Low-level laser therapy vs. pulsed electromagnetic field on neonatal rat calvarial osteoblast-like cells.

To compare the effects of pulsed electromagnetic field (PEMF) and low-level laser therapy (LLLT) on osteoblast cells in a cell culture model. Fifty thousand neonatal rat calvarial osteoblast-like cells per milliliter were seeded and 0.06 mT PEMF, 0.2 mT PEMF, and LLLT at 808 nm were applied for 24 and 96 h on the cells. To evaluate cellular proliferation and differentiation, specimens were examined for DNA synthesis, alkaline phosphatase (ALP) activity, cell numbers, and viability of the cells. Morphological appearances of the cells were observed using scanning electron microcopy after 24 and 96 h of incubation. At 24 and 96 h, the control group had a higher cell proliferation than 0.06 and 0.2 mT PEMF groups (p=0.001). At 96 h, 0.2 mT PEMF group had higher cell proliferation rate than 0.06 mT PEMF and LLLT groups (p=0.001). The cell count and cell viability in 0.2 mT PEMF group were higher than the 0.06-mT PEMF and LLLT groups, although these differences were not statistically significant at 96 h (p>0.05). At 24 and 96 h, cell viability in the control group was higher than the test groups. Alkaline phosphatase levels of the groups were comparable in both time intervals (p>0.05). 0.2 mT PEMF application on osteoblast-like cells led to cell proliferation and differentiation better than 0.06 mT PEMF and LLLT at 808 nm, although a remarkable effect of both PEMF and LLLT could not be detected. The ALP activity of 0.2 and 0.06 mT PEMF and LLLT were comparable.

The effects of pulsed electromagnetic field (PEMF) on osteoblast-like cells cultured on titanium and titanium-zirconium surfaces.

BACKGROUND: Commercially pure Ti, together with Ti Ni, Ti-6Al-4V, and Ti-6Al-7Nb alloys, are among the materials currently being used for this purpose. Titanium-zirconium (TiZr) has been developed that allows SLActive surface modification and that has comparable or better mechanical strength and improved biocompatibility compared with existing Ti alloys. Furthermore, approaches have targeted making the implant surface more hydrophilic, as with the Straumann SLActive surface, a modification of the SLA surface. PURPOSE: The aim of this study is to evaluate the effects of pulsed electromagnetic field (PEMF) to the behavior of neonatal rat calvarial osteoblast-like cells cultured on commercially pure titanium (cpTi) and titanium-zirconium alloy (TiZr) discs with hydrophilic surface properties. MATERIALS AND METHODS: Osteoblast cells were cultured on titanium and TiZr discs, and PEMF was applied. Cell proliferation rates, cell numbers, cell viability rates, alkaline phosphatase, and midkine (MK) levels were measured at 24 and 72 hours. RESULTS: At 24 hours, the number of cells was significantly higher in the TiZr group. At 72 hours, TiZr had a significantly higher number of cells when compared to SLActive, SLActive + PEMF, and machine surface + PEMF groups. At 24 hours, cell proliferation was significantly higher in the TiZr group than SLActive and TiZr + PEMF group. At 72 hours, TiZr group had higher proliferation rate than machine surface and TiZr + PEMF. Cell proliferation in the machine surface group was lower than both SLActive + PEMF and machine surface + PEMF. MK levels of PEMF-treated groups were lower than untreated groups for 72 hours. CONCLUSIONS: Our findings conclude that TiZr surfaces are similar to cpTi surfaces in terms of biocompatibility. However, PEMF application has a higher stimulative effect on cells cultured on cpTi surfaces when compared to TiZr.

CAD/CAM glass ceramics for single-tooth implant crowns: a finite element analysis.

