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This prospective case series study was conducted in subjects with partially edentulous mandibles. Implants were placed on day 21 and loaded with a provisional reconstruction after at least 21 days of healing (baseline, day 0) if their implant stability quotient (ISQ) was ≥ 70 (mean of three measurements) and were replaced by definitive porcelain-fused-to-metal prostheses at the 6-month follow-up visit. Follow-up examinations were planned 1, 3, 6, 12, and 36 months after baseline.

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The success rate of dental implants depends largely on osseointegration of the implant. One method for evaluating osseointegration that has garnered attention is measurement of the implant safety quotient (ISQ) using resonance frequency analysis, but there have been few studies that have observed chronological changes in ISQ in the same implant type.

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Patients were randomized to receive implants for fixed partial dentures. The immediate group was represented by immediate non‐occlusal implant loading, whereas the early group was represented by early non‐occlusal implant loading. The outcome variables were implant failure, complications, subjective satisfaction and radiographic bone level at implant sites 10 years after loading.

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The socket-shield technique, first published in 2010, has gained worldwide scientific and clinical acceptance. To address possible complications with this innovative approach in esthetic implant dentistry, we provide a comprehensive step-by-step protocol incorporating what we have learnt in the past decade.

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Short implants (intra‐bony length ≤ 8 mm) are generally considered as an alternative to bone augmentation in challenging situations; however, clinical evidence from large‐scale studies with long follow‐up regarding the application of short implants remains deficient.

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Osseointegration of dental implants can be promoted by implant-surface modifications using bisphosphonate coatings. In addition, it is of clinical interest to promote peri-implant bone formation and to restore bony structure in low bone-mass patients. The present study evaluated a combination of an anti-resorptive zoledronic acid (ZOL) implant-coating and a systemically applied sclerostin antibody, a known bone anabolic treatment principle, versus sole sclerostin antibody treatment or ZOL implant-coating in a rat osteoporosis model. 

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The characteristics of a dental implant surface have a decisive influence on the process of osseointegration. According to the current state of knowledge, surface modification can not only affect the morphology of cells, and in this way have a positive impact on osseointegration.

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The goal of every dental treatment should be a sustainable and functional care which is adapted to the individual movement patterns. In this context, a structured and anatomically accurate functional analysis can contribute to the correct muscular and skeletal adjustment of patients in order to develop the correct treatment strategy, which then guarantees a permanently stable reconstruction. The individual and whole-body analysis as well as the dental history of the patient and the correct transfer into the articulator play an important role. How accurately can the dental technician judge the actual situation of the patient? How realistic are planes, chewing patterns, jaw joint movements and closing angles represented in the articulator compared to the oral situation? Innovative aspects such as the reference to the natural head position (NHP), the exact determination of the anatomical centre and the correct three-dimensional transfer into the articulator are decisive factors which influence the success of the treatment.

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Dental implants with moderately rough surfaces show enhanced osseointegration and faster bone healing compared with machined surfaces. The sandblasting and acid-etching (SA) process is one technique to create moderately rough dental implant surfaces. The purpose of this study was to analyse different commercially available implant systems with a SA-modified surface and to explore the widespread notion that they have similar surface properties regarding morphology and cleanliness. SA-modified surfaces of nine implant systems manufactured by Alpha-Bio Tec Ltd, Camlog Biotechnologies AG, Dentsply Sirona Dental GmbH, Neoss Ltd, Osstem Implant Co. Ltd, Institute Straumann AG, and Thommen Medical AG were analyzed using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) and examined for surface cleanliness. Six implants from three different lots were selected per each implant system. Mean particle counts for each implant and the mean size of the particles were calculated from three different regions of interest and compared using ANOVA and Tukey’s test. SEM analysis showed presence of particles on the majority of analyzed implant surfaces, and EDX evaluations determined that the particles were made of Al2O3 and thus remnants of the blasting process. SPI®ELEMENT INICELL® and Bone Level (BL) Roxolid® SLActive® implant surfaces showed the highest mean particle counts, 46.6 and 50.3 per area, respectively. The surface of BL Roxolid® SLActive® implant also showed the highest variations in the particle counts, even in samples from the same lot. The mean size of particles was 1120±1011 μm², measured for USIII CA Fixture implants, while the biggest particle was 5900 μm² found on a BL Roxolid® SLActive® implant. These results suggest that not all manufacturers are able to produce implant surfaces without particle contamination and highlight that the surface modification process with the SA technique should be appropriately designed and controlled to achieve a clean and consistent final medical device.

