Dental Implants: The Last 100 Years.

The present article on the history of dental implants spans beyond the past 100 years of the American Association of Oral and Maxillofacial Surgeons. It was not until the materials and methods became less traumatic to the bone that implants could become firmly attached to the surrounding bone. This phenomenon is now used to replace single and multiple teeth and restore the patient to function and well-being. Many of the methods used to increase denture function are still used with modifications to augment the environment for an implant. These technological changes have allowed patients to be treated efficiently, with the same need for a good treatment plan and physical evaluation by the clinician.

Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions.

In the 1960s and 1970s, implant-supported prostheses based on subperiosteal or blade implants had a poor reputation because of questionable clinical outcomes and lack of scientific documentation. The change to a scientifically sound discipline was initiated by the two scientific pioneers of modern implant dentistry, Professor P. I. Brånemark from the University of Gothenburg in Sweden and Professor André Schroeder from the University of Bern in Switzerland. Together with their teams, and independently of each other, they laid the foundation for the most significant development and paradigm shift in dental medicine. The present volume of Periodontology 2000 celebrates 50 years of osseointegration. It reviews the progress of implant therapy over the past 50 years, including the basics of implant surgery required to achieve osseointegration on a predictable basis and evolving innovations. The development of bone-augmentation techniques, such as guided bone regeneration and sinus floor elevation, to correct local bone defects at potential implant sites has increased the indications for implant therapy. The paradigm shift to moderately rough implant surfaces resulted in faster and enhanced bone integration and led to improvements in various treatment protocols, such as immediate and early implant placement in postextraction sites, and made various loading protocols possible, including immediate and early implant loading. In the past 15 years, preoperative analysis and presurgical planning improved as a result of the introduction of three-dimensional imaging techniques. Hereby, cone-beam computed tomography offers better image quality with reduced radiation exposure, when compared with dental computed tomography. This opened the door for digital planning and surgical modifications. Over the last 50 years this evolution has facilitated tremendous progress in esthetic outcomes with implant-supported prostheses and improved patient-centered outcomes. This volume of Periodontology 2000 also discusses the current trends and open questions of implant dentistry, such as the potential of digital implant dentistry in the surgical and prosthetic field, the trend for an increasing average age of implant patients and the related adaptations of treatment protocols, and the second attempt to establish ceramic implants using, this time, zirconia as the implant material. Finally, some of the hottest controversies are discussed, such as recent suggestions on bone integration being a potential foreign-body reaction and the evidence-based appraisal of the peri-implantitis debate.

Fifty Years of Dental Implant Development: a Continuous Evolution.

Since their conception in the 1960s, dental implants have evolved into a predictable solution for replacing missing teeth. Many of these advances have come from an improved understanding of osseointegration and material sciences, most notably recognising the inherent biocompatibility of titanium. This has allowed researchers and clinicians to focus upon achieving better functional and aesthetic outcomes. This paper describes the evolution from the original concepts to current practice in dental implantology and considers some of the challenges to success facing clinicians and patients today.

A Dental Prosthesis from the Early Modern Age in Tuscany (Italy).

BACKGROUND: During archaeological excavation, carried out in the S. Francesco Monastery at Lucca (Tuscany, Italy), a golden dental appliance was discovered. The prosthesis was found, together with commingled human remains, in the collective tomb of the aristocratic family of the Guinigi, a powerful family who governed Lucca from 1392 until 1429. The exact archaeological dating of the prosthesis was not possible, but some elements suggest a dating to the beginning of the 17th century. PURPOSE: Aim of the paper is to study and describe the dental appliance trough a multidisciplinary approach. MATERIALS AND METHODS: Macroscopical and micro-CT examinations were performed to investigate the technics used for the realization of the dental prosthesis. SEM analysis was performed to study alloy composition of the metallic fixing lamina and microstructure of the deposits on the dental surface. RESULTS: The dental prosthesis consists in five mandibular teeth: three central incisors and two lateral canines linked together by a golden band inserted into the dental roots to replace the anterior arch of the jaw. Micro-CT scan revealed the presence of two small golden pins inserted into each tooth crossing the root and fixing the teeth to the internal gold band. SEM examination of the lamina indicated a homogeneous composition, with average contents of 73 wt% gold, 15.6 wt% Ag, and 11.4 wt% Cu. Apposition of dental calculus on the teeth indicated that the prosthesis had been worn for a long period. CONCLUSIONS: This dental prosthesis provides a unique finding of technologically advanced dentistry in this period. In fact, during the Early Modern Age, some authors described gold band technology for the replacement of missing teeth; nevertheless, no direct evidences of these devices have been brought to light up so far.

