Metal hypersensitivity and pro-inflammatory cytokine production in patients with failed orthopedic implants: A case-control study.

Orthopedic implants heal well without complications in most patients but fail for unclear reasons in some individuals. This study determined the relevance of metal hypersensitivity in patients with failed orthopedic implants and those requiring orthopedic implant surgery. The study included 35 patients with failed orthopedic implants and 15 subjects scheduled for orthopedic implant surgery. The production of selected pro-inflammatory cytokines was measured in patients with failed orthopedic implants. Metal hypersensitivity was measured in all subjects using the MELISA® test. Of common metals in orthopedic alloys, the patients with failed orthopedic implants responded most frequently to nickel, chromium, titanium, iron, and molybdenum. Hypersensitivity to metals found in implants was measured in 40% of patients with failed implants. The study also showed that titanium exposure in patients with titanium hypersensitivity might lead to implant failure. Metal hypersensitivity testing should be offered to patients before surgery to minimize the risk of implant failure.

Effect of Blood Component Coatings of Enosseal Implants on Proliferation and Synthetic Activity of Human Osteoblasts and Cytokine Production of Peripheral Blood Mononuclear Cells.

The study monitored in vitro early response of connective tissue cells and immunocompetent cells to enosseal implant materials coated by different blood components (serum, activated plasma, and plasma/platelets) to evaluate human osteoblast proliferation and synthetic activity and inflammatory response presented as a cytokine profile of peripheral blood mononuclear cells (PBMCs) under conditions imitating the situation upon implantation. The cells were cultivated on coated Ti-plasma-sprayed (Ti-PS), Ti-etched (Ti-Etch), Ti-hydroxyapatite (Ti-HA), and ZrO2 surfaces. The plasma/platelets coating supported osteoblast proliferation only on osteoconductive Ti-HA and Ti-Etch whereas activated plasma enhanced proliferation on all surfaces. Differentiation (BAP) and IL-8 production remained unchanged or decreased irrespective of the coating and surface; only the serum and plasma/platelets-coated ZrO2 exhibited higher BAP and IL-8 expression. RANKL production increased on serum and activated plasma coatings. PBMCs produced especially cytokines playing role in inflammatory phase of wound healing, that is, IL-6, GRO-α, GRO, ENA-78, IL-8, GM-CSF, EGF, and MCP-1. Cytokine profiles were comparable for all tested surfaces; only ENA-78, IL-8, GM-CSF, and MCP-1 expression depended on materials and coatings. The activated plasma coating led to uniformed surfaces and represented a favorable treatment especially for bioinert Ti-PS and ZrO2 whereas all coatings had no distinctive effect on bioactive Ti-HA and Ti-Etch.

Influence of metals on cytokines production in connection with successful implantation therapy in dentistry.

OBJECTIVES: In most of patients in need of implantation treatment in the oral cavity, implants heal well, nevertheless, there are some individuals, in whom titanium implants fail for reasons, which remain unclear. DESIGN: The aim of our study was to determine if there is a difference between metal influenced IL-1ß, IL-4, IL-6, TNF-α and IFN-γ cytokines production in patients with successfully healed implants compared to those, whose implant therapy was unsuccessful. SETTING: The two study groups included 12 patients with failed dental titanium implants and 9 patients with successfully healed implants. In the subjects, cytokine production was established after lymphocyte cultivation with mercury, nickel and titanium antigens. RESULTS: IL-1ß levels were significantly increased in all patients after stimulation with titanium and in patients with accepted implants compared to patients with failed implants after the stimulation with mercury and titanium. Titanium caused significantly increased IL-6 production in all patients. TNF-α and IFN-γ levels were also significantly increased after the stimulation with titanium. Significantly increased TNF-α levels were found in patients with accepted implants as compared to patients with failed implants. CONCLUSIONS: Increased production of IL-1ß a IL-6 cytokines in reaction to titanium and increased production of TNF-α and IFN-γ cytokines in reaction to mercury, which is very often present in the form of amalgam in the oral cavity of persons in need of implant therapy, can play an important role in immune reactions during implant healing process. In patients with failed titanium implants, decreased production of these cytokines may participate in implant failure.

