A influência da sobre carga vertical em diferentes níveis ósseos em implantes unitários: estudo comparativo de dois sistemas de implantes / The influence of vertical load on different bone levels in single implants: a comparative study of two implant systems

Embora existe um alto índice de sucesso implantes dentários, podem ocorrer perda da osseintegração após instalação das próteses sobre implante e as causas são as periimplantites e sobre cargas oclusais. Diferentes conexõessurgiram para o melhor desempenho estético, biomecânico e para evitar perdas ósseas perimplantares. Para analisar às deformações geradas ao redor dos implantes e suas conexões, as duas metodologias utilizadas neste estudo e que apresentam resultados numéricos,foram a análise de elementos finitos e a extensometria linear.Para o teste do FEA, foi utilizado o software Rhinoceros 4.0 para obter os desenhos em 3D dos dois modelos de implantes,com o mesmo comprimento e largura, um hexágono externo HE (Titaoss® TM cortical Intraoss®, SP, Brasil) com diâmetro de 3,75 mm e comprimento de 13 mm e o segundo sendo um implante conexão interna (CM) (Titaoss® Max Cone Morse, Intraoss®, SP, Brasil). Sobre os implantes foram modelados seus abutments respectivamente, Ucla anti- rotacional com plataforma de 4.1 mm e um Pilar Cone Morse CMN com transmucoso de 0,8 mm. Ambos abutments para próteses parafusadas e foram exportados para o software de análise (ANSYS 17.0, ANSYS Inc., Houston, TX, USA) em formato STEP.Para o teste de extensometria, foram obtidos blocos de poliuretano (Poliuretano F160 ISO Axson, Cercy, França) de forma retangular com dimensões internas de 95 x 45 x 30 mm e intalados implantes Titaoss® Max Cone Morse 3,75 X 13 mm e os implantes Titaoss® TM 3,75 X 13 mm (Intraoss- SP - Brasil), e os abutments e coroas metálicas de cromo-cobalto. Formado 4 grupos: a) CM no; b) HE no, c) CM po e d) He po; em cada grupo foram instalados 4 extensômetros tangenciando cada um dos implantes, segundo mapas colorimétricos da região de maior microdeformação óssea. Na aplicação de carga, foi utilizado o dispositivo de aplicação de carga-DAC(Nishioka - Proc. 08/53071-4), com carga axial de 30 kg aplicadas por um período de 10 segundos (Mericske-Stern et al.) na fosseta central (carga axial).Resultados:1) FEA- a) Tensão de von-Mises gerada no conjunto implante/parafuso mostrou maior concentraçao de tensao no parafuso protético de ambos os grupos independente da perda óssea; b) Tensão de von-Mises gerada na região mais estressada que mostrou a possível falha na região da cabeça do parafuso de ambos os grupos independente da perda óssea; c) Tensão de von-Mises gerada no implante em secçao longitudinal foi maior concentraçao de tensao na plataforma do hexagono externo, mas, com pouca diferença no restante do corpo do implante, e d) microdeformaçao gerada no interior do bloco de poliuretano .Não foi possível notar diferenças significativas entre as diferentes conexões. Para os implantes com perda óssea é possível notar maior deformaçao ápica. 2) Na extensometria foi realizada a média da deformação gerada de cada os quatro grupos, no qual não apresentou diferenças numéricas entre os grupos. Neste estudo podemos concluir que não há diferenças significativas na microdeformação entre o grupo dos implantes CM no e HE no, com uma maior deformação CM e HE quando há presença de perda óssea(AU)

