Success Rate of Mandible Implants Placed in Vascularized Fibula Bone Graft: A Systematic Review.

This systematic review addressed the implant success rate after mandible reconstruction with vascularized fibula bone graft. Therefore, preferred reporting items for systematic review and meta-analysis guidelines were used to perform the systematic review, and the search included following databases: PubMed, Lilacs, Google Scholar, Open Gray, Science Direct and Cochrane. A search of medical subject headings (MeSH) and related terms (fibula) OR (vascularized) OR (microvascularized) AND (implant) OR (rehabilitation) OR (osseointegrated) AND (mandible) OR (jaw) OR (maxillofacial), without any language or time restrictions until October 2017 was carried out. The eligible studies primarily consisted of clinical cohorts designed to evaluate the feasibility of mandible reconstruction using vascularized fibula bone grafts and implant-supported rehabilitations, with a minimum observation period of 12 months. After screening, 13 eligible cohort studies for this review were selected (3 retrospective and 10 prospective). Of 285 vascularized fibular reconstructions, only 6 failures were reported with a success rate of approximately 98% after a mean follow-up period of 40 months. In total, 910 implants were placed in vascularized fibular grafts with a success rate of 92.6% (range, 82%-100%) after 40 months. Also, similar success rates for primary (95%; range, 93%-100%) and secondary (91%; range, 83%-100%) implant surgeries have been demonstrated. Considering risk factors, implant survival in irradiated patients was usually lower (76%; range, 38%-88%) than nonirradiated patients (90%; range, 83%-94%); however, it was significantly different in only 1 study. Alcohol and tobacco use has shown no significant association with implant failure in any study. Hence, implant placement in vascularized fibula bone graft presented similar success rates relative to native mandible bone rehabilitations.

Technical Strategy of Bone Graft Augmentation in the Anterior Maxilla.

Bone graft augmentation in the anterior maxilla has a high successful rate. However, suture dehiscence and consequent bone graft exposure can compromise and fail this procedure. Therefore, this article presents a new strategy of closure technique to guarantee the bone graft augmentation. The sutures occur in muscular and mucous planes to avoid suture tension, thus decreasing complications of bone graft augmentation in the anterior maxilla.

Adipose-Derived Stem Cells Decrease Bone Morphogenetic Protein Type 2-Induced Inflammation In Vivo.

PURPOSE: Recombinant human bone morphogenetic protein type 2 (rhBMP-2) has been used to promote bone regeneration. In contrast, some reports have suggested rhBMP-2 does not provide advantages over autogenous bone grafting owing to the undesirable postoperative symptoms of this growth factor. Because the undesirable symptoms of rhBMP-2 are usually promoted by inflammation, this study evaluated the in vivo effect of human adipose-derived stem cells (ASCs) incorporated into polylactic co-glycolic acid (PLGA) scaffolds in decreasing the inflammatory response induced by a low dose of rhBMP-2. MATERIALS AND METHODS: PLGA scaffolds were characterized and loaded with rhBMP-2 1, 2.5, or 5 µg per scaffold (n = 6) and the in vitro released protein amounts were quantified at 7 hours and 1, 7, and 21 days after loading (n = 3). The muscle tissue of 6 beagles received the following treatments: PLGA, PLGA plus rhBMP-2 (2.5 µg), and PLGA plus rhBMP-2 plus ASCs (1 × 10(6) ASCs). The samples were evaluated 45 days after surgery. Statistical analyses were performed and the P value was set at .05. RESULTS: PLGA plus rhBMP-2 plus ASCs yielded the smallest number of inflammatory foci (P < .001) and giant cells (P < .001) and the largest number of angiogenesis sites (P < .001). CONCLUSIONS: Human ASCs administered in vivo into PLGA scaffolds with a low dose of rhBMP-2 decrease tissue inflammation and increase angiogenesis in muscular sites.

Adipose-derived stem cells incorporated into platelet-rich plasma improved bone regeneration and maturation in vivo.

