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Purpose: The purpose of this study was to evaluate the radiographic bone level and stability changes around early loaded chemically modified sandblasted and acid-etched implants with and without a machined collar. Materials and Methods: Seventy-two chemically modified sandblasted and acid-etched implants 4.1 mm in diameter and 8 mm in length were placed in six dogs. Thirty-six implants had no machined collar (NMC) and 36 had a 2.8-mm machined collar (MC). Resonance frequency measurements were obtained at placement and weekly for 3 weeks. All implants were loaded 21 days after surgery. Standardized periapical radiographs were obtained at baseline, at 3 weeks, and at 3, 6, 9, and 12 months. The radiographs were randomized and digitized, and linear measurements of the distance from the first bone-to-implant contact to the shoulder of the implant were performed at the mesial and distal aspects of each implant. For statistical analysis, mixed-model repeated-measures analysis of variance was used. Results: All implants achieved hard and soft tissue integration clinically and radiographically and were clinically immobile. From placement to week 3, the mean implant stability increased for MC implants by more than 5 ISQs and for NMC implants by more than 7 ISQs. Radiographically, there were significant differences between treatment groups beginning at 3 months. After 12 months of loading, the MC implants presented a mean bone loss of 1.00 mm and the NMC implants presented a mean bone gain of 0.11 mm. Conclusions: Chemically modified sandblasted and acid-etched implants without a machined collar presented bone gain, and implants with a machined collar showed bone loss after a 1 year following early (21-day) loading. The tendency toward a coronal apposition of bone observed under these conditions may be attributed to the osteoconductive properties of the chemically modified surfaces of these implants and to the absence of the machined collar. Int J Oral Maxillofac Implants 2010;25:548-557. [ABSTRACT FROM AUTHOR]

Purpose: Recent research has demonstrated that modification of implant surface chemistry can influence osseointegration events, leading to increased bone-to-implant contact at earlier times. Clinical studies have been initiated to investigate the potential of modified surfaces to reduce the needed healing period between surgery and prosthesis insertion. The purpose of this prospective clinical study was to evaluate the clinical outcome after 3 weeks of loading single implants with hydrophilic surfaces in the maxillary molar areas. MaterIals and Methods: This prospective two-center clinical trial consecutively included healthy patients who needed an implant in the maxillary molar areas. Drilling was limited to the minimum, most of the site preparation was produced with osteotomes, and screw tapping was never performed. Abutment connection was carried out at 15 Ncm, at 21 (± 2) days after surgery, and provisional restorations were fabricated in occlusion. Further abutment tightening at 35 Ncm was performed after 4 to 6 additional weeks, for the definitive restoration. Results: Thirty-five patients were treated. No major adverse events were registered during and/or after surgery. Primary stability was always achieved. At abutment connection, six of the 35 patients reported minor pain, and placement of provisional restorations was postponed for 4 additional weeks. Clinical and radiographic measures were taken at baseline (abutment connection) and at the 1-year follow-up appointment. No patients dropped out, and no implant losses were registered during the first 12 months of observation. No significant differences between baseline and the 1-year examination were recorded for any outcome measure. Conclusions: These results suggest that, by means of the surgical and restorative technique presented, surface-modified hydrophilic implants are suitable for loading at 3 weeks in maxillary molar areas. [ABSTRACT FROM AUTHOR]

The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns. A series of 22 cases with a 12-month follow-up is presented. Twenty-two patients (15 women and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical or horizontal root fracture, caries, endodontic lesions, or periodontal disease were treated with immediate postextraction implant placement. The implant was then restored with a screw-retained prosthetic restoration within 24 hours. Radiographic assessments were made at baseline and 12 months after implant placement. Clinical parameters, such as plaque score, mucositis score, probing attachment level, mucosal margin position, variation of gingival level, and variation of papilla position, were also measured at baseline and after 12 months of follow-up. At 12 months, no implants had failed. Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline. The mean variation of gingival level, compared to the neighboring teeth, was -0.75 mm. Probing attachment levels were 0.79, 0.45, and 0.54 mm at proximal, buccal, and lingual sites, respectively. The values for the mucosal margin position were 2.9, 2.2, and 2.4 mm at proximal, buccal, and lingual sites, respectively. Regarding variation of papilla position, according to Jemt's index, 27 papillae presented with a score of 2 (61%) and 17 with a score of 3 (39%). An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13%. Furthermore, mucositis (score 2) was not observed at any of the peri-implant units. Primary implant stability did not significantly increase over time. The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure. The success rate and radiographic and clinical results were comparable to those obtained following the standard protocol. Within the limits of the present investigation, immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth. However, long-term clinical trials are needed to confirm the present results. [ABSTRACT FROM AUTHOR]

Abutment screw loosening is the most common complication in single implant-supported crowns, typically remedied by simply reattaching the restoration, preferably using a new abutment screw. The internal aspect of the implant along with any other components should be decontaminated before reconnection. This clinical report provides information on the appropriate management of the decontamination process, as well as evidence of the foreign material found within the implant body., (Copyright © 2024 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Peri-implantitis is a growing concern and currently, there is no agreement on the best method for treating this condition. This study looked at surgical intervention with the use of enamel matrix derivative (EMD) for treating this condition. A cohort of 25 (34 implants) consecutive patients treated with EMD for peri-implantitis was followed for up to 6.4 years. The survival of the implants as well as changes in clinical parameters are reported. Statistical analysis was performed using paired t tests and general estimating equations. The mean length of time implants were followed post-surgery was 3.05 ± 1.53 years. All but two of the treated implants survived in function (94%). Both failed implants were lost in the same patient, who was a heavy smoker. The changes in mean probing depth (1.94 ± 1.18 mm), change in deepest probing depth (3.12 ± 1.45 mm), and reduction in bleeding on probing (73.6 ± 43.9%) according to patient means were all highly significant ( p < 0.001 for all changes). When EMD is used during surgical treatment of peri-implantitis, there is a high survival rate of implants and significant improvements in clinical parameters.