Although there is a high success rate, dental implants may lose osseintegration after implantation of prostheses on implants and the causes are peri-implantitis and occlusal loads.Different connections have emerged for better aesthetic and biomechanical performance to prevent perimplant bone loss.To analyze the deformations generated around the implants and their connections, the two methodologies used in this study and which present numerical results were the analysis of finite elements and linear extensometry.The Rhinoceros 4.0 software was used to obtain the 3D drawings of the two implant models with the same length and width, an external hexagon HE (Titaoss® TM cortical Intraoss®, SP, Brazil) with a diameter of 3.75 mm and a length of 13 mm and the second being an internal connection (CM) implant (Titaoss® Max Cone Morse, Intraoss®, SP, Brazil). The abutments were modeled on the implants, respectively, Ucla anti-rotational with 4.1 mm platform and a Morse Cone Abutment CMN with 0.8 mm transmucous. Both abutments for screwed prostheses and were exported to the analysis software (ANSYS 17.0, ANSYS Inc., Houston, TX, USA) in STEP format.For the extensometry test, rectangular polyurethane blocks (Polyurethane F160 ISO Axson, Cercy, France) with internal dimensions of 95 x 45 x 30 mm and Titaoss® Max Cone Morse 3.75 X 13 mm implants and implants were obtained Titaoss® TM 3.75 X 13 mm (Intraoss-SP - Brazil), and the abutments and metallic crowns of chromium-cobalt. Forming 4 groups: a) CM no; b) HE no; c) CM po and d) He po, each group installed 4 strain gauges tangent to each of the implants, according to colorimetric maps of the region with the greatest bone microdeformation. In the load application, the DAC load application device (Nishioka- Proc. 08 / 53071-4) was used, with an axial load of 30 kg applied for a period of 10 seconds (Mericske-Stern et al.) In the pit central (axial load).Results: 1) FEA- a) von-Mises tension generated in the implant / screw set showed a higher concentration of tension in the prosthetic screw of both groups regardless of bone loss; b) von-Mises tension generated in the most stressed region, showing possible failure in the screw head region of both groups regardless of bone loss; c) VonMises stress generated in the implant in longitudinal section was higher stress concentration in the external hexagon platform but with little difference in the rest of the implant body, and d) microdeformation generated inside the polyurethane block, it was not possible to notice significant differences between the different connections. For implants with bone loss, it is possible to notice greater apical deformation. 2) In the extensometry, the average strain generated for each of the four groups was performed, in which there were no numerical differences between the groups. In this study we can conclude that there was no difference in microdeformation between the group of CM implants and HE no, with a greater CM and HE deformation when there is bone loss(AU)

The Bacterial Anti-Adhesive Activity of Double-Etched Titanium (DAE) as a Dental Implant Surface.

This work aimed to compare the capability of Streptococcus oralis to adhere to a novel surface, double-etched titanium (DAE), in respect to machined and single-etched titanium. The secondary outcome was to establish which topographical features could affect the interaction between the implant surface and bacteria. The samples' superficial features were characterized using scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS), and the wetting properties were tested through sessile methods. The novel surface, the double-etched titanium (DAE), was also analyzed with atomic force microscopy (AFM). S. oralis was inoculated on discs previously incubated in saliva, and then the colony-forming units (CFUs), biomass, and cellular viability were measured at 24 and 48h. SEM observation showed that DAE was characterized by higher porosity and Oxygen (%) in the superficial layer and the measurement of the wetting properties showed higher hydrophilicity. AFM confirmed the presence of a higher superficial nano-roughness. Microbiological analysis showed that DAE discs, coated by pellicle's proteins, were characterized by significantly lower CFUs at 24 and 48 h with respect to the other two groups. In particular, a significant inverse relationship was shown between the CFUs at 48 h and the values of the wetted area and a direct correlation with the water contact angle. The biomass at 24 h was slightly lower on DAE, but results were not significant concerning the other groups, both at 24 and 48 h. The DAE treatment not only modifies the superficial topography and increased hydrophilicity, but it also increases the Oxygen percentage in the superficial layer, which could contribute to the inhibition of S. oralis adhesion. DAE can be considered a promising treatment for titanium implants to counteract a colonization pioneer microorganism, such as S. oralis.

[Progress on clinical application of orthodontic-implant combined therapy].

For complex implant cases, simple implantation could not achieve the desired therapeutic effect, and a multidisciplinary approach has become a general trend. Orthodontic treatment before implantation creates favorable conditions for subsequent implantation by increasing restoring three-dimensional space, improving occlusion of patients. It also stimulates the increase of autologous soft and hard tissue while biological potential of periodontal ligament is fully developed. The choice of operation time is vital to keep the level of soft and hard tissue at the implantation site, which improves the curative effect of implantation in terms of function and aesthetics. In this article, the orthodontic-implant combined therapy is briefly reviewed focusing on the three-dimensional space optimization, implant site enhancement by orthodontic extrusion and delayed orthodontic space opening.