BACKGROUND/AIM: Some cases of tooth loss related to dental trauma require bone-grafting procedures to improve the aesthetics before prosthetic rehabilitation or to enable the installation of dental implants. Bone regeneration is often a challenge and could be largely improved by mesenchymal stem cells therapy. However, the appropriate scaffold for these cells still a problem. This study evaluated the in vivo effect of human adipose-derived stem cells incorporated into autogenous platelet-rich plasma in bone regeneration and maturation. MATERIAL AND METHODS: Adipose-derived stem cells were isolated from lipoaspirate tissues and used at passage 4. Immunophenotyping and multilineage differentiation of cells were performed and mesenchymal stem cells characteristics confirmed. Bicortical bone defects (10 mm diameter) were created in the tibia of six beagle dogs to evaluate the effect of adipose-derived stem cells incorporated into platelet-rich plasma scaffolds, platelet-rich plasma alone, autogenous bone grafts, and clot. Samples were removed 6 weeks postsurgeries and analyzed by quantification of primary and secondary bone formation and granulation tissue. RESULTS: Adipose-derived stem cells incorporated into platelet-rich plasma scaffolds promoted the highest bone formation (primary + secondary bone) (P < 0.001), the highest bone maturation (secondary bone) (P < 0.001), and the lowest amount of granulation tissue (P < 0.001). CONCLUSIONS: Adipose-derived stem cells incorporated into platelet-rich plasma scaffolds promote more bone formation and maturation, and less granulation tissue in bone defects created in canine tibia. Therefore, platelet-rich plasma can be considered as a candidate scaffold for adipose-derived stem cells to promote bone regeneration.

Amoxicillin administrations and its influence on bone repair around osseointegrated implants.

PURPOSE: The objective of this study was to evaluate the influence of 4 different amoxicillin administration protocols on osseointegration of dental implants. MATERIALS AND METHODS: Thirty-five Wistar rats received an implant in the right tibia and were divided into 5 groups (n = 7): the control group (G1), a group that received a single dose of amoxicillin suspension (40 mg/kg) hour before surgery (G2), a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 3 days (G3), a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 5 days (G4), and a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 7 days (G5). The animals were sacrificed by anesthesia overdose 28 days after implant placement. The samples were retrieved for bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) analyses. RESULTS: BIC analysis indicated 3 different statistical groups: G1 plus G2, G3, and G4 plus G5. There was no statistical difference between G1 and G2 or between G4 and G5. G3 presented lower values, with statistical difference for G1 plus G2 and G4 plus G5. Also, a statistical difference was found between G1 plus G2 and G4 plus G5. For BAFO evaluation, no statistical difference was found for the experimental groups. CONCLUSION: The results of this study suggest that prolonged use of amoxicillin might have a negative effect on bone formation around implants.

NanoSynt: avaliação histológica e histomorfométrica de um novo substituto ósseo. O uso da nanotecnologia na conquista de um melhor padrão de osteocondução / NanoSynt: histological and histomorphometric analyses of a new bone substitute. The use of nanotechnology towards a better osteoconductive pattern

Objetivo: apresentar os resultados histológicos e histomorfométricos do uso de três substitutos ósseos disponíveis comercialmente, com relação à sua capacidade de regeneração óssea. Material e métodos: foram utilizados três biomateriais para preenchimento de defeitos críticos na calvária de coelhos, e mantidos por quatro e oito semanas in vivo. Resultados: do ponto de vista morfológico, um padrão de cicatrização semelhante foi observado para os três diferentes materiais, em que a formação do osso foi observada a partir das margens para o centro do defeito, nos tempos decorridos in vivo. De um ponto de vista quantitativo, o material NanoSynt apresentou maiores níveis médio de formação óssea, quantidade de biomaterial e de manutenção de espaço do defeito in vivo, quando comparado aos outros dois biomateriais. Conclusão: todos os substitutos ósseos utilizados apresentaram características de biocompatibilidade, não interferindo negativamente no processo de reparo. Entretanto, o biomaterial sintético NanoSynt apresentou maior nível de formação óssea e manutenção do espaço do defeito, quando comparado aos materiais Boneceramic e Bio-Oss durante os dois períodos in vivo do presente estudo (quatro e oito semanas).

Objective: to present the histological and histomorphometric results on the use of three commercially available bone substitutes with respect to its capacity of bone regeneration. Material and methods: three biomaterials were used to fill critical defects in the calvaria of rabbits kept 4 and 8 weeks in vivo. Results: from the morphological point of view, a similar pattern of healing was observed for three different materials, in which bone formation was observed from the margins to the center of the deffect, according to evaluated periods. From a quantitative point of view, the NanoSynt material exhibited higher mean levels of bone formation, amount of biomaterial, and space maintenance defect in vivo when compared to the other two biomaterials. Conclusion: all bone substitutes used showed biocompatibility and does not interfere negatively in the repair process. However, the synthetic biomaterial NanoSynt showed higher levels of bone formation and maintenance of the area of the defect when compared to materials BoneCeramic and Bio-Oss during the two periods in vivo in the present study (4 and 8 weeks).