Implant bone loss and implant failure are growing concerns. In some cases, a possible factor leading to bone loss may be an allergy to titanium (Ti). In this report, the existing literature on Ti allergy as a factor in implant loss is reviewed, and the current views on its potential role in implant bone loss are discussed. A case report of implant loss and retreatment in a patient with a potential Ti allergy or intolerance is presented and clinically analyzed. The subsequent success of a ceramic implant may support the finding of a Ti allergy or intolerance. Unfortunately, the lack of prospective clinical trials and lack of a reliable test for Ti allergy makes it impossible to clinically verify whether Ti allergy plays a part in implant bone loss.

Objective: Multiple implantations of the implant healing abutment (IHA) could adversely impact its surface properties in vivo. Furthermore, the effect of sterilization and reuse of the IHA on soft tissue viability and bacterial contamination has not been extensively studied. The goal of this study was to perform an in vitro analysis of mammalian cell viability and bacterial adhesion on the surfaces of retrieved IHA after single and multiple implantations and repetitive cycles of sterilization., Materials and Methods: IHA surface morphology was studied using optical microscopy. Cell viability of gingival fibroblasts (HGF-1) and oral keratinocytes (HOKg) in indirect contact with IHAs was assessed for 3 and 7 days. Immersion in bacterial culture was performed with a polyculture of Streptococcus species for 3 days and Streptococcus species with Fusobacterium nucleatum for 7 days., Results: IHAs exhibited signs of surface damage even after a single exposure to the oral cavity. Fibroblasts did not show a significant preference towards control IHAs over used IHAs, whereas keratinocytes exhibited a significant decrease in viability when exposed to IHAs after multiple implantation cycles as compared with controls. Adherent bacterial count increased with increasing number of IHA implantations for both polycultures., Conclusions: Reusing of IHAs in vivo promoted surface degradation in addition to adversely impacting host cell viability and oral bacterial attachment in vitro. These findings show IHA reuse might potentially affect its clinical performance., Clinical Relevance: Careful consideration should be taken when reusing IHAs in patients because this practice can result in permanent surface changes that might affect soft tissue integration during the healing period and promote bacterial colonization.

Most would agree that the etiology of dental implant failure is related to oral biofilm. At present one group of scientists and clinicians feel that biofilm is solely responsible for bone loss around the devices. However, there is strong evidence that particles and ions of titanium released into the surrounding tissues by the action of biofilm and/or mechanical forces, a process termed metallosis, can be responsible for bone loss around some dental implants. These findings are reinforced by similar responses found around failed metal on metal joint prostheses. Both possible etiologies are discussed in detail in this commentary., (© 2020 American Academy of Periodontology.)

Background: During videoscope-assisted minimally invasive surgery which uses a high magnification videoscope to treat periodontal defects, small areas resembling calculus are detected remaining on root surfaces following scaling. These are clinically termed microislands of calculus, which are removed by the use of a chelating agent. This material has not been verified as calculus and the ability of a chelating agent to remove calculus has not been proven. The purpose of this ex vivo study is to verify if the material is calculus and to determine if calculus is removed with a chelating agent., Methods: Extracted teeth (n = 22) with heavy calculus on root surfaces were selected. A 5-mm 2 area containing calculus was scribed on each root. Digital videoscope images were made of the marked areas using only white light and also with only a 655-nm diode laser that causes calculus to fluoresce. The marked areas were root planed until no calculus was visible with 3.5× surgical loupes. Digital images were again made. The test area was then burnished with a chelating agent (EDTA) for 30 seconds and images again made. Using the images, the percentage of the marked root surface containing calculus was calculated., Results: Calculus remained on the roots surfaces after they were judged to be clean using 3.5× loupe magnification. Remaining calculus was reduced after burnishing for 30 seconds with EDTA., Conclusions: Calculus remains on root surfaces judged to be calculus free using surgical loupes for visualization. Small areas of calculus are reduced or eliminated with a chelating agent., (© 2020 American Academy of Periodontology.)

Objective: Very few studies have investigated dental implant components involved in the early stage of healing, especially the implant healing abutment (IHA), despite its vital role in soft tissue contouring and shaping after implant placement. Although these components are labelled by the manufacturer for "single-use only," it is a common clinical practice to clean, sterilize, and reuse them., Methods: In the present study, IHAs after single and multiple implantations were retrieved as per standard procedures, and biological material isolated from the surface was subjected to 16S rRNA sequence analysis. The microbiome analysis was followed by cleaning and sterilization in order to replicate clinical sterilization techniques. Following sterilization, retrievals were subjected to surface characterization with optical and scanning electron microscopy to investigate surface features, and electrochemical testing was performed to evaluate corrosion behavior., Results: The microbiota was comprised of early colonizers including Streptococcus species and secondary anaerobic colonizers such as Fusobacterium, Capnocytophaga, and Prevotella species. The surface analysis revealed that irrespective of the cleaning and sterilization techniques, the pristine, homogeneous surface of the new, unused IHAs could not be restored. Both single and multiple-use IHAs had severe surface changes including discoloration, major abrasions, biological contamination, and the IHA retrievals exhibited higher corrosion rate as compared to control specimens., Significance: Reusing IHAs multiple times may not be a prudent practice as the microbial colonization and surface changes caused by using this component multiple times may affect the performance of IHAs in soft tissue healing., (Copyright © 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