Uso de scanners intraorais em implantodontia / Uso de los escáneres intrabucales en implantología / Use of intraoral scanners in implantology

RESUMO Introdução: O escâner intraoral é um aparelho que surge como alternativa aos métodos convencionais de moldagem utilizando a técnica de impressão digital. O meio acadêmico vem realizando diversos estudos para avaliar a real efetividade da tecnologia e sua aplicabilidade clínica. Objetivo: Analisar resultados obtidos em estudos sobre escâneres intraorais na área de implantodontia quanto ao tipo de escâneres e acurácia, tempo de trabalho e preferência do operador e do paciente. Métodos: Foram realizadas buscas de artigos nas bases de dados "Pubmed" e "SciELO" utilizando os seguintes descritores: «intraoral AND scanner AND implant¼, «digital AND scanner AND implant¼ e «digital AND impression AND implant¼ em inglês, português e espanhol respectivamente. Os critérios de inclusão foram: artigos de avaliação clínica (in vivo) ou laboratorial (in vitro) que avaliassem o uso da técnica de escaneamento intra-oral para impressão digital de implantes com acesso integral, escritos em português, inglês ou espanhol e publicados a partir de 2013. Análise e integração da informação: Foram encontrados 158 artigos. Após a análise e seleção, 35 artigos foram incluídos, sendo 28 laboratoriais e 7 clínicos. Apesar de limitações na padronização dos estudos, percebemos o potencial e a viabilidade da técnica digital, com resultados clínicos e de acurácia favoráveis e vantagens como redução do tempo e etapas de trabalho, comunicação dinâmica com os laboratórios, preferência de pacientes e estudantes de odontologia e facilidade de incorporação por profissionais já experientes. Conclusões: Estudos laboratoriais indicam que, além de vantagens quanto ao uso de materiais de moldagem, comunicação com os laboratórios e facilidade de manipulação, a técnica digital pode alcançar resultados superiores aos da técnica convencional, assim, a técnica se mostra promissora para a área de implantodontia sendo necessário, contudo, estudos futuros, especialmente in vivo, para avaliar a consistência dos resultados clínicos(AU)

RESUMEN Introducción: El escáner intrabucal es un aparato que surge como una alternativa frente a los métodos convencionales de moldeo, y el medio académico viene realizando diversos estudios para evaluar la real efectividad de esta tecnología y su aplicabilidad clínica. Objetivo: Analizar resultados obtenidos en estudios sobre escáneres intrabucales en el área de implantología en cuanto a los tipos de escáneres y la exactitud, tiempo de trabajo y preferencia del operador y del paciente. Métodos: Se realizaron búsquedas en las bases de datos "PubMed" y "SciELO" utilizando los siguientes descriptores: "intraoral AND scanner AND implant", "digital AND scanner AND implant" and "digital AND impression AND implant" en inglés, portugués y español, respectivamente. Los criterios de inclusión fueron: artículos clínicos o de laboratorio para evaluar el uso de la técnica de escaneamiento digital de los implantes, con acceso completo al artículo, escrito en portugués, inglés o español y publicados desde 2013. Análisis e integración de la información: Se encontraron 158 artículos. Después del análisis y selección, 35 artículos fueron incluidos, siendo 28 de laboratorio y 7 clínicos. A pesar de las limitaciones en la estandarización de los estudios, percibimos el potencial y la viabilidad de la técnica digital, con resultados clínicos y de precisión favorables y ventajas como reducción del tiempo y etapas de trabajo, comunicación dinámica con los laboratorios, preferencia de pacientes y estudiantes de odontología y facilidad de incorporación de profesionales experimentados. Conclusiones: Los estudios de laboratorio indican que, además de ventajas en cuanto al uso de materiales de moldeo, comunicación con los laboratorios y facilidad de manipulación, la técnica digital puede alcanzar resultados superiores a los de la técnica convencional, por lo que el uso de escáneres intrabucales se muestra prometedor para el área de implantología siendo necesario, sin embargo, estudios futuros, especialmente in vivo, para evaluar la consistencia de los resultados clínicos(AU)

ABSTRACT Introduction: Intraoral scanners are devices that emerged as an alternative to conventional impression methods. A variety of studies have been conducted to evaluate the actual effectiveness of this technology and its clinical applicability. Objective: Analyze the results obtained by studies about intraoral scanners in the area of implantology in terms of types, accuracy, working time, and operator and patient preference. Methods: A search was conducted in the databases PubMed and SciELO using the following descriptors: "intraoral AND scanner AND implant", "digital AND scanner AND implant" and "digital AND impression AND implant" in English, Portuguese and Spanish. The inclusion criteria were the following: clinical or laboratory papers evaluating the use of digital implant scanning technique, full access to the paper, written in Portuguese, English or Spanish and published as of the year 2013. Data analysis and integration: Of the 158 papers obtained and analyzed, 35 were selected: 28 laboratory and 7 clinical. Despite the limitations in the standardization of the studies, we perceive the potential and viability of the digital technique, with favorable clinical and accuracy results, as well as advantages such as a reduction in work time and stages, dynamic communication with laboratories, preference by patients and dental students and ease of technical incorporation by experienced dentists. Conclusions: Laboratory studies indicate that, in addition to the advantages concerning the use of impression materials, communication with laboratories and ease of manipulation, the digital technique may achieve better results than conventional impression techniques. The use of intraoral scanners is therefore a promising technique for the area of ​​implantology. However, further studies shouldbe conducted, especially in vivo, to evaluate the consistency of the clinical results obtained(AU)