Evaluation of collagen-based membranes for guided bone regeneration, by three-dimensional computerized microtomography.

OBJECTIVE: The aim of this study was to evaluate the use of a collagen-based membrane compared with no treatment on guided bone regeneration by 3-dimensional computerized microtomography (µCT). STUDY DESIGN: Defects were created between the mesial and distal premolar roots of the second and third premolars (beagle dogs; n = 8). A collagen-based membrane (Vitala; Osteogenics Biomedical Inc., TX, USA) was placed in one of the defects (membrane group; n = 16), and the other was left untreated (no-membrane group; n = 16). Left and right sides provided healing samples for 2 and 16 weeks. Three-dimensional bone architecture was acquired by µCT and categorized as fully regenerated (F, bone height and width) or nonregenerated (N). RESULTS: Chi-square tests (95% level of significance) showed that tooth did not have an effect on outcome (P = .5). Significantly higher F outcomes were observed at 16 weeks than 2 weeks (P = .008) and in membrane group than in no-membrane group (P = .008). CONCLUSIONS: The collagen-based membrane influenced bone regeneration at the furcation.

Conceitos Básicos de Pesquisa in vivo aplicada à Implantodontia / Basic concepts of in vivo implant research

As altas taxas de sucesso das reabilitações orais sobreimplantes osseointegráveis metálicos consolidaram esta modalidade de tratamento. Porém, é incessante a busca pela otimização da resposta implante/hospedeiro imediata e a longo prazo, sendo hoje o principal fator motivador das investigações nesta área. O impacto das alterações produzidas nos implantes nas diferentes escalas macro, micro e nanométricas com o objetivo de acelerar a resposta do hospedeiro, permitindo a reabilitação em tempos menores do que aqueles inicialmente propostos nos primórdios da Implantodontia moderna, serão discutidos. Devido à quase infinidade de superfícies disponíveis no mercado, uma classificação objetiva será apresentada para facilitar a comunicação entre profissionais, pesquisadores e indústria. O efeito destas modificações, das técnicas cirúrgicas e as implicações clínicas na osseointegração serão abordados com suporte em estudos in vivo.

High success rates of implant dentistry have made it a consolidated treatment modality. However, the quest for implant/host improved response has been the main driving force in research involving the topic. The impact of macro-, micro, and nanometric alterations tailored to foster early implant/host response allowing final rehabilitation at earlier time frames will be discussed. Considering the virtually “infinite” amount of implant surfaces available in the market, a novel classification code will be presented in attempt to facilitate communication between dental professionals, researchers and industry personal. The impact of implant surface modifications and surgical technique on clinical aspects of osseointegration will be discussed based on in vivo sudies

Implantes curtos como alternativa contra procedimentos invasivos: relato de caso / Short dental implant as an alternative to invasive procedures: case report

A utilização de implantes curtos (6,0–8,5mm) no tratamento reabilitador vem sendo bastante empregada em locais onde a altura óssea é limitada ou em regiões próximas a estruturas anatômicas importantes. Historicamente, o uso de implantes curtos tem sido associado a menores taxas de sucesso quando comparados com implantes de comprimento convencional. Entretanto, estudos clínicos recentes mostram uma similaridade na taxa de sucesso de implantes curtos e convencionais. Tanto para o clínico quanto para o paciente, esse tratamento apresenta-se como uma alternativa simples e segura, devido à redução dos custos, procedimentos cirúrgicos, morbidade e tempo de tratamento. Devido à similaridade nas taxas de sucesso, a indicação de implantes curtos pode ser feita em praticamente todos os casos, assim substituindo a realização de procedimentos invasivos para reconstrução do volume ósseo. O presente artigo apresenta uma resolução clínica que mostra a utilização de implantes curtos em mandíbula e maxila.

