A meta-analysis indicating extra-short implants (≤ 6 mm) as an alternative to longer implants (≥ 8 mm) with bone augmentation.

Extra-short implants, of which clinical outcomes remain controversial, are becoming a potential option rather than long implants with bone augmentation in atrophic partially or totally edentulous jaws. The aim of this study was to compare the clinical outcomes and complications between extra-short implants (≤ 6 mm) and longer implants (≥ 8 mm), with and without bone augmentation procedures. Electronic (via PubMed, Web of Science, EMBASE, Cochrane Library) and manual searches were performed for articles published prior to November 2020. Only randomized controlled trials (RCTs) comparing extra-short implants and longer implants in the same study reporting survival rate with an observation period at least 1 year were selected. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. A quantitative meta-analysis was performed to compare the survival rate, marginal bone loss (MBL), biological and prosthesis complication rate. Risk of bias was assessed with the Cochrane risk of bias tool 2 and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. 21 RCTs were included, among which two were prior registered and 14 adhered to the CONSORT statement. No significant difference was found in the survival rate between extra-short and longer implant at 1- and 3-years follow-up (RR: 1.002, CI 0.981 to 1.024, P = 0.856 at 1 year; RR: 0.996, CI 0.968 to 1.025, P = 0.772 at 3 years, moderate quality), while longer implants had significantly higher survival rate than extra-short implants (RR: 0.970, CI 0.944 to 0.997, P < 0.05) at 5 years. Interestingly, no significant difference was observed when bone augmentations were performed at 5 years (RR: 0.977, CI 0.945 to 1.010, P = 0.171 for reconstructed bone; RR: 0.955, CI 0.912 to 0.999, P < 0.05 for native bone). Both the MBL (from implant placement) (WMD: - 0.22, CI - 0.277 to - 0.164, P < 0.01, low quality) and biological complications rate (RR: 0.321, CI 0.243 to 0.422, P < 0.01, moderate quality) preferred extra-short implants. However, there was no significant difference in terms of MBL (from prosthesis restoration) (WMD: 0.016, CI - 0.036 to 0.068, P = 0.555, moderate quality) or prosthesis complications rate (RR: 1.308, CI 0.893 to 1.915, P = 0.168, moderate quality). The placement of extra-short implants could be an acceptable alternative to longer implants in atrophic posterior arch. Further high-quality RCTs with a long follow-up period are required to corroborate the present outcomes.Registration number The review protocol was registered with PROSPERO (CRD42020155342).

Comparative Analysis of Peri-Implant Bone Loss in Extra-Short, Short, and Conventional Implants. A 3-Year Retrospective Study.

OBJECTIVE: To evaluate the influence of implant length on marginal bone loss, comparing implants of 4 mm, 6 mm, and >8 mm, supporting two splinted crowns after 36-month functional loading. MATERIALS AND METHODS: this retrospective clinical trial evaluated the peri-implant behavior of splinted crowns (two per case) on pairs of implants of the same length placed in the posterior maxilla (molar area). Implants were divided into three groups according to length (Group 1: extra-short 4 mm; Group 2: short 6 mm; Group 3: conventional length >8 mm). Marginal bone loss was analyzed using standardized periapical radiographs at the time of loading and 36 months later. RESULTS: 24 patients (19 women and 5 men) were divided into three groups, eight rehabilitations per group, in the position of the maxillary first and second molars. The 48 Straumann® Standard Plus (Regular Neck (RN)/Wide Neck (WN)) implants were examined after 36 months of functional loading. Statistical analysis found no significant differences in bone loss between the three groups (p = 0.421). No implant suffered biological complications or implant loss. Long implants were associated with less radiographic bone loss. CONCLUSIONS: extra-short (4 mm); short (6 mm); and conventional length (>8 mm) implants in the posterior maxilla present similar peri-implant bone loss and 100% survival rates in rehabilitation, by means of two splinted crowns after 36 months of functional loading. Implants placed in posterior positions present better bone loss results than implants placed in anterior positions, regardless of the interproximal area where bone loss is measured. Conventional length (>8 mm) implants show better behavior in terms of distal bone loss than short (6 mm) and extra-short (4 mm) implants.

