Innovations in Amputation Rehabilitation and Prosthetic Design.

This article reviews emerging surgical techniques and prosthetic innovations related to amputation rehabilitation. Osseointegration is discussed from conception to modern implant designs. Motor and sensory reinnervation techniques are reviewed and compared. Prosthetic socket casting, interface, and design innovations are discussed, including direct molded sockets, water casting, adjustable sockets, and magnetic suspension. Advanced components with hydraulic and microprocessor control, power and crossover prosthetic feet are described.

Consensus Report by the Italian Academy of Osseointegration on the Importance of Peri-Implant Soft Tissues.

Background and Objectives: The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions: The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.

Analysis of osseointegration of implants with macrogeometries with healing chambers: a randomized clinical trial.

BACKGROUND: To verify the influence of macrogeometry with healing chambers on the osseointegration of dental implants by analyzing implant stability quotient (ISQ) and evaluate the correlation between insertion torque and ISQ insertion with different macrogeometries. METHODS: In total, 26 implants were installed in the posterior mandible of eight patients with sufficient bone height for the installation of implants measuring 3.5 mm in diameter and 9.0 mm in length. The implants were categorized according to two types of macrogeometry: a test group (GT) with 13 conical implants with healing chambers and a control group (GC) with 13 conical implants with conventional threads. To insert the implants, a bone drilling protocol was used up to a diameter of 3 mm with the last helical bur. The insertion torque of the implants was evaluated, followed by the measurement of ISQ at 0 (T-0), 7 (T-7), 14 (T-14), 21 (T-21), 28 (T-28), and 42 (T-42) days. RESULTS: The mean insertion torque was 43 Ncm in both groups, without a significant difference. Moreover, no significant difference in the ISQ values was found between the groups at different time points (p > 0.05), except at T-7 (GT = 69.87±1.89 and GC = 66.48±4.49; p = 0.01). Although there was no significant difference, ISQ median values were higher in the GT group than GC group at 28 days (GT = 67.98 and GC = 63.46; p = 0.05) and 42 days (GT = 66.12 and GC = 60.33; p = 0.09). No correlation was found between the insertion torque and ISQ insertion (p > 0.05). CONCLUSION: Furthermore, implants with a 3.5 mm diameter macrogeometry, with or without healing chambers, inserted with a drilling protocol up to 3 mm in diameter of the last helical bur, led to a similar secondary stability, with no difference in ISQ values. Although, implants with healing chamber demonstrates ascending values in the graph of ISQ, having a trend of faster osseointegration than implants without healing chambers. Both macrogeometries provide a similar primary stability to implants. TRIAL REGISTRATION: This study was registered retrospectively in ReBec (brazilian registry of clinical trials) under the number RBR-96n5×69, on the date of 19/06/2023.

Systemic Factors Affecting Prognosis of Dental Implants.

Clinicians who place and restore implants are always concerned about the success and longevity of the same. There are several local and systemic factors that affect osseointegration and the health of the peri-implant tissues. In this study, we review the systemic factors that can affect implant survival, osseointegration, and long-term success. The study highlights the importance of delineating, and taking into consideration these systemic factors from the planning phase to the restorative phase of dental implants. A thorough medical history, including prescription and over-the-counter medications, is vital, as there may be numerous factors that could directly or indirectly influence the prognosis of dental implants.

Effect of Densah Burs on Primary and Secondary Stability of Immediately Loaded Implants in Addition to Crestal Bone Loss and Gingival Probing Depth - An Evaluative Study.

