Reosseointegration of mechanically disintegrated implants in dogs: mechanical and histometric analyses.

OBJECTIVES: This study evaluated the reosseointegration of implants that had been reinserted following the mechanical disintegration of immature osseointegration in dogs. MATERIALS AND METHODS: Rotationally mobile implants were installed into an oversized drill space in five canine mandibles. After a healing period of 4 weeks, the immature osseointegration of the implant was intentionally disintegrated by the application of a mechanical countertorque and then reinserted at the same site (experimental group); in the control group, the mobile implant remained submerged without any surgical intervention. The animals were euthanized 4 weeks after the disruption of osseointegration. Changes in the implant stability quotient (ISQ) and Periotest value (PTV) were analyzed, and the bone-implant contact (%) was measured histometrically. RESULTS: All experimental and control sites showed successful mechanical stability at 8-week healing period. The mean ISQ was significantly higher in the experimental group than in the control group at 8 weeks (P < 0.01). In histology, immature woven-bone that bridged between the parent bone and the pre-existing residual bone on implant surface could be observed in experimental sites. The mean bone-implant contact was significantly higher in the experimental group than in the control group (P < 0.05). CONCLUSION: Within the limitation of the small sample used in this study, it is concluded that following the mechanical disruption of osseointegration, an implant can be successfully reosseointegrated with unloaded and submerged healing for a certain period.

Role of collagen membrane in lateral onlay grafting with bovine hydroxyapatite incorporated with collagen matrix in dogs.

PURPOSE: The objective of this study was to elucidate the role of collagen membranes (CMs) when used in conjunction with bovine hydroxyapatite particles incorporated with collagen matrix (BHC) for lateral onlay grafts in dogs. METHODS: The first, second, and third premolars in the right maxilla of mongrel dogs (n=5) were extracted. After 2 months of healing, two BHC blocks (4 mm×4 mm×5 mm) were placed on the buccal ridge, one with and one without the coverage by a CM. The animals were sacrificed after 8 weeks for histometric analysis. RESULTS: The collagen network of the membranes remained and served as a barrier. The quantity and quality of bone regeneration were all significantly greater in the membrane group than in the no-membrane group (P<0.05). CONCLUSIONS: The use of barrier membranes in lateral onlay grafts leads to superior new bone formation and bone quality compared with bone graft alone.

Dissolution behavior and early bone apposition of calcium phosphate-coated machined implants.

PURPOSE: Calcium phosphate (CaP)-coated implants promote osseointegration and survival rate. The aim of this study was to (1) analyze the dissolution behavior of the residual CaP particles of removed implants and (2) evaluate bone apposition of CaP-coated machined surface implants at the early healing phase. METHODS: Mandibular premolars were extracted from five dogs. After eight weeks, the implants were placed according to drilling protocols: a nonmobile implant (NI) group and rotational implant (RI) group. For CaP dissolution behavior analysis, 8 implants were removed after 0, 1, 2, and 4 weeks. The surface morphology and deposition of the coatings were observed. For bone apposition analysis, block sections were obtained after 1-, 2-, and 4-week healing periods and the specimens were analyzed. RESULTS: Calcium and phosphorus were detected in the implants that were removed immediately after insertion, and the other implants were composed mainly of titanium. There were no notable differences between the NI and RI groups in terms of the healing process. The bone-to-implant contact and bone density in the RI group showed a remarkable increase after 2 weeks of healing. CONCLUSIONS: It can be speculated that the CaP coating dissolves early in the healing phase and chemically induces early bone formation regardless of the primary stability.

Surface characteristics of a novel hydroxyapatite-coated dental implant.