Background: There is growing concern that titanium particles may play a role in peri-implant breakdown. Ultrasonic scalers are routinely used in the debridement of peri-implant lesions. This in vitro study is designed to evaluate if titanium particles are produced when an ultrasonic scaler is used on an implant., Methods: New sandblasted, large grit, acid etched (SLA) coated implants were subjected to ultrasonic scaling with stainless steel, titanium, and PEEK plastic tips. The implants were placed in a holding device and the ultrasonic scaler was positioned on the SLA surface under 25 grams of pressure. The implants were subjected to 30 scaling motions. The ultrasonic coolant water was collected and the number of metallic particles were counted under a light microscope. The particles were confirmed to be titanium via elemental analysis. The implants were visually evaluated for damage to the SLA coating., Results: No metallic particles were detected in the water supplied to the ultrasonic scalers (passive control). Metallic particles were detected when implants were subjected to the ultrasonic coolant water only without the scaler tip touching the implant (active control). All implants that were scaled produced metallic particles and showed easily detectable damage to the SLA layer., Conclusions: All ultrasonic scaling caused the production of titanium particles and caused damage to the SLA coating of the implant. Ultrasonic scalers should be used with great caution in the treatment of peri-implant conditions and care should be taken to not touch the SLA surface of the implant., (© 2018 American Academy of Periodontology.)

Background: Titanium (Ti) dominates as the material of choice for dental implant systems. Recently, titanium-zirconium alloy (TiZr) and zirconia (ZrO ₂ ) have emerged as alternative materials due to higher mechanical strength and lower corrosion susceptibility. Oral pathogenic bacteria can colonize Ti surfaces, leading to surface degradation, which has yet to be investigated on TiZr and ZrO 2 . The aim of this study was to compare in vitro oral bacterial adhesion and subsequent surface degradation on commercial Ti, TiZr, and ZrO 2 implants., Methods: Ti, TiZr, and ZrO 2 implants with sandblasted, acid-etched (SLA) surfaces in addition to modified SLA-treated (modSLA) Ti implants (n = 3) were immersed for 30 consecutive days in Streptococcus polyculture. Post-immersion, adherent bacterial count was quantified. Optical microscopy was used to assess qualitative degradation and score Ti-based implants based on degree of surface damage while electrochemical testing quantified corrosion behavior. Analysis of variance followed by post-hoc Tukey test was used to statistically compare quantitative results (α = 0.05)., Results: Ti-SLA, Ti-modSLA, and TiZr-SLA implants exhibited localized features characteristic of corrosion attack while ZrO 2 -SLA implants experienced minimal changes in surface morphology as compared to non-immersed control. Corrosion features were more numerous on Ti-modSLA implants but smaller in size as compared with those on Ti-SLA and TiZr-SLA implants. No significant differences in corrosion resistance (polarization resistance and corrosion rate) were observed between Ti-SLA, Ti-modSLA, and TiZr-SLA implants., Conclusion: TiZr and ZrO 2 dental implant surfaces were not more susceptible to colonization and surface degradation by oral Streptococcus species than commercially pure Ti implants., (© 2018 American Academy of Periodontology.)

Objective: Oral bacteria and periodontal pathogen have been predominantly linked with early- and late- stage failures of titanium (Ti) dental implants (DI) respectively. This study is based on the hypothesis that bacterial colonization can damage the surface oxide (TiO 2 ) layer. Early-failed DI were compared with DI post-in vitro immersion in early colonizing oral bacteria; late failed DI were weighed against DI immersed in late colonizing anaerobic pathogens., Methods: Retrieval analysis: Seven early- stage failed implants with five of them connected to healing abutments (HAs), and ten late- stage failed retrievals were subjected to surface analysis. Bacteria immersion test: Three dental implants each were immersed in polycultures containing (i) early colonizers (Streptococcus mutans, S. salivarius, S. sanguinis) (ii) late colonizers (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans). The implants were immersed for 30 days to simulate the healing period and bacterial biofilm adhesion. Optical microscope, x-ray photoelectron spectroscopy (XPS), and electrochemical test were performed to analyze the surface- morphology, chemistry, and potential respectively., Results: Early colonizers inflicted surface morphological damage (discoloration and pitting). Even though, XPS detected thinner oxide layer in 2/3 early retrievals, XPS and electrochemical tests illustrated that the TiO 2 layer was intact in HAs, and in DI post- immersion. Late colonizers also caused similar morphological damage (discoloration and pitting), while mechanical wear was evident with scratches, cracks, and mechanical fracture observed in late-stage retrievals. XPS indicated thinner oxide layer in late-stage retrievals (3/4), and in DI post-immersion in late colonizers. This was reflected in electrochemical test results post-immersion but not in the late-stage retrievals, which suggested an intact surface with corrosion resistance., Significance: This study concluded that bacteria could negatively affect implant surface with late colonizers demonstrating more pronounced damage on the surface morphology and chemistry., (Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36)., Materials and Methods: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved., Results: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes., Conclusions: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success., (© 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.)