Deep Neural Networks for Dental Implant System Classification.

In this study, we used panoramic X-ray images to classify and clarify the accuracy of different dental implant brands via deep convolutional neural networks (CNNs) with transfer-learning strategies. For objective labeling, 8859 implant images of 11 implant systems were used from digital panoramic radiographs obtained from patients who underwent dental implant treatment at Kagawa Prefectural Central Hospital, Japan, between 2005 and 2019. Five deep CNN models (specifically, a basic CNN with three convolutional layers, VGG16 and VGG19 transfer-learning models, and finely tuned VGG16 and VGG19) were evaluated for implant classification. Among the five models, the finely tuned VGG16 model exhibited the highest implant classification performance. The finely tuned VGG19 was second best, followed by the normal transfer-learning VGG16. We confirmed that the finely tuned VGG16 and VGG19 CNNs could accurately classify dental implant systems from 11 types of panoramic X-ray images.

Efficacy of deep convolutional neural network algorithm for the identification and classification of dental implant systems, using panoramic and periapical radiographs: A pilot study.

Convolutional neural networks (CNNs), a particular type of deep learning architecture, are positioned to become one of the most transformative technologies for medical applications. The aim of the current study was to evaluate the efficacy of deep CNN algorithm for the identification and classification of dental implant systems.A total of 5390 panoramic and 5380 periapical radiographic images from 3 types of dental implant systems, with similar shape and internal conical connection, were randomly divided into training and validation dataset (80%) and a test dataset (20%). We performed image preprocessing and transfer learning techniques, based on fine-tuned and pre-trained deep CNN architecture (GoogLeNet Inception-v3). The test dataset was used to assess the accuracy, sensitivity, specificity, receiver operating characteristic curve, area under the receiver operating characteristic curve (AUC), and confusion matrix compared between deep CNN and periodontal specialist.We found that the deep CNN architecture (AUC = 0.971, 95% confidence interval 0.963-0.978) and board-certified periodontist (AUC = 0.925, 95% confidence interval 0.913-0.935) showed reliable classification accuracies.This study demonstrated that deep CNN architecture is useful for the identification and classification of dental implant systems using panoramic and periapical radiographic images.

Marginal bone loss around bone-level and tissue-level implants: A systematic review and meta-analysis.

PURPOSE: To review the scientific evidence regarding the marginal bone loss around the tissue-level and bone-level implants. METHODS: MEDLINE-PubMed and EMBASE databases were searched for the relevant English articles (up to February 2019) assessing the marginal bone loss (MBL) as the primary outcome. To be selected, studies were supposed to directly mention "tissue-level" and "bone-level" implants or implants with and without a smooth neck. Relevant data were extracted and meta-analysis was performed to evaluate the effect of implant neck design. RESULTS: A total of 19 studies (10 clinical, and 9 RCT studies) were included for qualitative analysis. There was a vast heterogeneity between studies in terms of implant designs and study protocol. Out of 19 articles included, 11 studies reached to a statistically significant difference in MBL between the groups; however, the differences were not found to be clinically relevant. Bone-level implants with platform-switched abutments in most of the cases showed better marginal bone stability compared to tissue-level implants or bone-level implants with matching abutments. Seven RCTs with 12 months follow-up data were selected for meta-analysis (I2=93%; heterogeneous), and the results showed less MBL around bone-level implants compared to tissue-level group (WMD=-0.21mm; 95% CI -0.42, 0.00; P=0.06). CONCLUSION: The available data regarding comparison of MBL around bone-level and tissue-level implants are heterogeneous. Bone-level implants with platform switching may better preserve crestal bone.

Definition of a drilling protocol for mini dental implants in different bone qualities.

