Twelve-month evaluation of a novel mineral-organic adhesive material used to stabilize dental implants placed in oversized osteotomies in vivo in an animal model.

OBJECTIVES: The aim of this study is to evaluate long-term in vivo stability of dental implants stabilized at time of placement in oversized osteotomies with a novel, self-setting, mineral-organic bone adhesive. MATERIALS/METHODS: Canine (26) mandibular teeth were removed, and three oversized osteotomies prepared bilaterally. Implants were placed with either adhesive, particulate xenograft, or with blood clot filling the implant/osteotomy gaps. Removal torque and histology were assessed. RESULTS: The adhesive provided significant and clinically relevant immediate implant stability of 22.2 N-cm (95% CI 5.3; 39.0), which continued throughout the early postoperative course and persisted through the nine- (155 N-cm 95% CI 113; 197) and 12-month (171 N-cm 95% CI 134.2; 209.4) time points. This is in comparison with the blood clot of 1.4 N-cm (95% CI 0.7; 2.1), 128.6 N-cm (95% CI 66.8; 190.4), and 140.7 N-cm (95% CI 78.8; 202.5) and particulate xenograft, 1.3 N-cm (95% CI 0.6; 2.0), 132.1 N-cm (95% CI 94.5; 169.7), and 101.5 (95% CI 59.5; 143.5), respectively. Histological examination shows the adhesive establishes intimate contact with the implant and bony walls and is replaced with new bone without compromising stability. Soft tissue does not penetrate the adhesive, and marginal bone/biomaterial level is maintained. Control sites filled with xenograft or blood clot heal with reduced bone levels, and in some cases, xenograft particles were encapsulated in connective tissue. CONCLUSIONS: Implants placed in oversized osteotomies and lacking primary stability can be stabilized at placement with a novel, highly osteoconductive, and resorbable adhesive. Gradual replacement of the biomaterial allows osseointegration without loss of stability through 12 months of follow-up. This novel adhesive has the potential to stabilize implants placed in sites with inadequate bony support.

Radiographic evaluation of a novel bone adhesive for maintenance of crestal bone around implants in canine oversized osteotomies.

BACKGROUND: A novel bone adhesive (tetracalcium phosphate and O-phospho-L-serine) has been developed as an osteoconductive, biodegradable bone-adherent material. The purpose of this study was to evaluate the maintenance of crestal bone/material level by standardized radiographs. METHODS: This was a randomized, controlled, three arm, prospective study. Twenty-six mixed breed hound dogs were included in this study. Three implants were placed on either side of the mandible with either bone adhesive (BA), bovine bone mineral (BBM), or no biomaterial (negative control [NC]). Standardized periapical radiographs were taken immediately after implant placement and at every month up to 1 year. The vertical distance between the implant platform to the first radiopaque material on both the mesial and distal surfaces were measured and crestal bone/material level changes were analyzed. RESULTS: The crestal bone/material level adjacent to BA was stable and maintained throughout the study. There were statistically significant differences found between BA and NC in terms of maintenance of crestal bone levels at any given timepoint. CONCLUSION: This study demonstrated that BA maintained crestal bone levels and had a similar ability to maintain that level over 1 year compared with BBM.

Compression-Resistant Polymer/Ceramic Composite Scaffolds Augmented with rhBMP-2 Promote New Bone Formation in a Nonhuman Primate Mandibular Ridge Augmentation Model.

PURPOSE: This study was designed to test the hypothesis that compression-resistant (CR) scaffolds augmented with recombinant human bone morphogenetic protein-2 (rhBMP-2) at clinically relevant doses in a nonhuman primate lateral ridge augmentation model enhances bone formation in a dose-responsive manner without additional protective membranes. MATERIALS AND METHODS: Defects (15 mm long × 8 mm wide × 5 mm deep) were created bilaterally in the mandibles of nine hamadryas baboons. The defect sites were implanted with poly(ester urethane) (PEUR)/ceramic CR scaffolds augmented with 0 mg/mL rhBMP-2 (CR control), 0.75 mg/mL rhBMP-2 (CR-L), or 1.5 mg/mL rhBMP-2 (CR-H). The primary outcome of ridge width and secondary outcomes of new bone formation, cellular infiltration, and integration with host bone were evaluated using histology, histomorphometry, and microcomputed tomography (micro-CT) at 16 weeks following implantation. RESULTS: New bone formation in the mandible was observed in a dose-responsive manner. CR-H promoted significantly greater new bone formation compared with the CR control group. In all groups, ridge width was maintained without an additional protective membrane. CONCLUSION: CR scaffolds augmented with a clinically relevant dose of rhBMP-2 (1.5 mg/mL) promoted significant new bone formation. These results suggest that a CR PEUR/ceramic composite scaffold without a protective membrane may be a potential new rhBMP-2 carrier for clinical use.