Improvement of osseointegration by recruiting stem cells to titanium implants fabricated with 3D printing.

Slow and incomplete osseointegration and loss of osseointegration are major problems in dental and bone implants. We designed implants with interconnected 3D-tubulous structures and hypothesized that such interconnecting 3D (I3D) structures would serve as a repository for chemoattractants to recruit stem cells to promote osseointegration. A concept Laser Mlab-cusing-R laser-powder-bed-fusion (LPBF) 3D printing system was used to produce titanium implants with designed features. The implants were loaded (coated) with stromal cell-derived factor-1 alpha (SDF-1α), and subjected to stem cell recruitment. Implants were then surgically transplanted into the rabbit skull bone. After 12 weeks, osseointegration was analyzed by reverse-torque test and the implants were examined for calcium deposition by Alizarin Red staining. The I3D implants attracted significantly more stem cells than solid implants when coated (loaded) with SDF-1α. Greater torque force was needed to extract the I3D implants with 200 and 300 µm I3D structures than to extract solid implants from the skull. Generally, more calcium deposition was observed on the I3D implants than on the solid counterparts. LPBF 3D printing can be used to fabricate implants with complex structures. I3D-tubulous structures of implants can retain chemoattractant for recruitment of stem cells to enhance osseointegration.

Comportamento biomecânico e sobrevivência de coroas de cerâmica híbrida implanto- suportadas confeccionadas por diferentes técnicas / Biomechanical behavior and survival of implant-supported hybrid ceramic crowns made by different techniques

O presente estudo teve como objetivo investigar a probabilidade de sobrevivência e distribuição de tensão de restaurações de cerâmica infiltrada por polímero sobre implantes. Setenta e cinco coroas suportadas por implantes foram divididas de acordo com a técnica de fabricação, usando uma base de titânio(Tibase): CME - Solução protética de duas peças composta por uma coroa cimentada no pilar híbrido (Tibase + mesoestrutura cerâmica); MC - Solução protética de peça única composta por uma coroa cimentada diretamente sobre o Tibase; e MP - Solução protética de peça única composta por uma coroa cimentada em um Tibase com orifício de acesso para parafuso. Todas as coroas foram fadigadas pelo teste stepwise (intervalo de carga de 50 N a cada 20.000 ciclos até 1200 N e 350.000 ciclos). As coroas falhadas foram inspecionadas sob microscopia eletrônica de varredura e a probabilidade de sobrevivência foi analisada usando os testes Log-Rank e Willcoxon. Uma geometria tridimensional de cada grupo foi modelada e analisada pelo método dos elementos finitos. Resultados de deformação total, tensão de von-Misses, tensão principal máxima e microdeformação foram solicitados sob carga axial de 900 N. Log-Rank (p = 0,17) e Willcoxon (p = 0,11) revelaram uma probabilidade de sobrevivência semelhante entre as técnicas de fabricação sob 300 e 900 N. Independentemente da sobrevivência semelhante entre CME e MC, MP mostrou resistência característica superior e menor variação de dados. Maior concentração de tensão foi observada no perfil de emergência da coroa independente do grupo. A fractografia possibilitou identificar que a direção de propagação de trinca ocorreu da cervical para oclusal. É possível concluir que a sobrevivência de uma restauração implanto-suportada com cerâmica vítrea infiltrada por polímero independe da técnica utilizada para sua confecção; e que a região do perfil de emergência da coroa protética sempre deve ser avaliada nas consultas periódicas devido a grande prodominância de falhas nessa área(AU)