Mini dental implants (MDI) have proven to be a good alternative of the conventional implants to support lower overdentures in elderly edentulous patients with narrow residual ridge. The aim of the present study was to define drilling protocols for each diameter of the MDI in each bone quality. The number and the diameter of the drilling bur and the drilling depth was investigated. A total of 48 MDIs with a ball head and transgingival collar were used to the drilling protocol in four different bone qualities (Q1-Q4). All available four diameters of the implants were included: 1.8mm, 2.1mm, 2.4mm, and 2.9mm. The length of all implants was 15mm. Three different protocols were prepared for each of the four bone qualities and for each implant diameter. The insertion torques and the primary stability of the implants were measured in their final position. Regardless of implant diameter and bone quality, the insertion torque was significantly higher using drilling protocol 1 than 3 and using drilling protocol 2 than 3 as well. The insertion torque was significantly higher in bone quality Q1 than in Q2-Q4. The unscrewing resulted in considerably increase in the torque, which exceeded the insertion torques by up to two times. This repeatedly led to the bending and fractures of implants.

Abutment screw loosening in angulation-correcting implants: An in vitro study.

STATEMENT OF PROBLEM: Techniques that allow angulation correction for screw-retained implant-supported restorations are now available. However, whether angulation correction built into the head of the implant affects abutment screw loosening is unclear. PURPOSE: The purpose of this in vitro study was to assess abutment screw loosening in angulation-correcting implants and straight implants subjected to simulated nonaxial occlusal loading. MATERIAL AND METHODS: Seven external connection 12-degree angulation-correcting implants and 7 straight implants were embedded in an acrylic resin housing, and titanium abutments were secured with titanium screws tightened to 32 Ncm. Each specimen was secured in a tooth wear machine and subjected to 1 000 000 cycles of 50-N nonaxial load to simulate 1 year of clinical service. The mean abutment screw removal torque values were calculated, and the association between number of cycles and the abutment screw removal torque was analyzed using a linear mixed-effects model and statistical software (α=.05) RESULTS: The mean abutment screw torque loss was 59.8% for the angulation-correcting implant group and 68.7% for the straight implant group. A statistically significantly greater mean abutment screw removal torque was recorded in the angulation-correcting implant group compared with the straight implant group after 1 000 000 cycles (P=.019). CONCLUSIONS: A significant loss of abutment screw torque was found in both implant groups with increased cycles of occlusal loading. The angulation-correcting implants resisted screw loosening significantly more than the straight implants because of the reduced angle of abutment screw loading.

Efeito da aplicação de carga em coroas de diferentes materiais, confeccionadas sobre implantes unitários curtos e com diferentes diâmetros nas deformações da crista óssea: análise in vitro e in silico / Effect of the load application on crowns of different materials made on short unitary implants with different diameters in bone crest deformations: in vitro and in silico analysis

O intuito deste estudo in vitro e in silico, foi analisar as microdeformações, geradas pela aplicação de carga vertical, sobre coroas de 3 tipos de materiais restauradores diferentes (Zircônia, Dissilicato de Lítio e Cromo Cobalto), que foram selecionadas, através da biblioteca do software SMART DENT/Exocad (Darmstadt - Germany) e confeccionadas, através da tecnologia cad/cam, suportadas por implantes curtos (8mm), conexão cone morse, com diversos diâmetros (3,5 mm; 4,0 mm e 5,0 mm). Os implantes foram instalados 2mm infraósseo para análise através de elementos finitos e da extensometria. Foram confeccionados 3 blocos de poliuretano: bloco 1 (grupo experimento) no qual foi colocado um implante Titamax CM Neodent 3,5 X 08 mm, bloco 2 (grupo controle) no qual foi colocado um implante titamax CM Neodent 4,0 X 08 mm e bloco 3 (grupo controle) no qual foi colocado um implante titamax CM Neodent 5,0 X 08 mm. Pilares protéticos retos (Base de Titânio 4,5 - Neodent) foram instalados sobre os respectivos implantes sendo instalados 4 extensômetros, na região superior dos blocos ao redor dos implantes. Foi aplicada uma carga vertical de 300N ao redor da abertura de acesso do parafuso protético das coroas. Para a análise por elementos finitos (FEA), o mesmo bloco foi modelado e analisado sob a mesma carga de 300N. Os valores de tensão e deformação foram analisados quanto à correlação com a extensometria. A estatística inferencial consistiu no teste de análise de variância de Friedmann, um fator efeito fixo. Para o nível de significância, foi escolhido o valor convencional de 5%. Os resultados demonstraram haver diferença estatística significante para o fator diâmetro (p = 0,0001) no qual os implantes, com 3,5 mm de diâmetro apresentaram os maiores picos de microdeformações. Quando se analisa o material restaurador, observa-se que não houve diferenças estatísticas significativas (p = 0,783). Dentro das limitações deste estudo, pode-se concluir que a utilização de implantes unitários, curtos e estreitos com conexão cone morse instalados 2 mm infraósseo, são uma opção viável para reabilitações em regiões posteriores independente do material restaurador escolhido(AU)