Immediate Dental Implant Stabilization in a Canine Model Using a Novel Mineral-Organic Adhesive: 4-Month Results.

PURPOSE: This study evaluated a novel injectable, self-setting, osteoconductive, resorbable adhesive that provides immediate implant stabilization. MATERIALS AND METHODS: Twenty-six large canines had the mandibular second through fourth premolars and the first molar removed bilaterally. After 3 months, oversized osteotomies were prepared with only the apical 2 mm of the implant engaging native bone. One site had a novel resorbable, self-setting, mineral-organic adhesive (TN-SM) placed around the implant, a second site received bone graft, and a third site received only blood clot. Removal torque, standardized radiography, and histology were used to evaluate implant stability and tissue contact after 24 hours, 10 days, and 4 months. RESULTS: Mean removal torque values after 24 hours were 1.4, 1.3, and 22.2 Ncm for the control, bone graft, and mineral-organic adhesive, respectively. After 10 days, these values were 5.7, 6.2, and 45.7 Ncm and at 4 months increased to 88.7, 77.8, and 104.7 Ncm, respectively. Clinical, radiographic, and histologic evaluations showed a lack of inflammatory reaction. Control defects were initially radiolucent in the coronal area; grafted sites revealed particles in the gap, with both conditions gradually filling with bone over time. At 10 days, histologic evaluation demonstrated excellent biocompatibility and intimate contact of mineral-organic adhesive to both the implant and bone, providing an osseointegration-like bond; control sites revealed no bone contact in the defect area, while the bone-grafted sites revealed unattached graft particles. At 4 months, much of the mineral-organic adhesive was replaced with bone; the control and grafted sites had some bone fill, and many of the defects demonstrated no bone-to-implant contact and were filled with soft tissue or isolated graft particles. CONCLUSION: The mineral-organic adhesive provides immediate (osseointegration-like) and continued implant stabilization over 4 months in sites lacking primary stability. Experimental sites demonstrated maintenance of crestal bone levels adjacent to the mineral-organic adhesive and soft tissue exclusion without the use of membranes in this canine model. These results demonstrate that this novel mineral-organic adhesive can enable implant osseointegration in a site where insufficient native bone exists to allow immediate implant placement.

Hard and soft tissue evaluation of titanium dental implants and abutments with nanotubes in canines.

BACKGROUND: Little is known regarding the interaction of dental implant surface nanotubes and oral soft and hard tissues. The purpose of this study was to evaluate both histologically and radiographically the qualitative and quantitative effects of dental implant surface nanotubes on hard and soft tissue in a canine model. METHODS: Three subgroups consisting of a combination of test and control implants and abutments (Group A: control implant/control abutment, Group B: control implant/test abutment: Group C: test implant/test abutment) were placed in edentulous mandibles of six large-breed canines. Implants and abutments were placed on one side at baseline, and on the opposite side of the mandible at week 10; sacrifice occurred at week 12. Quantitative and qualitative analyses were used to measure newly formed hard and soft tissues histologically and radiographically. RESULTS: The mean radiographic change in marginal bone level from weeks 0 to 12 between implant groups was not statistically significant (P > 0.05). Mean soft tissue contact (junctional epithelium + connective tissue) for Groups A, B, and C were 2.29, 2.33, and 2.31 mm, respectively, with no statistically significant difference (P > 0.05) between the groups. All connective tissue fibers were oriented parallel to the abutment regardless of surface treatment. CONCLUSIONS: The findings of this study suggest that healing of hard and soft tissues around implants and abutments is similar when comparing grit-blasted surfaces to machined, turned surfaces with nanotubes. Both resulted in similar soft tissue contact values, as well as connective tissue fiber orientation.

The influence of collagen membrane and autogenous bone chips on bone augmentation in the anterior maxilla: a preclinical study.

