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Objective: This study proposed a new classification method of bone quantity and quality at the dental implant site using cone-beam computed tomography (CBCT) image analysis, classifying cortical and cancellous bones separately and using CBCT for quantitative analysis., Methods: Preoperative CBCT images were obtained from 128 implant patients (315 sites). First, measure the crestal cortical bone thickness (in mm) and the cancellous bone density [in grayscale values (GV) and bone mineral density (g/cm 3 )] at the implant sites. The new classification for bone quality at the implant site proposed in this study is a "nine-square division" bone classification system, where the cortical bone thickness is classified into A: > 1.1 mm, B:0.7-1.1 mm, and C: < 0.7 mm, and the cancellous bone density is classified into 1: > 600 GV (= 420 g/cm 3 ), 2:300-600 GV (= 160 g/cm 3 -420 g/cm 3 ), and 3: < 300 GV (= 160 g/cm 3 )., Results: The results of the nine bone type proportions based on the new jawbone classification were as follows: A1 (8.57%,27/315), A2 (13.02%), A3 (4.13%), B1 (17.78%), B2 (20.63%), B3 (8.57%) C1 (4.44%), C2 (14.29%), and C3 (8.57%)., Conclusions: The proposed classification can complement the parts overlooked in previous bone classification methods (bone types A3 and C1)., Trial Registration: The retrospective registration of this study was approved by the Institutional Review Board of China Medical University Hospital, No. CMUH 108-REC2-181., (© 2023. The Author(s).)

Purpose: To evaluate the effect of insertion depth, bone type, and implant diameter on the primary stability of short implants. Materials and Methods: Commercial dental implants with different lengths (6 and 8 mm; BLX, Straumann) were inserted into artificial bone specimens of good and poor quality at three different depth positions: equicrestal, 1-mm subcrestal, and 2-mm subcrestal. Insertion torque values were recorded spontaneously during the implant procedure. Both maximum insertion torque values (MITVs) and final insertion torque values (FITVs) were recorded. Subsequently, Periotest values (PTVs) and implant stability quotients (ISQs) were measured for all specimens. Results: The mean MITVs of all groups ranged from 31.8 to 46.2 Ncm. However, the mean FITVs of all groups ranged from 8.8 to 29 Ncm. Torque values decreased significantly when the implants were inserted into their final positions. When insertion depth was increased, the PTV and ISQ decreased. Long implants and implants inserted into good-quality bone yielded greater primary stability, and bone quality appeared to have a greater effect on primary stability. Conclusion: When 6-mm short implants are inserted in a subcrestal position, low primary stability may be yielded, particularly in poor-quality bone.

Dental implants are among the most common treatments for missing teeth. The thickness of the crestal cortical bone at the potential dental implant site is a critical factor affecting the success rate of dental implant surgery. However, previous studies have predominantly focused on female patients, who are at a high risk of osteoporosis, for the discussion of bone quality and quantity at the dental implant site. This study aimed to investigate the effect of male patients' age on the crestal cortical bone of the jaw at the dental implant site by using dental cone-beam computed tomography (CBCT). This study performed dental CBCT on 84 male patients of various ages to obtain tomograms of 288 dental implant sites at the jawbone (41 sites in the anterior maxilla, 95 in the posterior maxilla, 59 in the anterior mandible, and 93 in the posterior mandible) for measuring the cortical bone thickness. A one-way analysis of variance and Scheffe's test were performed on the measurement results to compare the cortical bone thickness at implant sites in the four jaw areas. The correlation between male patient age and cortical bone thickness at the dental implant site was determined. The four jaw areas in order of the cortical bone thickness were as follows: posterior mandible (1.07 ± 0.44 mm), anterior mandible (0.99 ± 0.30 mm), anterior maxilla (0.82 ± 0.32 mm), and posterior maxilla (0.71 ± 0.27 mm). Apart from dental implant sites in the anterior and posterior mandibles, no significant correlation was observed between male patients' age and the cortical bone thickness at the dental implant site.

Satisfactory host bone quality and quantity promote greater primary stability and better osseointegration, leading to a high success rate in the use of dental implants. However, the increase in life expectancy as a result of medical advancements has led to an aging population, suggesting that osteoporosis may become a problem in clinical dental implant surgery. Notably, relative to the general population, bone insufficiency is more common in women with post-menopausal osteoporosis. The objective of this study was to compare the thickness of the crestal cortical bone at prospective dental implant sites between menopausal and non-menopausal women. Prospective dental implant sites in the jawbone were evaluated in two groups of women: a younger group (<50 years old), with 149 sites in 48 women, and an older group (>50 years old) with 191 sites, in 37 women. The thickness of the crestal cortical bone at the dental implant site was measured based on each patient's dental cone-beam computed tomography images. For both groups, one-way analysis of variance and Tukey's post-test were used to assess the correlation between cortical bone thickness and the presence of implants in the four jawbone regions. Student's t -test was further used to compare differences between the older and younger groups. From the retrospective study results, for both groups, thickness of the crestal cortical bone was the highest in the posterior mandible, followed by anterior mandible, anterior maxilla, and posterior maxilla. Compared with the younger group, the older group had a lower mean thickness of the crestal cortical bone. Among the four regions, however, only in the posterior maxilla was the crestal cortical bone significantly thinner in the older group than in the younger group.

Resolving late failure of dental implant is difficult and costly; however, only few reviews have addressed the risk factors associated with late failure of dental implant. The aim of this literature review was to summarize the influences of different potential risk factors on the incidence of late dental implant failure. The protocol of this systematic review was prepared and implemented based on the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) guideline. In December 2018, studies published within the previous 10 years on late dental implant failure were selected by fulfilling the eligibility criteria and the risk factors identified in qualified studies were extracted by using a predefined extraction template. Fourteen eligible studies were assessed. The common risk factors for late failure were divided into three groups according to whether they were related to (1) the patient history (radiation therapy, periodontitis, bruxism and early implant failure), (2) clinical parameters (posterior implant location and bone grade 4) or (3) decisions made by the clinician (low initial stability, more than one implant placed during surgery, inflammation at the surgical site during the first year or using an overdenture with conus-type connection). Clinicians should be cautions throughout the treatment process of dental implant-from the initial examination to the treatment planning, surgical operation and prosthesis selection-in order to minimize the risk of late failure of dental implant.