INTRODUCTION: Osseodensification (OD) compaction increases primary stability by leaving the residual bone particles in the osteotomy site, which in turn act as an autograft. [ 1 ] Condensing the bone trabeculae through OD has demonstrated to have a potentiating influence on secondary stability. [ 2 ]. MATERIALS AND METHODS: A split-mouth study was conducted in 40 patients to determine the effect of OD on implant success rate in terms of primary and secondary stability in situations including immediate loading of implants placed in low-density bone, which was tested using resonance frequency analysis (RFA) at the interval of 0, 6 th month. In order to assess the implant success rate, gingival probing depth and crestal bone loss (CBL) around the implant were also assessed at baseline and 6 months. RESULTS: With respect to primary stability, at baseline, the mean RFA of Densah burs is 71.6 ± 9.5 and of conventional drills is 67.6 ± 10.4. The mean stability of Densah burs is significantly higher than conventional drills, both at baseline and after 6 months as well. CBL, at baseline, the mean CBL of Densah burs is 0.58 ± 0.11 and of conventional drills is 0.64 ± 0.12. The mean CBL of Densah burs is significantly lower than that of conventional drills for both. CONCLUSION: The implant stability values found in the present study were remarkable when compared between OD and conventional osteotomy techniques. Decreased loss of bone at the crest probing depth also aided in the increased success rate.

Advantages of customization of osseointegrated implants in transfemoral amputees: a comparative analysis of surgical planning.

BACKGROUND: Commercially available osseointegrated devices for transfemoral amputees are limited in size and thus fail to meet the significant anatomical variability in the femoral medullary canal. This study aimed to develop a customized osseointegrated stem to better accommodate a variety of femoral anatomies in transfemoral amputees than off-the-shelf stems. Customization is expected to enhance cortical bone preservation and increase the stem-bone contact area, which are critical for the long-term stability and success of implants. METHODS: A customized stem (OsteoCustom) was designed based on the statistical shape variability of the medullary canal. The implantability of the OsteoCustom stem was tested via 70 computed tomography (CT) images of human femurs and compared to that of a commercial device (OFI-C) for two different resection levels. The evaluations included the volume of cortical bone removed and the percentage of stem-bone contact area for both resection levels. Statistical significance was analyzed using paired and unpaired t tests. RESULTS: The OsteoCustom stem could be virtually implanted in all 70 femurs, while the OFI-C was unsuitable in 19 cases due to insufficient cortical thickness after implantation, further emphasizing its adaptability to varying anatomical conditions. The OsteoCustom stem preserved a greater volume of cortical bone than did the OFI-C. In fact, 42% less bone was removed at the proximal resection level (3.15 cm³ vs. 5.42 cm³, p ≤ 0.0001), and 33% less at the distal resection level (2.25 cm³ vs. 3.39 cm³, p = 0.003). The stem-bone contact area was also greater for the OsteoCustom stem, particularly at the distal resection level, showing a 20% increase in contact area (52.3% vs. 32.2%, p = 0.002) compared to that of the OFI-C. CONCLUSIONS: The OsteoCustom stem performed better than the commercial stem by preserving more cortical bone and achieving a greater stem-bone contact area, especially at distal resection levels where the shape of the medullary canal exhibits more inter-subject variability. Optimal fit in the distal region is of paramount importance for ensuring the stability of osseointegrated implants. This study highlights the potential benefits of customized osseointegrated stems in accommodating a broader range of femoral anatomies, with enhanced fit in the medullary canal.

Feasibility and Outcomes of an Active Osseointegrated Bone Conduction Implant in Children as Young as 5 Years of Age.