OBJECTIVES: To evaluate the effect of a resorbable collagen membrane and autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) on the healing of buccal dehiscence-type defects. MATERIAL AND METHODS: The second incisors and the first premolars were extracted in the maxilla of eight mongrels. Reduced diameter, bone-level implants were placed 5 weeks later. Standardized buccal dehiscence-type defects were created and grafted at implant surgery. According to an allocation algorithm, the graft composition of each of the four maxillary sites was DBBM + membrane (group D + M), autogenous bone chips + DBBM + membrane (group A + D + M), DBBM alone (group D) or autogenous bone chips + DBBM (group A + D). Four animals were sacrificed after 3 weeks of healing and four animals after 12 weeks. Histological and histomorphometric analyses were performed on oro-facial sections. RESULTS: The pattern of bone formation and resorption within the grafted area showed high variability among the same group and healing time. The histomorphometric analysis of the 3-week specimens showed a positive effect of autogenous bone chips on both implant osseointegration and bone formation into the grafted region (P < 0.05). The presence of the collagen membrane correlated with greater bone formation around the DBBM particles and greater bone formation in the grafted region after 12 weeks of healing (P < 0.05). The oro-facial width of the augmented region at the level of the implant shoulder was significantly reduced in cases where damage of the protection splints occurred in the first week of healing (P < 0.05). CONCLUSIONS: The addition of autogenous bone chips and the presence of the collagen membrane increased bone formation around DBBM particles. Wound protection from mechanical noxa during early healing may be critical for bone formation within the grafted area.

Periodontal Biotype: Gingival Thickness as It Relates to Probe Visibility and Buccal Plate Thickness.

BACKGROUND: Probe visibility is the clinical gold standard to discriminate thick from thin biotype but is prone to subjective interpretation. The primary objective of this study is to determine at what objective gingival thickness the probe becomes invisible through the tissue. A secondary objective is to compare mean buccal plate thickness between thick and thin biotypes as determined by probe visibility. METHODS: Maxillary anterior teeth (n = 306) were studied in 56 human patients. Biotype was determined by probe visibility through the tissue. Gingival thickness was measured via transgingival sounding. Buccal plate thickness was measured (n = 66 teeth) by cone beam computed tomography. For the primary objective, the gingival thickness that best corresponded with probe invisibility was selected using the receiver operating characteristic and area under the curve (AUC) with the highest combination of sensitivity and specificity. For the secondary objective, mean buccal plate thickness was compared between sites in which the probe was visible and when it was not (Student t test, α= 0.05). RESULTS: The gingival thickness that most closely corresponded with probe invisibility was >0.8 mm (0.666 AUC, 67.7% sensitivity, 65.4% specificity). When the probe was visible, mean gingival thickness was 0.17 mm less (P <0.001) compared to the "thick" counterparts. When the probe was visible, mean buccal plate thickness tended to be smaller by 0.212 mm (P = 0.08), but the difference was not statistically significant. CONCLUSIONS: The study failed to identify a gingival thickness threshold that can discriminate reliably between sites in which the probe was visible (i.e., thin biotype) and those in which it was not (i.e., thick biotype). Probe visibility was associated with thinner measurements of gingival thickness and showed a tendency to be associated with a thinner buccal plate.

Calculus detection calibration among dental hygiene faculty members utilizing dental endoscopy: a pilot study.

Dental and dental hygiene faculty members often do not provide consistent instruction in the clinical environment, especially in tasks requiring clinical judgment. From previous efforts to calibrate faculty members in calculus detection using typodonts, researchers have suggested using human subjects and emerging technology to improve consistency in clinical instruction. The purpose of this pilot study was to determine if a dental endoscopy-assisted training program would improve intra- and interrater reliability of dental hygiene faculty members in calculus detection. Training included an ODU 11/12 explorer, typodonts, and dental endoscopy. A convenience sample of six participants was recruited from the dental hygiene faculty at a California community college, and a two-group randomized experimental design was utilized. Intra- and interrater reliability was measured before and after calibration training. Pretest and posttest Kappa averages of all participants were compared using repeated measures (split-plot) ANOVA to determine the effectiveness of the calibration training on intra- and interrater reliability. The results showed that both kinds of reliability significantly improved for all participants and the training group improved significantly in interrater reliability from pretest to posttest. Calibration training was beneficial to these dental hygiene faculty members, especially those beginning with less than full agreement. This study suggests that calculus detection calibration training utilizing dental endoscopy can effectively improve interrater reliability of dental and dental hygiene clinical educators. Future studies should include human subjects, involve more participants at multiple locations, and determine whether improved rater reliability can be sustained over time.