PURPOSE: To evaluate the load distribution of CAD/CAM mono-ceramic crowns supported with single-tooth implants in functional area. MATERIALS AND METHODS: A 3-dimensional numerical model of a soft tissue-level implant was constructed with cement-retained abutment to support glass ceramic machinable crown. Implant-abutment complex and the retained crown were embedded in a Ø 1.5 × 1.5 cm geometric matrix for evaluation of mechanical behavior of mono-ceramic CAD/CAM aluminosilicate and leucite glass crown materials. Laterally positioned axial load of 300 N was applied on the crowns. Resulting principal stresses in the mono-ceramic crowns were evaluated in relation to different glass ceramic materials. RESULTS: The highest compressive stresses were observed at the cervical region of the buccal aspect of the crowns and were 89.98 and 89.99 MPa, for aluminosilicate and leucite glass ceramics, respectively. The highest tensile stresses were observed at the collar of the lingual part of the crowns and were 24.54 and 25.39 MPa, respectively. CONCLUSION: Stresses induced upon 300 N static loading of CAD/CAM aluminosalicate and leucite glass ceramics are below the compressive strength of the materials. Impact loads may actuate the progress to end failure of mono-ceramic crowns supported by metallic implant abutments.

Biomechanics of implant-tooth supported prostheses: effects of mesiodistal implant angulation and mode of prosthesis connection.

PURPOSE: The purpose of this study was to explore the effects of implant angulation and its possible influence on prosthetic connection as regards implant/tooth strains in a combined implant and natural tooth abutment fixed partial denture. METHODS: A natural tooth was embedded between vertically-aligned and 17° angulated implants in a polymethyl methacrylate acrylic resin model. Three designs (Group 1: tooth and vertically-aligned implant; Group 2: tooth and 17° angulated implant, Group 3: tooth and vertically-aligned implant having a different prosthetic connection to Group 1) of tooth-implant supported prostheses (n=4) were fabricated. Strain gauges were bonded on the prostheses and on the approximal sides of the natural tooth abutment and implants. Once the test fixed partial dentures were seated, a static load of 150 N was applied to each prosthesis. During testing, strain-gauge signals were digitalized by a data acquisition system and this signal was stored and assessed with corresponding software at a sample rate of 10 KHz. RESULTS: The data were then evaluated using Mann-Whitney U and Kruskal Wallis tests at 95% confidence level. Mesiodistal tilting of implants increased peri-implant strains in implant-tooth supported prostheses during torque-tightening and under load. The mode of prosthesis connection may affect strains within the prosthesis and natural tooth abutments, although its impact under static loading conditions seems negligible. CONCLUSIONS: This investigation suggests that mesiodistal tilting of implants may have a biomechanical effect in tooth-implant supported prostheses.

Spontaneous early exposure and marginal bone loss around conventionally and early-placed submerged implants: a double-blind study.

PURPOSE: The aim of this retrospective study was to compare the frequency of spontaneous early exposure of cover screws and marginal bone resorption in conventionally and early-placed submerged implants before second-stage surgery. MATERIALS AND METHODS: A total of 103 Nobel Biocare Branemark implants were conventionally (Group 1), or early-placed (Group 2) in 46 consecutive patients following the two-stage surgical protocol. Patients in both groups received oral hygiene training in self-performed plaque control measures, including exposure of cover screws during healing. Spontaneous cover screw exposure (CSE) of each implant was recorded for both groups and scored from Class 0 (no perforation) to Class 4 (complete exposure). Plaque index scores were recorded and marginal bone-level (MBL) changes were measured in radiographs before second-stage surgery in a blind manner. RESULTS: MBL in Group 2 was higher than Group 1 in patients with or without interim prosthesis (P<0.05). The use of interim prosthesis did not increase MBL in Group 1, but led to higher MBL in Group 2. The percentage of non-exposed implants in Group 1 was higher than Group 2 (P=0.007, odds ratio=7). Group 1 implants had 11.5 times greater plaque index score 0 than those in Group 2 (P=0.031, odds ratio=11.5). The differences between MBL with regard to CSE scores 0 and 1-4 was significant for both sides in Group 2 and the mesial side in Group 1 (P<0.05). The difference between MBL with regard to plaque index scores 1-3 was similar in both groups (P>0.05). CONCLUSIONS: There is a direct relation between spontaneous early cover screw perforations with early crestal bone loss. Early-placed implants experienced more spontaneous perforations and associated bone loss in comparison with conventionally placed submerged implants. The use of interim dentures may lead to more CSE and consequent MBL in the early-placement protocol.

