dental implant

Most of the experimental studies have been indicated that the bone matrix formation and bone mineralization was almost equal in controlled diabetic and non-diabetic animals but BIC was lower even in controlled diabetic subjects. Number of studies has proposed and explained mechanism of deleterious effect of diabetes over wound healing and true association (osseointegration) of bone to implant surface. However studies, performed in humans specifically with diabetes type-2, observed insignificant effect over BIC and consequently good osseointegration of dental implant in controlled diabetic patients(2). The difference in developing diabetes (alloxan or streptozotocin destruct beta cells of Langerhans consequently induces diabetes) in experimental animals and human being (type-2 diabetes develop due to glucose

Tooth loss is a common symptom of clinical diseases, which could reflect the condition of patients’ dental diseases [1, 2]. In most coun- tries, tooth loss is often considered as an effec- tive indication of good or bad oral health. Thus, it is necessary to constantly monitor and take care of oral health, and dental diseases need relevant lifelong treatment [3]. For patients with tooth loss, the depth and width of the tooth have an effect on the success rate of dental implant, and it is also the key factor for a successful implantation. Bad bone quality in implantation site would lead to a low success rate of dental implant [4]. The closure of bone and soft tissue, the masticatory pressure and

Abstract: High esthetic demand and expectation challenges the rehabilitation of the esthetic zone with dental implants. Most implant system manufacturers offer customized and pre- fabricated ceramic, speci fi cally zirconia or alumina abutments, as an alternative to titanium or gold alloy abutments, with the aid of computer-aided designing/computer aided manu- facturing (CAD/CAM) technology. A 45-year-old male patient was referred to the prostho- dontics clinic for the restoration of maxillary central incisors with all ceramic dental implants. After healing, both implants were restored with all-ceramic crowns but different customized abutment materials for the purpose of comparison. The all-ceramic crown was cemented on a customized zirconia abutment at the implant site # 11 and on a customized gold alloy abutment at implant site # 21. The treating dentist as well as two prosthodontists performed a meticulous clinical examination to compare the ceramic crowns side by side and agreed that the outcome was esthetically satisfactory. The patient was satis fi ed with the esthetics and functional outcome of the fi nal restorations, as was the prosthodontist. Keywords: dental implant abutments, esthetic outcome, zirconia abutment

The use of shared decision making in medical consultations can lead to several advantages for clinical care including improving the quality of healthcare and increasing satisfaction (Crawford et al. 2002; Thornton et al. 2003). This model has received rare consideration in dentistry, particularly in relation to implant therapy. Nevertheless, there have been some positive developments in dental research, for example, Johnson et al. (2006) have developed a decision aid to support patients and dentists when they are considering possible treatment choices in order to facilitate shared decision making in dentistry. Perhaps such aids might be used in relation to the provision of dental implant therapies? Johnson et al. (2006) concluded that using decision aids in dental consultations may enable greater shared decisions. Evidence has also demonstrated that the majority of the patients preferred making joint dental decisions with their dentists (Chapple et al. 2003). Yet these studies do not examine in detail the process of shared decision making between patients and dentists nor do they assess the social and economic dimensions of these decisions. These studies were also not focussed on shared decision making in relation to implant consultations, tending to be focused on dental treatments in general. On the plus side they do support making shared decisions in dental consultations.

Bran mark started comprehensive study on microscopic phenomenon of the bone healing in 1952. He reported the bone contacted on the titanium surface directly. 1 This study led to animal study of end osseous implant. Human study was started in 1965 and he presented the results of 10 years of study in1977. 2 In early development stage of dental implant, it had machined surface without any additional surface treatment. As time went by, scientists have studied and developed the surface, form and shape of implant. As a result, it showed high success rate and predictable results over 40 years and has been utilized for several decades. But also failed implants have been increased as compared with early development stage ofimplant. 2