Biologic width adjacent to loaded implants with machined and rough collars in the dog.

Dental implant surface technology has evolved from a relatively smooth machined implant surface for osseointegration to more roughened osteoconductive surfaces. Recent studies suggest that peri-implant soft tissue inflammation with progressive bone loss (ie, peri-implantitis) is becoming a prevalent condition. One possibility that could explain such a finding is that more bacterial plaque forms on the roughened implant and abutment surfaces, which may result in the peri-implant inflammation in the soft tissues. This study compared 36 tissue-level implants with a machined transmucosal collar to 36 implants with a relatively roughened (SLActive) transmucosal surface in the dog. The implants were evaluated histologically and histomorphometrically after 3 and 12 months of loading. The results demonstrated that the connective tissue contact was similar between the two implant types but that the junctional epithelium and biologic width dimensions were greater around the implants with the machined collars. Interestingly, the amount of inflammation was similar between the two implant types. Slightly more bone formation and more mature collagen formation occurred around the implants with the roughened collars compared to the implants with machined collars. These results suggested that even if more plaque biofilm forms on the implants with the roughened SLActive surface compared to the machined surface, there is no biologic consequence related to the amount of inflammation or bone loss. In fact, the roughened surface promoted bone formation (was more osteoconductive) and more mature soft collagenous connective tissue.

Biologic width around different implant-abutment interface configurations. A radiographic evaluation of the effect of horizontal offset and concave abutment profile in the canine mandible.

PURPOSE: The purpose of this experimental study was to analyze radiographically in a dog model how different implant-abutment interface configurations influence alveolar crestal bone changes. MATERIALS AND METHODS: Six different experimental implant-abutment connections were evaluated in six mixed-breed dogs. The following parameters were tested: absence of microgap, microgap proximal to bone crest, and microgap distant from bone crest. In addition, two different cervical abutment profiles, one straight and one featuring a supracrestal concavity, were evaluated. Implants were based on a cylindrical full-body screw design and made from cold-worked grade IV commercially pure titanium. The diameter (at thread tips) measured 4.1 mm, whereas the inner diameter was 3.5 mm. Standardized periapical digital radiographs were obtained for comparative analysis at baseline and at 3, 4, 5, 6, 7, 8, and 9 months after implant placement. Radiographs were randomized and calibrated for linear measurements. For statistical analysis, mixed-model repeated-measures analysis of variance was used. RESULTS: All implants integrated successfully and remained stable during the entire period of the study. Radiographically, when comparing groups with straight profiles, crestal bone remodeling in group C (one-piece design) was significantly less than in group A (matching diameters) and B (nonmatching diameters). In fact, implant group C showed the least crestal bone remodeling of all groups. When comparing groups with a concave profile but different microgap configurations, all three designs demonstrated bone loss with no significant differences among the three groups. CONCLUSION: A nonsubmerged one-piece implant design demonstrated the least amount of bone remodeling of all groups. Implant-abutment connections with a concave profile established crestal bone levels immediately apical to the concavity regardless of the microgap variable.

The use of a magnesium-based bone cement to secure immediate dental implants.

PURPOSE: The use of a magnesium-based bone cement, OsteoCrete, has shown promise as a means to secure bone and tendon-to-bone connections in orthopedic medicine. The presence of a bone cement to fill the residual socket and stabilize a dental implant during healing could make immediate implant placement in molar sites more predictable. The aim of this study was to determine whether this magnesium-based bone cement can be used predictably for this purpose. MATERIALS AND METHODS: The mandibular third premolars and first molars were extracted bilaterally from four mongrel dogs (60 to 80 lb each). Implants were placed in each extraction socket and supported by only 2 to 3 mm of apical furcation bone. OsteoCrete bone cement was placed randomly for implant stabilization in half of the sites. Clinical healing was evaluated until the 4-month time point. All animals were then sacrificed, and mandibular en bloc resection was performed for histologic evaluation of the biologic response and bone-to-implant contact. RESULTS: Clinically, healing showed a poor response when the test site implant was left exposed in a one-stage manner. No statistically significant difference was noted in bone-to-implant contact (52% in test sites versus 44% in control sites). Histologic specimens showed no adverse biologic response to the material but only minimal replacement at 4 months. CONCLUSIONS: OsteoCrete bone cement was successful in stabilizing the immediate dental implant in a large extraction socket when placed in a closed environment in the dog model but did not show a benefit as compared to controls. The limited data warrant further studies to determine the further potential of this material.

