An Osteotomy Tool That Preserves Bone Viability: Evaluation in Preclinical and Clinical Settings.

The main objectives of this work were to assess the efficiency, ease-of-use, and general performance of a novel osseoshaping tool based on first-user clinical experiences and to compare these observations with preclinical data generated in rodents using a miniaturized version of the instrument. All patients selected for the surgery presented challenging clinical conditions in terms of the quality and/or quantity of the available bone. The presented data were collected during the implant placement of 15 implants in 7 patients, and included implant recipient site (bone quality and quantity) and ridge evaluation, intra-operative handling of the novel instrument, and the evaluation of subsequent implant insertion. The instrument was easy to handle and was applied without any complications during the surgical procedure. Its use obviated the need for multiple drills and enabled adequate insertion torque in all cases. This biologically driven innovation in implant site preparation shows improvements in preserving vital anatomical and cellular structures as well as simplifying the surgical protocol with excellent ease-of-use and handling properties.

Dental Implants in an Aged Population: Evaluation of Periodontal Health, Bone Loss, Implant Survival, and Quality of Life.

PURPOSE: To evaluate aged partially and fully edentulous patients who received dental implants and were maintained over time. Further, to determine how the partially and edentulous ageing populations (65 and above) with dental implants maintain bone levels, proper oral hygiene, and perceive benefits of dental implants. MATERIALS AND METHODS: Since 1995, patients receiving dental implants have been prospectively entered into an Access-based computerized program (Triton Tacking System). Patient demographics (age, sex), bone quality, quantity, implant location, and type of surgery have been continuously entered into the database. The database was queried for patients receiving implants (first stage) between 66 and 93 years of age. Thirty-one patients were within this age group. Twenty-five patients returned to the clinic for periodontal and dental implant evaluation. The Periodontal Index was used to evaluate selected teeth in terms of probing depth, bleeding on probing, plaque accumulation, and mobility. Using NIH Image J, radiographs taken at second stage and last examination were measured for changes in interproximal bone levels. Once identified, each patient anomalously filled out an abbreviated quality of health life form. Due to small sample size, descriptive statistics were used to compare clinical findings. RESULTS: Fifteen males ranging from 78 to 84 (mean age 84 years) years and 16 females from 66 to 93 (mean age 83 years) (age range 66-93) were contacted by phone or mail and asked to return to our office for a re-examination. For this group, the first dental implants were placed in 1996 (n = initial two implants) and continuously recorded through 2013 (n = last seven implants). Thirty-one patients received a total of 84 implants. Two patients were edentulous, and the remaining were partially edentulous. Four implants were lost. Between implant placement and 6- to 7-year interval, 13 patients with 40 implants had a cumulative survival rate of 94.6%. Of the original group (n = 33), three were deceased, two were in nursing homes, and three could not be located. CONCLUSIONS: Aged patients receiving dental implants had excellent implant survival rates, low periodontal disease index scores with minimal changes in interproximal bone levels. Results from this study indicate that patients with advanced age, in reasonably good health, have excellent implant survival rates, excellent quality of life scores, and can be maintained in good oral health.

Predictably replacing maxillary incisors with implants using 3-D planning and guided implant surgery.

Replacement of multiple adjacent teeth in the esthetic zone with dental implants is a surgical and restorative challenge, especially when an esthetic outcome is essential. Sound diagnosis and treatment planning can be combined with use of cone-beam computed tomography (CBCT) and 3-dimensional (3-D) software to achieve desired results. Placement of implants using guided surgical templates is critical when there is limited space between adjacent teeth or limited bone volume. Slight deviations in implant positioning during placement can lead to implants being too close to adjacent teeth, resulting in bone loss, recession, and encroachment upon adjacent papillae. Placement of implants in anatomically deficient or compromised areas is difficult when using a freehand drill protocol, because attaining the necessary precision cannot be achieved routinely. Esthetically demanding patients require precise implant placement. Use of guided surgical planning and implant placement enables the surgeon to take maximum advantage of available bone in anatomically restricted areas. Restoratively, ideal implant placement facilitates rehabilitation; therefore, all parameters must be observed in order to achieve an esthetically pleasing final restoration.

Survival rates and bone level changes around porous oxide-coated implants (TiUnite™).

PURPOSE: This prospective study evaluated implant survival rates and crestal bone changes for porous oxide-coated (TiUnite, Nobel Biocare AB, Gothenburg, Sweden), parallel-walled implants. MATERIALS AND METHODS: All patients receiving TiUnite (porous oxide-surfaced implants [POS]) implants were entered into a database (Triton Tracking System) starting February 1999. Survival rates were calculated from the date of implant placement and related to surgical method of placement (two-stage buried, flapless, immediate placement, immediate placement flapless, one stage), bone quality, and implant characteristics. Failed and nonfailed implants were compared with respect to changes in mean proximal bone levels and the presence of radiolucent areas around the implant apex (shadows). RESULTS: Four hundred nine patients received 817 porous oxide-coated implants, of which 38 failed. Using the last office visit as the censoring date, the cumulative survival date was 93%. The failure rate was independent of bone quality or quantity; implant diameter or length; and surgical method. For the 102 surviving implants, there was no significant change in the average crestal bone loss (+0.13 mm with a standard error, 0.17). For the 17 failing implants, the average crestal bone loss was -4.14 mm (standard error, 0.55). This difference between bone levels of failing and nonfailing implants was highly significant (p < .0001). There was no difference in the prevalence of radiographic shadows around failing and nonfailing implants at time of placement (p < .16). CONCLUSION: Results from this prospective clinical study indicate that 7% of TiUnite surfaced implants failed for unknown reasons. Failing implants were characterized by significant bone loss but not by the presence of shadows.

Nobel Perfect esthetic scalloped implant: rationale for a new design.

BACKGROUND: Over the past 20 years, there have been relatively few changes in implant designs. Most systems are manufactured from commercially pure titanium with turned threads, are sprayed with plasma, are coated with hydroxyapatite, or have an oxide surface. The majority of dental implants have not been designed for differing bone morphologies. Today patients have high esthetic demands that require modifications of implant designs to fulfill their expectations. PURPOSE: This article evaluates the problems encountered when trying to achieve an optimum esthetic outcome with dental implants. Implants and abutment designs, biologic width, ridge anatomy, and timing of implant placement all affect esthetic results. Each of these factors is discussed and is related to the introduction of a new scalloped implant design. The purpose of the scalloped design is to keep or create interdental bony peaks that support the soft tissue, thereby maintaining or creating interimplant papillae. METHODS: Clinical documentation of patients treated with the scalloped implant is presented. The esthetic outcome can be determined by comparing clinical documentation prior to and after treatment. CONCLUSIONS: The scalloped implant provides clinicians and patients with the option of improving esthetic outcomes. Placement and restoration of this implant are important when planning implant treatment in the esthetic zone.