PURPOSE: This study evaluated the surface characteristics and bond strength produced using a novel technique for coating hydroxyapatite (HA) onto titanium implants. METHODS: HA was coated on the titanium implant surface using a super-high-speed (SHS) blasting method with highly purified HA. The coating was performed at a low temperature, unlike conventional HA coating methods. Coating thickness was measured. The novel HA-coated disc was fabricated. X-ray diffraction analysis was performed directly on the disc to evaluate crystallinity. Four novel HA-coated discs and four resorbable blast medium (RBM) discs were prepared. Their surface roughnesses and areas were measured. Five puretitanium, RBM-treated, and novel HA-coated discs were prepared. Contact angle was measured. Two-way analysis of variance and the post-hoc Scheffe's test were used to analyze differences between the groups, with those with a probability of P<0.05 considered to be statistically significant. To evaluate exfoliation of the coating layer, 7 sites on the mandibles from 7 mongrel dogs were used. Other sites were used for another research project. In total, seven novel HA-coated implants were placed 2 months after extraction of premolars according to the manufacturer's instructions. The dogs were sacrificed 8 weeks after implant surgery. Implants were removed using a ratchet driver. The surface of the retrieved implants was evaluated microscopically. RESULTS: A uniform HA coating layer was formed on the titanium implants with no deformation of the RBM titanium surface microtexture when an SHS blasting method was used. CONCLUSIONS: These HA-coated implants exhibited increased roughness, crystallinity, and wettability when compared with RBM implants.

Comparative evaluation of three calcium phosphate synthetic block bone graft materials for bone regeneration in rabbit calvaria.

Various synthetic materials were developed to be used for implant dentistry and periodontal treatments. Among the various synthetic bone substitutes, calcium phosphate ceramics have been extensively investigated because their mineral chemistry resembles that of human bone. We evaluated the regeneration of three calcium phosphate synthetic block bone grafts in rabbit calvarial noncritical size defects. Four 8-mm-diameter defects were created in each rabbit (N = 10). Three defects, hydroxyapatite (HA), beta-tricalcium phosphate (ß-TCP), and biphasic calcium phosphate (BCP), were randomly filled with one of three fabricated synthetic block bone graft materials. The fourth defect was filled with blood clots. Specimens were harvested at 4 and 8 weeks postsurgery. Histological and histometrical findings indicated that all three calcium phosphate block bone graft materials were able to maintain space significantly better than the control group at both 4 and 8 weeks. In the BCP group, the amount of newly formed bone was increased more than for the other groups. Additionally, ß-TCP showed a large resorption of graft materials after 4 weeks postsurgery, while there were only small resorption for HA and BCP.

Development of the implant surgical technique and assessment rating system.

PURPOSE: There has been no attempt to establish an objective implant surgical evaluation protocol to assess residents' surgical competence and improve their surgical outcomes. The present study presents a newly developed assessment and rating system and simulation model that can assist the teaching staffs to evaluate the surgical events and surgical skills of residents objectively. METHODS: Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed regarding surgical competence and assessment tools. Particularly, medical journals reporting rating and evaluation protocols for various types of medical surgeries were thoroughly analyzed. Based on these studies, an implant surgical technique assessment and rating system (iSTAR) has been developed. Also, a specialized dental typodont was developed for the valid and reliable assessment of surgery. RESULTS: The iSTAR consists of two parts including surgical information and task-specific checklists. Specialized simulation model was subsequently produced and can be used in combination with iSTAR. CONCLUSIONS: The assessment and rating system provided may serve as a reference guide for teaching staffs to evaluate the residents' implant surgical techniques.

Periodontal regenerative effect of a bovine hydroxyapatite/collagen block in one-wall intrabony defects in dogs: a histometric analysis.

PURPOSE: The aim of this study was to elucidate the effect of a bovine hydroxyapatite/collagen (BHC) block in one-wall intrabony periodontal defects in dogs. METHODS: A one-wall intrabony periodontal defect (4 mm wide and 5 mm deep) was prepared bilaterally at the mesial side of the mandibular fourth premolar in five beagle dogs. After thorough root planing, block-type BHC (4×5×5 mm) was placed on one side. The contralateral defect area did not receive any material as a sham-surgery control. Histological analysis of the sites was performed after an 8-week healing period. RESULTS: Two of five samples in the experimental group healed well without dissipation of the graft materials, and histological analysis revealed excellent regeneration of the periodontal tissues. However, most of the grafted materials had been displaced in the other three samples, leaving only a small portion of the graft. The measured parameters exhibited large standard deviations, and the mean values did not differ significantly between the experimental and sham-surgery control sides. CONCLUSIONS: The application of BHC alone-without a barrier membrane-to wide, one-wall intrabony periodontal defects yielded inconsistent results regarding both periodontal regeneration and substantivity of the graft materials. Thus, the use of a barrier membrane for noncontained-type defects is recommended to improve the stability of the grafted material, and to condense it.