Background: The influences of potential bone-to-implant contact (BIC) area (pBICA), BIC area (BICA), and three dimensional (3D) BIC percentage (3D BIC%; defined as BICA divided by pBICA) in relation to the implant length on initial implant stability were studied. Correlations between these parameters were also evaluated., Methods: Implants with lengths of 8.5, 10, 11.5, and 13 mm were placed in artificial bone specimens to measure three indexes of the initial implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ). The implants and bone specimens were also scanned by microcomputed tomography, and the obtained images were imported into Mimics software to reconstruct the 3D models and calculate the parameters of 3D bone-to-implant contact including pBICA, BICA, and 3D BIC%. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were applied for statistical and correlation analyses., Results: The implant length affected ITV more than PTV and ISQ, and significantly affected pBICA, BICA, and 3D BIC%. A longer implant increased pBICA and BICA but decreased 3D BIC%. The Spearman coefficients were high (>0.78) for the correlations between the three 3D BIC parameters and the three indexes of the initial implant stability., Conclusions: pBICA, BICA, and 3D BIC% are useful when deciding on treatment plans related to various implant lengths, since these 3D BIC parameters are predictive of the initial implant stability.

Background/purpose: This study investigated the effects of three three-dimensional (3D) bone-to-implant contact (BIC) parameters-potential BIC area (pBICA), BIC area (BICA), and 3D BIC percentage (3D BIC%; defined as BICA divided by pBICA)-in relation to the implant diameter on primary implant stability, as well as their correlations were also evaluated., Methods: Dental implants with diameters of 3.75, 4, 5, and 6 mm and artificial bone specimens were scanned by microcomputed tomography to construct 3D models for calculating pBICA, BICA, and 3D BIC%. Indexes of the primary implant stability including the insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ) were measured after implants with various diameters were placed into bone specimens. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were all performed as statistical and correlation analyses., Results: The implant diameter significantly influenced pBICA and BICA, but not 3D BIC%. ITV and PTV were more sensitive to implant diameter than was ISQ. The coefficients of determination were high (>0.92) for the correlations between pBICA (or BICA) and indexes of the primary implant stability., Conclusion: This study revealed how the implant diameter and the three-dimensional (3D) BIC influence the primary stabilities of dental implant. ITV and PTV were more sensitively influenced by the implant diameter than ISQ. The pBICA and BICA seem to be more important than 3D BIC % for using wider implant in treatment plan, since those two parameters are highly predictive of variations in the primary stability of dental implant., (Copyright © 2017. Published by Elsevier B.V.)

Background: Dental implants have become reliable and predictable tools for treating missing teeth. The survival rate of dental implants is markedly influenced by the host bone quality and quantity of the jawbone. A better host bone provides higher initial stability of the dental implant, resulting in better osseointegration and a higher success rate. Host bone quality and quantity are determined by the crestal cortical bone thickness and inner cancellous bone density., Objective: The purpose of this study was to determine the crestal cortical bone thickness at dental implant sites in different regions of the jawbone through the use of dental cone-beam computed tomographic (CBCT) images., Materials and Methods: A total of 661 dental implant sites (81 in the anterior mandible, 122 in the anterior maxilla, 224 in the posterior mandible, and 234 in the posterior maxilla) were obtained from the jawbones of 173 humans. The data were subjected to statistical analysis to determine any correlation between crestal cortical bone thicknesses and jawbone regions using one-way analysis of variance with Tukey's post-test., Results: The crestal cortical bone thicknesses at dental implant sites in the four regions decreased in the following order: posterior mandible (1.07 ± 0.47 mm, mean ± SD) >anterior mandible (0.99 ± 0.36 mm) >anterior maxilla (0.82 ± 0.30 mm) >posterior maxilla (0.75 ± 0.35 mm)., Conclusion: The dental CBCT data demonstrate that crestal cortical bone thickness varies markedly between dental implant sites in the four regions of the jawbone., (© 2017 Wiley Periodicals, Inc.)

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., (Copyright © 2016. Published by Elsevier B.V.)

Background: The study compared the implant mobility and surrounding bone strain between the titanium-zirconium (Ti-Zr) alloy and the commercial pure (CP) Ti implants., Methods: The mobility--quantified as the implant stability quotient (ISQ) and Periotest value (PTV)--of implants constructed from Ti-Zr alloy and CP Ti placed into artificial type-2 jawbone models were measured. Specimens were tested by applying 190 N vertically or at 30 degrees laterally. Peak values of the principal strains of bone were recorded by rosette strain gauges with a data acquisition system and were analyzed statistically using Wilcoxon rank-sum test., Results: PTV and ISQ values did not differ significantly between the Ti-Zr and CP Ti implants (P > 0.01). Under vertical loading, the peak bone strains did not differ significantly between the Ti-Zr and CP Ti specimens (P > 0.006). However, the peak strains were 52% lower around the Ti-Zr implant than around the Ti implant on the buccal side of bone under lateral loading (P < 0.001)., Conclusions: The implant material (Ti-Zr alloy vs CP Ti) had no effect on the mobility of small-diameter dental implants. However, using Ti-Zr alloy as an implant material decreased the periimplant bone strain under lateral loading in this pilot study.

Objective: This study evaluated the correlation between the initial stability of a dental implant, quantified as the implant stability quotient (ISQ), and the bone-implant contact percentage ( BIC%)., Study Design: Dental implants were inserted into specimens comprising an artificial cortical shell representing cortical bone and foam bone representing cancellous bone with 4 elastic moduli. Each specimen with an implant was subjected to microcomputed tomography (micro-CT) scanning, from which the 2D and 3D BIC% values were calculated. The values of the Spearman correlation coefficient (r) were calculated between the ISQ and the 2D and 3D BIC% values., Results: Increasing the elasticity of the specimen enhanced the ISQ. There was statistically significant correlation between the ISQ and 3D BIC% values (r = 0.85, P < .0001). However, the correlation between ISQ and 2D BIC% values was not statistically significance (r = 0.42, P = .062)., Conclusions: The initial implant stability was strongly positively correlated with the 3D BIC%., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: This study investigated how the primary stability of a dental implant as measured by the insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ) is affected by varying thicknesses of cortical bone and strengths of trabecular bone using synthetic bone models., Materials and Methods: Four synthetic cortical shells (with thicknesses of 0, 1, 2, and 3 mm) were attached to four cellular rigid polyurethane foams (with elastic moduli of 137, 47.5, 23, and 12.4 MPa) and one open-cell rigid polyurethane foam which mimic the osteoporotic bone (with an elastic modulus 6.5 MPa), to represent the jawbones with various cortical bone thicknesses and strengths of trabecular bone. A total of 60 bone specimens accompanied with implants was examined by a torque meter, Osstell resonance frequency analyzer, and Periotest electronic device. All data were statistically analyzed by two-way analysis of variance. In addition, second-order nonlinear regression was utilized to assess the correlations of the primary implant stability with the four cortex thicknesses and five strengths of trabecular bone., Results: ITV, ISQ, and PTV differed significantly (p < .05) and were strongly correlated with the thickness of cortical bone (R(2) > 0.9) and the elastic modulus of trabecular bone (R(2) = 0.74-0.99)., Conclusions: The initial stability at the time of implant placement is influenced by both the cortical bone thickness and the strength of trabecular bone; however, these factors are mostly nonlinearly correlated with ITV, PTV, and ISQ. Using ITV and PTV seems more suitable for identifying the primary implant stability in osteoporotic bone with a thin cortex., (© 2011 Wiley Periodicals, Inc.)