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Computer-assisted implant planning has become an important diagnostic and therapeutic tool in modern dentistry. This case report emphasizes the possibilities in modern implantology combining virtual implant planning, guided surgery with tooth and implant supported templates, immediate implant placement and loading. Case presentation: A straight forward approach was followed for the mandible presenting with hopeless lower incisors. Diagnosis, decision making and treatment approach were based on clinical findings and detailed virtual threedimensional implant planning. Extractions of the hopeless mandibular incisors, immediate and guided implant placement of six standard implants, and immediate loading with a provisional fixed dental prosthesis (FDP) were performed fulfilling patient’s functional and esthetic demands. The final computer assisted design / computer assisted manufacturing (CAD/ CAM) FDP with a titanium framework and composite veneering was delivered after 6 months. At the 1-year recall the FDP was free of technical complications. Stable bony conditions and a healthy peri-implant mucosa could be observed. Conclusions: Computer assisted implantology including three-dimensional virtual implant planning, guided surgery, and CAD/CAM fabrication of provisional and final reconstructions allowed for a concise treatment workflow with predictable esthetic and functional outcomes in this mandibular full-arch case. The combination of immediate implant placement and immediate loading was considerably more complex and required a high level of organization between implantologist, technician and patient. After the usage of a first tooth-supported surgical template with subsequent extraction of the supporting teeth, a second surgical template stabilized on the previously inserted implants helped to transfer the planned implant position in the extraction sites with a guided approach.

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Purpose: This case series illustrates a simplified soft tissue management, namely, the subperiosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant. Materials and Methods: Twenty-seven implants in 16 patients presenting either a buccal bone dehiscence or a thin (< 1 mm) buccal cortical bone plate (BCBP) were consecutively treated. Briefly, a split-thickness flap (namely, the mucosal layer) was raised on the buccal aspect. Then, the periosteal layer was elevated from the bone crest. A full-thickness flap was elevated on the oral aspect. After implant site preparation, a xenograft was used to fill the space between the periosteal layer and the BCBP and/or exposed implant surface and, if present, to completely correct the bone dehiscence. The periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At 3 to 6 months, a re-entry procedure for implant exposure was performed. Results: Healing was uneventful, with no signs of infection in all cases. A wound dehiscence was observed in three implants in two patients at 2 weeks postsurgery. Out of 15 implants showing an initial bone dehiscence, 12 implants (80%) showed a complete resolution, with a subperiosteal tissue thickness (SPTT) at the time of re-entry of 3.1 ± 1.0 mm. Three implants presented a residual dehiscence of 1 mm (two implants) or 2 mm (one implant), with a SPTT of at least 2 mm. Out of 12 implants showing a thin BCBP at implant placement, 10 implants (90%) revealed a SPTT ≥ 2 at the time of re-entry. Two implants revealed a SPTT of 1 mm. Conclusion: The SPAL technique represents a valuable simplified surgical approach associated with a low rate of complications in the treatment of peri-implant bone dehiscence and in the horizontal augmentation of peri-implant tissue thickness.

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The modification of the implant surface influences implant osseointegration. A physico-chemical means to modify implant surfaces is the creation of hydrophilic surfaces. The aim is an accelerated osseointegration for earlier implant loading and possibly the increase of bone quantity and quality. This review gives an update on the current scientific knowledge on hydrophilic implant surfaces. In vitro, hydrophilic titanium surfaces exhibit different positive effects on hard and soft tissues with significant differences to hydrophobic surfaces. Several cell types and the initial wound healing phase are positively affected. In vivo, an increased osseointegration is detected in the early phase of wound healing. In later stages these significant differences are rarely detectable. Based on clinical trials, early implant loading of hydrophilic surfaces is considered safe and predictable. There is only few data on hydrophilic surfaces in areas of reduced bone quality or quality.

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The modification of the implant surface influences implant osseointegration. A physico-chemical means to modify implant surfaces is the creation of hydrophilic surfaces. The aim is an accelerated osseointegration for earlier implant loading and possibly the increase of bone quantity and quality. This review gives an update on the current scientific knowledge on hydrophilic implant surfaces. In vitro, hydrophilic titanium surfaces exhibit different positive effects on hard and soft tissues with significant differences to hydrophobic surfaces. Several cell types and the initial wound healing phase are positively affected. In vivo, an increased osseointegration is detected in the early phase of wound healing. In later stages these significant differences are rarely detectable. Based on clinical trials, early implant loading of hydrophilic surfaces is considered safe and predictable. There is only few data on hydrophilic surfaces in areas of reduced bone quality or quality.