Background: Implant healing abutments (IHA) have a vital role in soft tissue healing after implant placement. Although there is thorough investigation on the implant surface, little is known about the effects potentially damaging oral conditions impose on healing abutments., Purpose: To characterize the surface of titanium healing abutments before and after clinical placement to understand the effects of the oral environment and time on the device surface., Materials and Methods: Ten regular Straumann IHA were subjected to characterization pre and postplacement to elucidate the effects of the oral environment on device surfaces. Changes in surface crystallinity, morphology, and elemental composition were monitored with Raman spectroscopy, scanning electron microscopy, optical microscopy, and x-ray photoelectron spectroscopy, respectively. In addition, corrosion rate and polarization resistance were obtained to assess electrochemical device stability after placement., Results: Control analysis indicated the titanium oxide of IHAs was thicker than natural commercially pure titanium and had the structure of crystalline anatase. After removal, the abutments possessed large amounts of biological debris, visible scratches, and discoloration sparsely on the surface. Spectroscopic analysis revealed the titanium oxide on the surface of IHAs was structurally unchanged, with crystalline titanium dioxide still present on the surface. Electrochemical results revealed that implanted healing abutments possessed a significantly higher corrosion rate than controls (change in corrosion rate = 2.34 ± 0.58 nm/year)., Conclusions: Healing abutments were stable in the oral environment due to the chemical stability of the oxide, and were likely subjected to abrasions from unintentional loading and oral hygiene techniques., (© 2017 Wiley Periodicals, Inc.)

Presence of metal ions and debris resulting from corrosion processes of dental implants in vivo can elicit adverse tissue reactions, possibly leading to peri-implant bone loss and eventually implant failure. This study hypothesized that the synergistic effects of bacterial biofilm and micromotion can cause corrosion of dental implants and release of metal ions in vivo. The goal is to simulate the oral environment where an implant will be exposed to a combination of acidic electrochemical environment and mechanical forces. Four conditions were developed to understand the individual and synergistic effects of mechanical forces and bacterial biofilm on the surface of dental implants; In condition 1, it was found that torsional forces during surgical insertion did not generate wear particle debris or metal ions. In condition 2, fatigue tests were performed in a wet environment to evaluate the effect of cyclic occlusal forces. The mechanical forces applied on the implants were able to cause implant fracture as well as surface corrosion features such as discoloration, delamination, and fatigue cracks. Immersion testing (condition 3) showed that bacteria ( Streptococcus mutans ) were able to create an acidic condition that triggered surface damage such as discoloration, rusting, and pitting. A novel testing setup was developed to understand the conjoint effects of micromotion and bacterial biofilm (condition 4). Surface damage initiated by acidic condition due to bacteria (condition 3), can be accelerated in tandem with mechanical forces through fretting-crevice corrosion. Permanent damage to surface layers can affect osseointegration and deposition of metal ions in the surrounding tissues can trigger inflammation.

Aim: To investigate the impact of treatments used to detoxify dental implants on the oxide layer morphology and to infer how changes in morphology created by these treatments may impact re-osseointegration of an implant., Materials and Methods: Pure titanium (cpTi) and the alloy Ti6Al4V were subjected to a series of chemical treatments and mechanical abrasion simulating surface decontamination of dental implants. The morphology and roughness of the surface layer before and after treatment with these solutions were investigated with optical and atomic force microscopy (OM, AFM). The solutions employed are typically used for detoxification of dental implants. These included citric acid, 15% hydrogen peroxide, chlorhexidine gluconate, tetracycline, doxycycline, sodium fluoride, peroxyacetic acid, and treatment with carbon dioxide laser. The treatments consisted of both immersions of samples in solution and rubbing with cotton swabs soaked in solution for 1, 2, and 5 min. Cotton swabs used were analyzed with energy dispersive spectroscopy (EDS)., Results: The microscopy investigation showed that corrosion and pitting of the samples were present in both metal grades with immersion and rubbing methods when employing more acidic solutions, which had pH <3. Mildly acidic solutions caused surface discoloration when coupled with rubbing but did not cause corrosion with immersion. Neutral or basic treatments resulted in no signs of corrosion with both methods. EDS results revealed the presence of titanium particles on all rubbing samples., Conclusion: It was demonstrated in this study that acidic environments coupled with rubbing are able to introduce noticeable morphological changes and corrosion on the surface of both titanium grades., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The most common approach to lessen treatment times is by decreasing the healing period during which osseointegration is established. Implant design parameters such as implant surface, primary stability, thread configuration, body shape, and the type of bone have to be considered to obtain this objective. The relationship that exists between these components will define the initial stability of the implant. It is believed implant sites using a tapered design and surface modification can increase the primary stability in low-density bone. Furthermore, recent experimental preclinical work has shown the possibility of attaining primary stability of immediately loaded, tapered dental implants without compromising healing and rapid bone formation while minimizing the implant stability loss at compression sites. This may be of singular importance with immediate/early functional loading of single implants placed in poor-quality bone. The selection of an implant that will provide adequate stability in bone of poor quality is important. A tapered-screw implant design will provide adequate stability because it creates pressure on cortical bone in areas of reduced bone quality. Building on the success of traditional tapered implant therapy, newer tapered implant designs should aim to maximize the clinical outcome by implementing new technologies with adapted clinical workflows., (© International & American Associations for Dental Research 2016.)

Dissolution of titanium wear particles in the oral environment, and their accumulation in the surrounding tissues have been associated with failure of dental implants (DI). The goal of this study is to investigate the effect of mechanical forces involved in surgical insertion of DI on surface wear and metal particle generation. It was hypothesized that mechanical factors associated with implant placement can lead to the generation of titanium particles in the oral environment. The testing methodology for surface evaluation employed simulated surgical insertion, followed by removal of DI in different densities of simulated bone material. Torsional forces were monitored for the insertion and removal of DI. The surface of the simulated bone materials was inspected with optical microscopy to detect traces of metallic particles that may have been generated during the procedure. Further characterization of the composition of powders collected from osteotomy cavities was conducted with powder X-ray diffraction. The results showed that the different densities of simulated bone material affected the torsional forces associated with implant insertion. However, the mechanical factors involved in the implant insertion/removal procedure did not generate wear particles, as confirmed by powder X-ray experiments.

