before surgery. Materials and Methods: In this retrospective cohort study, data from the Swedish National Death Register on patients, consecutively treated in the edentulous arch between 1986 and 2013, were compared with information from the patient files regarding the preexisting health conditions of the deceased patients. One-year survival rates were calculated and compared with expected mortality in a Swedish reference population based on three age groups: young ( 45 years of age), middle-aged (45 to 64 years of age), and old patients ( 64 years of age). Proportions of mortality between study groups and reference populations were tested by means of a log-rank test, and agreement between diagnoses before surgery and cause of death was tested by means of kappa test. Results: Altogether, 3,877 patients were included, of whom 60 patients died within 1 year after implant surgery (1.5%). The expected mortality in the Swedish reference population was 2.1% (P < .05). Mortality was higher for middle-aged (P = .02) but lower for old patients (P = .0001) compared with the Swedish reference populations. Eight of the deceased patients (13%) had no preexisting conditions, while 48 patients reported a health diagnosis before implant surgery. The most common of these were related to the circulatory system (ICD 10-I), which was the cause of death for 30 patients. A "none to slight agreement" between presurgical diagnoses and cause of death was observed in the population (kappa: 0.152). Conclusion: Edentulous implant patients presented overall lower mortality than expected in the general population during the first year after surgery. However, middle-aged patients showed a higher proportion of deceased patients compared with control people of the same age. Cardiovascular diseases were the cause of death in 50% of the group, and the agreement between presurgical and cause of death diagnoses was poor.
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| 7. |
- Jemt, Torsten, 1950, et al.
(författare)
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Could Future Implant Failures be Predicted Based on Observed Bone Levels and Bone Loss After 5 Years? A Retrospective Investigation on Patients Presented in Previous Studies
- 2023
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Ingår i: International Journal of Oral & Maxillofacial Implants. - 0882-2786. ; 38:2, s. 259-267
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the diagnostic accuracy of bone loss/bone levels, as detected after 5 years of implant function, in identifying patients who suffered implant failures in the following 5 years. Materials and Methods: Data on radiographic measurements of marginal bone levels at prosthesis placement and after 5 years of function were retrospectively retrieved from 11 previous publications. Included patients were allocated into different subgroups with regard to bone loss/bone level during/after 5 years in function, respectively. A diagnostic test was used to estimate the accuracy of finding patients/jaws/implants at risk for a future implant failure by calculating sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) in different subgroups, respectively. Results: Altogether, 749 treated jaws (723 patients/3,363 implants) were included in the study group. Treated jaws in the high-level subgroups presented an overall higher risk of implant failures from 5 to 10 years in function (P < .05). Many treated jaws/implants were allocated into the high-level groups, but the proportions of implant failures were low in these groups. The diagnostic test comparing high-and low-level groups with and without implant failures showed low accuracy to predict implant failures; the PPV ranged from 4% to 33%. Lower PPVs were observed for diagnostic tests for individual implants (range: 4% to 6%). Conclusion: More severe bone loss was associated with higher risk of future implant failure. However, many patients/ implants with obvious bone loss in the study group and low prevalence of implant failures at the 10-year examination resulted in poor accuracy in identifying individual patients or implants at risk for failure. This suggests that it is difficult to predict future implant failures based only on radiographic measurements. Int J Oral Maxillofac Implants 2023;38:259-267. doi: 10.11607/jomi.10042
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| 8. |
- Klinge, Anna, et al.
(författare)
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Craniofacial Height in Relation to Cross-Sectional Morphology of the Anterior Maxilla : An Anatomica Considers ion in Implant Therapy
- 2020
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : QUINTESSENCE. - 0882-2786 .- 1942-4434. ; 35:2, s. 386-394
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Patients who have a vertical growth pattern are more prone to complete alveolar bone growth later and run a higher risk for inhibition of growth and infraposition after implants have been placed. Moreover, it has been suggested for the same category of patients that craniofacial height may influence the alveolar bone morphology of the anterior maxilla during growth. Hence, it is important to identify such patients early when considering implant treatment in young patients. The purpose of this study was to investigate the height and width of the alveolar bone in the anterior maxilla in subjects with different craniofacial heights to assess if there is a relation between craniofacial height and the dimensions of the alveolar bone in the anterior part of the maxilla. Materials and Methods: Measurements on cephalograms and cone beam computed tomography (CBCT) images of the maxilla from 180 fully dentate subjects were analyzed and categorized into three angle groups based on the craniofacial height: low-, normal-, and high-angle groups. Measurements of the alveolar bone were taken interradicular, at six reference points distributed between the first premolar regions in the maxilla. The height and width of the alveolar bone were measured with a standardized technique at 3, 6, 9, and 12 mm from the top of the alveolar process. Results: Significant differences were found regarding the height of the alveolar bone in all the subgroups and regarding the width in the 9- and 12-mm subgroups, and between low-/normal- and low-/high-angle groups, where the high-angle group represented the thinnest alveolar bone. A significant difference was found between male and female patients concerning all dimensions of the alveolar bone. Conclusion: There is a relation between craniofacial height and the dimensions of the alveolar bone in the anterior part of the maxilla. Craniofacial height is an important factor to analyze when implant treatment is considered in the maxillary anterior region. This identification can preferably be carried out early in young patients who are still growing when various treatment options can still be considered.