Marginal bone loss and prosthetic maintenance of bar-retained implant-supported overdentures: a prospective study.

PURPOSE: To compare marginal bone loss, soft tissue conditions, and prosthetic outcomes of implants supporting mandibular and maxillary bar-retained overdentures. MATERIALS AND METHODS: A total of 124 implants (80 in the mandible and 44 in the maxilla) were placed in 35 patients. Bar-retained overdentures were fabricated for each patient. Prosthetic complications were recorded throughout the study. Plaque, peri-implant inflammation, bleeding, and calculus indices were recorded, and standard periapical radiographs were obtained at each implant site for measurement of marginal bone loss. RESULTS: One implant failed in the mandible prior to prosthesis fabrication and one failed in the maxilla 5 years after prosthesis delivery. Both were replaced after 12 weeks of bone healing. The mean marginal bone loss around maxillary implants was greater than that around mandibular implants. Comparative evaluations of subgroups followed for < 5 years and greater than or equal to 5 years showed that soft tissue parameters were similar for maxillary and mandibular implants. One- and 5-year survival probabilities of the mandibular and maxillary overdentures were comparable. Kaplan-Meier and log-rank tests revealed that the probabilities of retightening of retainer and requirements for occlusal adjustments were higher for mandibular overdentures, whereas other maintenance requirements were comparable. The retainers in mandibular overdentures needed retightening more frequently than the retainers in maxillary overdentures. CONCLUSIONS: Dental implants supporting mandibular and maxillary bar-retained overdentures have similar peri-implant soft tissue outcomes and overall prosthetic survival probabilities.

Systematic review of prosthetic maintenance requirements for implant-supported overdentures.

PURPOSE: To evaluate prosthetic maintenance requirements for implant-retained/supported overdentures via a review of the literature. MATERIALS AND METHODS: Using the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand-searching. The initial search yielded 3,120 titles, and 287 articles were assigned to full-text analysis. Upon classification of the prosthetic complications with regard to the jaws treated and the attachment systems used, within- and between-group comparative frequency analyses were undertaken with the Kruskal-Wallis test or the Mann-Whitney U test at P < .05. RESULTS: A total of 49 articles were included. Within- and between-group evaluations with regard to jaw treated as well as the attachment systems used showed that the frequency of complications did not change over time (P > .05). The differences detected were more matrix replacements after 5 years in the maxilla and mandible and more matrix replacements and patrix fractures after the first year in the mandible (P < .05). Among the attachment systems, a dislodged, worn, or loose matrix or its respective housing was more common in the ball-attachment group after the first year (P < .05). Prosthetic complications for all types of attachments were comparable (P > .05), except for the differences in peri-implant or interabutment mucosal enlargement rates after 1 year. CONCLUSIONS: Prosthetic maintenance requirements for overdentures on both jaws seem to be comparable. The impact of attachment system on the prosthetic outcome is negligible.

A systematic review of marginal bone loss around implants retaining or supporting overdentures.