INTRODUCTION: This study reviews the feasibility of implanting active osseointegrated bone conduction devices in young children, below the prior age for FDA indication (<12 years), which has recently been reduced to 5 years. Outcomes included differences in adverse event rates and operative time between two groups (<12 and 12 years or older). MATERIALS AND METHODS: This study is a retrospective review of children receiving active osseointegrated bone conduction devices at a tertiary referral center academic hospital. One hundred and twenty-four children received 135 active osseointegrated bone conduction devices (May 2018-March 2024). RESULTS: Of 135 devices, 77 (57%) were in children <12 years (mean age (SD) = 7.9 (2.0) years, range = 4.9-11.9 years) and 58 (43%) were in 12 years or older (mean age (SD) = 15.1 (1.7) years, range = 12-18 years). Adverse events were significantly higher in the older group, occurring in 8 (10%) of 77 devices in children <12 years and 15 (26%) of 58 devices in children 12 years and older (26%) (Fisher's exact test = 0.0217 at p < 0.05). Major adverse events occurred in 5/124 (4%) patients, with 2 in patients <12 years (2/73, 3%) and 3 in children 12 and older (3/51, 6%). The proportion of major events between groups was not significantly different (Fisher's exact test = 0.4, p < 0.05). Mean surgical time was significantly less (t = -2.8799, df = 120.26, p = 0.005) in the children <12 years (mean (SD) = 66.5 (22.4) min) compared to those 12 and over (mean (SD) = 78.32 (23.1) min). CONCLUSIONS: Implantation of active osseointegrated bone conduction devices is feasible in children as young as 5 years and demonstrates low rates of complication. Further miniaturization may allow even earlier safe intervention.

Advancements in dental implantology: The alveolar ridge split technique for enhanced osseointegration.

The alveolar ridge split (ARS) technique is a pivotal advancement in dental implantology, addressing the limitation of insufficient bone width for implant placement. This review traces the historical development of ARS from its initial conceptualization to current practices and future directions. Emphasizing the technique's development, indications, procedural overview, and osteotomy variations, we highlight its minimally invasive nature, which reduces patient morbidity and treatment time. This article reviews various osteotomy methods within ARS, examining their applications, benefits, and limitations. Furthermore, it discusses the technique's role in expanding treatment options for patients with compromised alveolar structures, underpinned by a high implant survival rate and the potential for immediate implant placement. We also cover the necessity of meticulous surgical technique, the importance of patient-specific factors, and the promising future of ARS facilitated by advancements in biomaterials and regenerative medicine. In summary, this review provides a comprehensive overview of ARS, offering valuable insights for dental professionals and informing future clinical practices and research in implantology.

Osteointegration of functionalised high-performance oxide ceramics: imaging from micro-computed tomography.

BACKGROUND: This study evaluated the osseointegration potential of functionalised high-performance oxide ceramics (HPOC) in isolation or coated with BMP-2 or RGD peptides in 36 New Zeeland female rabbits using micro-computed tomography (micro CT). The primary outcomes of interest were to assess the amount of ossification evaluating the improvement in the bone volume/ total volume (BV/TV) ratio and trabecular thickness at 6 and 12 weeks. The second outcome of interest was to investigate possible differences in osteointegration between the functionalised silanised HPOC in isolation or coated with Bone Morphogenetic Protein 2 (BMP-2) or RGD peptides. METHODS: 36 adult female New Zealand white rabbits with a minimum weight of three kg were used. One-third of HPOCs were functionalised with silicon suboxide (SiOx), a third with BMP-2 (sHPOC-BMP2), and another third with RGD (sHPOC-RGD). All samples were scanned with a high-resolution micro CT (U-CTHR, MILabs B.V., Houten, The Netherlands) with a reconstructed voxel resolution of 10 µm. MicroCT scans were reconstructed in three planes and processed using Imalytics Preclinical version 2.1 (Gremse-IT GmbH, Aachen, Germany) software. The total volume (TV), bone volume (BV) and ratio BV/TV were calculated within the coating area. RESULTS: BV/TV increased significantly from 6 to 12 weeks in all HPOCs: silanised (P = 0.01), BMP-2 (P < 0.0001), and RGD (P < 0.0001) groups. At 12 weeks, the BMP-2 groups demonstrated greater ossification in the RGD (P < 0.0001) and silanised (P = 0.008) groups. Trabecular thickness increased significantly from 6 to 12 weeks (P < 0.0001). At 12 weeks, BMP-2 promoted greater trabecular thickness compared to the silanised group (P = 0.07), although no difference was found with the RGD (P = 0.1) group. CONCLUSION: Sinalised HPOC in isolation or functionalised with BMP-2 or RGD promotes in vivo osteointegration. The sinalised HOPC functionalised with BMP-2 demonstrated the greatest osseointegration.