The present study aimed to investigate the survival probability and the stress distribution of a polymer infiltrate ceramic restorations cemented on a chairside titanium­base manufactured using different techniques. Seventy-five implant-supported crowns were divided according to the manufacturing technique using a chairside titanium­base: CME - Two-piece prosthetic solution composed by a crown cemented on the hybrid abutment; MC - One-piece prosthetic solution composed by a crown direct cemented on a titanium base; and MP - One-piece prosthetic solution composed by a crown cemented on a Tibase with screw access hole. All crowns were staircase fatigued (load step of 50 N in each 20,000 cycles until 1200 N and 350,000 cycles). The failed crowns were inspected under scanning electron microscopy. And the survival probability using Log-Rank and Willcoxon tests. One threedimensional geometry from each group were modeled and analyzed using the finite element method. Results in total deformation, von-Misses stress, maximum principal stress and microstrain were requested under 900 N axial load. Log-Rank (p = 0.17) and Willcoxon (p = 0.11) revealed similar survival probability between the techniques at 300 and 900 N. Regardless of the similar survival between CME and MC, MP showed superior characteristic strength and less data variation. Higher stress concentration was observed in the emergence profile of the crown regardless the group design. Fractography analysis allowed to identify that the crack propagation direction occurred from cervical to occlusal. It is possible to conclude that the survival of an implant-supported restoration with polymer infiltrated ceramic network is not influence by the technique used to make it; and that the emergence profile of the prosthetic crown must always be evaluated due to the great incidence of failures in this area(AU)

[Changes in the "classical" factors influencing dental implant-osseointegration in recent decades]. / A fogászati implantátumok csontbeépülését befolyásoló "klasszikus" tényezok változásai az elmúlt évtizedekben.

Nowadays, it is almost naturally taken among dentists that seemed unimaginable a few decades ago, namely that an inorganic material (titanium) inserted in an organic environment (bone) can be integrated and become a permanent pillar of prosthetics. Bone integration - meaning a structural and functional connection between the implant and the bone - itself was discovered and described in the late 1960s. This provides the basis of dental implantology. In those days, the conditions affecting the positive or negative course of bone integration have been formulated. This process is investigated at the level of basic research and rarely mentioned in the daily clinical practice. The material, form, and surface of the implant all contribute to success if we design well and apply the correct surgical technique. Our goal is to present the changes that have taken place over the past decades, which have resulted in an increasingly perfect integration and clinical success of implants. Orv Hetil. 2019; 160(37): 1455-1463.

Manejo de la cresta maxilar atrófica con la técnica de Ridge Split / Management of the Athrofic Maxilar Crest with the Ridge Split Technique

Resumen 14. Introducción: la atrofia ósea del reborde maxilar siempre es una limitante para instalar implantes dentales. El procedimiento de Ridge Split demuestra ser una técnica exitosa para realizar el manejo de los defectos horizontales, aumentando las dimensiones del reborde atrófico para instalar de forma inmediata implantes dentales. Objetivo: describir el uso clínico de la técnica de Ridge Split como tratamiento del aumento óseo en sentido horizontal del maxilar atrófico. Presentación del caso: se presentó el caso de una paciente femenina de 61 años de edad, edéntula parcial, que busca recuperar sus dientes superiores. Al examen clínico presenta solo dos dientes y al examen radiográfico-tomográfico se observó reabsorción ósea severa y neumatización de los senos maxilares. Se planifica instalar dos implantes para realizar una sobre dentadura, utilizando la técnica de Ridge Split e instalación inmediata de los implantes. Cinco meses posteriores, se realiza un control tomográfico evidenciando aumento horizontal del reborde alveolar y se rehabilita con una sobredentadura, con lo que se logró la conformidad estética y funcional de la paciente. Conclusión: el caso presentado revela que esta técnica incrementa el reborde oseo en sentido horizontal y permite instalar en forma simultánea los implantes. Es un tratamiento predecible, seguro y cómodo, y acorta el tiempo de tratamiento, por lo que es una alternativa viable para el manejo de los defectos óseos alveolares.

Abstract 20. Introduction: the bony atrophy of the maxillary ridge is always a limitation to install dental implants. The Ridge Split procedure proves to be a successful technique to perform the management of horizontal defects, increasing the dimensions of the atrophic ridge to immediately install dental implants. Aim: to describe the clinical use of the Ridge Split technique as a treatment for bone augmentation in the horizontal direction of the atrophic maxilla. Case presentation: the case of a female patient of 61 years of age, partially edentulous, who seeks to recover her upper teeth was presented. The clinical examination shows only two teeth and the radiographic-tomographic examination showed severe bone resorption and pneumatization of the maxillary sinuses. It is planned to install two implants to make an over denture, using the Ridge Split technique and immediate installation of the implants. Five months later, a tomographic control was performed evidencing a horizontal increase of the alveolar ridge and it was rehabilitated with an overdenture, with which the patient's aesthetic and functional compliance was achieved. Conclusion: the presented case reveals that this technique increases the bone ridge in horizontal direction and allows to install the implants simultaneously. It is a predictable, safe and comfortable treatment, and shortens the treatment time, making it a viable alternative for the management of alveolar bone defects.