Purpose: Bone stress and interfacial sliding at the bone-implant interface (BII) were analyzed in zirconia and titanium implants with various thread designs and interface conditions (bonded BII and contact BIIs with different frictional coefficients) for both conventional and immediately loaded treatments., Materials and Methods: A total of 18 finite element models comprising two implant materials (zirconia and titanium), three thread designs (different shapes and pitches), and three interface conditions (bonded and contact BIIs) were analyzed to assess the effects on bone stresses and on sliding at the BII. The material properties of the bone model were anisotropic, and a lateral force of 130 N was applied as the loading condition., Results: In the immediately loaded implant, the stress was highly concentrated at one site of the peri-implant bone. The peak bone stress was more than 20% lower in zirconia implants than in titanium implants for a bonded BII and 14% to 20% lower for a contact BII. The bone stresses did not differ significantly between implants with V-shaped threads and square threads. However, sliding at the BII was more than 25% lower with square-thread implants than with V-shaped-thread implants for titanium implants and 36% lower for zirconia implants. Reducing the thread size and pitch in cortical bone (via two V-shaped threads with different pitches) decreased the bone stress by 13%. Increasing the frictional coefficient reduced sliding at the BII in both zirconia and titanium implants., Conclusions: As an implant material, zirconia can reduce the bone stress in the crestal cortical region. Bone stress and sliding at the BII are heavily dependent on the thread design and the frictional coefficient at the BII of immediately loaded implants.

Objectives: The purpose of this study was to determine the correlation between the peak insertion torque value (ITV) of a dental implant and the bone-implant contact percentage (BIC%)., Material and Methods: Dental implants were inserted into specimens comprising a 2-mm-thick artificial cortical shell representing cortical bone and artificial foam bone representing cancellous bone with four densities (groups 1 to 4--0.32, 0.20, 0.16, and 0.12 g/cm(3)). Each specimen with an inserted implant was subjected to micro-computed tomography (micro-CT) scanning, from which the 3D BIC% values were calculated. Pearson's correlation coefficients (r) between the ITV and BIC% were calculated., Results: The ITVs in groups 1 to 4 were 56.2 ± 4.6 (mean±standard deviation), 45.6 ± 0.9, 43.3 ± 4.3, and 38.5 ± 3.4 N cm, respectively, and the corresponding BIC% values were 41.5 ± 0.5%, 39.0 ± 1.0%, 30.8 ± 1.1%, and 26.2 ± 1.6%. Pearson's correlation coefficient between the ITV and BIC% was r = 0.797 (P < 0.0001)., Conclusion: The initial implant stability, quantified as the ITV, was strongly positively correlated with the 3D BIC% obtained from micro-CT images., Clinical Relevance: The ITV of a dental implant can be used to predict the initial BIC%; this information may provide the clinician with important information on the optimal loading time.

Background: The aim of this study is to determine the effects of various designs of internal tapered abutment joints on the stress induced in peri-implant crestal bone by using the three-dimensional finite element method and statistical analyses., Methods: Thirty-six models with various internal tapered abutment-implant interface designs including different abutment diameters (3.0, 3.5, and 4.0 mm), connection depths (4, 6, and 8 mm), and tapers (2°, 4°, 6°, and 8°) were constructed. A force of 170 N was applied to the top surface of the abutment either vertically or 45° obliquely. The maximum von Mises bone-stress values in the crestal bone surrounding the implant were statistically analyzed using analysis of variance. In addition, patterns of bone stress around the implant were examined., Results: The results demonstrate that a smaller abutment diameter and a longer abutment connection significantly reduced the bone stresses (P <0.0001) in vertical and oblique loading conditions. Moreover, when the tapered abutment-implant interfaced connection was more parallel, bone stresses under vertical loading were less (P = 0.0002), whereas the abutment taper did not show significant effects on bone stresses under oblique loading (P = 0.83). Bone stresses were mainly influenced by the abutment diameter, followed by the abutment connection depth and the abutment taper., Conclusion: For an internal tapered abutment design, it was suggested that a narrower and deeper abutment-implant interface produced the biomechanical advantage of reducing the stress concentration in the crestal region around an implant.

Objectives: The aim of this study was to evaluate the effects of cortical bone thickness and trabecular bone elastic modulus on the strain in the bone surrounding an immediately loaded implant. We also examined the correlations between bone structure and the following indices of primary implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ)., Material and Methods: The ITV, PTV, and ISQ were measured in 24 artificial jaw bone models representing cortical bone with four thicknesses (0, 1, 2, and 3 mm) and trabecular bone with four elastic moduli (137, 47.5, 23, and 12.4 MPa). Two loading conditions were applied (force of 130 N applied vertically and at 45° laterally), and the strains in the crestal region were measured by rosette strain gauges with a data acquisition system., Results: When the cortical bone thickness and the elastic modulus of trabecular bone decreased, the bone strains increased by 10.3-52.1% and 39-73.1%, respectively, for vertical loading and by 35-62% and 42.4-56.2% for lateral loading. The cortical bone thickness has a stronger correlation (R(2) =0.95-0.71) with ITV, PTV, and ISQ than the elastic modulus of trabecular bone (R(2) =0.89-0.59)., Conclusions: The initial stability at the time of implant placement is influenced by both the cortical bone thickness and the elastic modulus of trabecular bone; however, these parameters are not totally linearly correlated with ITV, PTV, and ISQ. The placement of an immediately loaded implant in cases with thin cortical bone and/or weak trabecular bone can induce extreme bone strains and may increase the risk of implant failure., (© 2010 John Wiley & Sons A/S.)

