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Analysis of Short-term Success Rate and Healing Patterns of Implantium ® Implant

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This study is an analysis of distribution of patients who installed Implantium® implant in Yonsei University Dental Hospital and types of implant site for about 1 years recall check and success rate. 164 implants were installed to 52 patients in this study. It shows the conclusion below.
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Analysis of Short-term Success Rate and Healing Patterns of
Implantium
®
Implant
Gyung-Joon Chae
1
, Sung-Min Chung
2
, Ui-Won Jung
1
, Kyoo-Sung Cho
1
, Jung-Kyu Chai
1
, Chong-Kwan
Kim
1
, Seong-Ho Choi
1
, and Chang-Sung Kim
1
1
Department of Periodontology, College of Dentistry, Yonsei University, Reasearch Institute for
Periodontal Regeneration,
2
Dentium Co., Ltd.
I. Introduction
Recently, tooth loss has been occurring more frequently alongside the increase in the aging population.
1,2
Tooth loss may be due to various reasons, possibly leading to functional, aesthetic, and social issues.
Therefore, the recovery of lost teeth has become a very important part in dental treatment.
Specifically, the recovery of lost teeth using implant has been performed using stable operation methods.
For one, implant has a number of advantages compared to the crown, bridge, or removable prosthesis.
3-7
Since the concept of modern implant based on the osseointegration between bone and titanium was
established in the 1960s by Branemark et al,
8
implants have been used mainly to stabilize the prosthesis
for edentulous patients permanently. It has also been used successfully in operations, offering long-term
stability for the prosthetic recovery of partially edentulous patients.
9,10,11
The
development of implant
enabled doctors to prioritize the treatment using implant not only for the recovery of partially edentulous
jaw but also for the recovery of a single tooth. Even the immediately loaded implant treatment -- which
provides temporary prosthesis on the day of the operation following the insertion of the implant without
the waiting period -- became common practice.
12-14
The primary factor in predicting the success of implant treatment is the operator’s skill and quantity and
density of false keel. Atwood
15
evaluated the emerging changes in bone quantity following tooth loss. On
the other hand, in 1985, Lekholm and Zarb
16
classified the type of residual jaw vis-à-vis implant grafting
into 5 stages. Moreover, many studies reported that the use of short implants accompanied by massive
resorption in the implant position would increase the failure rate.
17
Bone density also decreases following
tooth loss, thereby influencing the success of implant as well.
18
Many systems are introduced to improve
the success rate of the implant. Similarly, many studies are conducted by introducing changes to the
design and surface of the implant. In particular, many studies reported that an implant whose rough
surface was treated using various methods was more effective in case of inferior bone quality compared
to the implant with mechanically ground smooth surface.
19,20
Considering the shape of the implant, the use of the self-tapping implant improved initial stabilization and
eventually increased the success rate. Based on recent studies, the use of the tapered implant in case of
low bone density can improve bone density through internal condensation.
21
Compared to the straight-
walled implant, the use of the tapered implant is even easier in case of anatomical restrictions such as
narrow alveolar ridge or concavity of such. Occlusal pressure is also distributed to the peripheral bone
structure more evenly.
22
This study was sponsored by Dentium Co., Ltd. in 2004.
Send all correspondence to: Kim, Chang-seong, Department of Periodontology, College of Dentistry, Yonsei University,
134 Shinchon-dong, Seodaemun-gu, Seoul, Korea
Postal Code 120-752
The recently developed Implantium
®
implant features an SLA surface subjected to hydrochloric-sulfuric
acid etching and large grit sandblasting -- which is advantageous for osseointegration – for larger surface
area and increased roughness of the fixture. Its internal connection and conical sealing design distribute
pressure to the peripheral bones of the fixture evenly for minimum bone resorption. Moreover, the
synchronized micro thread enables excellent initial fixation strength, renders appropriate strength to the
marginal compact bone, increases bone density, and minimizes the resorption of marginal bones during
the healing process. This study sought to analyze the clinical results of the Implantium
®
implant system
applied to the edentulous region of the jaw to examine the success rate and healing patterns of marginal
bones.