The aim of this in vitro and in silico study was to analyze the microdeformations generated by the application of vertical load on crowns of 3 different types of restorative materials (Zirconia, Lithium Dissilicate and Cobalt Chromium) that were selected through the software library SMART DENT / Exocad (Darmstadt - Germany), and made using cad / cam technology, supported by short implants (8 mm), cone morse connection with various diameters (3.5 mm, 4.0 mm and 5.0 mm). These were installed 2 mm subcrestal for finite element analysis and extensometry. Three blocks of polyurethane were made; block 1 (experimental group) in which a Titamax CM Neodent 3.5 X 08 mm implant, block 2 (control group) was implanted in which a CM Neodent 4.0 X 08 mm titamax and block 3 (control group) were implanted in which an implant was placed titamax CM Neodent 5.0 X 08 mm. Straight prosthetic abutments (Titanium Base 4.5 - Neodent) were installed on the respective implants and 4 extensometers were installed, in the upper region of the blocks around the implants. A vertical load of 300N was applied around the access opening of the crown prosthetic screw. For the finite element analysis (FEA), the same block was modeled and analyzed under the same 300N load. The stress and strain values were analyzed for correlation with extensometry. The inferential statistics consisted of Friedmann's analysis of variance, a fixed effect factor. For the level of significance, the conventional value of 5% was chosen. The results showed a statistically significant difference for the diameter factor (p = 0.0001) where 3.5 mm diameter implants presented the highest peaks of microdeformations. When analyzing the restorative material, we observed that there were no significant statistical differences (p = 0.783). Within the limitations of this study, we can conclude that the use of short, narrow unit implants with cone morse connection installed 2 mm subcrestal are a viable option for rehabilitation in posterior regions independent of the restorative material chosen(AU)

A comparative study of the effectiveness of early and delayed loading of short tissue-level dental implants with hydrophilic surfaces placed in the posterior section of the mandible-A preliminary study.

The objective of the present study was to compare the primary and secondary stability of tissue-level short dental titanium implants with polished necks and hydrophilic surfaces of two different designs and manufacturers. The first implant system used (SPI®ELEMENT RC INICELL titanium implants, Thommen Medical AG, Grenchen, Switzerland), allowed functional loading 6 weeks after its placement, whereas the second implant system (RN SLActiv® tissue-level titanium implants, Straumann GmbH, Fribourg, Germany), was loaded after 15 weeks. The degree of primary and secondary stability was determined using an Osstell ISQ measuring device. Marginal bone loss (MBL) was evaluated radiographically 12 and 24 weeks after implantation and the Wachtel's healing index as well as the patient's satisfaction with the treatment was registered on a VAS scale. The intergroup comparison revealed significant differences in terms of primary stability as well as differences in MBL 3 months after the procedure, but no significant differences could be found after 6 months and for secondary stability. The primary stability was significantly higher for Thommen® compared to Straumann® implants. Insertion of short dental implants with a hydrophilic conditioned surface significantly shortens patient treatment time.