Soft and hard tissue histologic dimensions around dental implants in the canine restored with smaller-diameter abutments: a paradigm shift in peri-implant biology.

PURPOSE: To evaluate the biologic width dimensions around implants with nonmatching implant-abutment diameters. MATERIALS AND METHODS: Five canines had their mandibular premolars and first molars removed bilaterally and replaced with 12 implants that had nonmatching implant-abutment diameters. On one side, six implants were placed in a submerged surgical approach, and the other side utilized a nonsubmerged approach. Two of the implants on each side were placed either 1 mm above, even with, or 1 mm below the alveolar crest. Two months later, gold crowns were attached, and the dogs were sacrificed 6 months postloading. Block sections were processed for histologic and histomorphometric analyses. RESULTS: The bone level, connective tissue length, epithelial dimension, and biologic width were not significantly different when the implants were initially placed in a submerged or nonsubmerged surgical approach. The bone level was significantly different around implants placed 1 mm above the crest compared to implants placed even with or 1 mm below the alveolar crest. The connective tissue dimension was not different for any implant level placement. The epithelial dimension and biologic width were significantly greater for implants placed 1 mm below the alveolar crest compared to implants placed even with or 1 mm above the alveolar crest. For five of six implant placements, connective tissue covered the implant/abutment interface. CONCLUSIONS: This study reveals a fundamental change in the biologic response to implants with nonmatching implant-abutment diameters. Unlike implants with matching implant-abutment diameters, the connective tissue extended coronally past the interface (microgap). This morphologic tissue alteration represents a significant change in the biologic reaction to implant-abutment interfaces and suggests that marginal inflammation is eliminated or greatly reduced in these implant designs.

Biological complication in guided bone regeneration with a polylactic acid membrane: a case report.

PURPOSE: This case report describes a biologic complication related to polylactic acid membrane in guided bone regeneration (GBR). MATERIALS AND METHODS: A healthy 42-year-old patient complained of persistent discomfort of the maxillary anterior gingiva. Clinical examination and radiographs showed severe periodontal destruction of teeth 7 through 10. Teeth extraction was followed by early implant placement with GBR. RESULTS: Four months later, severe bone resorption was observed upon surgical exposure. A second GBR was performed. Wound healing progressed uneventfully and an implant-supported fixed partial denture was later loaded. CONCLUSION: We presume that this complication was a foreign body reaction to the polylactic acid membrane. Such a reaction can affect soft and hard tissue healing following GBR. Long-term follow-up is needed to determine stability of the results.

A 5-year prospective multicenter study of early loaded titanium implants with a sandblasted and acid-etched surface.

PURPOSE: For dental implants to be successful, osseointegration must occur, but it is unknown how much time must pass for osseointegration to be established. Preclinical studies suggested that titanium implants with a sandblasted and acid-etched (SLA) surface were more osteoconductive and allowed more rapid osseointegration than machined or turned implant surfaces. The hypothesis of this study was that implants with an SLA surface could be loaded in half the conventional healing time of machined-surface implants and that, after loading, the implants would be successful for 5 years. MATERIALS AND METHODS: A prospective multicenter clinical study was conducted with 439 implants placed in native bone in 135 edentulous and partially edentulous patients. Abutments were attached to the implant with 35 Ncm of torque without countertorque after 6 weeks in type I to III bone and after 12 weeks in type IV bone. The patients were carefully evaluated for 5 years. RESULTS: Most implants were placed in nonsmoking, nondiabetic patients with a mean age of 55 years (range, 21 to 82 years). Eighty percent of the implants were 10 or 12 mm long, 96% had a diameter of 4.1 mm, and 78% were placed in type II or III bone. Patients maintained good oral hygiene and were satisfied with the restorations. Four implants failed, and one implant was deemed unsuccessful between surgery and the 1-year postloading visit. No implants failed or were unsuccessful in subsequent years. The cumulative survival and success rates for 385 implants in 120 patients after 5 years were 99.1% and 98.8%, respectively. CONCLUSION: Implants with an SLA surface can be restored in 6 weeks for type I to III bone and 12 weeks for type IV bone. Furthermore, they can be maintained after loading for 5 years with very high success and survival rates.