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| 9. |
- Riben, Christopher, et al.
(författare)
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Quantification of Bone Height and Bone Volume Around Dental Implants After Open Maxillary Sinus Elevation Surgery Using CBCT.
- 2023
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786 .- 1942-4434. ; 38:4, s. 789-800
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess, using CBCT, the volume and height of bone formation after open maxillary sinus elevation without the use of grafts.Materials and Methods: The study was retrospective and included 24 patients with a total of 67 implants. CBCT examinations were conducted at baseline (0 to 43 days postsurgery) and after an average healing period of 6.2 months (range: 5.1 to 7.8 months). The image analysis included metal artifact reduction, registration, and a standardized protocol for segmenting the anatomical structures of the maxillary sinus, including calculating the 3D volumetric changes after bone formation. Conventional manual 2D measurement of vertical bone formation was executed for comparison. Clinical factors assumed to be relevant for bone formation were obtained from patient medical records.Results: One implant was lost before prosthetic loading, representing an early implant loss rate of 1.5%. Differences in intra- and interexaminer reproducibility were registered for the conventional 2D method (P < .05). The average vertical bone formation measured with the 2D method was 4.8 mm (4.6 to 5.0 mm), covering 60.2% of the implant height within the sinus. The average volumetric bone formation measured with the developed 3D image-analysis method was 801 mm3 in total and 195 mm3 in a restricted region around each implant. Bone formation was registered in 62% of the volume of the restricted region. A correlation regarding bone formation was found between the two methods (R2 = 0.705). Clinical factors such as age, smoking, general health, and postoperative complications did not correlate with the amount of bone formed.Conclusion: CBCT image analysis is a promising method for objective 3D evaluation of bone formation after sinus elevation. A correlation was seen between the manually measured bone height (2D) and the bone volume in a restricted region around each implant using the developed method (3D). Reducing visual interpretation minimizes errors related to examiner reliability. Clinical factors did not significantly affect the volumetric bone formation.
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| 10. |
- Stocchero, Michele, et al.
(författare)
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Effect of Drilling Preparation on Immediately Loaded Implants : An In Vivo Study in Sheep
- 2023
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Ingår i: International Journal of Oral & Maxillofacial Implants. - : Quintessence Publishing. - 0882-2786 .- 1942-4434. ; 38:3, s. 607-618
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine the biologic and biomechanical effects of two implant drilling protocols on the cortical bone around implants subjected to immediate loading. Materials and Methods: A total of 48 implants were inserted into the mandibles of six sheep following one of two drilling protocols: undersized preparation (US; n = 24) and nonundersized preparation (NUS; n = 24). Immediately after implant insertion, an abutment was placed on each implant and 36 implants were subjected to 10 sessions of dynamic vertical loads (1,500 cycles, 1 Hz) of 25 N or 50 N. Insertion torque value (ITV) was recorded at implant installation. Resonance frequency analysis (RFA) was measured at implant insertion and at each loading session. Fluorochrome was administered at day 17, and the animals were euthanized after 5 weeks. The removal torque values (RTVs) were measured, and samples underwent histomorphometric, mu CT (microcomputed tomography), and fluorescence image acquisition analyses. The bone volume density (BV/TV), bone-to-implant contact (BIC), bone area fraction occupancy (BAFO), and fluorochrome stained bone surface (MS) were calculated. A linear mixed model analysis was performed, and Pearson paired correlation was calculated. Results: Five implants from the NUS group failed, with a mean ITV of 8.8 Ncm and an RFA value of 57. The mean ITVs for US group and NUS group were 80.5 (+/- 14) Ncm and 45.9 (+/- 25) Ncm, respectively (P < .001). No differences were noted in the RFA values from the time of implant insertion until the end of the study. No differences in RTV, BV/TV, BAFO, or MS were observed between the groups. Intense new bone formation took place in the NUS group implants that were subjected to load. Conclusions: Undersized preparation of cortical bone ensured a greater BIC compared to a nonundersized preparation. Moreover, this study demonstrated that immediate loading did not interfere with the osseointegration process, but loading induced intense new bone formation in the NUS group. It is not recommended to immediately load the implants when the clinically perceived primary stability is lower than an ITV of 10 Ncm and an RFA value of 60.
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