Current state-of-the-art and future perspectives of the three main modern implant-dentistry concerns: Aesthetic requirements, mechanical properties, and peri-implantitis prevention.

The idea of permanent tooth replacement goes back to the year 2000 BC at least, when carved bamboo pegs were used to replace missing teeth in ancient China. The phenomenon of osseointegration, however, was not verified until the mid-1960s, when Branemark discovered that titanium could integrate to bone. Since then, the osseointegration capacity of implants has been profoundly investigated and implants as such have evolved enormously in all possible aspects, from material selection and processing to specific surface engineering, among many others. This review article, in particular, focuses on dental implants and aims to introduce the main concerns involved in modern dentistry, concentrating especially on the importance of finding an effective way to prevent peri-implantitis. In this sense, strategies such as shifting from metal to ceramic implant components and applying novel antimicrobial antibiotic-free coatings seem to be taking the lead. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2019.

Guidelines for development of Implant Dentistry in the next 10 years regarding innovation, education, certification, and associations.

BACKGROUND: During the third Summer Camp of European Association of Osseointegration (EAO), 40 junior representatives from various European societies and associations were brought together to discuss and explore the following topics in Implant Dentistry in the next 10 years: (I) certification, (II) societies and associations, (III) continuing education, and (IV) innovations. AIMS: The aims of all working groups were to identify and outline the present situation in the area of the selected topic and to propose improvements and innovations to be implemented in the following 10 years. MATERIALS AND METHODS: Four different groups were assigned randomly to one of the four working units. The method to discuss the selected topics was World Cafè. The summaries of four topics were then given to all participants for peer review. RESULTS AND CONCLUSIONS: All four groups presented the conclusions and guidelines accordingly: (I) The recognition for Implant Dentistry and accreditation of training programs would lead to an improvement of the quality of care to the benefit of the patients; (II) Dental associations and societies have to continuously improve communication to meet needs of dental students, professionals, and patients (III) European Dental Board should be installed and become responsible for continue dental education; (IV) dental engineering, peri-implant diseases, and digital workflow in dentistry currently have limited tools that do not guarantee predictable results.

Trends in Dental Implant Use in the U.S., 1999-2016, and Projections to 2026.

Dental implants have become an increasingly popular treatment choice for replacing missing teeth. Yet, little is known about the prevalence and sociodemographic distribution of dental implant use in the United States. To address this knowledge gap, we analyzed data from 7 National Health and Nutrition Examination Surveys from 1999 to 2016. We estimated dental implant prevalence among adults missing any teeth for each survey period overall as stratified by sociodemographic characteristics. We calculated absolute and relative differences from 1999-2000 to 2015-2016 and fit logistic regression models to estimate changes over time. We also used multivariable logistic regression to estimate independent associations of sociodemographic covariates with the presence of any implant. We projected the proportion of patients treated with dental implants into the year 2026 under varying assumptions of how the temporal trend would continue. There has been a large increase in the prevalence of dental implants, from 0.7% in 1999 to 2000 to 5.7% in 2015 to 2016. The largest absolute increase in prevalence (12.9%) was among individuals 65 to 74 y old, whereas the largest relative increase was ~1,000% among those 55 to 64 y old. There was an average covariate-adjusted increase in dental implant prevalence of 14% per year (95% CI, 11% to 18%). Having private insurance (vs. none or public insurance) or more than a high school education (vs. high school or less) was each associated with a 2-fold increase in prevalence, with an almost 13-fold (95% CI, 8 to21) increase for older adults. Dental implant prevalence projected to 2026 ranged from 5.7% in the most conservative scenario to 23% in the least. This study demonstrates that dental implant prevalence among US adults with missing teeth has substantially increased since 1999. Yet access overall is still very low, and prevalence was consistently higher among more advantaged groups.