II. Research Target and Methodology (method)
A.Research Subject
This study examined 164 implants grafted onto 52 patients from among those undergoing implant
operation using the Implantium
®
implant system at the Department of Periodontology, College of
Dentistry, Yonsei University between October 2004 and October 2005.
B. Implants Grafted
Implantium
®
implants with various diameters -- 3.4 mm to 3.8 mm, 4.3 mm, and 4.8 mm -- and various
lengths (from 8 mm to 12 mm) were used.
C. Methods
Using the patient’s chart, the 1) Patient Type and Implant Distribution, 2) Condition of Bone in the
Surgery Area, 3) Diameter and Length of Grafted Implants, and 4) Quantity of Previous Bone After the
Grafting Operation Involving Maxillary Sinus Elevation and Guided Bone Generation were evaluated.
The success rate was then examined for the implants investigated in each case.
Oral cavity examination and radiological examination were performed on all patients; their medical
history and smoking habits were also investigated. Patients with absolutely uncontrollable
contraindications were not subjected to implant operation; instead, other methods were recommended for
the recovery of lost teeth.
In addition, the cause and period of extraction were examined through interviews to determine the pattern
of tooth loss vis-à-vis age and gender.
For the bone condition in the surgery area, bone quality and quantity were evaluated and recorded during
the operation according to the classification of Lekholm and Zarb. The implants used in the operation
were then evaluated based on records of their length and diameter.
III. Results
1. Patient Type and Implant Distribution
1-1. Distribution of Patient’s Age and Gender
A total of 19 male patients (36.5%) and 33 female patients (63.5%) were considered for the study. In
terms of the number of implants used, the results were pretty close. In particular, a total of 76 implants
were used for the male patients, whereas 88 implants were placed on the female patients. Approximately
3.2 implants were used for 1 patient on the average. The number of patients in their teens and 20s and the
number of implants used both fell below the average. In contrast, the figures were quite high for patients
in their 50s (Table 1).
Table 1. Distribution of implants according to patients' age and gender
Male Female Total (%)
Age
(year)
Implants Patients Implants Patients Implants Patients
<20 0 0 1 1 1(0.6) 1(1.9)
20-29 12 2 3 1 15(9.2) 3(5.8)
30-39 23 3 6 5 29(17.7) 8(15.4)
40-49 13 6 20 7 33(20.1) 13(25.0)
50-59 24 6 48 15 72(43.9) 21(40.4)
60-69 4 2 7 3 11(6.7) 5(9.6)
>70 0 0 3 1 3(1.8) 1(1.9)
Total 76 19 88 33 164(100.0) 52(100.0)
1-2 Location and Distribution of Implants Used
Among the 164 implants, 75 were grafted onto the maxilla; 89 were used in the mandible, 19 (12%), in
the anterior, and 145 (88%), in the posterior. The use of implants tended to cluster <?>around the 1
st
molars on each side. (Tables 2, 3).
Table 2. Localization of the 164 implants inserted
0 10 14 6 1 2 2 0 1 2 1 5 10 13 8 0
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
1 13 20 6 2 3 2 1 2 1 2 3 5 12 16 0
* WHO site classification
Table 3. Distribution of implants
Anterior* (%) Posterior (%) Total (%)
Maxilla 8(5) 67(41) 75(45.7)
Mandible 11(7) 78(47) 89(54.3)
Total 19(12) 145(88) 164(100.0)
*Anterior maxilla in the 13-23 area, Mandible in the 34-44 area
2. Bone Condition in the Surgery Area
The following shows the result of analyzing bone quality and quantity in patients undergoing the implant
operation. Overall, type III was found to be the most common, followed by type II and type IV. Type I
was found to be the least common.
Type III bone was mostly found in the maxilla, type II bone, in the anterior, and type IV bone, in the
posterior. In particular, most of the bones in the maxilla posterior were type IV; in contrast, the
mandibular posterior occasionally had type IV bones in case healing of extraction was not completed
(Table 4).