Background: This study investigates the effect of depth of insertion in subcrestal cortical bone (SB) and thickness of connected cortical bone (CB) for a subcrestal implant placement on bone stress and strain using statistical analyses combined with experimental strain-gauge tests and numerical finite element (FE) simulations., Methods: Three experimental, artificial jawbone models and 72 FE models were prepared for evaluation of bone strain and stress around various equicrestal and subcrestal implants. For in vitro tests, rosette strain gauges were used with a data acquisition system to measure bone strain on the bucco-lingual side. The maximum von Mises stresses in the bone were statistically analyzed by analysis of variance for FE models., Results: The experimental bone strains reduced significantly (22% to 49%) as the thickness of CB increased. FE analyses indicated that the suggested CB thickness for efficiently minimizing bone stress was 0.5 to 2.5 mm. The results for the depth of SB were not absolute because obvious stress reductions only presented at a certain range of depth (0.6 to 1.2 mm)., Conclusion: Within the limitations of this study, increasing the thickness of CB and maintaining the depth of SB within a limited range can provide the benefit of decreasing the stress and strain in surrounding bone for subcrestally placed implants.

Purpose: Ideally, implants for dental prostheses should be placed parallel to each other. However, anatomic limitations sometimes make nonparallel implants necessary. The purpose of this study was to determine the bone stresses on implants tilted at various angles and to determine what arrangements might carry a higher risk of failure., Materials and Methods: Three-dimensional finite element models were constructed using the mean values measured for the Asian mandible in the first and second molar areas. Eight implants were divided into three tilting types: parallel implants (P1(PP), P2(MM), and P3(DD)), convergent implant apices (C1(PD) and C2(MP)), and divergent implant apices (D1(DP), D2(DM), and D3(PM)). A biting load of 200 N was applied vertically and obliquely on the occlusal central fossa of the splinted crowns. The main effects of each level of the three investigated factors (loading type, relationship of implant apices, and distal tilting of one or both implants) in terms of the stress values were computed for all models., Results: The loading type was the main factor affecting the stress in bone when comparing implant apices and distal tilting of the implant body. When loading was combined with distal tilting, the stress values were significantly increased, especially in models P3(DD) and C1(PD)., Conclusion: The loading type is the main factor affecting the stress distribution for different implantation arrangement. Moreover, placement of the implants with distal tilting should be avoided in the posterior mandible.

Purpose: The aim of this study was to evaluate the effects of cortical bone thickness and implant length on strain in the surrounding bone and micromotion at the bone-implant interface in single immediately loaded implants., Materials and Methods: Experiments with rapid prototyping technique and finite element simulations were performed to evaluate bone strain and micromotion at the bone-implant interface. Implants (13-mm long) were embedded into models with three thicknesses of cortical bone (0.5, 1.7, and 3.4 mm), and implants with different lengths (11.5 and 15.0 mm) were inserted into models with 1.7 mm of thickness of cortical bone. Vertical and lateral loads of 130 N were applied to the models., Results: On lateral loading, the strains were highly concentrated on one side of the mandible in both experimental and finite element models. Sliding and gap distances were reduced when the cortical bone was thicker and when the implant was longer., Conclusion: Placement of a longer implant into thicker cortical bone will result in reduced sliding and gap distances. However, bone strain is influenced more by the cortical bone thickness than by the implant length for single immediately loaded implants.

Experiment with rapid prototyping technique and validation finite element model was performed to evaluate the biomechanical behavior of an immediately loaded mandibular implant. Also, 18 finite element models of six implant designs and three surface roughnesses with anisotropic bone material properties were analyzed to compare the bone stresses and the sliding at the bone-implant interface under a vertical or lateral force of 130N. The results show that bone stress (strain) of an immediately loaded implant is heavily dependent on the implant design and surface roughness. Improving the initial interfacial interlocking using a threaded implant has a higher priority than using cylindrical or step designs with a rough surface for an immediately loaded implant., (2010. Published by Elsevier Ltd. All rights reserved.)

Background: Strain gauge analysis and finite element (FE) simulations were used to estimate the bone strain and micromovement at the bone-implant interface (BII) for platform switching and different diameters of a single, immediately loaded mandibular implant., Methods: Four models were created, including 5-mm-diameter implants assembled with abutments that were 5 or 4 mm in diameter on bonded (delay-loading treatment) and contact (immediate-loading treatment) BIIs; a model with an implant diameter of 3.75 mm was also analyzed. Vertical and lateral loads of 130 N were applied to all models., Results: During lateral loading, the strains were highly concentrated on one side of the mandible in the experimental and validation FE models. Bone strains were reduced by <10% when platform switching was used compared to no platform switching. However, increasing implant diameter decreased the surrounding bone strain significantly. The sliding and gap distances at the BII did not differ significantly among all models considered., Conclusions: Bone strain was reduced more by increasing the diameter of the implant than by using platform switching in the immediately loaded implant. However, neither a wide implant nor platform switching reduced micromotion at the BII for enhancing implant stability.

Purpose: The biomechanical effects of different strengths of grafted bone, bicortical anchorage, and dimensional alterations of a dental implant with maxillary sinus augmentation were investigated., Materials and Methods: Sixteen finite element (FE) models that included five implant lengths, two implant diameters, and grafted bone with two levels of stiffness were studied. A posterior maxillary model was constructed from computerized tomographic images of a human skull, and the implant models were created via computer-aided design software (SolidWorks 2006). All materials were assumed to be isotropic and linearly elastic. A 45-degree oblique force of 129 N was applied to the buccal cusp of the first molar., Results: The von Mises stress was highest in the 7-mm-long implant. Stresses in cortical and trabecular bone were reduced by at least 50% for all other implants (length greater than or equal to 8.5 mm) with bicortical anchorage. Increasing the length of the bicortically anchored implant did not decrease the stress in native bone, but it decreased the stress in sinus grafts by at least 20%. The use of a wide implant decreased the stress by 24% to 42% in cortical bone and 17% to 36% in trabecular bone. Increasing the elastic modulus of grafted bone decreased the stress in native bone by approximately 10%., Conclusions: Bicortical fixation of implants and the presence of grafted bone with greater stiffness reduced the stresses in native bone. Increasing the length of the implant in grafted bone did not reduce the stress in native bone, but it did reduce the stress in grafted bone. The effects of implant diameters on reducing bone stress are primarily a result of the increased contact area between implant and bone. The results of the FE analysis imply that the success of a sinus-augmented dental implant is heavily dependent on the implant design and rigidity of the bone grafts.