Causas y complicaciones de los fracasos de la implantología dental. Matanzas / Causes and consequences of failures of the dental implantology. Matanzas

Introducción: Los implantes son fijaciones de titanio puro que se colocan en el hueso maxilar o mandibular con el fin de sustituir las raíces de los dientes perdidos, lo cual permite reemplazar el diente natural por uno artificial de mejor funcionalidad pero a pesar de ser una cirugía programada no está exenta de fracasos y las complicaciones se presentan en cualquiera de las fases del tratamiento implantológico. Objetivo: Determinar las causas y complicaciones del fracaso de este tratamiento en la Clínica Estomatológica Docente de Especialidades 3er Congreso del PCC en el periodo de Enero 2010 hasta diciembre 2016. Materiales y métodos: Se realizó una investigación observacional, descriptiva, retrospectiva donde se revisaron 500 Historias Clínicas de pacientes rehabilitados con implantes dentales, el universo lo conformó la totalidad de implantes que fracasaron en el tratamiento por diversas causas o complicaciones (32), en la CEDE Tercer Congreso del PCC del Municipio de Matanzas, en el periodo de Enero 2010 hasta diciembre 2016. Resultados: La mayoría de los fracasos de implantes ocurrió en los pacientes de 35 a 65 años y sexo masculino. En el 53,1 % de los fracasos, la motivación de los pacientes fue por la estética, la mayoría de los fracasos se asociaron a la no oseointegración y a la perimplantitis ocurridos en la fase inicial del tratamiento (62,5%). Conclusiones: Las cifras de fracasos en el tratamiento de implantologia dental en todas las regiones anatómicas de la cavidad bucal fueron bajas y la tasa de supervivencia y éxitos fue alta (AU).

Introduction: theimplants are pure titanium fixations located in the maxillary or mandibular bone with the aim of taking the place of lost teeth roots. They allow to replace the natural tooth for an artificial one with better functioning. Although it is a programmed surgery, it is not free of failures, and complications may appear in any stage of the implantation treatment. Objective: to determine the causes and complications of these treatment failure in the Teaching Dental Clinic "Tercer Congreso del PCC", municipality of Matanzas, in the period from January 2010 to December 2016. Materials and methods: a retrospective, descriptive, observational research was carried out, where 500 clinical records of patients rehabilitated with dental implants were reviewed; the universe was formed by the total of the implants that failed in the treatment due to different causes and complications (32) in the clinic "Tercer Congreso del PCC". Results: most of the implant failures occurred in male patients aged 35-65 year. 53.1 % of the failures were due to the patients' motivation for esthetics; most of the failures were associated to no osseointegration and to perimplantitis occurred in the initial stage of the treatment (62.5 %). Conclusions: the figures of failures in dental implantology treatment were low in all of the anatomic regions of the oral cavity, and the rate of survival and success was high (AU).

Effects of sunitinib targeted chemotherapy on the osseointegration of titanium implants.

Targeted chemotherapies are novel therapeutic approaches for many malignancies. In contrast to conventional chemotherapies, which are given for a predetermined duration, treatment with targeted chemotherapies like sunitinib is routinely continuous over longer periods, sometimes years. During this prolonged treatment period, patients may need to restore their missing teeth with dental implants. The aim of this study was to examine the effect of the anti-angiogenic substance sunitinib targeted chemotherapy on the osseointegration of titanium implants in a rabbit model. Fourteen white New Zealand rabbits were randomly assigned to two groups of either oral sunitinib at 10 mg/kg twice per week dose for 4 weeks (n = 7) or placebo (n = 7). The first dose was given 2 days before the surgical intervention. Each rabbit received one titanium dental implant in the right distal femoral condyle. Four weeks following implant insertion, rabbits were sacrificed and bone specimens containing the implants were retrieved. Osseointegration of the implants was analyzed using micro-computed tomography and histomorphometric evaluation. Both micro-computed tomography and histomorphometric analysis showed that the osseointegration parameters, including the ratio of bone volume to total volume and bone-implant contact percent for the sunitinib group were significantly lower than those in the control group (P ≤ 0.05). Sunitinib targeted chemotherapy had a negative effect on the osseointegration of titanium implants inserted in a rabbit model.

Surface characteristics of dental implants: A review.