Table 4. Distribution of bone quality
Type I (%) Type II Type III (%) Type IV (%) Total(%)
Max. Ant. 0(0.0) 2(1.2) 4(2.4) 2(1.2) 8(5)
Max. Post. 3(1.8) 11(6.7) 27(16.5) 26(16.1) 67(41)
Man. Ant. 4(2.4) 4(2.4) 3(1.8) 0(0.0) 11(7)
Man. Post. 6(3.6) 34(20.7) 27(16.5) 11(6.7) 78(47)
Total 13(7.8) 51(31) 61(37.2) 39(24) 164(100.0)
The distribution of bone quantity based on the classification of Lekholm and Zarb showed Type C bone
taking up the largest ratio, followed by Type B, Type D, and Type A. The maxilla had thrice more type D
bone than the mandible. Broad resorption of Type E bone was not observed, however (Table 5).
Table 5. Distribution of bone quantity
A B C D E Total (%)
Maxilla 4(2.4) 15(9.2) 47(28.8) 9(5.5) 0(0.0) 75(46)
Mandible 1(0.6) 31(18.9) 54(32.9) 3(1.8) 0(0.0) 89(54)
Total 5(3.0) 46(28.1) 111(61.7) 12(7.3) 0(0.0) 164(100.0)
*Classification by Lekolm and Zarb
3. Diameter and Length of Grafted Implants
3-1 Length of Grafted Implants
Implantium
®
implants of varying lengths (from 8 mm to 10 mm, 12 mm, and 14 mm) were used; implants
shorter than 8 mm or longer than 14 mm were excluded. Most implants were 10 mm or 12 mm long, with
a number of 8 mm implants grafted onto the 2
nd
molar in the mandibular posterior. This was because
grafting depth was restricted owing to the path of the inferior alveolar canal and internal oblique line
(Table 6).
Table 6. Distribution of implant length
Maxilla Mandible
Length (mm)
Anterior Posterior Anterior Posterior
Total (%)
8 mm 0 0 0 22 22(13.4)
10 mm 4 39 1 31 75(45.7)
12 mm 3 27 9 25 64(39.0)
14 mm 1 1 1 0 3(1.9)
Total 8 67 11 78 164(100.0)
3-2 Diameter of Grafted Implants
The diameters of the implants used ranged from 3.4 mm (narrow) to 3.8 mm and 4.3 mm (regular) and 4.8
mm (wide). The narrow form was mostly grafted onto the maxilla and mandibular anterior, whereas the
wide form was mostly used in the posterior. A total of 7 narrow implants were grafted onto the maxilla
and mandibular posterior owing to the resorption of the residual ridge.
Table 7. Distribution of implant diameter
Maxilla Mandible
Anterior Posterior Anterior Posterior
Total (%)
Narrow 4 4 3 3 14(8.5)
Regular 4 38 7 31 80(48.8)
Wide 0 25 1 44 70(42.7)
Total 8 67 11 78 164(100.0)
4. Grafting Operation Involving Maxillary Sinus Elevation and Guided Bone Generation
Among the 164 implants, 30 required additional methods other than ordinary implant operation such as
bone graft, membrane, ridge splitting, and maxillary sinus elevation due to insufficient bone volume
(Table 8).
The length of the implant was restricted by the position of the maxillary sinus in the maxilla. In fact, bone
quality was expected to deteriorate over time due to the resorption of the residual ridge and expansion of
the maxillary sinus. The operation required other methods such as maxillary sinus elevation -- which lifts
the sinus floor -- and osteotome techniques designed to address the problem of limited bone volume.
Various bone materials such as autogenous bones collected from the surgery area and neighboring part,
allografts including ICB, xenografts of Bio-oss
®
, and Macroporous Biphasic Calcium Phosphate® were
also used. Non-resorptive Gore-tex membrane and resorptive Collagen membrane were used during the
operation.
Table 8. Number of advanced techniques on the recipient site
Number
GBR* 13
Sinus graft (window opening) 5
Sinus graft (BAOSFE*) 8
Ridge splitting 4
Total 30
*GBR: Guided bone regeneration
*BAOSFE: Bone-added osteotome sinus floor elevation
5. Success Rate of Implant
A total of 164 implants were grafted onto 52 patients. The patients were then examined for 15.2 months
on the average, with 2 implants failing during the period of clinical and radiological examination. A
success rate of 98.8% was recorded. The failed implants were surgically removed. One of the 2 implants
removed had regular diameter and dimension of 3.8 x 10 mm; the other implant measured 4.3 x 10 mm.