Short dental implants (6.0-8.5 mm) have been widely used in the rehabilitation of atrophic areas or in sites close to important anatomic structures. Historically, short implants were associated with lower success rates when compared with the treatment using long implants (>8.5 mm). However, recent clinical researches show similar success rates to short and long implants. Moreover, this sort of treatment is considered a simple and safe option for both patients and surgeons. It has the potential of decreasing costs, number of surgical interventions, treatment time and morbidity. Due to the similarity between both types of implants, short implants have been largely used as a substitute for invasive surgical interventions for bone volume reconstruction. This paper shows short dental implants as a safe clinical option for the rehabilitation of atrophic maxilla and mandible.

The effect of different implant macrogeometries and surface treatment in early biomechanical fixation: an experimental study in dogs.

Implant surface characterization and biomechanical testing were made to evaluate the effect of different surface treatments along with different implant bulk configurations expressed as biomechanical fixation at early implantation times. Three implant surfaces, namely bioactive ceramic electrodeposition (ED), alumina-blasted/acid etched (AB/AE), and resorbable blasting media (RBM) were fabricated in three implant macrogeometries (cylindrical, small chamber, and large chamber). All combinations between surface and bulk configurations were placed in the radii of beagle dogs (n=18), which were euthanized 14 and 40 days after surgery (n=9 animals per time in vivo). The implants were subjected to torque to interface fracture. Effects of time, surface, and macrogeometry on torque to interface fracture were evaluated by a GLM at 95% level of significance. The results showed a significant increase in torque as time elapsed in vivo (p<0.001), and that the ED surface presented significantly higher values compared to AB/AE and RBM (p<0.001) at both times. The small chamber only presented a significantly higher biomechanical fixation compared to other geometries at 40 days in vivo (p=0.02). Biomechanical fixation at 14 and 40 days was affected by implant surface treatment, whereas implant design only affected results at 40 days in vivo.

Effect of drilling technique on the early integration of plateau root form endosteal implants: an experimental study in dogs.

PURPOSE: This study tested the hypothesis that early integration of plateau root form endosseous implants is significantly affected by surgical drilling technique. MATERIALS AND METHODS: Sixty-four implants were bilaterally placed in the diaphysial radius of 8 beagles and remained 2 and 4 weeks in vivo. Half the implants had an alumina-blasted/acid-etched surface and the other half a surface coated with calcium phosphate. Half the implants with the 2 surface types were drilled at 50 rpm without saline irrigation and the other half were drilled at 900 rpm under abundant irrigation. After euthanasia, the implants in bone were nondecalcified and referred for histologic analysis. Bone-to-implant contact, bone area fraction occupancy, and the distance from the tip of the plateau to pristine cortical bone were measured. Statistical analyses were performed by analysis of variance at a 95% level of significance considering implant surface, time in vivo, and drilling speed as independent variables and bone-to-implant contact, bone area fraction occupancy, and distance from the tip of the plateau to pristine cortical bone as dependent variables. RESULTS: The results showed that both techniques led to implant integration and intimate contact between bone and the 2 implant surfaces. A significant increase in bone-to-implant contact and bone area fraction occupancy was observed as time elapsed at 2 and 4 weeks and for the calcium phosphate-coated implant surface compared with the alumina-blasted/acid-etched surface. CONCLUSIONS: Because the surgical drilling technique did not affect the early integration of plateau root form implants, the hypothesis was refuted.

Characterization of five different implant surfaces and their effect on osseointegration: a study in dogs.

BACKGROUND: Chemical modification of implant surface is typically associated with surface topographic alterations that may affect early osseointegration. This study investigates the effects of controlled surface alterations in early osseointegration in an animal model. METHODS: Five implant surfaces were evaluated: 1) alumina-blasting, 2) biologic blasting, 3) plasma, 4) microblasted resorbable blasting media (microblasted RBM), and 5) alumina-blasting/acid-etched (AB/AE). Surface topography was characterized by scanning electron microscopy and optical interferometry, and chemical assessment by x-ray photoelectron spectroscopy. The implants were placed in the radius of six dogs, remaining 2 and 4 weeks in vivo. After euthanization, specimens were torqued-to-interface failure and non-decalcified-processed for histomorphologic bone-implant contact, and bone area fraction-occupied evaluation. Statistical evaluation was performed by one-way analysis of variance (P <0.05) and post hoc testing by the Tukey test. RESULTS: The alumina-blasting surface presented the highest average surface roughness and mean root square of the surface values, the biologic blasting the lowest, and AB/AE an intermediate value. The remaining surfaces presented intermediate values between the biologic blasting and AB/AE. The x-ray photoelectron spectroscopy spectra revealed calcium and phosphorus for the biologic blasting and microblasted RBM surfaces, and the highest oxygen levels for the plasma, microblasted RBM, and AB/AE surfaces. Significantly higher torque was observed at 2 weeks for the microblasted RBM surface (P <0.04), but no differences existed between surfaces at 4 weeks (P >0.74). No significant differences in bone-implant contact and bone area fraction-occupied values were observed at 2 and 4 weeks. CONCLUSION: The five surfaces were osteoconductive and resulted in high degrees of osseointegration and biomechanical fixation.