Background: Bacteria are major contributors to the rising number of dental implant failures. Inflammation secondary to bacterial colonization and bacterial biofilm is a major etiological factor associated with early and late implant failure (peri-implantitis). Even though there is a strong association between bacteria and bacterial biofilm and failure of dental implants, their effect on the surface of implants is yet not clear., Purpose: To develop and establish an in vitro testing methodology to investigate the effect of early planktonic bacterial colonization on the surface of dental implants for a period of 60 days., Materials and Methods: Commercial dental implants were immersed in bacterial (Streptococcus mutans in brain-heart infusion broth) and control (broth only) media. Immersion testing was performed for a period of 60 days. During testing, optical density and pH of immersion media were monitored. The implant surface was surveyed with different microscopy techniques post-immersion. Metal ion release in solution was detected with an electrochemical impedance spectroscopy sensor platform called metal ion electrochemical biosensor (MIEB)., Results: Bacteria grew in the implant-containing medium and provided a sustained acidic environment. Implants immersed in bacterial culture displayed various corrosion features, including surface discoloration, deformation of rough and smooth interfaces, pitting attack, and severe surface rusting. The surface features were confirmed by microscopic techniques, and metal particle generation was detected by the MIEB., Conclusion: Implant surface oxidation occurred in bacteria-containing medium even at early stages of immersion (2 days). The incremental corrosion resulted in dissolution of metal ions and debris into the testing solution. Dissolution of metal ions and particles in the oral environment can trigger or contribute to the development of peri-implantitis at later stages., (© 2015 Wiley Periodicals, Inc.)

Purpose: Peri-implantitis is a disease characterized by soft tissue inflammation and continued loss of supporting bone, which can result in implant failure. Peri-implantitis is a multifactorial disease, and one of its triggering factors may be the presence of excess cement in the soft tissues surrounding an implant. This descriptive study evaluated the composition of foreign particles from 36 human biopsy specimens with 19 specimens selected for analysis. The biopsy specimens were obtained from soft tissues affected by peri-implantitis around cement-retained implant crowns and compared with the elemental composition of commercial luting cement., Materials and Methods: Nineteen biopsy specimens were chosen for the comparison, and five test cements (TempBond, Telio, Premier Implant Cement, Intermediate Restorative Material, and Relyx) were analyzed using scanning electron microscopy equipped with energy dispersive x-ray spectroscopy. This enabled the identification of the chemical composition of foreign particles embedded in the tissue specimens and the composition of the five cements. Statistical analysis was conducted using classification trees to pair the particles present in each specimen with the known cements., Results: The particles in each biopsy specimen could be associated with one of the commercial cements with a level of probability ranging between .79 and 1. TempBond particles were found in one biopsy specimen, Telio particles in seven, Premier Implant Cement particles in four, Relyx particles in four, and Intermediate Restorative Material particles in three., Conclusion: Particles found in human soft tissue biopsy specimens around implants affected by peri-implant disease were associated with five commercially available dental cements.

Background: Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis., Methods: Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer., Results: At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells., Conclusions: At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.

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

The large majority of dental implants are successful over the long term. Failure is usually associated with infection, trauma, inflammation, or a combination of these factors. Early identification and appropriate treatment can identify and eliminate these problems in the majority of cases. Thus routine implant maintenance structured along the guidelines for patients with periodontal diseases is recommended.

Introduction: Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging., Clinical Innovation: A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery., Discussion: The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed., Conclusion: The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the success and survival of immediately placed tapered implants to support fixed restorations in the maxilla and mandible., Materials and Methods: The study was a prospective, multicenter, non-interventional study of patients requiring tooth extraction who requested an implant-supported restoration in the maxilla or mandible. Patients received at least one tapered implant (either immediately after tooth extraction or at a later time point). Abutments were placed 42 to 56 days after surgery, and prostheses were placed after a further 14 days. Treatment and implant success were the primary effectiveness criteria, and secondary parameters included radiographic bone loss, patient satisfaction, and gingival health., Results: A total of 436 patients were enrolled, of whom 376 were included in the safety analysis. Single implants were placed in 77% of patients, two implants in 16%, and three or more implants in the remainder. The cumulative implant survival rates for immediately placed implants were 98.3% after 1 year and 97.7% from 2 to 5 years. Patient satisfaction was good or excellent in most patients and the majority of implants showed no or < 1-mm change in bone level for up to 5 years., Conclusions: The survival rate of immediately placed tapered implants was comparable to that found in other studies. Immediate implant placement with tapered implants can allow rapid rehabilitation with no adverse impact on implant survival.

Purpose. Peri-implantitis is one of the major causes of implant failure. The detoxification of the implant surface is necessary to obtain reosseointegration. The aim of this review was to summarize in vitro and in vivo studies as well as clinical trials that have evaluated surgical approaches for detoxification of the implant body surfaces. Materials and Methods. A literature search was conducted using MEDLINE (PubMed) from 1966 to 2013. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters, radiographic bone fill, and histological reosseointegration. Results. From 574 articles found, 76 were analyzed. The findings, advantages, and disadvantages of using mechanical, chemical methods and lasers are discussed. Conclusions. Complete elimination of the biofilms is difficult to achieve. All therapies induce changes of the chemical and physical properties of the implant surface. Partial reosseointegration after detoxification has been reported in animals. Combination protocols for surgical treatment of peri-implantitis in humans have shown some positive clinical and radiographic results, but long-term evaluation to evaluate the validity and reliability of the techniques is needed.