Both implants were removed from #17 and #12 approximately 8 months and 1 month after grafting,
respectively, owing to the failed osseointegration. The implant placed on #12 was grafted onto the narrow
alveolar ridge of a patient with cleft lip and palate. The radiological analysis using the Starpacs
®
system
of INFINITT showed marginal bone resorption of 0.28 mm on the average during the average treatment
period of 15.2 months. No implant showed marginal bone resorption of more than 1 mm within 1 year of
grafting.
IV. Discussions
The implant treatment introduced based on the concept of titanium osseointegration is a method boasting
of high predictability, providing maximum satisfaction to both patient and doctor. Currently, many
implants with different advantages for different types are available. Such advantages must be fully
considered when making treatment plans.
Implantium
®
implant features an SLA surface subjected to etching and sandblasting processes. In terms of
design, it has root form body, internal connection, and conical sealing connecting to the abutment. For the
top, it adopted a tapered structure with synchronized micro thread to enhance initial fixation strength,
render appropriate strength to the marginal compact bone, and increase bone density.
In this study, a total of 164 implants were grafted onto 52 patients. Similar to the distribution of
periodontitis patients, people in their 50s made up 40% of the patient group. A total of 75 implants were
grafted onto the maxilla, 89, onto the mandible, 19, onto the anterior, and 145, onto the posterior.
Considering the position of the tooth, majority of the implants (59) were grafted onto the 1
st
molar. This is
because the 1
st
molar is engaged in the largest number of occlusal activities when it contracts periodontal
diseases or dental caries; thus often leading to tooth loss. This study examined the condition of the bones
in the region included in the implant operation in terms of bone quality and bone quantity. Type III bone
quality was observed in most cases (37.2% of the total), followed by Type II (31.0%) and Type IV
(24.0%). Type I bone quality was the least common (7.8% of all cases). By bone quantity, Type C was
noted in most cases (61.7%), followed by Type B (28.1%), Type D (7.3%), Type A (3.0%), and Type E
(0.0%). Note that these results were consistent with those presented in the report by Park et al. in
2004.
23
In terms of the surgery part, the maxilla was mostly made up of Type III and Type IV bones. The
maxilla had disadvantages in terms of implant operation compared to the mandible; in fact, reports
showed that implant operation on the region with weak bone quality such as Type IV and insufficient
false keel had low success rate.
24,25,26
In other words, the mandible has better bone quality and quantity for
operation than the maxilla. This finding was consistent with that of other studies.
In the operation using Implantium implants, implants of varying diameters (3.4 mm ~ 4.8 mm) and
lengths (8 mm ~ 14 mm) were grafted onto the patients according to the false keel and position of teeth to
be implanted. Most implants used were 10-12 mm long. Note that implants with the appropriate length
can now be grafted, thanks to the advancement of grafting techniques. With the advancement of surface
treatment techniques, however, implants 15 mm long or more are no longer used. In terms of the diameter
of the implant, the regular implant was the most commonly used in general, followed by the wide implant
in the posterior and narrow implant in the anterior. This is because the diameter of the implant is
restricted by the buccolingual thickness of the false keel. Moreover, the doctor chooses the implant whose
diameter is close to that of the natural tooth in the position to be grafted to reconstruct the emergence
profile when producing the prosthesis. Regular implant was used many times in the posterior because
most doctors tended to secure the stability of the prosthesis by choosing a regular implant and splitting it
rather than performing additional bone grafting in the posterior not only when grafting implants in the
premolar region but also when grafting a number of implants. A total of 13 implants were grafted during
the maxillary sinus elevation performed in the posterior due to the insufficiency of false keel, with
another 13 implants grafted through guided bone generation (GBR).
In this study, a total of 164 Implantium implants were grafted during the 15.2 months’ treatment on the
average. Two implants were removed, thereby making the success rate 98.8%. The removed implants had
been grafted onto #17 and #12; they had regular diameter and length of 10 mm. In particular, the implant
on #12 was removed 1 month after grafting; the patient with cleft lip and palate had narrow alveolar ridge.