Estudo clínico prospectivo longitudinal não interferencial avaliando implantes com tratamento de superfície e câmara de cicatrização / A non interferencial longitudinal prospective study evaluating dental implants with treated surface and healing chambers

O uso de implantes osseointegráveis no tratamento do edentulismo é hoje uma das técnicas mais previsíveis e bem sucedidas no âmbito da odontologia contemporânea. Entretanto o protocolo mais utilizado para utilização destes implantes requer um período de osseointegração de alguns meses antes que a restauração protética seja efetivamente instalada. Muitas vezes, até mesmo de maneira empírica, para se diminuir este tempo de espera o protocolo original é alterado, diminuindo-se o período de osseointegração. O objetivo deste trabalho é apresentar de maneira sucinta o estágio atual de aprimoramento dos implantes dentários para aperfeiçoar o processo de osseointegração, com relação às alterações de superfície e da forma destes dispositivos, além de apresentar os resultados clínicos obtidos com a instalação de 603 implantes com tratamento de superfície por duplo ataque ácido e câmara de cicatrização.

The use of osseointegrated implants in the handling of the edentulism is today one of the most foreseeable techniques and well happened in the scope of the contemporary dentistry. However the more utilized protocol for utilization of these implants requires a period of osseointegration of some months before the prosthetic restoration can be actually installed. Many times, to even of empirical way, for diminish this time of wait the original protocol is bad-tempered, diminishing the period of osseointegração. The objective of this work is going to present in a succinct way, the present stage of improvement the dental implants to optimize the trial of osseointegration, regarding the alterations of surface and of the form of these devices and to present the clinical results of 603 dual acid etched dental implants with healing chambers.

Avaliação biomecânica e histológica de implantes com diferentes macrogeometrias no período inicial de osseointegração: estudo experimental em cães / Early biomechanical and histological analyses of different implant macrogeometries: an experimental study in beagle dogs

Desde que o conceito de osseointegração foi introduzido na Odontologia, várias mudanças ocorreram no modelo e na texturização de superfície dos implantes dentários. O objetivo deste estudo foi avaliar biomecânica e histologicamente diferentes macrogeometrias no período inicial da osseointegração na porção proximal da tíbia de cães Beagle. Seis cães Beagle adultos foram utilizados, onde 24 implantes tratados com jateamento com micropartículas e ataque ácido foram inseridos na porção proximal da tíbia bilateralmente (dois implantes por tíbia), 12 implantes cilíndricos com roscas triangulares (grupo controle) e 12 implantes cônicos com roscas trapezoidais (grupo experimental). Após a eutanásia, as tíbias foram removidas e destinadas ao teste de torque de remoção e processamento histológico. A análise estatística foi realizada através de teste t com intervalo de confiança de 95%. Os resultados para o torque de remoção foram 70 ± 20 Ncm e 120 ± 20 Ncm (média ± 95% de intervalo de confiança). Diferença estatisticamente significante entre os grupos foi encontrada (p < 0,001). Histologicamente, ambos os grupos apresentaram adequada biocompatibilidade e osseocondução com neoformação óssea nas regiões cortical e medular da tíbia. Baseado nos resultados obtidos, a macrogeometria com o tratamento de superfície empregados promoveu a osseointegração nos períodos iniciais do reparo e a macrogeometria do grupo experimental melhorou o desempenho para o torque de remoção comparado ao grupo controle. Novos estudos são necessários para confirmar suas potenciais vantagens.