Soft tissue volume augmentation by the use of collagen-based matrices in the dog mandible -- a histological analysis.

OBJECTIVES: The aim was to test, whether or not soft tissue volume augmentation with a specifically designed collagen matrix (CM), leads to ridge width gain in chronic ridge defects similar to those obtained by an autogenous subepithelial connective tissue graft (SCTG). MATERIAL AND METHODS: In six dogs, soft tissue volume augmentation was performed by randomly allocating three treatment modalities to chronic ridge defects [CM, SCTG and sham-operated control (Control)]. Dogs were sacrificed at 28 (n = 3) and 84 days (n = 3). Descriptive histology and histomorphometric measurements were performed on non-decalcified sections. RESULTS: SCTG and CM demonstrated favourable tissue integration, and subsequent re-modelling over 84 days. The overall mean amount of newly formed soft tissue (NMT) plus bone (NB) amounted to 3.8 ± 1.2 mm (Control), 6.4 ± 0.9 mm (CM) and 7.2 ± 1.2 mm (SCTG) at 28 days. At 84 days, the mean NMT plus NB reached 2.4 ± 0.9 mm (Control), 5.6 ± 1.5 mm (CM) and 6.0 ± 2.1 mm (SCTG). Statistically significant differences were observed between CM/SCTG and Control at both time-points (p < 0.05). CONCLUSION: Within the limits of this animal model, the CM performed similar to the SCTG, based on histomorphometric outcomes combining NB and NMT.

Tissue integration of a new titanium-zirconium dental implant: a comparative histologic and radiographic study in the canine.

BACKGROUND: This study evaluates a newly developed titanium-zirconium implant (TiZr), comparing it to a commercially available pure titanium (Ti) implant subjected to the same surface treatment. METHODS: In nine dogs, 12 implants (six TiZr and six Ti) were randomly placed in the mandible with the implant shoulder at the bone crest and subjected to submerged healing. Standardized radiographs were taken after implantation, and at the sacrifice of 2 weeks (three dogs), 4 weeks (three dogs), and 8 weeks (three dogs). Histologic and histomorphometric measurements were performed on non-decalcified histologic sections. The main outcome measures included the first bone-implant contact (fBIC) and BIC over time. For statistical analysis, Wilcoxon signed-rank test and mixed model regressions were applied. RESULTS: From baseline to 8 weeks, a mean bone loss of 0.09 ± 0.33 mm for TiZr and a gain of 0.02 ± 0.33 mm for Ti were calculated radiographically. The number of implants with the fBIC coronal to the reference point (implant shoulder) gradually increased over time, reaching 39% of all TiZr implants and 50% of all Ti implants at 8 weeks. The mean fBIC values for Ti and TiZr were 0.29 ± 0.42 mm and 0.26 ± 0.32 mm (2 weeks), -0.01 ± 0.20 mm and 0.10 ± 0.28 mm (4 weeks), and -0.06 ± 0.22 mm and 0.08 ± 0.30 mm (8 weeks), respectively. The mean BIC values peaked at 86.9% ± 6.8% (8 weeks) for TiZr and at 83.4% ± 5.9% (4 weeks) for Ti. No statistically significant differences were observed at any time point. CONCLUSION: TiZr and Ti bone level implants with chemically-modified, sandblasted, and acid-etched surfaces performed similarly in regards to osseointegration in this unloaded canine study.

Influence of a machined collar on crestal bone changes around titanium implants: a histometric study in the canine mandible.