Implementation of contact definitions calculated by FEA to describe the healing process of basal implants.

AIMS: Bone structure around basal implants shows a dual healing mode: direct contact areas manifest primary osteonal remodeling, in the void osteotomy-induced spaces, the repair begins with woven bone formation. This woven bone is later converted into osteonal bone. The purpose of this study was to develop a model to accurately represent the interface between bone and basal implant throughout the healing process. The model was applied to the biological scenario of changing load distribution in a basal implant system over time. METHODS: Computations were made through finite element analysis using multiple models with changing boneimplant contact definitions which reflected the dynamic nature of the interface throughout the bony healing process. Five stages of bony healing were calculated taking into account the changes in mineral content of bone in the vicinity of the load transmitting implant surfaces. RESULTS: As the bony integration of basal implants proceeds during healing, peak stresses within the metal structure shift geographically. While bony repair may still weaken osteonal bone, woven bone has already matured. This leads to changes in the load distribution between and within the direct contact areas, and bone areas which make later contact with implant. CONCLUSIONS: This study shows that basal implants undergo an intrinsic shift of maximum stress regions during osseointegration. Fatigue testing methods in the case of basal implants must therefore take into account this gradual shift from early healing phase until full osseointegration is achieved.

The use of finite element analysis to model bone-implant contact with basal implants.

OBJECTIVE: The purpose of this study was to develop a model that accurately represents the interface between bone and basal implants throughout the healing process. STUDY DESIGN: The model was applied to the biological scenario of changing load distribution in a basal implant system over time. We did this through finite element analysis (FEA, or finite element method [FEM]), using multiple models with changing bone-implant contact definitions, which reflected the dynamic nature of the interface throughout the bony healing process. RESULTS: In the simple models, peak von Mises stresses decreased as the bone-implant-contact definition was changed from extremely soft contact (i.e., immature bone during early loading) to hard contact (i.e., mature bone). In upgraded models, which more closely approximate the biological scenario with basal dental implant, peak von Mises stresses decreased at the implant interface; however, they increased at the bone interface as a harder contact definition was modeled. Further, we found a shift in peak stress location within the implants during different contact definitions (i.e., different stages of bony healing). In the case of hard contact, the peak stress occurs above the contact surface, whereas in soft contact, the stress peak occurs in the upper part of the contact area between bone and the vertical shaft of the implant. Only in the extreme soft contact definitions were the peak stresses found near the base plate of the implant. CONCLUSION: Future FEM studies evaluating the functional role of dental implants should consider a similar model that takes into account bone tissue adaptations over time.

Bendable vs. angulated dental implants: consideration of elastic and plastic material properties based on experimental implant material data and FEA.

AIM: Bendable and angulated single-piece implants are used alternatively to screwable abutments in two-piece dental implant designs. Though used frequently, data on the stress distribution within such implants are not available and the question whether the bending contributes to fracture resistance has not been addressed. METHODS: We used the method of finite element to identify von Mises stresses and maximum stresses in bent and non-bent but angulated implants. Implants with one (e.g. applicable to screw designs) or two (applicable to basal implants) bending areas were the variables under investigation. RESULTS: For bends up to 13 degrees we discovered that if there is only one bend, the maximum stress is in the bent area. If two bends are made in two different bending areas, the maximum stresses are distributed between the two and, if either one of the bent areas is machined, there are no residual stresses within the implant body in this area. The maximum stresses are always located near the base-plates. The absolute value of the maximum stress is higher because no residual stresses are available to compensate stresses that stem from loading. CONCLUSION: Assuming that all other parameters are equal, bendable (basal) implants show a more even stress distribution along the vertical implant region than identically shaped implants with a machine-angulated area. Bendable basal implants therefore probably resist masticatory forces better than pre-angulated, machined implants, and unbent implants which provide a thin region in the vertical implant area.