Although dehiscence or fenestration was not likely to occur, osseointegration was believed to have failed
due to the resorption of the narrow bony housing during the bone remodeling process after grafting.
The average resorption of marginal bone during the resuommoning period was found to be 0.28 mm. In
1997, Palmer et al.
27
reported marginal bone resorption of 0.53 mm in the Astra implant whose micro
threaded conical neck was similar to Implantium for 1 year after grafting. The Implantium implant
exhibits minimal marginal bone resorption because its SLA surface has an advantage in terms of
osseointegration. Likewise, the internal connection and conical sealing design evenly distribute stress to
the peripheral bones of the fixture; hence the minimal bone resorption. According to the study of
Hansson
28
et al on the finite element method, the conical abutment distributes occlusal pressure even to
the bones at the back to prevent the pressure from being concentrated on the marginal bone and reduce
marginal bone resorption such that even greater occlusal pressure can be withstood. This was consistent
with reports showing less resorption of marginal bone in the Implantium implant or similar Astra implant
system compared to the flat top implant system.
29
Moreover, the synchronized micro thread is considered
more advantageous because it enhances initial fixation strength, renders appropriate strength to the
marginal compact bone, and increases bone density.
The result of the treatment suggests the need for long treatment period. Likewise, the factors that can
determine the prognosis in each case must be clearly defined. This study evaluated the newly introduced
Implantium system for a relatively short period of time. The factors for determining the success rate were
also limited to clinical and radiological factors. Therefore, more in-depth studies on implant treatment,
causes of and factors contributing to failure, and prognostic factors must be conducted by evaluating the
implant system for a long period of time based on the continuous resummoning of patients and through
periodic examination to improve the success rate of implant, a more important part in dental treatment.
V Conclusion
The success rate of 164 Implantium implants grafted onto 52 patients for a resummoning period of 15.2
months on the average was 98.8%; the resorption of marginal bone for the same period was 0.28 mm.
Although more evaluations accumulated over a long period of time are required together with additional
studies, the results of this study suggest that Implantium® implant can yield excellent treatment results in
various cases.
VI. References
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adults: United States, 1988-1991. J Dent Res 1996; 75:684-695.
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3. Waerhaug, J. Periodontology and partial prosthesis. Int Dent J 1968; 18(1):101-107.
4. Carlsson, G., and Persson, G. Morphological changes in the mandible following extraction and wearing
of dentures: Alongitudinal clinical and x-ray cephalometric study spanning 5 years. Odont Revy 1967;
18:27-54.
5. Pietrokovski, J. The bony residual ridge in man. J. Prosthet. Dent., 1975;34:456-462.
6. Carr, A., Laney, W.R. Maximum occlusal force levels in patients with osseointegrated oral implant
prosthesis and patients with complete dentures. Int J Oral Maxillofac Implants 1987; 8:301-110.
7. Wetherell, J., and Smales, R. Partial denture failure: A long-term clinical survey. J Dent Res 1980;
8:333-340.
8. Branemark, P.I., Adell, R., Breine, U., Hansson, B.O., Lindstrom, J., and Ohlsson, A.
Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg. 1969;
3(2):81-100.
9. Lekholm, U., Gunne, J., Henry, P., Higuchi, K., Linden, U., Bergstrom, C., and van Steenberghe,
D. Survival of the Branemark implant in partially edentulous jaws: a 10-year prospective multicenter
study. Int J Oral Maxillofac Implants. 1999 Sept-Oct.; 14(5):639-45.
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Lang, N.P. Long-term evaluation of non-submerged ITI implants. Part 1: 8-year life table analysis of a
prospective multicenter study with 2359 implants.
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of Bra
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nemark single-tooth implants: An18-month clinical pilot follow-up study. Clin Oral
Implants Res 2000; 11:26:00-33.
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prospective 5-year multicenter study. Int J Oral Maxillofac Implants 1996;3:129-455.
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prosthesis implant placement. Int J Oral Maxillofac Implants 1997;15:505-503.