Objectives: This study investigated the surrounding bone stress and the implant-bone interfacial sliding of implant designs and implant sizes of immediately loaded implant with maxillary sinus augmentation by using three-dimensional (3D) non-linear finite element (FE) analysis., Methods: Twenty-four FE models including four implant designs (cylindrical, threaded, stepped and step-thread implants) and three implant dimensions (standard, long and wide threaded implants) with a bonded and three levels of frictional contact of implant-bone interfaces were analyzed. The maxillary model was constructed from computer tomography (CT) images of a human skull and all 3D implant models were created via the computer-aided design (CAD) software., Results: The use of threaded implants decreased the bone stress and sliding distance obviously about 30% as compared with non-threaded (cylindrical and stepped) implants. Increasing the implant's length or diameter reduced the bone stress by 13-26%. Employing a immediately loaded implant with smooth machine surface (mu=0.3, mu represents frictional coefficient) increased the bone stress by 28-63% as compared with the osseointegrated (bonded interfaces) implants. Roughening the implant surface (mu>0.3) did not reduced the bone stress, however it did decrease the interfacial sliding between implant and bone., Conclusions: For an immediately loaded implant placed with sinus augmentation, using threaded implant could decrease both the bone stress and implant-bone sliding distance which may improve the implant initial stability and long-term survival. Rough surface of implants shows no benefit to reduce the bone stress but they could lower the interfacial sliding. On the contrary, employing long or wide implants decrease the bone stress but they cannot diminish the interfacial sliding.

Clinically, many implant cases with different angulation over the lower posterior area have been found. The purpose of this study was to analyze the bony stress with different implant tilting during normal masticatory load using the finite element method (FEM), with the hope of discovering a desirable installation of implant. A three-dimensional finite element method was employed to analyze the bony stress generated by different angulation designs (15 degrees) of implant bodies. Eight solid models of the mandibular first and second molars were built up and then transferred to a mesh model in FEM (ANSYS) to perform a stress analysis. A simulated load (400 N) was applied to the splinted crowns with vertical and horizontal forces. The loading sites were on the central fossa of the splinted crowns. For stress distribution, some designs will be better than a parallel installation. The results suggested that not all implant bodies tilting with the splinted crowns lead to stress concentration.

Purpose: Stress analysis was performed for various implant designs using 3-dimensional finite element analysis approaches., Materials and Methods: Six implant designs were included: 3 parallel-sided implants (no thread, triangular thread, and squared thread), 2 stepped configurations (non-thread and triangular thread), and a tapered body of implant with squared thread. All threads had spiral characteristics. The mandibular model was constructed from computed tomographic (CT) images of a human mandible, and the material properties were anisotropic (different in different directions). A 100-N oblique force was applied at a 45-degree angle to the long axis of the implants at the buccal cusp as the loading condition., Results: Compared with cylindric implants, threaded implants (either triangular or squared) demonstrated increased peak stress at the crestal bone. The bone stress of stepped implants was decreased in the cortical region but was increased in the trabecular region. However, both threaded and stepped designs showed decreased interfacial stresses of bone near the valleys of the threaded and stepped areas. The tapered design decreased stresses by up to 32% in the cortical region and 17% in the trabecular region., Conclusions: Although threaded implants could not decrease the peak stress at the crestal bone, both threaded and stepped designs show an ability to dissipate the interfacial stresses of bone. The use of tapered implants could reduce peak stress in both cortical and trabecular bone.

Objectives: Three-dimensional finite element (FE) models of splinted prosthetic crowns were studied and stress analyses were evaluated with different types of implant support, including standard, wide or two implant(s) for partial, posterior edentulous restorations., Material and Methods: The FE models were constructed based on a cadaver mandible containing the 2nd premolar and the 1st molar. The crowns of these two teeth were modeled as connected and disconnected to mimic the splinted and non-splinted designs, respectively. One standard implant was placed at the premolar region, while three types of implant support, one at a time (the standard implant, wide implant and two implants), were used to support the molar crown. A 100 N oblique load was applied to the buccal cusp on each crown. The FE simulation was validated experimentally via strain gauge measurement., Results: The experimental data were well correlated with the FE predictions (r(2)=0.97). When compared with the standard implant used in the molar area, the wide implant and two implants reduced the peak stress in crestal bone by 29-37% for both splinted and non-splinted cases. Inserting the standard implant into both the premolar and molar area, the bone stresses were identical for splinted and non-splinted designs. However, splinting the adjacent crowns has shown to decrease the bone stresses at the premolar region by 25%, while the wide implant or two implants were placed at the molar region., Conclusion: The biomechanical advantages of using the wide implant or two implants are almost identical. The benefit of load sharing by the splinted crowns is notable only when the implants on the premolar and molar regions have different supporting ability.

This study reports a method for controlling loads on an in vivo dental implant and its application for the investigation of early loading versus delayed loading of dental implants. The method was developed for the purpose of studying an ongoing hypothesis that amounts to bone loss around dental implants are related to mechanical-mediated adaptation of the alveolar bone. Using a customized intra-oral hydraulic system, the daily loading over a dental implant has been completed and recorded for six Sinclair swine. Each pig had a 5-month duration implant loading. During the experiments (loading), no analgesic treatment was supplied. The mean of the in vivo daily loadings was confirmed through an in vitro bench test after each animal was euthanized. Variations of the averaged loading input among the six animals were smaller than 10%. Preliminary data produced by the model suggests that cervical bone loss is less for early loading than for delayed loading. The current system is expected to provide a useful load control model for the study of alveolar bone adaptation around dental implants in relation to various loadings.

Background: Dental cone beam computed tomography (CBCT) is commonly used to evaluate cancellous bone density before dental implant surgery. However, to our knowledge, no measurement approach has been standardized yet. This study aimed to evaluate the relationship between three different regions of interest (ROI) methods on cancellous bone density at the dental implant site using dental CBCT images. Methods: Patients' dental CBCT images (n = 300) obtained before dental implant surgery were processed using Mimics (Materialise, Leuven, Belgium). At the potential implant sites, the rectangle, cylinder, and surrounding cylinder ROI methods were used to measure bone density. Repeated measures one-way analysis of variance was performed to compare the three ROI methods in terms of measurement results. Pearson correlation analysis was performed to identify the likely pair-wise correlations between the three ROI methods. Results: The density value obtained using the surrounding cylinder approach (grayscale value [GV],523.56 ± 228.03) was significantly higher than the values obtained using the rectangle (GV, 497.04 ± 236.69) and cylinder (GV,493 ± 231.19) ROI methods in terms of results. Furthermore, significant correlations were noted between the ROI methods (r > 0.965; p < 0.001). Conclusions: The density measured using the surrounding cylinder method was the highest. The choice of method may not influence the trends of measurement results. Trial registration: This study was approved by the Institutional Review Board of China Medical University Hospital, No. CMUH111-REC3-205. Informed consent was waived by the Institutional Review Board of China Medical University Hospital, CMUH111-REC3-205, owing to the retrospective nature of the study. [ABSTRACT FROM AUTHOR]