The mechanism of fracture has a multi-factorial aetiology; when number, position, dimension, design of implant and restoration are inadequate to the site needing rehabil- itation, the situation of bending overload is present and an initial bone loss around the implant begins. If no cor- rection of the prosthesis is introduced, the coronal screws become as soon as exposed and a crater-like appearance of the surrounding bone is observable. At this time, the coro- nal portion of the implant represents a lucus minoris resist- enziae, being the implant internally filleted and consequently extremely thin, upon which overstress pro- motes the creation of numerous micro-fractures that can result, after a variable time range, in a complete fatigue fracture. Ideally, implants with internal abutment connec- tion should be more suitable to this complication. Besides, the findings of cracks on the root of the screw thread led us to sustain that bending overload creates a deformation of whole implant with consecutive micro- fractures, as previously described in experimental studies [18-21]. The observation of the cracks we performed at the confocal laser scanning microscope, is surely more easily executable unlike other techniques for metal fracture anal- ysis, as no preparation of the sample is necessary; in fact, it leads rapidly to a diagnosis of fatigue fracture by the 3D reconstruction and the examination on several confocal plans of the cracks of the root of the screw thread; in this way defects or alterations of implant surface due to indus- trial workmanship or surface treatment to promote and increased osseointegration can be easily excluded. Addi- tionally, this investigations could be useful for insurance reasons when failure of a dental implant occurs, while they are surely helpful in the planning of the new implant rehabilitation.

Replacement of missing tooth with various materials dates back to ancient period of Greek and Egyptian civilization where bone, carved ivory, shells, metal and even animal teeth were used. Many materials were introduced later on but unpredictable failures occurred with them due to the lack of firm attachment. In 1952, Dr Perr Ingvar Branemark developed a threaded implant design made of pure titanium that showed direct contact with bone. This phenomenon was called osseointegration, defined by the American Academy of Implant Dentistry as “the firm, direct and lasting biological attachment of a metallic implant to vital bone with no intervening connective tissue” [1]. With the emerging concept of osseointegration, devices were designed to mimic as much as possible cell interactions that normally take place during bone remodeling. Currently the implant materials available are diverse. Different materials, such as platinum, silver, steel, cobalt alloys, titanium and alloys, acrylic, carbon, sapphire, alumina, tantalum, niobium, zirconia and calcium phosphate compounds have been used as dental implant material [2].

ABSTRACT Little is known about longitudinal development of the peri-implant sub- gingival microbiome and cytokine production as a new sulcus forms after dental im- plant placement. Therefore, the purpose of this observational study was to evaluate simultaneous longitudinal changes in the oral microbiome and cytokine production in the developing peri-implant sulcus compared to control natural teeth. Four and 12 weeks after implant placement and abutment connection, a dental implant and a natural tooth were sampled in 25 patients for subgingival plaque and gin- gival crevicular fluid (GCF [around teeth] and peri-implant crevicular fluid [PICF] around implants). DNA from plaque samples was extracted and sequenced using Illumina-based 16S rRNA sequencing. GCF and PICF samples were analyzed using a customized Milliplex human cytokine and chemokine magnetic bead panel. Beta di- versity analysis revealed that natural teeth and implants had similar subgingival mi- crobiomes, while teeth had greater alpha diversity than implants. At the genus level, however, few differences were noted between teeth and dental implants over 12 weeks. Specifically, Actinomyces and Selenomonas were significantly elevated around teeth versus dental implants at both 4 weeks and 12 weeks, while Coryne- bacterium and Campylobacter were significantly elevated only at 4 weeks around teeth. The only difference between PICF and GCF biomarkers was significantly ele- vated granulocyte-macrophage colony-stimulating factor levels around teeth versus dental implants at the 4-week visit. The subgingival microbiome and cytokine pro- duction were similar between teeth and implants during early healing, suggesting that these profiles are driven by the patient following dental implant placement and are not determined by anatomical niche.

The review from the research papers it is concluded that the proper sizes and shapes of dental implant is essential to avoid the failure of dental implant and infection related tissues. To avoid the diseases the proper implantation process is needed. Diameter of dental implant and length also need proper selection. If bone quality is soft the dental implant selection must proper. In the cases of peri implant diseases the proper care is necessary.

Reports that investigate the use of bone allograft, xenograft, and alloplasts in the dental implant literature do not show a unified approach to the preparation of non-autogenous particulate grafts. Hydration of the graft with physiological saline has been a regularly reported procedure. Tidwell et al (1992) reported on composite autogenous and non- resorbable hydroxyapatite grafts on 48 patients, storing the graft materials in physiological saline. Avera et al (1997) mixed graft in saline (pH, 5.5; isotonic) prior to sinus grafting in an evaluation of resorbable and non-resorbable membranes. Tatum et al (1993) mixed graft with blood and antibiotic in the use of many diSerent materials in the sinus. Wagner (1991) described microfibrillar collagen and resorbable hydroxyapatite mixed with fi'eshly drawn venous blood for grafting. Vlassis et al (1993) described a 1:1 mix of resorbable hydroxyapatite and demineralised allogenic bone matrix in a flowable gel for the sinus graft: no mention was made of the liquid medium. Hurzeler et al (1996) reported on the use of multiple graft types and combinations Avithout any description as to the means of graft preparation of either Avith blood or saline or other medium. Smiler et al (1992), in a multi-centre study of case reports, described the admixture of graft materials Avith reconstituted patient’s blood fi-om participating centres. However, in reports on personal cases, they recognised the toxicity of blood by-products in catabolism and the acidic nature of anaesthetic solutions, as did Misch (1993a). They both mixed graft Avith sterile saline, or D5W (5% dextrose in water, pH, 4.0) as recommended in the study by Marx et al (1979). Marx et al (1998) used platelet enriched plasma to enhance the quality and quantity of new bone formation when used Avith autogenous grafts.