Type of Case: Implant placement in a postextraction site in the esthetic zone is a challenge for clinicians, since esthetic expectations of patients are high and potential esthetic complications can be devastating. The timing of implant placement is crucial, since it has an influence on esthetic treatment outcomes and the risk of complications. The topic of this paper is the timing of dental implant placement in the esthetic zone in relation to removal of the tooth to be replaced. Two opinions on the topic are presented. The first author (TGW) contends that under certain circumstances, immediate implant placement is appropriate in the esthetic zone. The second author (DB) favors early implant placement performed after 4 to 8 weeks of soft tissue healing. Both cite literature to substantiate their position and present their current therapeutic approach. Each author has been allowed to review the paper with the opposing view and comment. Clinical Approach #1 (TGW): By definition, an immediate implant is one that is put into position at the same surgery that the tooth to be replaced is removed. Sites that respond optimally to this approach in the esthetic zone are those with adequate bone for implant stability and an intact socket. Also important is the complete degranulation of the socket and in infected sites, the use of systemic antibiotics. The best implant position is normally to the palatal side of the extraction socket. This allows placement of hard and soft tissue grafts on the facial aspect, which increases the probability of esthetic outcomes. Clinical Approach #2 (DB): Following tooth extraction, early implant placement is performed after 4 to 8 weeks of soft tissue healing. This surgical approach allows implant insertion and simultaneous guided bone regeneration with an intact mucosa, which improves the predictability of contour augmentation. It is done with a resorbable collagen membrane, which is combined with autogenous bone grafts and a low-substitution, hydroxyapatite-based bone filler. In combination with a correct 3-dimensional implant position, successful contour augmentation provides a low risk for mucosal recession, and a convex contour of the alveolar process. Both are important prerequisites for successful esthetic outcomes., (© 2011 American Academy of Periodontology.)

Purpose: Minimum criteria were used in the placement of 100 consecutive provisional restorations on single-tooth dental implants placed into extraction sites within 3 days of surgery., Materials and Methods: Provisional restorations were placed on 4.1- and 4.8-mm diameter standard ITI (Straumann, Waltham, MA) implants in the anterior mandible and maxilla in 100 treatment sites over a 3-year period. Provisionals were placed despite low insertion torque values of 15 N-cm or 50 implant stability quotient using radiofrequency analysis. Implants had final impressions for definitive restorations done 8 to 12 weeks after implant placement. All patients were recalled 1 year after restoration and evaluated according to parameters suggested by Albrektsson et al (Int J Oral Maxillofac Implants 1:11, 1986)., Results: One implant was not osseointegrated. The remaining implants were judged successful at the 1-year recall appointment., Conclusion: Immediate provisionalization of implants placed into fresh extraction sites can be effective even when minimal provisionalization criteria are met., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Minimally invasive surgery (MIS) is a surgical technique using very small incisions indicated for performing regenerative therapy in periodontal defects. The 11-month results from a prospective study of MIS were previously published. This article presents the 6-year results of that prospective study., Methods: Patients from two private periodontal practices with advanced periodontitis who, after non-surgical therapy, had one or more sites with probing depths >or=6 mm were included in the study. An MIS surgical approach was used for all sites >or=6 mm. After surgical debridement, enamel matrix derivative (EMD) was placed into the bony defect. The surgical sites were reevaluated after >or=6 years., Results: Six-year data were available on 142 sites in 13 patients. No significant differences were noted in the results between the two offices, and the data were combined. Probing depths (mean: 3.18 mm; SD: 0.59 mm) and attachment levels (mean: 3.93 mm; SD: 0.19) at 6 years were unchanged from the 11-month measurements. No recession from preoperative levels was noted. All sites continued to be considered clinically successful., Conclusions: The combination of MIS and EMD yielded significant reductions in probing depths and improvements in attachment levels while producing no detectable recession. The 11-month results remained stable at 6 years.

Background: Cement-retained restorations are commonly used on dental implants. Residual excess cement after placement of fixed partial dentures has been associated with clinical and radiographic signs of peri-implant disease. The purpose of this study was to explore the relationship between excess dental cement and peri-implant disease using the dental endoscope., Methods: Thirty-nine consecutive patients with implants exhibiting clinical and/or radiographic signs of peri-implant disease were studied. Patients were enrolled in the study during a 5-year period in a private periodontal practice. Twelve of these patients had similar implants without signs of inflammation; these implants served as controls. There were 20 controls and 42 test implants. All were evaluated using a dental endoscope initially, and all but one implant was evaluated at a 30-day follow-up. Results from both groups were assessed by two trained operators and recorded., Results: None of the controls and all 42 of the test implants had clinical signs of peri-implant disease at initial treatment. Excess cement was found in none of the controls and 34 of the test sites. Thirty days after cement removal, 25 of 33 test sites from which the cement was removed had no clinical or endoscopic signs of inflammation., Conclusions: Excess dental cement was associated with signs of peri-implant disease in the majority (81%) of the cases. Clinical and endoscopic signs of peri-implant disease were absent in 74% of the test implants after the removal of excess cement.

Background: The primary goal of periodontal therapy is the reduction or elimination of inflammation. Traditionally, this is accomplished through removal of subgingival tooth-borne accretions using non-surgical and/or surgical treatment modalities. Numerous studies indicated the difficulty in removing these accretions to the point that histologic manifestations of chronic inflammation are eliminated. A companion to the current study demonstrated that subgingival inflammation was associated most often with calculus covered with biofilm, not biofilm alone. This pilot study evaluated the histologic response in humans to removal of calculus and biofilm with the aid of the dental endoscope., Methods: Twelve teeth in six patients were identified as test teeth, and all subgingival deposits visible with the endoscope were removed in a single treatment by an operator experienced in root planing and the use of the dental endoscope. The 12 teeth and the coronal portion of their periodontal attachment apparatus were removed 6 months after a single episode of closed subgingival scaling and root planing. Biopsies were processed for histologic evaluation., Results: There were no histologic signs of chronic inflammation. Deposits of calculus and biofilm were seen on one section of one tooth but apparently were deposited after initial therapy. Bone repair and the growth of a long junctional epithelium were observed on previously diseased root surfaces., Conclusion: Histologic signs of chronic inflammation were absent 6 months after a single course of closed subgingival scaling and root planing using the dental endoscope.