PURPOSE: To evaluate, through a systematic review of the literature, the effects of implant design and attachment type on marginal bone loss in implant-retained/supported overdentures. MATERIALS AND METHODS: With the combined search terms "implant and overdenture," "implant-supported overdenture," "implant-retained overdenture," and "implant-anchored overdenture," along with specific inclusion and exclusion criteria, eligible articles between 1997 and 2008 (up to April 1) were retrieved from PubMed, EMBASE, OVID, the Cochrane Library databases, and seven journals by hand searching. Marginal bone loss values with regard to time, attachment type, and implant system used were compared by Kruskal-Wallis tests. Means and standard deviations of data were combined using fixed- and random-effect models and evaluated using meta-analysis. RESULTS: Forty-six articles were included in the analyses; data extraction and meta-analysis were able to be conducted on eight studies. Data regarding maxillary overdentures could not be analyzed statistically. Bone loss around mandibular implants did not seem to be influenced by implant system or attachment design (bar, ball, magnet, and other types) in the first year, from 1 to = or < 5 years, and even after 5 years (P > .05). Meta-analysis could not detect differences in implant systems or attachment types (P > .05). CONCLUSIONS: Based upon a systematic review and meta-analysis of the literature that identified a total of 4,200 implants from 13 manufacturers, there was no difference in marginal bone loss around implants retaining/supporting mandibular overdentures relative to implant type or attachment designs.

Astra Tech, Brånemark, and ITI implants in the rehabilitation of partial edentulism: two-year results.

PURPOSE: To explore the soft tissue, marginal bone, and prosthetic complications (if any) of Astra Tech, Brånemark, and ITI implants supporting fixed prostheses during an observation period of 2 years. MATERIALS: The study comprised 26 patients, who received 42 Astra Tech, 36 Brånemark, and 29 ITI implants. After 3 months of healing, abutment connections were performed for Astra Tech and Brånemark implants, and fixed prostheses were delivered to the patients at 4 months. At 6-month, 1-year, and 2-year recall appointments, plaque index, periimplant inflammation index, and bleeding index scores, were recorded. The marginal bone levels were also measured at 2-year recall by means of radiographic evaluation, and prosthetic complications were recorded throughout the study. RESULTS: All implants survived during the 2-year observation period. The plaque index and periimplant inflammation index scores around Brånemark implants were higher than ITI and Astra Tech implants in the first year of function (P > 0.05). Marginal bone loss around ITI and Astra Tech implants was similar at 2 years (P > 0.05). The marginal bone loss around Brånemark implants was higher than Astra Tech implants (P < 0.05) but similar to ITI implants at 2-year recall appointment (P > 0.05). Fixed prostheses supported by ITI and Astra Tech implants did not experience prosthetic complications, and only 1 patient of the Brånemark group had porcelain veneer fracture. CONCLUSIONS: Astra Tech, Brånemark, and ITI implants supporting fixed prostheses had same survival rates (100%) in this study. ITI and Astra Tech implants had similar changes in marginal bone levels, whereas Brånemark implants had higher marginal bone loss, particularly in the first year of function.

Fresh-frozen vs. embalmed bone: is it possible to use formalin-fixed human bone for biomechanical experiments on implants?

PURPOSE: As formalin is an extremely reactive electrophilic chemical that reacts with tissues, the purpose of this study was to explore whether formalin fixation could potentially alter the mechanical properties of bone tissue and have an effect on the primary stability measurements of implants. MATERIAL AND METHODS: Ø 3.3 x 8 mm, Ø 4.1 x 8 mm, and Ø 4.8 x 8 mm implants were placed on sockets prepared into the anterior surface of the radius of two fresh-frozen human cadavers. The insertion torque of each implant was quantified using a strain-gauged torque-wrench connected to a data acquisition system at a sample rate of 10 KHz, and resonance frequency analysis measurements were also undertaken for each implant. The cadavers were then subjected to embalment with 10% formalin for 3 months, and the same experiments were undertaken on the contra lateral radius of the cadavers. RESULTS: The insertion torques before and after chemical fixation were similar for Ø 3.3 mm (P>0.05), and higher values were obtained for Ø 4.1 mm and Ø 4.8 mm implants after chemical fixation (P<0.05). The resonance frequency analysis values before and after chemical fixation were similar for all implants (P>0.05). CONCLUSIONS: Implants have higher insertion torque values in formalin-fixed bone than fresh-frozen human bone, but similar implant stability quotients in both cases. The insertion torque technique can detect the difference between formalin-fixed and fresh-frozen human bone, but resonance frequency analysis cannot.