A 63-year-old man who complained of pain on the left cheek area was referred from local dental clinic for re- moval of a displaced dental implant which was placed 3 years ago. Panoramic radiograph, cone beam com- puted tomography (CBCT) scans disclosed a dental im- plant in the left maxillary sinus with mucosal thickening maxillary sinusitis (Fig. 1). The operation was done under local anesthesia. The surgical intervention began with elevation of full-thickness mucoperiosteal flap. After exposure of lateral wall of the maxillary sinus, the bony window was marked by ditching with a round bur. The size of bony window was vertically wider than usual bony window in maxillary sinus elevation. The upper portion is for removal of the displaced implant, while the lower portion is for lifting of the maxillary sinus membrane (Fig. 2). Following exposure of the sinus membrane and removal of the bony window, a horizon- tal incision is placed at the upper portion of the bony window. Through this opening, the implant is removed using dental suction. Then, the sinus membrane is lifted, starting from the lower edge of the bony window. The perforated sinus membrane is covered with absorbable collagen membrane, and the new implant is placed sim- ultaneously with sinus bone grafting using a mixture of graft from the maxillary tuberosity and allograft (Fig. 3).

Material and Methods: This study was employed the observational research method, carried out at Islamic International Dental College and Hospital, Islamabad, Pakistan. Several inclusion and exclusion criteria were established in order to refine the results. The patients qualifying the inclusion criteria of missing/failing teeth, sufficient quality and quantity of bone to support the implant were required to sign consent forms. Cases with documentation of uncontrolled metabolic diseases, immunosuppressed status (post renal, liver, and bone marrow transplants), chemotherapy and head and neck radiation, psychological disorders and patients on bisphosphonates medication were excluded from the research. Results: In this study, 307 implants placed in 170 patients (92 females, 78 males). 301 implants were successfully Osseo integrated while 6 failed. Out of the unsuccessful 6, 2 belonged to patients smoking more than 5 cigarettes a day qualifying as smokers according to our inclusion criteria. 301 (98%) implants were successfully Osseo integrated while 6 (2%) implants failed and had to be removed adding up to the total of 307 mentioned cases. Out of the 6 failed implants (all observed during the early phase of Osseo integration) 2 belonged to tobacco smokers while 4 failed im- plants were observed in non-smokers. Implant failure occurred in 3 females and 3 males equally, all being observed in the posterior quadrants of maxilla and mandible (UL6, UL4, LR6, LR4, LR5, LR6).

The state of edentulism has negative impact on the person. It changes his dietary habits and decreases his social interaction due to speech affection, and senile appearance. Complete dentures had been the only treatment option until the emergence of dental implants. Implants were used to support both fixed and removable prosthesis [1, 2]. The basic technique in using dental implants is to place a fixture in the bone for a period of 3-6 months to insure osseointegration and then add the final prosthesis. This is called a two stage implantation. This is a long period for patients wishing to have good aesthetics’ [3]. Immediate loading, adding the prosthesis immediately after placing the fixture, reduces the clinical steps and eliminates the long period required for osseointegration. This appears to satisfy the patient’s needs but it introduces a great threatening to the bone and the whole structure. In case of structure failure, the patient should pass through several clinical visits to remove and replace the implant [1].