Since the concept of osseointegration was introduced in dentistry, several changes concerning surface texture and macrodesign of dental implants were implemented. The objective of this study was to evaluate the effect of different implant macrogeometries on the early biomechanical and histomorphologic response in a beagle dog proximal tibia model. Six adult beagle dogs were used, and the implants with a grit-blasted and acid-etched surface were bilaterally placed along the proximal tibia (2 per limb)- 12 conic shaped with trapezoidal threads (experimental) and 12 cylindrical implants with triangular threads (control). After animal sacrifice, the limbs were retrieved and mechanical test and histological processing were performed. Statistical evaluation was performed by a Student´s t-test at 95% level of confidence. Removal torque test mean values were 70 ± 20Ncm and 120 ± 20Ncm for control and experimental groups, respectively (p < 0.001). Histological observations showed that both implant groups were biocompatible and osseoconductive, presenting newly formed bone at regions of cortical and trabecular bone. Based on results obtained, both macrogeometries and surface treatment presented osseointegration at early implantation times, and the experimental group geometry improved torque to interface fracture relative to the control geometry. Additional studies are necessary to confirm its potential benefits.

Biomechanical evaluation of endosseous implants at early implantation times: a study in dogs.

PURPOSE: This study tested the null hypothesis that differences in surgical instrumentation, macrogeometry, and surface treatment imposed by different implant systems do not affect early biomechanical fixation in a canine mandible model. MATERIALS AND METHODS: The lower premolars of 6 beagle dogs were extracted and the ridges allowed to heal for 8 weeks. Thirty-six (n = 12 each group) implants were bilaterally placed, remaining for 1 and 3 weeks in vivo. The implant groups were as follows: group 1, Ti-6Al-4V with a dual acid-etched surface with nanometer scale discrete crystalline deposition (Nanotite; Certain Biomet-3i, West Palm Springs, FL); group 2, Ti-6Al-4V with a titanium oxide-blasted fluoride-modified surface chemistry (Osseospeed 4.0 S; Astra Tech, Mölndal, Sweden); group 3: Ti-6Al-4V with a bioceramic microblasted surface (Ossean; Intra-Lock International, Boca Raton, FL). Following euthanasia, implants were torqued to interface failure and histologically evaluated. General linear modeling (ANOVA) at 95% level of significance was performed. RESULTS: Histology showed that interfacial bone remodeling and initial woven bone formation were observed around all implant groups at 1 and 3 weeks. Torque values were significantly affected by time in vivo, implant group, and their interaction (P = .016, P < .001, and P = .001, respectively). Regarding torque values, group 3, group 2, and group 1 ranked highest, intermediate, and lowest, respectively. CONCLUSION: Early biomechanical fixation at 1 and 3 weeks was affected by surgical instrumentation, macrogeometry, and surface treatment present for one of the implant systems tested. The null hypothesis was rejected.

Histomorphologic and bone-to-implant contact evaluation of dual acid-etched and bioceramic grit-blasted implant surfaces: an experimental study in dogs.

PURPOSE: The objective of this study was to histologically evaluate a bioceramic grit-blasted and acid-etched surface (presenting calcium and phosphorous incorporation within the surface and its oxide) versus a dual acid-etched (no calcium and phosphorous, control) moderately rough implant surface in a dog tibia model. MATERIALS AND METHODS: Implants 3 x 10 mm were placed bilaterally along the proximal tibia of 6 Doberman dogs and remained for 2 and 4 weeks in vivo. After the dogs were euthanized, the implants were nondecalcified processed to approximately 30-microm-thick plates. Transmitted light optical microscopy was used to evaluate healing patterns and bone-to-implant contact. Statistical analysis was performed by 1-way analysis of variance at the 95% level of significance and by Tukey post hoc tests. RESULTS: At 2 weeks, histologic evaluation showed woven bone formation throughout the perimeter of both implant surfaces. However, replacement of woven bone by lamellar bone was only observed around the test surface at 4 weeks in vivo. No significant differences in bone-to-implant contact were observed for the different groups (P > .27). CONCLUSION: Despite nonsignificant differences between bone-to-implant contact for the different surfaces and times in vivo, higher degrees of bone organization were observed for the test implants. Biomechanical testing is warranted to verify potential differences in biomechanical fixation effectiveness between surfaces.