Few studies have investigated the effects of abutment screw diameter in the stress of dental implants and alveolar bones under occlusal forces. In this study, we investigated how variations in implant diameter, abutment screw diameter, and bone condition affect stresses in the abutment screw, implant, and surrounding bone. Three-dimensional finite element (FE) models were fabricated for dental implants with external hex-type abutments measuring 4 and 5 mm in diameter. The models also included abutment screws measuring 2.0 and 2.5 mm in diameter. Each implant model was integrated with the mandibular bone comprising the cortical bone and four types of cancellous bone. In total, 12 finite element models were generated, subjected to three different occlusal forces, and analyzed using FE software to investigate the stress distribution of dental implant and alveolar bone. Wider implants demonstrated lower stresses in implant and bone compared with standard-diameter implants. The quality of cancellous bone has a minimal impact on the stress values of the implant, abutment screw, and cortical bone. Regardless of occlusal arrangement or quality of cancellous bone, a consistent pattern emerged: larger abutment screw diameters led to increased stress levels on the screws, while the stress levels in both cortical and cancellous bone showed comparatively minor fluctuations. Wider implants tend to have better stress distribution than standard-diameter implants. The potential advantage of augmenting the abutment screw diameter is unfavorable. It may result in elevated stresses in the implant system. [ABSTRACT FROM AUTHOR]

Dental implants are a mainstream solution for missing teeth. For the improvement of dental implant surface treatment and design, short dental implants have become an alternative to various complex bone augmentation procedures, especially those performed at the posterior region of both the maxilla and mandible. The objective of this study was to evaluate the effect of various insertion methods on the primary stability of short dental implants. Commercial dental implants were inserted into artificial mandibular bone specimens using various insertion methods (equicrestal position, subcrestal position 1.5 mm, and lateral cortical anchorage) in accordance with an implant surgical guide. Insertion torque value (ITV) curves were recorded while implant procedures were performed. Both maximum ITVs (MITVs) and final ITVs (FITVs) were evaluated. Subsequently, Periotest values (PTVs) and implant stability quotients (ISQs) were measured for all specimens. A Kruskal–Wallis test was conducted to analyze the results for four primary stability parameters, and the Dunn test was used for a post hoc pairwise comparison when a difference was identified. For all groups, their mean MITVs ranged from 33.6 to 59.4 N cm, whereas their mean FITVs ranged from 17.5 to 43.5 N cm. Insertion torque value, ISQ, and PTV decreased significantly when implants were inserted into subcrestal positions. When implants were inserted in the lateral bicortical position, the four aforementioned parameters yielded greater values. When 6-mm short implants were inserted in a lateral cortical anchorage position, high primary stability was yielded. [ABSTRACT FROM AUTHOR]

Residual alveolar ridge resorption often occurs after tooth extraction, which causes issues requiring further prothesis rehabilitation. A treatment concept referred to as all-on-four, involving fixed dentures supported with four implants, was recently developed. The current study aimed to determine the effect of changing bone atrophy and implant length in all-on-four treatments on stress and strain in the surrounding bone of the implant. A three-dimensional finite element method was used in this research. The stress analysis was conducted with von Mises stress values. Two types of synthetic jawbone models with mild and moderate atrophy were used. Furthermore, two different implant lengths with a similar implant design and diameter were selected, and they were classified into eight models. Then, the bone model was assessed via a computed tomography (CT) scan and was transformed into a virtual model in Geomagic and SolidWorks with implant rebuilding. After modifying bone atrophy, the von Mises stresses in the surrounding bone of the implant were as follows: mild type 2 < mild type 3 < moderate type 3 < moderate type 4. The bone quantity change rate increased more than when bone conditions were limited. Compared with changes in implant lengths, the stresses in the peri-implant surrounding bone were generally higher in the 9 mm implant length group than in the 11.5 mm group. However, the results did not significantly differ. In conclusion, the von Mises stress and strain increased in the models with moderate atrophy and low-density trabecular bone. Hence, bone atrophy and its presurgical diagnosis in long-term implant prognosis are crucial. [ABSTRACT FROM AUTHOR]

Dental implant surgery involves the insertion of a dental implant into the alveolar bone; the success of the surgery depends on the initial stability of the implant. The objective of this study was to examine the effects of dental implant insertion approaches in clinical surgery and in accordance with the standards of American Society for Testing and Materials on initial implant stability. Three insertion approaches were used for dental implant placement (Branemark Systems NobelSpeedy Groovy, Nobel Biocare AB, Gothenburg, Sweden) in two types of artificial bone—good bone (GB) and poor bone (PB). The three insertion approaches were as follows: (1) continuous rotation insertion (CRI): using a torque testing machine to continuously screw in an implant to completion and (2 and 3) intermittent rotation insertion (IRI)_90 and IRI_80: using CRI to bury an implant to 90% and 80% of its full length followed by IRI to complete the implantation, respectively. The maximum insertion torque value (ITV), periotest value (PTV), and implant stability quotient (ISQ) were measured and compared. The results indicated that bone quality and insertion approach both affected implant stability. Insertion approaches affected all three implant stability indicators differently in the GB and PB groups (p = 0.008). In GB groups, the insertion approach primarily affected ITV, whereas in PB groups, it primarily affected PTV. The effect of the insertion approach was less apparent for ISQ. Overall, in both the GB and PB groups, the implant stability for IRI_80 was greater than that for IRI_90, and the implant stability for IRI_90 was greater than that for CRI. Future in vitro studies should adopt an insertion approach that complies with the clinical practice for dental implant surgery. Dentists should adjust the timing for IRI in dental implant surgery to achieve greater initial dental implant stability. [ABSTRACT FROM AUTHOR]

Background/purpose: Impact of the implant shape on the biomechanical performance of all-on-four treatment of dental implant is still unclear. This study evaluated the all-on-four treatment with four osseointegrated implants in terms of the biomechanical effects of implant design and loading position on the implant and surrounding bone by using both in vitro strain gauge tests and three-dimensional (3D) finite element (FE) analyses.Methods: Both in vitro and 3D FE models were constructed with placing NobelSpeedy and NobelActive implants as well as a titanium framework in an edentulous jawbone based on the concept of all-on-four treatment. Three types of loads were applied: at the central incisor area (loading position 1) and at the molar regions with (loading position 2) and without (loading position 3) the denture cantilever. For the in vitro tests, the principal bone strains were recorded by rosette strain gauges and statistically evaluated using Wilcoxon's rank-sum test. The 3D FE simulations analyzed the peak von-Mises stresses in the implant and surrounding cortical bone.Results: The peak stress and strain in the surrounding bone were typically 36-62% (3D FE analysis) and 47-57% (in vitro test) (p < 0.001)higher for loading position 3 than for loading positions 1 and 2. Between those two implant designs, the bone strains and bone stresses did not differ significantly.Conclusion: For all-on-four treatment with four osseointegrated dental implants, altering the implant design does not appear to affect the biomechanical performance of the entire treatment, especially in terms of the stresses and strains in the surrounding bone. [ABSTRACT FROM AUTHOR]