Validation of IMU against optical reference and development of open-source pipeline: proof of concept case report in a participant with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant.

BACKGROUND: Systems that capture motion under laboratory conditions limit validity in real-world environments. Mobile motion capture solutions such as Inertial Measurement Units (IMUs) can progress our understanding of "real" human movement. IMU data must be validated in each application to interpret with clinical applicability; this is particularly true for diverse populations. Our IMU analysis method builds on the OpenSim IMU Inverse Kinematics toolkit integrating the Versatile Quaternion-based Filter and incorporates realistic constraints to the underlying biomechanical model. We validate our processing method against the reference standard optical motion capture in a case report with participants with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant (POI) and without amputation walking over level ground. We hypothesis that by using this novel pipeline, we can validate IMU motion capture data, to a clinically acceptable degree. RESULTS: Average RMSE (across all joints) between the two systems from the participant with a unilateral transfemoral amputation (TFA) on the amputated and the intact sides were 2.35° (IQR = 1.45°) and 3.59° (IQR = 2.00°) respectively. Equivalent results in the non-amputated participant were 2.26° (IQR = 1.08°). Joint level average RMSE between the two systems from the TFA ranged from 1.66° to 3.82° and from 1.21° to 5.46° in the non-amputated participant. In plane average RMSE between the two systems from the TFA ranged from 2.17° (coronal) to 3.91° (sagittal) and from 1.96° (transverse) to 2.32° (sagittal) in the non-amputated participant. Coefficients of Multiple Correlation (CMC) results between the two systems in the TFA ranged from 0.74 to > 0.99 and from 0.72 to > 0.99 in the non-amputated participant and resulted in 'excellent' similarity in each data set average, in every plane and at all joint levels. Normalized RMSE between the two systems from the TFA ranged from 3.40% (knee level) to 54.54% (pelvis level) and from 2.18% to 36.01% in the non-amputated participant. CONCLUSIONS: We offer a modular processing pipeline that enables the addition of extra layers, facilitates changes to the underlying biomechanical model, and can accept raw IMU data from any vendor. We successfully validate the pipeline using data, for the first time, from a TFA participant using a POI and have proved our hypothesis.

Comportamiento orgánico en la utilización de barreras con polímeros impresos 3D para la regeneración ósea guiada en implantología / Organic behavior in the utilization of barriers with 3D printed polymers for guided bone regeneration in implantology

Este estudio aborda la viabilidad y los retos inherentes al uso de barreras de polímeros impresos en 3D para la regeneración ósea guiada (en adelante, ROG) en procedimientos de implantología dental. A través del análisis exhaustivo de investigaciones y aplicaciones clínicas actuales, se evalúa detalladamente la biocompatibilidad, la funcionalidad estructural y las respuestas biológicas inducidas por estas barreras innovadoras en entornos terapéuticos. Este enfoque permite una comprensión más profunda de las interacciones osteointegrativas y las perspectivas de adaptabilidad tisular asociadas con materiales poliméricos avanzados (AU)

This scholarly investigation delineates the efficacy and inherent challenges of utilizing 3D printed polymer barriers for guided bone regeneration (GBR) in dental implantology procedures. An extensive review of current research and clinical implementations provides a critical assessment of biocompatibility, structural functionality, and the biological responses elicited by these innovative barriers within therapeutic contexts. The study delves into the osteointegrative interactions and tissue adaptability prospects facilitated by advanced polymeric materials, offering significant insights into their clinical utility.(AU)

Influence of torque and bone type on stability quotient of two implant platforms: a clinical trial.