Implantes dentales cortos en la rehabilitación de los maxilares atróficos. Puesta al día / Short dental implants in atrophic jaws rehabilitation. Update

Los implantes dentales cortos, aunque históricamente se han asociado a un mal pronóstico en las rehabilitaciones orales implantosoportadas, con el paso de los años y los avances en implantología, se han convertido en un tratamiento habitual en la práctica diaria de muchos clínicos, obteniendo tasas de éxito que se han incrementado recientemente hasta prácticamente igualarse a los implantes convencionales para muchos autores. La necesidad de reducir tiempos de trabajo, costes económicos y morbilidad intraoperatoria unida a la creciente demanda derehabilitaciones implanto soportadas en pacientes de un rango de edad cada vez mayor hace necesario añadirlos entre nuestras opciones rehabilitadoras implantológicas. Para ello es necesario conocer sus pros y contras y establecer unos protocolos quirúrgicos y de selección del paciente receptor (AU)

Short dental implants, with the passage of time and advances in implantology, have become astandard treatment in clinical practice. The need to reduce intraoperative time, morbidity and economic costs, linked to the increasing demand for implant rehabilitation in patients with a range of growing old (elder patients) makes it necessary to add the min our rehabilitative implantology options. For this reason, it is important to know its advantages and disadvantages, to set up thesurgical protocols and to select the patients correctly (AU)

Dental Implant Length and Diameter: A Proposed Classification Scheme.

PURPOSE: To propose a length-and-diameter-based classification scheme for dental implants to standardize terminology in the dental literature and communication between interested parties. MATERIALS AND METHODS: This study was mainly based on searching two major resources: published scientific research papers and 14 of the most popular dental implant manufacturers. Indexed databases were searched from January 2004 up to and including February 2016 using the keywords "dental implant length" and "dental implant diameter." Retrieved titles and abstracts were screened, and related full-text articles were reviewed. Full-text articles that clearly stated the terms and measurements of implants used were included and considered for proposing this classification scheme. RESULTS: The initial search for implant diameter and length yielded 1007 and 936 articles, respectively. A total of 85 studies (41 about diameter, 44 about length) were selected and reviewed. The remaining studies (966 about diameter, 892 about length) that did not abide by the eligibility criteria were excluded. The terms "long," "short," "standard," "wide," and "narrow" were the most commonly used terms in the literature. A classification scheme for implants by diameter and length was proposed. CONCLUSIONS: Indexed publications contain a variety of terms used by authors to describe diameter and length of dental implants without conformity and standardization. The classification scheme proposed in this article could serve as a reference for interested parties.

Avaliação do efeito de modificações topográficas e químico-estruturais de superfícies de titânio no potencial osteogênico de células tronco mesenquimais e pré-osteoblásticas / The effect of topographic and chemical-structural modifications of titanium surfaces on the osteogenic potential of mesenchymal stem cells and pre-osteoblastic cells