Dental implants designed with platform switching have been used clinically to reduce crestal bone resorption. The aim of this study was to determine the biomechanical effects of loading types, diameter of platform, and implant diameter in bone strain around immediately loaded implants with platform switching concept. Platform-switching features of dental implants with various diameters of implant body and implant platform (named as RP5.0, RP4.3, and NP3.5) were inserted into artificial bone blocks. The initial implant stability was confirmed using a Periotest device before the loading test. Rosette strain gauges were placed on the alveolar region around the implants, and peak values of the bone strain during a 190-N vertical load or 30-degree lateral load were measured by a data acquisition system. The Kruskal-Wallis test and post-hoc pairwise comparisons were performed as statistical analyses. The median Periotest values of the RP5.0, RP4.3, and NP3.5 implants ranged from −6.59 to −7.34. The RP5.0 implant always showed the lowest bone strain around the implant, regardless of whether a vertical or lateral load was applied. Relative to the RP4.3 and NP3.5 implants, the RP4.3 implant produced a higher bone strain (by approximately 8%) under a vertical load but a lower bone strain (by approximately 25%) under a lateral load. This study confirmed that using a wider implant could relieve the bone strain around an immediately loaded implant with platform switching concept especially under lateral loading. [ABSTRACT FROM AUTHOR]

The surface characteristics of biomaterials play an important role in their interaction with biological systems. Tantalum (Ta) oxides and their coatings have been proved to increase their applications in the biomedical fields such as medical devices and dental implants by improving their osseointegration and corrosion resistance. In this study, Ta and amorphous tantalum oxide coatings were deposited by using magnetron sputtering. A hydrophilic crystalline β-Ta 2 O 5 coating was obtained by rapid thermal annealing of the deposited tantalum oxide coating at 700 °C. In this study, Staphylococcus aureus and Actinobacillus actinomycetemcomitans ( A. actinomycetemcomitans ) are Gram-positive and Gram-negative bacteria, respectively, that exhibit physiological commensalism on the human skin and oral areas. Both bacteria were chosen as the model for in vitro anti-bacterial analyses by a fluorescence staining method employing Syto9. The cytocompatibility of human skin fibroblast cells (CCD-966SK) on the coatings was also determined using an MTT assay. It showed that the amorphous tantalum oxide coatings possessed good antibacterial performance, while the hydrophilic crystalline tantalum oxide coatings exhibited outperformed human skin fibroblast cellular biocompatibility. [ABSTRACT FROM AUTHOR]

Objective: Small-diameter implants have been available since the 1990s, but few studies have analyzed their mechanical properties. This study evaluated the effects of the implant material and the implant-abutment connection designs on the primary stability and the marginal bone strain of small-diameter implant subject to immediate loading. Materials and methods: Insertion torque value (ITV), implant stability quotient (ISQ), and Periotest value (PTV) of three implant systems with four parameters (titanium, titanium alloy, internal and external hexagon connections) were measured after placing implants into artificial type 2 jaw-bone models. Specimens were tested under both vertical and oblique static loads at 190 N. Peak values of the principal bone strain were recorded and analyzed statistically by the Kruskal-Wallis test and multiple-comparisons Bonferroni test. Results: PTV and ISQ were higher for the NIOSM311 (internal-hex and Ti alloy) and FOSM311 (external-hex and pure Ti) implants, respectively, than for the NOSM311 (external-hex and Ti alloy) implant. Under vertical loading the peak value of peri-implant bone strains did not differ significantly among these three implant systems. However, the peak bone strains were at least 32 % lower for the NIOSM311 and FOSM311 implants than for the NOSM311 implant under lateral loading. Conclusions: The implant material and the implant-abutment connection design significantly influence the peri-implant bone strain of immediately loaded small-diameter implants, but barely affect their primary stability. Clinical Relevance: A commercially pure titanium implant with an internal connection has the potential to reduce the risk of implant failure of small-diameter implant related to biomechanical complications. [ABSTRACT FROM AUTHOR]

Abstract: Bacterial adhesion and colonization are considered to play key roles in the pathogenesis of peri-implant disease, which is an inflammatory process leading the destruction of both soft and hard tissue around a Titanium (Ti) implant. The osseointegration of Ti implants is influenced by their composition and surface treatment. Zirconia (ZrO2) coatings have been shown to improve implant osseointegration in various biomedical fields, including orthopedic devices and dental implants. This study used a twin-gun magnetron sputtering system to deposit ZrO2–Sliver (Ag) and ZrO2–Copper (Cu) coatings on biograde pure-Ti implant materials. The effects of Ag and Cu on the antibacterial properties of the coated Ti samples were investigated using Staphylococcus aureus (S. aureus) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), which are found frequently in implant-associated infections. The in vitro antibacterial analyses employed a fluorescence staining method using SYTO9 and bacterial-viability tests on agar plates. Incorporating Ag and Cu into ZrO2 changed the structure of crystalline ZrO2, and the nanostructures of the resulting ZrO2–Ag and ZrO2–Cu coatings were found to be correlated with the antibacterial performance. The adherence of S. aureus and A. actinomycetemcomitans was less for ZrO2 samples with a small doping of Cu than for uncoated Ti. The ZrO2–Ag coating with an Ag content of 10.6at.%, which showed hydrophobicity, exhibited the lowest bacterial retention and viability of S. aureus and A. actinomycetemcomitans. The results suggest that ZrO2–Ag and ZrO2–Cu coatings improve the antibacterial performance relative to pure-Ti implant materials. [Copyright &y& Elsevier]

Titanium (Ti)-based materials are widely used in biomedical implant components and are applied successfully in various types of bone-anchored reconstructions. However, in dental implants the Ti materials contact not only bone but also gingival tissues, and are partially exposed to the oral cavity that includes bacteria. This study used titania and silver (TiO/Ag) compound coatings and zinc oxide (ZnO) films to enhance the antibacterial activity of the Ti-based implant. The hydrophobicity of each sample was examined by measuring the contact angle. Streptococcus mutans and human gingival fibroblast (HGF) was cultured on the coated samples, and the antibacterial effects and cell compatibility were determined using a Syto9 fluorescence staining and MTT methods. For the TiO/Ag samples, depositing Ag on the plate at a higher power (which increased the proportion of Ag) increased the contact angle and the hydrophobicity. The bacterial count was lowest for the 50 W TiO/Ag sample, which contained 5.9% Ag. The contact angles of the ZnO samples did not show the same tendency. The antibacterial effect was higher on ZnO-coated samples since bacterial count was threefold lower on ZnO samples as compared to control samples (Ti plate). From the MTT assay test, the mean optical density values for TiO/Ag-coated samples after 72 h of HGF adhesion were similar to the value obtained from the uncoated Ti. However, biocompatibility was lower on ZnO films than in control samples. Conclusively, the antibacterial activity was higher but the cell compatibility was lower on ZnO films than on TiO/Ag coatings. [ABSTRACT FROM AUTHOR]