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mid-sagittal sections and serial cephalometric roentgenograms. J. Prosthet. Dent., 1963;13:810-
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clinical dentistry. Chicago, Quintensence., 1985; 199-209.
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center. Compendium 1996; 17(9):848-859.
18. Stephen, W. Use of the Frialit-2 implant system in private practice: AClinical report. Int J Oral
Maxillofac Implants. 2003 Vol.18 4: 552-555.
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L.P. Interface shear strength of titanium implants with sandblasted and acid-etched surface: a
biomechanical study in the maxilla of miniature pigs.
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Abstract
Analysis of Short-term Success Rate and Healing Patterns of
Implantium
®
Implant
Gyung-Joon Chae
1
, Sung-Min Chung
2
, Ui-Won Jung
1
, Kyoo-Sung Cho
1
, Jung-Kyu Chai
1
, Chong-Kwan
Kim
1
, Seong-Ho Choi
1
, and Chang-Sung Kim
1
1
Department of Periodontology, College of Dentistry, Yonsei University, Reasearch Institute for
Periodontal Regeneration,
2
Dentium Co., Ltd.
This study analyzed the distribution of patients who had Implantium
implant placed at Yonsei
University Dental Hospital as well as the types of implant site for about 1-year recall check and the
success rate. Specifically, a total of 164 implants were placed on 52 patients. The following conclusions
were drawn:
1. Patients in their 40s and 50s made up 65% of all implant cases; the average number of implants was 4
for males and 2.7 for females. A total of 75 implants were used on the maxilla, whereas 89 were placed
on the mandible. On the other hand, 19 implants were used in the anterior region, and 145 implants, in the
posterior region.
2. Bone quality for the implant site was mostly Type (37.2%); bone quantity was Type C (61.7%).
3. Majority of the implants used had length of 10, 1 2 mm (85%) and regular diameter (48.8%).
4. A total of 30 implants were placed using advanced techniques, e.g., GBR, window opening, and
osteotome technique.
5. Two implants were removed prior to prosthodontic treatment owing to osseointegraton failure. A
success rate of 98.8% was recorded in the 15.2-month follow-up period, with marginal bone loss of 0.28
mm.
The results provided basic data on patient type, implant distribution, bone condition, and survival rate.
Based on the results of this study, Implantium
implant can be said to be applicable to various clinical
situations.
Keywords : Implantium
implant, success rate.
* This study was supported by a grant from Dentium Co., Ltd. in 2004.
Article
Full-text available
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1. 1. Bone is a living tissue of varying size, shape, and density and is subject to constant remodeling throughout life. 2. 2. It is helpful in research, teaching, and patient care to classify adult mandibles into 6 orders of anatomic form: I, pre-extraction; II, postextraction; III, high, well-rounded residual ridge; IV, knife-edge residual ridge; V, low, well-rounded residual ridge; VI, depressed residual ridge. 3. 3. Microradiography of thin sections of bone shows clearly the variations in form and degree of mineralization of the various elements of bone. 4. 4. Microradiography of midsagittal sections of 21 edentulous mandibles revealed external resorption and an absence of periosteal bone on the residual ridges in all specimens. 5. 5. Evidence of mild to moderate osteoporosis was seen in one half of the specimens (average age of this group, 76 years). 6. 6. There are many avenues for the study of resorption of residual ridges. The possible roles of a constricting mucoperiosteum and of surgical technique are discussed.
Article
1.1. Bone is a living tissue of varying size, shape, and density and is subject to constant remodeling throughout life.2.2. It is helpful in research, teaching, and patient care to classify adult mandibles into 6 orders of anatomic form: I, pre-extraction; II, postextraction; III, high, well-rounded residual ridge; IV, knife-edge residual ridge; V, low, well-rounded residual ridge; VI, depressed residual ridge.3.3. Microradiography of thin sections of bone shows clearly the variations in form and degree of mineralization of the various elements of bone.4.4. Microradiography of midsagittal sections of 21 edentulous mandibles revealed external resorption and an absence of periosteal bone on the residual ridges in all specimens.5.5. Evidence of mild to moderate osteoporosis was seen in one half of the specimens (average age of this group, 76 years).6.6. There are many avenues for the study of resorption of residual ridges. The possible roles of a constricting mucoperiosteum and of surgical technique are discussed.