OBJECTIVES: During the last decades, several changes of paradigm have modified our view on how biomaterials' surface characteristics influence the bioresponse. After becoming aware of the role of a certain microroughness for improved cellular contact and osseointegration of dental titanium implants, the likewise important role of surface energy and wettability was increasingly strengthened. Very recently, synergistic effects of nanoscaled topographical features and hydrophilicity at the implant/bone interface have been reported. METHODS: Questions arise about which surface roughness and wetting data are capable to predict the bioresponse and, ultimately, the clinical performance. Current methods and approaches applied for topographical, wetting and surface energetic analyses are highlighted. Current knowledge of possible mechanisms explaining the influence of roughness and hydrophilicity at the biological interface is presented. RESULTS: Most marketed and experimental surfaces are based on commonly available additive or subtractive surface modifying methods such as blasting, etching or anodizing. Different height, spatial, hybrid and functional roughness parameters have been identified as possible candidates able to predict the outcome at hard and soft tissue interfaces. Likewise, hydrophilic implants have been proven to improve the initial blood contact, to support the wound healing and thereby accelerating the osseointegration. SIGNIFICANCE: There is clear relevance for the influence of topographical and wetting characteristics on a macromolecular and cellular level at endosseous implant/biosystem interfaces. However, we are still far away from designing sophisticated implant surfaces with the best possible, selective functionality for each specific tissue or cavity interface. Firstly, because our knowledge of the respective surface related reactions is at best fragmentary. Secondly, because manufacturing of multi-scaled complex surfaces including distinct nanotopographies, wetting properties, and stable cleanliness is still a technical challenge and far away from being reproducibly transferred to implant surfaces.

[Understanding new progress in prosthodontics from the perspective of updates in the glossary of prosthodontic terms].

Glossary of Prosthodontic Terms is a standardized vocabulary with international influence. Its ninth edition was published in J Prosthet Dent in 2017, 12 years after the last edition. During this period, great development has taken place in the dental prosthetics due to dental implant and digital dentistry as well as application of new materials and technologies. The research results of dental adhesion, aesthetic dentistry, orofacial function, and tissue regeneration has been fully applied in dental clinic. This paper attempts to capture and accurately understand the changes of some important, especially controversial academic concepts through the comparison of the seventh, eighth and ninth edition of vocabulary. Four parts including new terms, obsolete terms, terms with updated concept, and terms with the continuity of concept are used to show the important progress of prosthodontics.

Implant dentistry in Australia: the present and future. A survey of Australian dentists and specialists.

BACKGROUND: In recent years, implant dentistry has become a routine part of many general dental practices in Australia. However, there has been little information regarding its extent and scope. This investigation aimed to address this issue by surveying Australian general dental practitioners (GDP) and relevant specialists regarding their practice of implant dentistry. METHODS: Anonymous electronic surveys were designed online using SurveyMonkey™ and delivered to the following professional bodies: all seven state/territory branches of the Australian Dental Association, the Australian and New Zealand Academy of Periodontists, the Australian and New Zealand Academy of Oral and Maxillofacial Surgeons, and prosthodontist members of the Australian Prosthodontic Society. The surveys were completed online via SurveyMonkey in 2014. RESULTS: The response rates were 7.61% (N = 801) for GDP, 41.76% (N = 38) for prosthodontists, 34.16% (N = 55) for periodontists and 34.07% (N = 46) for oral and maxillofacial (OMF) surgeons. Among the respondents, 66.37% (N = 521) of GDP, 86.11% (N = 31) of prosthodontists, 82.98% (N = 39) of periodontists and 97.67% (N = 42) of OMF surgeons indicated that they currently practise implant dentistry. A strong perceived need for further education in this field was also expressed by the respondents. CONCLUSIONS: Implant dentistry presently appears to be practised by a significant proportion of GDP across Australia. This is likely to continue to grow in the future.

Silicon Nitride (Si3N4) Implants: The Future of Dental Implantology?

For decades titanium has been the preferred material for dental implant fabrication, with mechanical and biological performance resulting in high clinical success rates. These have been further enhanced by incremental development of surface modifications aimed at improving speed and degree of osseointegration and resulting in enhanced clinical treatment options and outcomes. However, increasing demand for metal-free dental restorations has also led to the development of ceramic-based dental implants, such as zirconia. In orthopedics, alternative biomaterials, such as polyetheretherketone or silicon nitride, have been used for implant applications. The latter is potentially of particular interest for oral use as it has been shown to have antibacterial properties. In this article we aim to shed light on this particular biomaterial as a future promising candidate for dental implantology applications, addressing basic specifications required for any dental implant material. In view of available preclinical data, silicon nitride seems to have the essential characteristics to be a candidate for dental implants material. This novel ceramic has a surface with potentially antimicrobial properties, and if this is confirmed in future research, it could be of great interest for oral use.