Estética periimplantar em cirurgias de segundo estágio: relato de caso / Peri-implant esthetics in second-stage surgeries: a case report

Artigo de apresentação de caso clínico em que se utilizam técnicas de manejo tecidual associadas a procedimentos protéticos preestabelecidos na região do dente 11, os quais proporcionam completa reabilitação da estética e função. Por meio da discussão e descrição detalhada dos procedimentos cirúrgico-protéticos envolvidos, concluímos que os cuidados ao se manipular os tecidos moles na cirurgia de segundo estágio de implantes, assim como a utilização conjunta dos recursos advindos das técnicas protéticas, são fundamentais quando se quer aperfeiçoar a estética e aumentar a proteção natural dos implantes

The aim of this article is to report a clinical case in which an alternative procedure was used at the second-stage implant surgery of a right central maxillary incisor (tooth #8). A detailed description of surgical and prosthetic procedures in provided and discussed. It was concluded that the second-stage implant surgery should be performed in association with prosthetic procedures in order to optimize the esthetics and to achieve natural life-like implants rehabilitations

Effect of surface modifications on early bone healing around plateau root form implants: an experimental study in rabbits.

PURPOSE: The objective of the present study was to evaluate the biomechanical fixation and bone-to-implant contact (BIC) of plateau root form implants of varied surfaces. MATERIALS AND METHODS: Plateau root form implants, 3.5 mm in diameter, 8 mm in length, with 4 surfaces (n = 16 each)--machined, alumina-blasted/acid-etched, alumina-blasted/acid-etched plus nanothickness bioceramic coating, and plasma-sprayed calcium-phosphate--were used. They were bilaterally placed at the distal femur of 16 New Zealand rabbits and remained in place for 2 and 4 weeks in vivo. After euthanizing the rabbits, the implants were subjected to torque to interface fracture and were subsequently processed as nondecalcified approximately 30-microm-thickness slides for histomorphologic analysis and BIC determination. Statistical analysis was performed using analysis of variance at the 95% level of significance, considering implantation time and implant surface as independent variables and the torque-to-interface fracture and BIC as dependent variables. RESULTS: The torque-to-interface fracture was significantly affected by the implant surface (P < .001) but was not affected by the implantation time (P > .20). The implantation time and implant surface had significant effects on the BIC (P < .04 and P < .001, respectively). The greatest torque-to-interface fracture and BIC was observed for the plasma-sprayed calcium-phosphate. CONCLUSION: The implant surface significantly influenced early bone healing around plateau root form implants.

Surface treatment at the cervical region and its effect on bone maintenance after immediate implantation: an experimental study in dogs.

OBJECTIVE: The aim of this study was to evaluate the effect of surface treatment at the cervical region of endosseous dental implants on the alveolar bone remodeling after implantation immediately after tooth extraction in a dog model. STUDY DESIGN: The third and fourth premolars of 6 dogs were bilaterally extracted with a full-thickness flap, and threaded implants presenting a textured or a polished surface at the cervical regions were placed on the distal root extraction sockets. Submerged healing was allowed for 4 weeks, and bone-to-implant contact (BIC) and buccal and lingual bone loss were morphometrically measured. RESULTS: The BIC and lingual bone loss were not significantly different between textured and polished groups. Significantly lower buccal bone loss (P < .01) was observed for the textured surface at 4 weeks in vivo. CONCLUSION: Textured surface implants placed immediately after tooth extraction resulted in less bone loss only at the buccal cervical region compared with smooth surface implants.

Biomechanical and bone histomorphologic evaluation of four surfaces on plateau root form implants: an experimental study in dogs.

OBJECTIVE: To evaluate the early bone response to plateau root form dental implants with 4 different surface treatments. STUDY DESIGN: Surface treatments comprised (n = 12 each): as-machined (M), alumina-blasted/acid-etched (AB/AE), alumina-blasted/acid-etched + nanothickness bioceramic coating (Nano), and plasma-sprayed calcium phosphate (PSCaP). Implants were placed in the radius diaphyses of 12 beagle dogs, remaining in vivo for 3 and 5 weeks. After euthanasia, the implants were subjected to torque to interface fracture and subsequently nondecalcified for histomorphology. Statistical analysis was performed by a GLM analysis of variance model at 5% significance level. RESULTS: Torque to interface fracture was significantly greater for the PSCaP group than for other groups (P < .001). Histomorphologic analysis showed woven bone formation around all implant surfaces at 3 weeks, and its replacement by lamellar bone at 5 weeks. Time in vivo did not affect torque measures. CONCLUSION: The PSCaP surface increased the early bone biomechanical fixation of plateau root form implants.