Plasma gas etching can be done with the exposure of low power plasma gases such as water vapour, oxygen, argon/ammonia. Plasma gas etching makes PEEK more hydrophilic by exposing the functional groups and producing low water contact angle on the PEEK surface. 23 It also produces Nano roughness on the surface of implant which increases its bioactivity. Invitro studies have shown that it can also lead to mesenchymal stem cell proliferation, which may be the result of increased hydrophilicity and protein adsorption. 24 Poulsson et al evaluated use of low-pressure oxygen plasma on surface of PEEK implants but concluded that there are no significant differences in the bone implant contact of unmodified or modified PEEK. 25 Rochford et al had suggested that there was increased adherence of osteoblasts even in the presence of Staphylococcus aureus on the surface of plasma gas etched PEEK implants. 26 There is no coating applied in this technique hence no risk of delamination of coating .1

Furthermore, PTV was measured by connecting a tem- porary abutment (implant temporary hexed cylinder, 3i Implant Innovation) and then measuring the mobility of the implant using the Periotest device (Medizintechnik Gulden, Bensheim, Germany) (Fig. 2b). The tip of the Periotest device was placed perpendicular to the abutment at a distance of 2 mm, and it impacted the implant four times per second for 4 s. The Periotest™ device measures the contact time between the implant and the tapping tip as the single and that single were then transformed to a special value called PTV [23]. In general, a shorter contact time presents a lower value of PTV which indicates that the implant in bone is more stable. The attached micro- computer converted the duration obtained from the meas- urement cycle to PTV on a scale from − 8 (very stable) to +50 (extremely unstable) [23].

During the last decades the definition of peri- implantitis has suffered several modifications with the development in the understanding of dental implantology and its biological implications. Recently, as described by the American Academy of Periodontology [1] mucositis is defined as an inflammatory process around a dental implant without loss of supporting bone beyond biological bone remodelling. On the other hand, peri- implantitis is characterized by both, inflammation of the surrounding peri-implant tissues and loss of supporting bone beyond initial biological bone remodelling. Nonetheless recent investigations have recognized at least 7 definitions of peri-implantitis based on the extension and severity of the bone loss [2]. These interpretations of the peri-implant disease certainly reflect the multifactorial nature of the entity, displaying a multitude of clinical presentations. Hence, it is reasonable to assume that further definitions will appear in upcoming years as we continue performing research in the field. Nonetheless, the complex mechanisms that influence initial bone remodelling, among other variables, will certainly ensure this to be a challenging duty.

These studies (including a recently completed in vivo study demonstrating superior osseointegration of nio- bium oxide-coated smooth Ti implants relative to smooth Ti implant controls) have contributed to the scope of the utility of the niobium oxide morphology as a viable coating, but have not yet involved studies on roughened Ti surfaces. Combining the structured niobium oxide morphology with the rough framework of a sand-blasted titanium oxide coating attractive for cellular attachment and growth may provide an opportunity to ultimately im- prove bone apposition. Thus, it is necessary to explore whether niobium oxide can be generated on the surface of a roughened Ti implant. Therefore, the purpose of this study was to determine the feasibility of creating a nio- bium oxide coating on a commercially available sand- blasted Ti alloy (SB-Ti) dental implant.

The inclusion criteria applied for case selection were: (1) patients aged ≥ 18 years (2) patients with at least one professional malpractice in implant dentistry (3) professional malpractice in implant dentistry of the substandard dental implant treatments done in dental health premises (hospitals, polyclinics, private clinics) in the Kingdom of Saudi Arabia. The exclusion criterion was: cases with unacceptable diagnostic quality of radiographs. The sample of the study was randomly selected. The term case was used in this study to indicate to one patient with at least one implant malpractice, and some cases had more than one detection of claimed error. The study was carried out from September 2019 to December 2019. The patient consent was taken on an informed consent statement form for clinical studies. Clinical and radiographic examinations were applied including panoramic and periapical radiographs in addition to three- dimensional imaging CBCT. All cases were subjected to consultations of experienced implantologists. The data obtained including age and gender were documented in a patient examination form then statistically analyzed using Chi-Square Test to test the contingency of the variables and Spearman’s Correlation Coefficient to test the association between categorical variables; the statistical parameter was estimated (confidence intervals for proportions at confidence level 95%). All statistical analyses were performed using the IBM SPSS Statistics version 20 data processing

blasted implant surfaces showed the lowest percentage of BIC area (20-25%). Large-grit-sandblasted and Ti plasma sprayed (TPS) implant surfaces had an average of 30-40% while large- grit-sandblasted and acid-etched implant surfaces had an average of 50-60% and HA-coated implant surfaces showed the highest BIC area (60-70%). The authors concluded that “the extent of bone-implant interface was positively correlated with an increased roughness of the implant surface.” In this review, we will discuss the diff erent biological reaction to certain dental implant surface treatments. Summary of advantages and disadvantages of diff erent types of implant surface treatment is provided in Table 1.

dental implant surface was modified by bioactive vitamin D3 coating prepared by self-assembly.. 61.[r]