Os efeitos de modificações topográficas e químico-estruturais em superfícies de implantes e sua relação com o comportamento celular na interface com o biomaterial, não foram totalmente elucidados. Avaliou-se o efeito de modificações na topografia, composição química e estrutura cristalina de superfícies de titânio comercialmente puro (TiCP) grau IV sobre o potencial osteogênico de células-tronco mesenquimais humanas (CTMh), de células-tronco mesenquimais de camundongo (CTMc) e de células pré-osteoblásticas murinas (MC3T3E1), em diferentes meios de cultivo celular. Amostras de TiCP com superfície lisa e com topografia rugosa em micro e nanoescala foram criadas e caracterizadas por difratometria de raios-X (DFX), goniômetro; microscopia eletrônica de varredura (MEV), perfilômetro óptico (PO) e microscopia de força atômica (MFA). Realizaram-se ensaios osteogênicos de atividade da fosfatase alcalina (ALP); de formação de colônias de osteoblastos (UFC-Ob); de mineralização; de atividade da luciferase (colágeno) e de expressão gênica (qPCR). Para todas as análises estatísticas o nível de significância foi de 5%. Fases cristalinas do TiCP como Ti α, rutilo e anatase, foram identificadas por DFX; o goniômetro comprovou a hidrofilicidade das superfícies; as superfícies rugosas apresentaram valores de rugosidade média (Ra), obtidos por PO maiores do que a superfície lisa (p<0,0001); características micro e nanoestruturais foram comprovadas, medidas e analisadas por MEV e por MFA. A superfície nanotexturizada apresentou maior potencial osteogênico independente do tipo celular e/ou meio de cultivo utilizados nos ensaios de mineralização (p<0,05) e qPCR. Nos ensaios de atividade de ALP em CTMh sob meio osteogênico (p=0,001) e expressão de colágeno em meio regular, também observou-se maior potencial osteogênico da superfície nanotexturizada. A superfície microtexturizada apresentou maior atividade de ALP em CTMh sob meio regular (p=0,006) e em MC3T3E1 sob meio osteogênico 2 (p=0,01); maior produção de colágeno sob meio osteogênico 2 e maior número de UFC-Ob em CTMc em meio regular (p=0,004). Concluiu-se que a diferenciação osteogênica é influenciada tanto pelos efeitos sinérgicos dos tratamentos empregados para a criação de superfícies micro e nanotexturizadas, quanto pelo tipo celular e meios de cultivo utilizados nos testes biológicos. A superfície nanotexturizada apresentou maior potencial de induzir mineralização e expressão de genes osteogênicos in vitro(AU)

The effects of topography and chemical modifications on implants surfaces and its relation with the cellular behavior at the interface with the biomaterial, are not fully elucidated. The effect of changes in the topography, chemical composition and surface crystalline structure of commercially pure titanium (TiCP) grade IV on the osteogenic potential of human mesenchymal stem cells (hMSCs), mouse mesenchymal stem cells (mMSCs) and pre-osteoblastic cells (MC3T3E1), in different cell culture media were evaluated. Smooth surfaces and rough topography in micro and nanoscale were created and characterized by X-ray diffraction (XRD), wettability, scanning electron microscopy (SEM), light interferometry (IFM), atomic force microscopy (AFM). Osteogenic assays of alkaline phosphatase activity (ALP), of osteoblast colonies formation (CFU-Ob); mineralization; luciferase activity (collagen) and gene expression (qPCR) were performed. For all statistical analyzes the level of significance was set to 5%. Crystalline TiCP phases such as Ti α, rutile and anatase were identified by XRD; the goniometer confirmed hydrophilicity of all surfaces; the rough surfaces presented mean of Ra roughness parameter obtained by IFL greater than the smooth surface (p <0.0001); micro and nanofeatures were verified, measured and analyzed by MEV and MFA. Nanotexturized surface presented higher osteogenic potential independent of the cell type or culture media used in the mineralization (p <0,05) and qPCR assays. A greater osteogenic potential of the nanotexturized surface was also observed for ALP activity in hMSCs under osteogenic medium (p=0,001) and expression of collagen in regular medium assays. The microtexturized surface presented higher ALP activity in hMSCs under regular media (p =0.006) and in MC3T3E1 cells under osteogenic media 2 (p=0.01); higher collagen production under osteogenic medium 2 and higher CFU-Ob number in mMSCs in regular media (p=0,004). It was concluded that osteogenic differentiation is influenced both by the synergistic effects of the treatments used to create micro- and nanotexturized surfaces, and by the cell type and culture media used in biological tests. The nanotexturized surface presented greater potential in vitro to induce mineralization and osteogenic genes expression(AU)