Abstract: Titanium-based materials have been used for dental implants due to their excellent biological compatibility, superior mechanical strength and high corrosion resistance. The osseointegration of titanium dental implants is related to their composition and surface treatment. A better anti-bacterial performance of the abutment seated in the prosthetic crown is beneficial for the osseointegration and for avoiding the infection after implantation surgery. In this study, TaN-Ag coatings with different Ag contents were deposited on a bio-grade pure Ti dental implant material. A twin-gun magnetron sputtering system was used for the deposition of TaN-Ag coatings. The Ag content in the deposited coatings was controlled by the magnetron power ratio of Ag/(Ta+Ag) targets. To verify the susceptibility of implant surface to bacterial adhesion, Staphylococcus aureus, one of the major pathogen frequently found in the implant-associated infections, was chosen for in vitro anti-bacterial analyses. In addition, the biocompatibility of human gingival fibroblast (HGF) cells on coatings was also evaluated. A composite structure of crystalline TaN and Ag nanoparticles was identified. The TaN-Ag coating with the highest Ag content of 21.4at.% possessed the lowest bacterial retention and viability of S. aureus. From the MTT assay test, the mean optical density values for the TaN and TaN-Ag coated samples after 72h of HGF adhesion were greater than the value obtained from the uncoated Ti. The results suggested that the TaN-Ag coatings improve antibacterial performance with compatible biological response. [ABSTRACT FROM AUTHOR]

Dental implant surgery is a common treatment for missing teeth. Its survival rate is considerably affected by host bone quality and quantity, which is often assessed prior to surgery through dental cone-beam computed tomography (CBCT). Dental CBCT was used in this study to evaluate dental implant sites for (1) differences in and (2) correlations between cancellous bone density and cortical bone thickness among four regions of the jawbone. In total, 315 dental implant sites (39 in the anterior mandible, 42 in the anterior maxilla, 107 in the posterior mandible, and 127 in the posterior maxilla) were identified in dental CBCT images from 128 patients. All CBCT images were loaded into Mimics 15.0 to measure cancellous bone density (unit: grayscale value (GV) and cortical bone thickness (unit: mm)). Differences among the four regions of the jawbone were evaluated using one-way analysis of variance and Scheffe's posttest. Pearson coefficients for correlations between cancellous bone density and cortical bone thickness were also calculated for the four jawbone regions. The results revealed that the mean cancellous bone density was highest in the anterior mandible (722 ± 227 GV), followed by the anterior maxilla (542 ± 208 GV), posterior mandible (535 ± 206 GV), and posterior maxilla (388 ± 206 GV). Cortical bone thickness was highest in the posterior mandible (1.15 ± 0.42 mm), followed by the anterior mandible (1.01 ± 0.32 mm), anterior maxilla (0.89 ± 0.26 mm), and posterior maxilla (0.72 ± 0.19 mm). In the whole jawbone, a weak correlation (r = 0.133, p = 0.041) was detected between cancellous bone density and cortical bone thickness. Furthermore, except for the anterior maxilla (r = 0.306, p = 0.048), no correlation between the two bone parameters was observed (all p > 0.05). Cancellous bone density and cortical bone thickness varies by implant site in the four regions of the jawbone. The cortical and cancellous bone of a jawbone dental implant site should be evaluated individually before surgery. [ABSTRACT FROM AUTHOR]

In finite element (FE) simulations, the peak bone stresses were higher when loading with a cantilever extension (CE) than when loading without a CE by 33–49% in the cortical bone. In the in vitro experiments, the highest values of principal strain were all within the range of the minimum principal strain, and those peak bone strains were 40–58% greater when loading with a CE than when loading without a CE (p < 0.001). This study investigated how varying the implanted position and angulation of anterior implants in the All-on-Four treatment influenced the biomechanical environment in the alveolar bone around the dental implants. Ten numerical simulations of FE models and three in vitro samples of All-on-Four treatment of dental implants were created to investigate the effects of altering the implanted position and angulation type of anterior implants. A single load of 100 N was applied in the molar region in the presence or absence of a CE of the denture. The 3D FE simulations analyzed the von-Mises stresses in the surrounding cortical bone and trabecular bone. For the in vitro tests, the principal bone strains were recorded by rosette strain gauges and statistically evaluated using the Mann–Whitney U test and the Kruskal–Wallis test. Loading in the presence of a CE of the denture induced the highest bone stress and strain, which were 53–97% greater in the FE simulation and 68–140% in the in vitro experiments (p < 0.008) than when loading without a CE. The bone stresses in the FE models of various implanted positions and angulation types of anterior implants were similar to those in the model of a typical All-on-Four treatment. In vitro tests revealed that the bone strains were significantly higher in the samples with various angulation types of anterior implants (p < 0.008). In the All-on-Four treatment of dental implants, the bone stress and strain were higher when the load was applied to the CE of dentures. Altering the position or angulation of the anterior dental implant in the All-on-Four treatment has no benefit in relieving the stress and strain of the bone around the dental implant. [ABSTRACT FROM AUTHOR]

Abstract: Titanium (Ti)-based materials have been used for dental/orthopedic implants due to their excellent biological compatibility, superior mechanical strength and high corrosion resistance. The osseointegration of Ti implants is related to their composition and surface treatment. Better biocompatibility and anti-bacterial performances of Ti implant are beneficial for the osseointegration and for avoiding the infection after implantation surgery. In this study, nanocomposite ZrCN/amorphous carbon (a-C) coatings with different carbon contents were deposited on a bio-grade pure Ti implant material. A cathodic-arc evaporation system with plasma enhanced duct equipment was used for the deposition of ZrCN/a-C coatings. Reactive gas (N2) and C2H2 activated by the zirconium plasma in the evaporation process were used to deposit the ZrCN/a-C coatings. To verify the susceptibility of implant surface to bacterial adhesion, Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), one of the major pathogen frequently found in the dental implant-associated infections, was chosen for in vitro anti-bacterial analyses. In addition, the biocompatibility of human gingival fibroblast (HGF) cells on coatings was also evaluated by a cell proliferation assay. The results suggested that the ZrCN/a-C coatings with carbon content higher than 12.7at.% can improve antibacterial performance with excellent HGF cell compatibility as well. [Copyright &y& Elsevier]