The evolution of the CEREC system.

BACKGROUND AND OVERVIEW: Early in 1980, the author anticipated the attraction of restoring posterior teeth with tooth-colored material. He conducted studies and developed the clinical concept of bonded ceramic inlays, at the same time raising the issue of the fast fabrication of the ceramic restorations. The author developed plans for in-office computer-aided design/computer-aided manufacturing (CAD/CAM) fabrication of ceramic restorations specifically to enable the dentist to complete one or multiple ceramic restorations chairside, in a single appointment. The initial concept comprised a small mobile CAD/CAM unit integrating a computer, keyboard, trackball, foot pedal and optoelectronic mouth camera as input devices, a monitor and a machining compartment. CEREC 3 (Sirona Dental Systems GmbH, Bensheim, Germany) divided the system into an acquisition/design unit and a separate machining unit. Three-dimensional software makes the handling illustrative and easy both in the office and in the laboratory. CONCLUSIONS: It appears that the CEREC CAD/CAM concept is becoming a significant part of dentistry. CLINICAL IMPLICATIONS: Sound knowledge of adhesive bonding and diligent planning are essential for the successful integration of CAD/CAM into clinical dental offices.

History and current state of metal adhesion systems used in prosthesis fabrication and placement.

The adhesion techniques used in prosthetic dentistry have substantially improved with respect to retention of veneering resin to the metal framework of resin-veneered restorations and the bonding of resin-bonded fixed partial dentures (RBFPDs) to abutment teeth. In the early 1970s, prostheses relied on macromechanical retention for veneering surfaces and the retention holes of retainers. Later, retention was achieved by using small spherical particles. In addition, the use of small pits created by electrochemical corrosion was tested in resin-veneered restorations and RBFPDs. Thus, micromechanical retention gradually supplanted macromechanical retention. First-generation adhesive monomers were introduced at the end of the 1970s and were succeeded in the early 1980s by the marketing of adhesive resin cements, which were effective for use with non-noble alloys when surface oxidation procedures were used. In 1994, a second-generation adhesive primer for noble alloys was introduced, which prompted development of other adhesive primers. These primers were applied mainly to silver-palladium-copper-gold and type IV gold alloys and improved the reliability of RBFPDs. Recent studies have confirmed the effectiveness of such primers when used with high-gold-content metal ceramic alloys. Due to these developments, RBFPDs now have excellent esthetic characteristics.

Early designs for the occlusal anatomy of posterior denture teeth: part III.

Part III of this series of articles, like Part II, reviews the pioneering efforts in the 19th century to improve the quality of artificial teeth. The focus of this article, unlike that of Part II, is specifically modifications in the design of the occlusal anatomy of the 19th century denture teeth, along with the theories of mandibular movement that inspired those modifications. This article concludes the introductory phase of this project, which seeks to unravel the confusing history of the development of (posterior) denture teeth.

Anterior single-tooth dental implant restorations: now is the perfect time to recall significant contributions.

Significant contributions by clinicians, researchers, and manufacturers have brought us to a previously almost unimaginable point in time, where it is possible to place and restore a single dental implant in the esthetic zone with a success rate above 96% and with the probability that it will look very much like a natural tooth. In addition, in select cases it is possible to do the extraction, implant placement, and provisional restoration on the same day. There is very little trauma at the implant site, which results in greater comfort for the patient and ultimately greater tissue preservation long-term. We have now observed single-tooth anterior implant cases for 15 years and have every belief that these implants will continue to function in health for many years. So what is next? We will have to wait and see, but it is this clinician's hope that the next 15 years will bring us more of these cooperative efforts that have so dramatically improved our patients' lives.