Topographic characterisation of dental implants for commercial use

BACKGROUND: To characterize the surface topography of several dental implants for commercial use. MATERIAL AND METHODS: Dental implants analyzed were Certain (Biomet 3i), Tissue Level (Straumann), Interna (BTI), MG-InHex (MozoGrau), SPI (Alphabio) and Hikelt (Bioner). Surface topography was ascertained using a confocal microscope with white light. Roughness parameters obtained were: Ra, Rq, Rv, Rp, Rt, Rsk and Rku. The results were analysed using single-factor ANOVA and Student-Neuman-Keuls (p< 0.05) tests. RESULTS: Certain and Hikelt obtained the highest Ra and Rq scores, followed by Tissue Level. Interna and SPI obtained lower scores, and MG-InHex obtained the lowest score. Rv scores followed the same trend. Certain obtained the highest Rp score, followed by SPI and Hikelt, then Interna and Tissue Level. MG-InHex obtained the lowest scores. Certain obtained the highest Rt score, followed by Interna and Hikelt, then SPI and Tissue Level. The lowest scores were for MG-InHex. Rsk was negative (punctured surface) in the MG-InHex, SPI and Tissue Level systems, and positive (pointed surface) in the other systems. Rku was higher than 3 (Leptokurtic) in Tissue Level, Interna, MG-InHex and SPI, and lower than 3 (Platykurtic) in Certain and Hikelt. CONCLUSIONS: The type of implant determines surface topography, and there are differences in the roughness parameters of the various makes of implants for clinical use

Biomechanical evaluation of one-piece and two-piece small-diameter dental implants: In-vitro experimental and three-dimensional finite element analyses.

BACKGROUND/PURPOSE: Small-diameter dental implants are associated with a higher risk of implant failure. This study used both three-dimensional finite-element (FE) simulations and in-vitro experimental tests to analyze the stresses and strains in both the implant and the surrounding bone when using one-piece (NobelDirect) and two-piece (NobelReplace) small-diameter implants, with the aim of understanding the underlying biomechanical mechanisms. METHODS: Six experimental artificial jawbone models and two FE models were prepared for one-piece and two-piece 3.5-mm diameter implants. Rosette strain gauges were used for in-vitro tests, with peak values of the principal bone strain recorded with a data acquisition system. Implant stability as quantified by Periotest values (PTV) were also recorded for both types of implants. Experimental data were analyzed statistically using Wilcoxon's rank-sum test. In FE simulations, the peak value and distribution of von-Mises stresses in the implant and bone were selected for evaluation. RESULTS: In in-vitro tests, the peak bone strain was 42% lower for two-piece implants than for one-piece implants. The PTV was slightly lower for one-piece implants (PTV = -6) than for two-piece implants (PTV = -5). In FE simulations, the stresses in the bone and implant were about 23% higher and 12% lower, respectively, for one-piece implants than those for two-piece implants. CONCLUSION: Due to the higher peri-implant bone stresses and strains, one-piece implants (NobelDirect) might be not suitable for use as small-diameter implants.

The efficacy of maxillary protraction protocols with the micro-implant-assisted rapid palatal expander (MARPE) and the novel N2 mini-implant-a finite element study.

BACKGROUND: Maxillary protraction with the novel N2 mini-implant- and micro-implant-assisted rapid palatal expander (MARPE) can potentially provide significant skeletal effects without surgery, even in older patients where conventional facemask therapy has limited skeletal effects. However, the skeletal effects of altering the location and direction of force from mini-implant-assisted maxillary protraction have not been extensively analyzed. In this study, the application of the novel N2 mini-implant as an orthopedic anchorage device is explored in its ability to treat patients with class III malocclusions. METHODS: A 3D cranial mesh model with associated sutures was developed from CT images and Mimics modeling software. Utilizing ANSYS simulation software, protraction forces were applied at different locations and directions to simulate conventional facemask therapy and seven maxillary protraction protocols utilizing the novel N2 mini-implant. Stress distribution and displacement were analyzed. Video animations and superimpositions were created. RESULTS: By changing the vector of force and location of N2 mini-implant, the maxilla was displaced differentially. Varying degrees of forward, downward, and rotational movements were observed in each case. For brachyfacial patients, anterior micro-implant-supported protraction at -45° or intermaxillary class III elastics at -45° are recommended. For dolicofacial patients, either anterior micro-implants at -15° or an intermaxillary spring at +30° is recommended. For mesofacial patients with favorable vertical maxillary position, palatal micro-implants at -30° are recommended; anterior micro-implants at -30° are preferred for shallow bites. For patients with a severe mid-facial deficiency, intermaxillary class III elastics at -30° are most effective in promoting anterior growth of the maxilla. CONCLUSIONS: By varying the location of N2 mini-implants and vector of class III mechanics, clinicians can differentially alter the magnitude of forward, downward, and rotational movement of the maxilla. As a result, treatment protocol can be customized for each unique class III patient.