Background: The subepithelial connective tissue graft, traditionally harvested from the patient's palate, is commonly used for root coverage in periodontal recession defects. This study evaluates the safety and effectiveness of a living human fibroblast-derived dermal substitute (HF-DDS) compared to a connective tissue graft (CTG) for root coverage in these situations., Methods: Thirteen patients were selected for this study. Each patient had Miller Class I or II bilateral facial recession defects > or =3 mm on two non-adjacent teeth. The test tooth received an HF-DDS graft, while a CTG was placed on the control site. The 10 test surgeries were performed by one operator and three pilot surgeries were performed by another surgeon. Eight of the HF-DDS sites received a single thickness of material; five received a double thickness. Clinical measurements were taken at baseline; 1 week; and 1, 3, and 6 months following surgery. Parameters measured were plaque index, recession depth, clinical attachment levels, recession width, probing depth, and width of keratinized tissue. All clinical readings were taken by a masked, calibrated examiner., Results: There were no statistically significant differences between the test and control groups. The amount of root coverage was slightly greater for the control group than for the test group, but statistically the difference was insignificant. The width of the recession defect measured at the cemento-enamel junction (CEJ) for the test group was slightly smaller than that of the control group at the conclusion of the study. The amount of keratinized tissue was the same in both groups at 6 months. The probing depth was slightly greater in the control group as was the gain in clinical attachment, but neither was statistically significant. The amount of root coverage obtained when one layer of HF-DDS was used compared to the amount of coverage obtained when two layers were used approached statistical significance, but the small sample size may have been responsible for the difference., Conclusion: Within the limits of this study, the human fibroblast-derived dermal substitute may offer potential as a substitute to the connective tissue graft for covering areas of facial Miller Class I or Class II gingival recession in humans.

Purpose: The aim of this article was to review the current literature with regard to survival and success rates, along with the clinical procedures and outcomes associated with immediate and delayed implant placement., Materials and Methods: A MEDLINE search was conducted of studies published between 1990 and June 2003. Randomized and nonrandomized clinical trials, cohort studies, case-control studies, and case reports with a minimum of 10 cases were included. Studies reporting on success and survival rates were required to have follow-up periods of at least 12 months., Results: Thirty-one articles were identified. Most were short-term reports and were not randomized with respect to timing of placement and augmentation methods used. All studies reported implant survival data; there were no reports on clinical success. Peri-implant defects had a high potential for healing by regeneration of bone, irrespective of healing protocol and bone augmentation method. Sites with horizontal defects (HD) of 2 mm or less healed by spontaneous bone fill when implants with rough surfaces were used. In the presence of HDs larger than 2 mm, or when socket walls were damaged, concomitant augmentation procedures with barrier membranes and bone grafts were required. Delayed implant placement allowed for resolution of local infection and an increase in the area and volume of soft tissue for flap adaptation. However, these advantages were diminished by simultaneous buccolingual ridge resorption and increased requirements for tissue augmentation., Discussion: Immediate and delayed immediate implants appear to be predictable treatment modalities, with survival rates comparable to implants in healed ridges. Relatively few long-term studies were found. Successful clinical outcomes in terms of bone fill of the peri-implant defect were well established. However, there was a paucity of data on long-term success as measured by peri-implant tissue health, prosthesis stability, and esthetic outcomes., Conclusions: Short-term survival rates and clinical outcomes of immediate and delayed implants were similar and were comparable to those of implants placed in healed alveolar ridges.

Background: Osseointegration has been shown to occur around implants placed immediately after tooth extraction in humans. To date, such osseointegration has been achieved only with titanium plasma-sprayed (TPS) implants placed in extraction sockets with a bone-to-implant distance of less than 2 mm. In a previous report, when this horizontal defect dimension (HDD) exceeded 2 mm, the resulting percentage of bone-to-implant contact was reduced, indicating that the immediate technique would be limited in most cases to non-molar teeth. In an attempt to improve the bone-to-implant contact and the initial bone-to-implant contact in a vertical dimension, the implant surface, the type of membrane, and the method of membrane placement used in a previous study by our group were modified., Methods: Ten large-grit sandblasted, acid-attacked (SLA) titanium implants were placed into immediate extraction sites in 5 patients. HDDs of 0.0 to 1.5 mm (controls), 1.5 to 4.0 mm, and >4.0 mm were used. Following insertion, implants were completely covered with a connective tissue membrane. This was in contrast to the use of an expanded polytetrafluoroethylene (ePTFE) membrane penetrated by the neck of the implant in our previous report. Primary closure of soft tissue flaps was achieved in each case. Six months after placement, 7 of the implants were histologically examined., Results: Osseointegration occurred across all HDDs, with the percentage of bone-to-implant contact in the 0.0 to 1.5 mm HDDs similar to that seen in the >4.0 mm HDDs. The first bone-to-implant contact measured vertically was similar in both the smaller and larger HDDs., Conclusions: Osseointegration was successful in immediate implant placement sites with horizontal defect dimensions wider than 4 mm in humans when SLA titanium implants were completely covered with connective tissue membranes. It remains undetermined whether the different type of membrane, placement of the membrane, type of implant surface, or a combination of these 3 factors were responsible for the improved osseointegration in HDDs >4 mm. Further study is needed.