Article
Background: Overloading has been identified as a primary factor behind dental implant failure. The peak bone stresses normally appear in the marginal bone. The anchorage strength is maximized if the implant is given a design that minimizes the peak bone stress caused by a standardized load. Clinical studies have shown that it is possible to obtain a marginal bone level close to the crest of the implant. Different implant systems make use of different designs of the implant-abutment interface. Different implant-abutment interfaces imply that the functional load is distributed in different ways upon the implant. According to Saint-Venant's principle, this will result in different stress patterns in the marginal bone when this reaches levels close to the implant crest. Purpose: One aim of the study was to theoretically investigate if a conical implant-abutment interface gives rise to a changed stress pattern in the marginal bone, as compared to a flat top interface, for an axially loaded mandibular titanium implant, the neck of which is provided with retention elements giving effective interlocking with the bone. Further aims were to investigate if the way in which the axial load is distributed on the flat top and on the inner conus respectively affects the stress pattern in the marginal bone. The pertinent stress was considered to be the bone-implant interfacial shear stress. It was assumed that the marginal bone reached the level of the implant-abutment interface. Method: The investigation was performed by means of axisymmetric finite element analysis. Results: The conical implant-abutment interface of the type studied brought about a decrease in the peak bone-implant interfacial shear stress as compared to the flat top interface of the type studied. This peak interfacial shear stress was located at the top marginal bone for the flat top implant-abutment interface whereas it was located more apically in the bone for the conical implant-abutment interface. The way in which the axial load was distributed on the flat top and on the inner conus respectively affected the peak interfacial shear stress level. Conclusion: The design of the implant-abutment interface has a profound effect upon the stress state in the marginal bone when this reaches the level of this interface. The implant with the conical interface can theoretically resist a larger axial load than the implant with the flat top interface.
Article
The bone which fills in the socket after tooth extractions was investigated in 120 dry skull specimens and 100 radiographs in which one or more teeth had been missing for at least three months. The bony content of the socket was of the trabecular type. This trabecular bone was well differentiated from the adjacent cortical bony plates. In buccolingual sections, the residual crest was formed by dense trabecular bone, clearly differentiated from the cortical plates as well as from the less dense trabecular bone that was deeper within the former sockets. From the occlusal aspect, the crest of the edentulous surface had shifted lingually when compared to the original position of the teeth before extractions. From the lateral aspect, the residual ridge formed a concavity or went straight between the alveolar crests of the adjacent remaining teeth. When several teeth were missing, the concavity was more pronounced than when a single tooth was missing.
Article
This study comprised 4,641 Brånemark dental implants, which were retrospectively followed from stage 1 surgery to completion of the prosthetic restorations. The implants were placed during a 3-year period (1986 to 1988) in 943 jaws, representing 889 patients with complete and partial edentulism. The jaw and sex distribution revealed a predominance of mandibles (564/943) and females (534/943). The mean age of the patients was 57.5 years (range 13 to 88 years) at implant placement. Only 69 (1.5%) fixtures failed to integrate, and most losses were seen in completely edentulous maxillae (46/69), in which the jaw bone exhibited soft quality and severe resorption. A preponderance of failures could also be seen among the shortest fixtures (7 mm). A majority of the mobile implants were recorded at the abutment connection (stage 2) operation (48/69).
Article
The predictability of branemark implants has been well documented. High success rates in the maxilla and mandible in fully and partially edentulous patients can be expected. A host of factors may be attributed to the etiology of fixture loss. However, the quality of bone stands out as the single greatest determinant in fixture loss. Types I, II, and III bone offer good strength. Type IV bone has a thin cortex and poor medullary strength with low trabecular density. Ninety percent of 1,054 implants placed were in Types I, II, and III bone. Only 3% of these fixtures were lost; of the 10% of the fixtures placed in Type IV bone, 35% failed. Presurgical determination of Type IV bone may be one method to decrease implant failure.