BACKGROUND: It has been shown that peri-implant crestal bone reactions are influenced by both a rough-smooth implant border in one-piece, non-submerged, as well as an interface (microgap [MG] between implant/abutment) in two-piece butt-joint, submerged and non-submerged implants being placed at different levels in relation to the crest of the bone. According to standard surgical procedures, the rough-smooth implant border for implants with a smooth collar should be aligned with the crest of the bone exhibiting a smooth collar adjacent to peri-implant soft tissues. No data, however, are available for implants exhibiting a sandblasted, large-grit and acid-etched (SLA) surface all the way to the top of a non-submerged implant. Thus, the purpose of this study is to histometrically examine crestal bone changes around machined versus SLA-surfaced implant collars in a side-by-side comparison. METHODS: A total of 60 titanium implants (30 machined collars and 30 SLA collars) were randomly placed in edentulous mandibular areas of five foxhounds forming six different subgroups (implant subgroups A to F). The implants in subgroups A to C had a machined collar (control), whereas the implants in subgroups D to F were SLA-treated all the way to the top (MG level; test). Furthermore, the MGs of the implants were placed at different levels in relation to the crest of the bone: the implants in subgroups A and E were 2 mm above the crest, in subgroups C and D 1 mm above, in subgroup B 3 mm above, and in subgroup F at the bone crest level. For all implants, abutment healing screws were connected the day of surgery. These caps were loosened and immediately retightened monthly. At 6 months, animals were sacrificed and non-decalcified histology was analyzed by evaluating peri-implant crestal bone levels. RESULTS: For implants in subgroup A, the estimated mean crestal bone loss (± SD) was -0.52 ± 0.40 mm; in subgroup B, +0.16 ± 0.40 mm (bone gain); in subgroup C, -1.28 ± 0.21 mm; in subgroup D, -0.43 ± 0.43 mm; in subgroup E, -0.03 ± 0.48 mm; and in subgroup F, -1.11 ± 0.27 mm. Mean bone loss for subgroup A was significantly greater than for subgroup E (P = 0.034) and bone loss for subgroup C was significantly greater than for subgroup D (P <0.001). CONCLUSIONS: Choosing a completely SLA-surfaced non-submerged implant can reduce the amount of peri-implant crestal bone loss and reduce the distance from the MG to the first bone-implant contact around unloaded implants compared to implants with a machined collar. Furthermore, a slightly exposed SLA surface during implant placement does not seem to compromise the overall hard and soft tissue integration and, in some cases, results in coronal bone formation in this canine model.

Teaching evidence-based practice at the University of Texas Health Science Center at San Antonio dental school.

The overarching goal of the Evidence-Based Practice Program at San Antonio is to provide our graduates with life-long learning skills that will enable them to keep up-to-date and equip them with the best possible patient care skills during their 30-40 years of practice. Students are taught to (1) ask focused clinical questions, (2) search the biomedical research literature (PubMed) for the most recent and highest level of evidence, (3) critically evaluate the evidence, and (4) make clinical judgments about the applicability of the evidence for their patients. Students must demonstrate competency with these "just-in-time" learning skills through writing concise one-page Critically Appraised Topics (CATs) on focused clinical questions. The school has established an online searchable library of these Critically Appraised Topics. This library provides students and faculty with rapid, up-to-date evidence-based answers to clinical questions. The long-range plan is to make this online library available to practitioners and the public.

A 5-year prospective multicenter clinical trial of non-submerged dental implants with a titanium plasma-sprayed surface in 200 patients.

BACKGROUND: Endosseous dental implants are a popular treatment to replace missing teeth. Although many advances have occurred and affected the macrogeometry and surface characteristics of dental implants, among other aspects, it is important to document how the implants perform in patients over time. Such evaluations are helpful not only to document the clinical survival of the implants but also patient satisfaction over an extended period. METHODS: A formal prospective multicenter human clinical was performed at five centers involving 200 patients and 626 implants. Specific inclusion and exclusion criteria were used and detailed data collected at specified times using case report forms. An independent study monitor reviewed all study data before entry into the study database. Two implant designs were used in two different clinical indications. A non-submerged titanium plasma-sprayed (TPS) hollow cylindrical implant with a smooth transgingival collar was evaluated in the maxillary anterior sextant and a non-submerged TPS solid screw implant with similar collar in the mandible. RESULTS: Over the course of the 5-year clinical trial, there was one early failure occurring before definitive prosthesis delivery. Three late failures were documented, one occurring at each of the 6, 12, and 18 months postoperative visits. Life table analysis at 5 years revealed a 99.4% survival rate and a 92.5% success rate. Patient satisfaction was rated as good to excellent for 96.1% of implants in regards to esthetics after 5 years; 98.8% for appearance; and 99.4% for prosthesis comfort, ability to chew and taste, fit, and general satisfaction. No serious adverse events were reported. CONCLUSIONS: Implant success and survival was over 92% and 99%, respectively, in a formal 5-year prospective multicenter clinical trial involving 200 patients and 626 non-submerged TPS implants. These implants included hollow cylinder implants in the anterior maxilla and solid screw implants placed in the mandible. These findings document the predictability and patient satisfaction of tooth replacement using a non-submerged surgical technique involving a tissue-level, rough surfaced endosseous dental implant.