The objective of this study was to analyze the influence of insertion torque, bone type, and peri-implant bone loss on implant stability quotient (ISQ) of cylindrical external hexagon (EH) and Morse Taper (MT) implants. Forty-four single implants were placed in the edentulous areas of 20 patients who met the inclusion and exclusion criteria. Immediately after implant placement (t1) and after osseointegration (four and six months for mandible and maxilla, respectively) (t2), insertion torque, resonance frequency, and peri-implant bone loss were measured using probing depths and digital periapical radiography. A significant difference was noted in the ISQ values between t1 and t2 in type III bone for EH and MT implants. No significant difference in bone loss values was observed when comparing bone types for EH or MT in all evaluated sites. Based on marginal bone loss assessed using radiography, there was no significant difference between the MT and EH groups. A positive correlation between torque and ISQ t1 value was observed for MT (correlation: 0.439; p = 0.041) and EH (correlation: 0.461; p = 0.031) implants. For EH and MT implants, the greater the insertion torque, the greater was the ISQ value (moderately positive correlation). A weak negative correlation was found between bone type and ISQ t1 for MT implants. Contrarily, no correlation was observed between bone type and ISQ t1 for EH implants. In all cases, bone loss around the implants was clinically normal.

Bio-Inspired Micro- and Nano-Scale Surface Features Produced by Femtosecond Laser-Texturing Enhance TiZr-Implant Osseointegration.

Surface design plays a critical role in determining the integration of dental implants with bone tissue. Femtosecond laser-texturing has emerged as a breakthrough technology offering excellent uniformity and reproducibility in implant surface features. However, when compared to state-of-the-art sandblasted and acid-etched surfaces, laser-textured surface designs typically underperform in terms of osseointegration. This study investigates the capacity of a bio-inspired femtosecond laser-textured surface design to enhance osseointegration compared to state-of-the-art sandblasted & acid-etched surfaces. Laser-texturing facilitates the production of an organized trabeculae-like microarchitecture with superimposed nano-scale laser-induced periodic surface structures on both 2D and 3D samples of titanium-zirconium-alloy. Following a boiling treatment to modify the surface chemistry, improving wettability to a contact angle of 10°, laser-textured surfaces enhance fibrin network formation when in contact with human whole blood, comparable to state-of-the-art surfaces. In vitro experiments demonstrate that laser-textured surfaces significantly outperform state-of-the-art surfaces with a 2.5-fold higher level of mineralization by bone progenitor cells after 28 days of culture. Furthermore, in vivo evaluations reveal superior biomechanical integration of laser-textured surfaces after 28 days of implantation. Notably, during abiological pull-out tests, laser-textured surfaces exhibit comparable performance, suggesting that the observed enhanced osseointegration is primarily driven by the biological response to the surface.

Oversized Surgical Preparation of the Implant Site: Systematic Review and Meta-analysis of Preclinical Studies.

PURPOSE: To answer the following focus question: In preclinical in vivo experimental models, do oral implants placed in overdimensioned (OD) sites present greater biomechanical properties and histomorphometric parameters of osseointegration compared to implants placed in standard or undersized implant sockets? MATERIALS AND METHODS: Online databases were searched for controlled animal studies reporting on OD sites up to February 2023. The relative implant- final drill discrepancy (IDD) was used to categorize the control and test groups according to surgical drilling protocol: (1) control: undersized (IDD > 0.5 mm) or standard (IDD = 0.2 to 0.5 mm); and (2) test OD: stress-free oversized (IDD = 0.0 to -0.1 mm); test GAP: friction-free oversized (IDD ≤ -0.1 mm). Random-effects meta-analyses were performed for the outcomes of insertion and removal torque values (ITV and RTV, respectively), bone-to-implant contact (%BIC), and bone density (%BD) for short- (0 to 2 weeks), intermediate- (3 to 4 weeks), and long-term (≥ 5 weeks) healing periods. RESULTS: Of the 527 records identified, 13 studies met the eligibility criteria. Histologically, the OD and GAP groups prevented ischemic necrosis and extensive bone resorption at the bone-implant interface in both the marginal cortical layer and the trabeculae. Faster and increased rates of bone formation, characterized by primary osteons and highly vascularized tissue, took place in OD sites between 1 and 5 weeks of healing. Meta-analyses indicated statistically significant benefits in favor of (1) control vs OD for short-term healing in extraoral sites, with pooled estimates (weighted mean difference) of ITV = 25.35 Ncm, %BIC = 2.10%, and %BD = 26.19%; (2) control vs OD for long-term healing in intraoral sites, with %BD = 11.69%; (3) control vs GAP for intermediate-term healing in extraoral sites, with %BD = 3.03%; and (4) control vs GAP for long-term healing in extraoral sites, with RTV = 5.57 Ncm. CONCLUSIONS: Oversized surgical preparation of the implant site does not seem to provide any additional benefit compared to standard or undersized sites regarding quantitative parameters of osseointegration. However, it does minimize marginal bone resorption and yields better-quality bone healing, despite the comparable results among different experimental animal models in the late postoperative period.