Implant stability and bone density: assessment of correlation in fresh cadavers using conventional and osteotome implant sockets.

OBJECTIVE: To compare the primary stability of implants placed in conventional and osteotome sites and to evaluate the level of correlation between cutting torque measurements, resonance frequency analysis (RFA), and bone density. MATERIALS AND METHODS: Eight human femoral heads were scanned with computed tomography for bone density measurements as Hounsfield units (HU), and individualized computed tomography-based surgical stents were prepared for placement of implants. Five implant sockets were prepared in each collum (CoF), caput (CaF), and trochanter (Tr-MM) section of the femoral heads using the conventional drilling technique or by a combination of drilling and use of an osteotome. Cutting-torque values (CTV) of the implants were measured by a manual torque wrench, followed by determination of implant stability quotients (ISQ) by RFA. RESULTS: The CTVs of implants were similar in the conventional group, but different in the osteotome group (P<0.05). There was a general tendency toward achieving higher CTV and ISQ values in CoF than CaF and Tr-MM (P<0.05), and measurements in CaF and Tr-MM were comparable (P>0.05). The mean HU of sites were similar, although CoF had higher HU values (P>0.05). CTV of implants in CaF and Tr-MM and ISQ values in CoF in the conventional groups were higher than those in the osteotome groups (P<0.05). The correlation between CTV and HU in Tr-MM was significant in the osteotome group, although no other correlations between CTV, ISQ, and HU could be detected (P>0.025). CONCLUSIONS: Conventional placement led to higher implant stability than the drilling and osteotome technique used in the study. No correlation could be found between CTV, RFA, and bone density.

Nonlinear finite element analysis versus ex vivo strain gauge measurements on immediately loaded implants.

PURPOSE: To evaluate the level of agreement between nonlinear finite element stress analysis (NL-FEA) and ex vivo strain gauge analysis (EV-SGA) on immediately loaded implants. MATERIALS AND METHODS: Four 4.1-mm-diameter, 12-mm-long implants were placed bilaterally into the lateral and first premolar regions of completely edentulous maxillae of four human cadavers. Two-element 90-degree rosette strain gauges were bonded to the labial cortical bone around the implants, and 100 N maximal load was applied over two miniature load cells on bar-retained overdentures while simultaneous data acquisition from load cells and strain gauges was performed at a sample rate of 10 KHz. Individualized numeric models of the cadavers were constructed, and contact analysis with normal contact detection and separation behavior was performed between the implants and bone. Upon simulation of the loading regimen, axial and lateral strains were recorded. The NL-FEA data and EV-SGA data were compared. RESULTS: There was a high level of agreement regarding the quality of strains, as determined by both techniques, although the mean values obtained with EV-SGA were higher than those found with NL-FEA. However, the strains recorded by NL-FEA did not differ significantly (P<.05) from the strains recorded by EV-SGA. CONCLUSION: Considering the complex biomechanical behavior of human hard and soft tissues, EV-SGA and NL-FEA did not suggest inconsistency in the detection of the quality of strains. Further, the methods provided comparable values for the quantification of strains on implants supporting maxillary overdentures.

Numeric simulation of time-dependent remodeling of bone around loaded oral implants.