Proving a relationship between inflammatory periodontal disease and systemic disease will bring significant changes to the average periodontal practice. First, there will be a time of confusion with competing ideas and techniques. Determination of acceptable levels of inflammation will bring an end to the discussion. As this transition occurs, patients will need to be kept as current as possible without being unnecessarily alarmed. The average periodontal practice will shift its emphasis toward controlling inflammation. Initially, this will mean more periodontal surgery, more tooth extraction, and more implant placement. In the long run, periodontal disease may be treated by the patient with anti-inflammatory medications; by the general dentist with local therapy including antibiotics and anti-inflammatory medications, advanced nonsurgical techniques, and surgery; and, less frequently, by the periodontist.

In recent years, understanding of the multifactorial nature of periodontal disease has taken great strides. Periodontal disease is initiated and sustained by the presence of bacteria, but disease progression is significantly modified by the body's response to the bacteria. This article highlights the emerging evidence regarding which risk factors are predominant in influencing the disease process and how the incorporation of prognostic risk factors in overall diagnosis can help facilitate treatment planning. These factors appear to be smoking, genetic susceptibility, compliance, and diabetes. The first three factors mentioned are the focus of this article. Each is discussed with regard to their role in amplifying the disease process and how this information can be used in clinical practice. By acknowledging the importance of these factors, dentists can consider their patients' risk to allow for more cost-effective planning and treatment. The opportunity to identify high-risk patients and treat them more proactively is significant; the challenge rests with dentists' willingness and ability to embrace the change before them.

Background: This study investigated the relationship of the interleukin-1 (IL-1) genotype, smoking status, and the patient's age to the survival of osseointegrated dental implants., Methods: Twenty-seven patients with 33 implants that had been lost or who had at least 50% bone loss on radiographs were compared to a group of 38 patients who had experienced no bone or implant loss. All lost implants in a private practice were included in the data, except those that had fractured with no previous bone loss., Results: Smoking was demonstrated to increase the risk of implant failure by a factor of almost 2.5., Conclusions: Statistical testing failed to provide evidence of an increased risk for implant failure for patients who are positive for the IL-1 genotype. There was no apparent relationship between the patient's age at the time of placement and implant loss. This study raises several questions concerning the etiology of implant loss and the comparative biology of tissues surrounding implants when compared to those surrounding natural teeth.

This report involves the retrospective evaluation of ITI implants placed by a group of 12 clinicians located throughout the United States. Of the original 174 single implants placed in 129 patients reported previously, 157 were examined in 110 patients after 2 or more years (average 40.1 months). Twenty-two implants remained in the anterior and 135 implants (86%) remained in the posterior areas of the mouth, with 81 being restored with an octabutment screw-retained crown and 76 restored with a conical-abutment cemented crown (in function 2 years or longer). Occlusal screw loosening was observed in 22.2% of implants over both periods, with only 1 tooth loosening in both study periods (6 months to 2 years and > or = 2 years). Loosening of a solid conical abutment occurred in 1 additional patient, for cumulative conical abutment loosening of 5.3%. Significant radiographic bone loss was observed around 4 implants, with implant fracture noted with 3 additional implants (all mandibular first molars with hollow-screw or hollow-cylinder implant design). The survival rate at > or = 2 years was 95.5%. The data suggest that ITI implants can be a satisfactory choice for posterior single-tooth restorations.

Five titanium plasma-sprayed implants were biopsied from a human volunteer 6 months after placement. Four test implants had been placed in immediate extraction sockets, while one implant was placed in a mature site and served as a control. The histologic analysis demonstrated that all five implants achieved osseointegration as demonstrated by light microscopy, whereas a varying degree of bone-implant contact was observed. The non-loaded control implant had the highest percentage of bone-implant contact, 72%, followed by the two implants placed in the canine sites presenting with a horizontal defect dimension of 1.5 nm or less. These implants were placed without a barrier membrane, but in a submerged fashion. The histometric analysis showed a mean bone-implant contact of 50% for these two implants. The lowest mean bone-implant contact (17%) was observed for the two molar implants, which had horizontal defect dimensions of 4 mm; these implants were placed in a non-submerged fashion with the implants perforating an expanded polytetrafluoroethylene membrane. The authors concluded that osseointegration may occur in immediate extraction sites in humans using titanium implants with a plasma-sprayed surface. The horizontal component of the peri-implant defect was apparently the most critical factor relating to the final amount of bone-implant contact.

1. In medicine and dentistry, compliance tends to be poor in patients who have chronic diseases that they perceive as nonthreatening. 2. Even in the most optimistic studies, the rate of complete compliance with suggested toothbrushing is less than 50%; other studies show it much lower. In studies focusing on the use of interproximal cleaning aids, compliance is poorer still. 3. Patients in university-based programs have had a dropout rate (noncompliance) of 11% to 45%. In private periodontal practices, complete compliance was seen in one third or less of the patients. 4. The nature and the rate of disease progression affect SPT. The converse is also true. 5. In studies of the effect of therapy, it would be beneficial to record the results of treatment on all the patients, even those who drop out of therapy, to determine the part SPT plays in stabilizing the disease. 6. Patients fail to comply for many reasons, including self-destructive behavior, fear, economic factors, health beliefs, stressful events in their lives, and perceived dentist indifference. 7. By recognizing the problem, compliance can be improved in most patients. 8. There is a need for studies to define further the extent to which SPT affects the longevity of the dentition.