Nano-superhydrophilic and bioactive surface in poor bone environment. Part 1: transition from primary to secondary stability. A controlled clinical trial : Bioactive implant surfaces in poor density bone.

OBJECTIVES: Bioactive surfaces were designed to increase the interaction between the surface and the cells. This may speed up the biological stability and loading protocols. MATERIALS AND METHODS: 36 patients with D3-D4 bone density were recruited and allocated into two groups. 30 bioactive (test group) and 30 traditional (control group) surfaced implants were placed. Insertion torque value (Ncm), insertion torque curve integral (cumulative torque, Ncm), torque density (Ncm/sec), implant stability quotient (ISQ) measured at three timepoints (baseline (T0), 30 (T30) and 45 (T45) days after surgery), and marginal bone loss (MBL) at 6 months of loading were assessed. RESULTS: The mean ISQ and standard deviation at T0, T30, T45 were respectively 74.57 ± 7.85, 74.78 ± 7.31, 74.97 ± 6.34 in test group, and 77.12 ± 5.83, 73.33 ± 6.13, 73.44 ± 7.89 in control group, respectively. Data analysis showed significant differences between groups in ΔISQ at T0-T30 (p = 0.005) and T30-T45 (p = 0.012). Control group showed a significant decrease in ISQ at T30 (p = 0.01) and T45 (p = 0.03) compared to baseline, while no significant change was observed in test group. Due to the stability of the ISQ value ≥ 70, 26 test group and 23 control group implants were functionally loaded after 45 days. Conversely, due to the ISQ < 70 at T45, four test group implants and one control group implant were loaded after 90 days, and 6 control group implants were loaded after 180 days. Neither insertion torque nor ISQ at baseline were correlated with bone density (in Hounsfield units). There was no significant correlation between cumulative torque and ISQ at baseline. There was a significant positive slope in the correlation between torque density and ISQ at baseline, more accentuated in D3 than D4. This correlation remained significant for the test group in D3 bone at day 30 and 45 (p < 0.01 in both time frames), but not in D4 bone, and it was not significant in CG. CONCLUSIONS: The bioactive surface showed better behavior in terms of implant stability in D3-D4 bone quality in the early stages of bone healing. Clinical relevance This study demonstrated that the transition from primary to secondary stability is improved using bioactive surface, especially in cases of poor bone environment (D3/D4 bone).

Mussel-Derived and Bioclickable Peptide Mimic for Enhanced Interfacial Osseointegration via Synergistic Immunomodulation and Vascularized Bone Regeneration.

Inadequate osseointegration at the interface is a key factor in orthopedic implant failure. Mechanistically, traditional orthopedic implant interfaces fail to precisely match natural bone regeneration processes in vivo. In this study, a novel biomimetic coating on titanium substrates (DPA-Co/GFO) through a mussel adhesion-mediated ion coordination and molecular clicking strategy is engineered. In vivo and in vitro results confirm that the coating exhibits excellent biocompatibility and effectively promotes angiogenesis and osteogenesis. Crucially, the biomimetic coating targets the integrin α2ß1 receptor to promote M2 macrophage polarization and achieves a synergistic effect between immunomodulation and vascularized bone regeneration, thereby maximizing osseointegration at the interface. Mechanical push-out tests reveal that the pull-out strength in the DPA-Co/GFO group is markedly greater than that in the control group (79.04 ± 3.20 N vs 31.47 ± 1.87 N, P < 0.01) and even surpasses that in the sham group (79.04 ± 3.20 N vs 63.09 ± 8.52 N, P < 0.01). In summary, the novel biomimetic coating developed in this study precisely matches the natural process of bone regeneration in vivo, enhancing interface-related osseointegration and showing considerable potential for clinical translation and applications.