PURPOSE: The objective of this study was to investigate the time-dependent biomechanics of marginal bone around osseointegrated dental implants within physiologic loading conditions. MATERIALS AND METHODS: The remodeling of marginal bone around a 4.1-mm-diameter, 10-mm-long implant was studied by implementing the Stanford theory into axisymmetric mathematical models simulating different bone support at the implant neck: 1-mm-thick cortical bone (model 1), 0.5-mm-thick cortical bone (model 2), absence of cortical bone (model 3), and absence of cortical bone with 0.5 mm of resorption of marginal trabecular bone (model 4). The results were examined separately for all models at five time intervals: the first loading after osseointegration and 3, 6, 9, and 12 months after osseointegration. Minimum principal stress, maximum principal stress, strain energy, total equivalent strain, displacement, average elastic modulus, and bone density were evaluated. RESULTS: In models 1 and 2, the magnitude of the stresses increased during the 1-year period. The distributions of stresses in models 3 and 4 were less variable and lower than models with cortical bone. The region of high stresses enlarged during the first 3 months and then decreased over time. There was a time-dependent increase in strain energy density around the neck of the implant in models 1 and 2. The time-dependent displacement values of implants were almost constant over time (maximum 1 Mum change). The lowest implant displacement values were observed in model 1. There was a slight increase in the elastic modulus of cortical bone and a decrease in trabecular bone (maximum 1% change). CONCLUSION: The time-dependent increase in stresses in the marginal zone of the implants with cortical bone support was higher than that of the implants supported solely by trabecular bone in the first year of function. Higher strain energy density around the implants with cortical bone support might indicate apposition and increase in interface stiffness, whereas lower strain energy density around implants supported solely by trabecular bone could be associated with skeletal tissue loss.

Meta-analysis of methods used to assess implant stability.

PURPOSE: To evaluate correlations between Periotest, cutting torque or insertion torque, and/or the reverse torque test with resonance frequency analysis measurements. MATERIALS AND METHODS: The combined search terms dental implant, primary stability, resonance frequency analysis, removal torque, vibration analysis, torque, Periotest, cutting torque, and insertion torque and specific inclusion and exclusion criteria were used to retrieve eligible articles published between 1998 and 2008 (up to April 1) from PubMed, EMBASE, OVID, The Cochrane Library databases, and 10 journals by hand-searching. The pooled P value was calculated with the Fisher method. The correlation coefficients (r) were combined using fixed and random effect models. Heterogeneity of the studies was tested by performing the homogeneity test. RESULTS: Fifty articles were identified, but 3 studies were excluded because of limitations in study design. Studies that fulfilled the inclusion criteria fell into a variety of categories (11 human cadaver, 16 clinical, 15 animal, and 5 in vitro studies). Assessment of P values revealed that correlation between cutting torque or insertion torque and resonance frequency analysis was significant (6 studies; P = .0022). Correlation between Periotest and cutting torque or insertion torque was significant (1 study; P = .015), and correlations between resonance frequency analysis and reverse torque test values (1 study; P = .319; r = 0.405) and Periotest and resonance frequency analysis (P = .28) were insignificant. Nine articles provided r values, and cutting torque or insertion torque and resonance frequency analysis showed a statistically significant and direct relationship of 55.4% (P = .000). One study provided an r value of -0.149. A statistically significant and direct relationship of 87.6% was found between cutting torque or insertion torque and reverse torque (2 studies; P = .000). CONCLUSION: This meta-analysis of 47 studies showed a statistically significant correlation between cutting torque or insertion torque and resonance frequency analysis.

Human ex vivo bone tissue strains around immediately-loaded implants supporting mandibular fixed prostheses.

PURPOSE: The purpose of this study was to qualify and quantify bone strains around immediately-loaded implants supporting mandibular fixed prostheses with regard to number of implant support. MATERIALS: Linear strain gauges were bonded on the labial bone of 5 Straumann dental implants placed in the mandibular symphysis region of 2 completely edentulous mandibles of fresh human cadavers. Installation torque value of each implant was measured by a custom-made torque wrench and resonance frequency analyses were undertaken. A one-piece full-arch fixed prosthesis was fabricated for each cadaver and 2 miniature load cells were integrated in the cantilever region of the prostheses for controlled loading experiments. 5-, 4-, and 3-implant support designs were consecutively tested. Strain measurements were performed at a sample rate of 10 KHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to data acquisition system. RESULTS: The installation torque values and implant stability quotient values of the implants ranged between 42.12 to 145.67 N cm and 61 to 80, respectively. Between-group comparisons revealed that the highest strain magnitudes were recorded for the 3-implant design followed by the 4- and 5-implant designs, although there was a tendency toward similar load partitioning between 4- and 5-implant designs (P < 0.05). CONCLUSIONS: Bone strains around 3-implant supported mandibular fixed prostheses is significantly higher than those around 4- and 5-implant designs, and this may lead to failure of supporting implants. Four- and 5-implant designs might have similar clinical outcome.