Immediate rehabilitation of the posterior maxilla with extensive sinus pneumatization with one axial and one trans-sinus tilted implant: a 3-year clinical report and a classification.

Implant rehabilitation of the posterior maxilla can entail difficulties due to reduced bone quantity and poor bone quality, especially after long-term edentulism. In some patients, multiple surgeries are necessary, which may lead to higher patient morbidity and longer treatment times before a prosthetic rehabilitation can be achieved. This article presents an immediate fixed prosthesis in a posterior atrophic maxilla supported by 1 anterior axial implant and 1 posterior tilted fixture placed with an intrasinus insertion. Additionally, a classification scheme for immediate treatment for the posterior maxilla based on the available residual bone is provided.

Implant-prosthodontic classification of the edentulous jaw for treatment planning with fixed rehabilitations.

PURPOSE: This study aimed to develop a classification of edentulous jaws for use as a diagnostic tool during implant-prosthodontic treatment planning. MATERIALS AND METHODS: The morphology of 200 fully edentulous alveolar ridges (100 maxillae, 100 mandibles) was assessed with cone beam computed tomography. Generic implants (length: 8 mm; diameter: 4.1 mm) were used. To develop the classification system, the feasibility of virtually placing the implants without vertical ridge augmentation was considered. Potential implant sites were evaluated in terms of ridge width and described as either type A (no horizontal augmentation required) or type B (horizontal augmentation required). A descriptive statistical analysis of subjects' age, sex, and arch classification was performed. RESULTS: In total, 880 implants were virtually planned. Based on alveolar ridge height, four arch patterns were identified (C1 to C4), providing a basis for prosthodontic planning with either removable or fixed implant-supported restorations. The frequencies of each category were as follows: C3 (n = 62, 62%), C4 (n = 16, 16%), C2 (n = 12, 12%), and C1 (n = 10, 10%) for the maxilla and C3 (n = 36, 36%), C4 (n = 31, 31%), C1 (n = 24, 24%), and C2 (n = 9, 9%) for the mandible. CONCLUSION: The proposed classification of the edentulous arch represents a useful tool for communication between clinicians when planning implant-supported rehabilitations.

Dental devices; reclassification of blade-form endosseous dental implant. Final order.

The Food and Drug Administration (FDA) is issuing a final order to reclassify the blade-form endosseous dental implant, a preamendments class III device, into class II (special controls). On its own initiative, based on new information, FDA is revising the classification of blade-form endosseous dental implants.

TADs: an evolutionary road to success.

UNLABELLED: This is a literature search about the clinical use of temporary anchorage devices (TADs) as a means of providing effective orthodontic anchorage. It takes the reader through a journey from the initial description of the technique to the enormous popularity TADs are currently experiencing in clinical practice. This paper aims to present good quality clinical information to allow the clinician and the patient to make an informed decision. CLINICAL RELEVANCE: The purpose of this literature review is to provide readers with an overview of the current available literature on this subject and encourage general dental practitioners to adopt a more evidence-based approach to this aspect of orthodontic care.

Complete arch site classification for all-on-4 immediate function.

Complete arch immediate function of dental implants requires a treatment protocol that takes advantage of residual areas of cortical bone for the apical fixation of implants. A site and jaw bone classification is proposed that has been in use since 2006 for all stages of atrophy for both jaws. The use of the classification is strictly for immediate function based on specific cortical bone sites in the facial skeleton to assist practitioners in diagnosis, treatment planning, and interdisciplinary communication, as well as to reduce human error in patient management. A recent series of 100 consecutive arches that were treated according to this classification is presented.