Thermal implant removal in a pig jaw: a proof of concept study.

OBJECTIVES: The aim of this study was to evaluate whether thermal implant removal of osseointegrated implants is possible using a diode laser with an specific temperature-time interval. MATERIALS AND METHODS: First, tooth extraction of the first three premolars was performed in the maxilla and mandible on both sides of 10 pig. After 3 months, implants were inserted into the upper and lower jaws of 10 pigs. After 3 more months, osseointegrated implants were heated with a laser device to a temperature of 50 °C for 1 min. After 14 days, the implant stability quotient (ISQ), torque-out values, and bone-to-implant contact (BIC) ratio were assessed using resonance frequency analysis. RESULTS: ISQ values showed no significant differences within each group or between the control and test groups. Furthermore, torque-out and BIC value measurements presented no significant differences between the groups. CONCLUSIONS: At 50°C, changes in the BIC values were noticeably smaller; however, these differences were not significant. Future studies should evaluate the same procedures at either a higher temperature or longer intervals. CLINICAL RELEVANCE: With only 50 °C for 1 min, a dental implant will not de-integrate predictably.

Dynamic analyses of a soft tissue-implant interface: Biological responses to immediate versus delayed dental implants.

AIM: To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around 'immediate' and 'delayed' implants. MATERIALS AND METHODS: Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri-implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control. RESULTS: No differences were observed in the rate of soft-tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft-tissue integration indicated an initially disorganized peri-implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri-implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri-implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction. CONCLUSIONS: Within the timeframe examined, quantitative analyses showed that connective tissue maturation never reached that observed around teeth. Hemidesmosomal attachment protein expression levels were also significantly reduced compared to those in an intact JE, although quantitative analyses indicated that macrophage density in the peri-implant environment was reduced over time, suggesting an improvement in PIE barrier functions. Perhaps most unexpectedly, maturation of the peri-implant soft tissues was a significantly slower process than osseointegration.

Biomechanical Investigation of the Osseointegration of Titanium Implants With Different Surfaces Placed With Allogeneic Bone Transfer.

Allogeneic grafts can be preferred to autogenous grafts in plastic and oral-maxillofacial surgery for vertical and horizontal bone deficiencies. Implant surface properties are an important factor in osseointegration. This study aims to evaluate the osseointegration levels of titanium implants with machined, sand-blasted, and acid-etched (SLA) and resorbable blast material (RBM) surfaces placed together with allogeneic bone tissue transplantations obtained from the tibia bone using biomechanical method. Twenty-five female Sprague-Dawley rats were included in the study. The rats were divided into groups in which machined (n=7), SLA (n=7), and RBM (n=7) surface implants were placed with the transplantation of bone taken from the tibia. Four rats (both left and right tibias) were used as donors. Grafts and implants were surgically placed in the corticocancellous part of the metaphyseal area of the tibia bones of rats. At the end of the 4-week experimental setup, all rats were killed, and the implants and surrounding bone tissue were subjected to biomechanical reverse torque analysis (N/cm). Sand-blasted acid-etched surface implants were observed to have higher biomechanical osseointegration levels than RBM and machined surface implants ( P <0.05). No statistical difference could be detected between the RBM and machined surface implants ( P >0.05). On the basis of the limited results of this study, it can be concluded that the osseointegration levels of SLA surface implants placed with allogeneic bone transplantation may be better than those of machined and RBM surface implants.