Bone strains around immediately loaded implants supporting mandibular overdentures in human cadavers.

PURPOSE: To compare the biomechanical effect of splinted versus unsplinted mandibular implants supporting overdentures subjected to experimental static immediate load on bone tissue deformation using strain gauge analysis. MATERIALS AND METHODS: Strain gauges were bonded on the labial cortical bone adjacent to 2 Straumann dental implants placed in the mandibular interforaminal region of 4 completely edentulous mandibles of fresh human cadavers. The installation torque value (ITV) of each implant was measured using a custom-made torque wrench, and implant stability quotients (ISQs) were also obtained using resonance frequency analysis. Three overdentures (ODs), 2 splinted (bar- and cantilevered bar-retained) and 1 unsplinted (ball-retained), were fabricated for each edentulous mandible. Two experimental loads were applied subsequently via 2 miniature load cells that were placed bilaterally 10 mm (anterior loading) and 15 mm (posterior loading) from the implant. Strain measurements were performed at a sample rate of 10 KHz and under a maximum experimental static load of 100 N; they were simultaneously monitored from a computer connected to a data acquisition system. Finally, the removal torque values (RTV) of the implants were measured. RESULTS: Strains on the labial cortical bone around implants supporting mandibular ODs under anterior loading were significantly higher than measured under posterior loading for all attachment types (P < .05). All strain values were compressive in nature, and the minimum strain (-19 microepsilon) was recorded for bar-retained ODs under 25 N posterior loading, while the maximum strain (-797 microepsilon) was for recorded for retentive anchor-retained ODs under 100 N anterior loading. Nonparametric correlations between ISQs, ITVs, and RTVs identified significant correlations only for ITVs and RTVs (P < .05). CONCLUSION: Splinting of 2 interforaminal dental implants, regardless of attachment type, to support mandibular ODs subjected to immediate load significantly reduced initial bone tissue strains experienced on the labial cortical bone in comparison with the use of unsplinted implants.

Bone strains around apically free versus grafted implants in the posterior maxilla of human cadavers.

The objective of this study was to compare the bone strains of apically free versus grafted implants in the posterior maxilla. The experiments were undertaken in four edentulous maxillary posterior regions of fresh human cadavers, having a minimum bone height of 8 mm. In each bone fragment, two Ø 4.1 mm x 12 mm Straumann implants were placed, and insertion torque values (ITV) and implant stability quotients (ISQ) of the implants were quantified to determine implant anchorage. Two splinted crowns were fabricated for each experimental model. Strain gauges were bonded on the buccal and sinus floor cortical bones around apically free and grafted implants. Microstrains were recorded by a data acquisition system and corresponding software at a sample rate of 10 KHz under central and buccally oriented lateral-axial static loads of 100 and 150 N in separate cases. The data were compared by independent T test at a significance level set at P<0.05. Bone tissue strains on the buccal cortical areas adjacent to apically free implants were higher than those of apically grafted implants (P<0.05). The differences ranged between 10 and 48 mu epsilon under central and lateral axial loads of 100 and 150 N. The shift in load application from central to buccally oriented lateral axial mode increased strains between 60 and 201 mu epsilon on buccal cortical bone around apically free and grafted implants (P<0.05). Bone strains around anterior implants were higher than those of posterior implants. Microstrains in the sinus floor cortical bone in apically grafted models were slightly higher than apically free models. Bone tissue strains on the buccal cortical areas adjacent to apicallyfree implants are higher than those of apically grafted implants. Sinus lifting, resulting in an enhanced apical support, slightly increases strains at the sinus floor region, but leads to a decrease in bone strains around the collar of supporting implants.

Biomechanical consequences of progressive marginal bone loss around oral implants: a finite element stress analysis.

The purpose of this study was to explore the biomechanical effects of progressive marginal bone loss in the peri-implant bone. Finite element model of a Ø 4.1 x 10 mm Straumann dental implant and a solid abutment was constructed as predefined eight-layers around the implant neck. The implant-abutment complex was embedded in a cylindrical bone model to analyze bone biomechanics regardless of anatomical influences. Angular and circular progressive marginal bone loss was simulated by sequential removal of each layer, resulting crater-like defects and a total of ten finite element models for analysis. Each model was subjected to a vertical and oblique static load of 100 N in separate load cases. Principal stress minimum and maximum, displacement, and equivalent of elastic strain outcomes were compared. Under vertical loading, principal stresses minimum and maximum decreased remarkably as with the increase in bone resorption. Under oblique load simulations, decrease in principal stress maximum and minimum was evident. With progressive bone loss and under oblique load simulations, displacement and equivalent of elastic strain increased considerably in trabecular bone contacting the implant neck. The presence of cortical bone contacting a load-carrying implant, even in a bone defect, improves the biomechanical performance of implants in comparison with only trabecular bone support as a sequel of progressive marginal bone loss.

Towards the limit of quantifying low-amplitude strains on bone and in coagulum around immediately loaded oral implants in extraction sockets.

The purpose of this study was to quantify strains in coagulum around immediately loaded oral implants in extraction sockets at the ex vivo level. Bilateral maxillary premolar teeth of two fresh human cadavers were extracted and psi 4.1 x 12 mm Straumann TE implants were placed in the sockets of first and second premolars by utilizing mesio-distal and palatal anchorage, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken to determine intraosseous stability. Upon abutment connection, a gold coping allowing the placement of a miniature load cell to contact the underlying solid abutment was fabricated. A linear strain gauge was connected to the coping at a distance for strain measurements in coagulum around the implant neck in the extraction socket. Linear strain gauges were also bonded on the labial marginal bone of each extraction socket. Strain measurements were performed at a sample rate of 10 kHz simultaneously monitored from a computer connected to data acquisition system and under a maximum load of 100 N on each implant with or without human coagulum in the extraction socket. Low-amplitude strains were measured around immediate implants. The increase in load increased strains on labial marginal cortical bone around implants (P < 0.05). Bone strains were higher on the implant loaded, when coagulum was present in the bone defects (P < 0.05). Strains within coagulum around mesiodistally anchored implants were higher than palatally anchored implants (P < 0.05). The type of implant on anchorage and presence of coagulum has an impact mechanotransduction to buccal marginal bone around immediate implants.

Numerical assessment of bone remodeling around conventionally and early loaded titanium and titanium-zirconium alloy dental implants.

The aim of this study was to investigate conventionally and early loaded titanium and titanium-zirconium alloy implants by three-dimensional finite element stress analysis. Three-dimensional model of a dental implant was created and a thread area was established as a region of interest in trabecular bone to study a localized part of the global model with a refined mesh. The peri-implant tissues around conventionally loaded (model 1) and early loaded (model 2) implants were implemented and were used to explore principal stresses, displacement values, and equivalent strains in the peri-implant region of titanium and titanium-zirconium implants under static load of 300 N with or without 30° inclination applied on top of the abutment surface. Under axial loading, principal stresses in both models were comparable for both implants and models. Under oblique loading, principal stresses around titanium-zirconium implants were slightly higher in both models. Comparable stress magnitudes were observed in both models. The displacement values and equivalent strain amplitudes around both implants and models were similar. Peri-implant bone around titanium and titanium-zirconium implants experiences similar stress magnitudes coupled with intraosseous implant displacement values under conventional loading and early loading simulations. Titanium-zirconium implants have biomechanical outcome comparable to conventional titanium implants under conventional loading and early loading.