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This study was undertaken to evaluate the relation between bone quality and alterations of implant stability quotient values measured during the initial phase of healing. Nineteen patients treated with 106 implants were included in the current study. The mean bone density of the implant recipient area was measured using Simplant 11 software incorporated in the computerized tomography (CT) machine. Mean bone density measurements were recorded in Hounsfield units. The implant recipient sites were subdivided into 5 groups according to bone quality. The numbers of the structures on the recipient site belonging to D1 and D5 types showed no statistical significance and were excluded. Standard 2-stage surgical technique was utilized to prepare the surgical sites. The implant stability quotient (ISQ) value at implant placement was recorded and did not influence the treatment procedure. The ISQ was measured by an Osstell instrument. The ISQ was further registered on the 21st and 60th days. SPSS statistical software was used for the statistical analysis. In comparison with the time of insertion, the mean values of the ISQ were decreasing for the first 21 days. However, on subsequent days, the ISQ values of all bone types have increased and on the 60th day reached the values recorded at the time of insertion. Analysis of the relation between changes in stability and bone type does not reveal statistical significance. With knowledge of the current clinical study, it can be concluded that bone quality in the recipient bone site does not effect changes in implant stability at the early stages of the osseointegration process.

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Aim: To comparatively evaluate the morbidity following maxillary sinus floor elevation according to either transcrestal (tSFE) or lateral (lSFE) approach with concomitant implant placement. Materials &

Methods: Patients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3–6 mm were enrolled. tSFE was performed in association with a xenograft and a collagen matrix. For lSFE, the sinus was grafted with the xenograft, and the antrostomy was covered with a membrane. Implants were inserted concomitantly. The postoperative course was assessed through questionnaires. Pain level (VASpain) was recorded using a 100- mm visual analogue scale. Results: Twenty- nine and 28 patients were included in tSFE and lSFE group, respectively. On the day of surgery, VASpain was significantly higher for tSFE compared to lSFE, and similar from day 1 to 14. tSFE was characterized by significantly lower incidence of swelling, bruising and nasal discharge/bleeding. Significantly less severe limitation in swallowing, continuing daily activities, eating, speaking, opening the mouth and going to school/work was found for tSFE only at specific postsurgery intervals.

Conclusions: lSFE was associated with lower pain on the day of surgery, and tSFE revealed lower postoperative morbidity as well as more tolerable postoperative course.

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To demonstrate in a prospective cohort study that immediate implantation and provisionalization in combination with the socket-shield technique will result in volume stability of the mucosa adherent to the inserted implant.
Material and methods: Patients with an indication for a single tooth implant underwent application of the socket-shield technique and immediate implantation of a provisional implant crown. A noninvasive volumetric measurement was performed according to the method described by Windisch et al (2007) at baseline and 12 weeks later. The influence of potential confounders was evaluated. Patients rated their satisfaction with the treatment, fitting accuracy of implant, intraoperative discomfort, postoperative pain, and ability to chew soft and hard foods using visual analog scales. 

Results: Fifteen patients with a mean age of 49.2 ± 11.9 years were enrolled in the study. All implant sites showed uneventful healing and no socket-shield exposures were observed. The soft tissue volume change assessed with the mean distance change was < 0.5 mm in all cases (-0.07 ± 0.16; range -0.37 to +0.32). A slight but significant influence of the buccal bone plate width on the soft tissue volume change was observed (b = 0.25; P = 0.037). No influence was found for apical bone height, width of gingival tissue, buccal recession or probing depths. The patients were highly satisfied with their treatment as well as with the pain and functional outcomes.

Conclusions: Based on preliminary data, preservation of a buccal root segment in conjunction with immediate implant placement and provisionalization can minimize buccal contour changes after tooth extraction on a short-term basis.

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Maxillary sinus pathologies are a potential risk for failure of implant and bone augmentation. Management of lateral sinus floor elevation in the presence of a pseudocyst remains controversial, and reports on histological outcomes of endo‐sinus bone augmentation with maxillary cysts are scarce.

Purpose
To present a modified surgical technique for removal of maxillary pseudocyst with simultaneous sinus floor elevation, and to evaluate clinical and histological outcomes of the bone grafting.

Materials and Methods
Patients with a radiographic dome‐shaped opacity in the posterior maxillary sinus were included to receive lateral sinus floor elevation with simultaneous pseudocyst removal. Bone core specimens harvested from the lateral aspect of the augmentation sites were histomorphometrically analyzed. Data were recorded and evaluated in terms of survival rates and complications.

Results
A total of 15 patients were included who underwent 17 maxillary sinus augmentation surgeries. Implant survival rate was 97.0%. Bone biopsy specimens were obtained at 6 months after surgery. Histomorphometric analysis revealed that mean percentages of mineralized bone, bone substitute, and nonmineralized tissue were 24.9% ± 18.1%, 14.4% ± 12.5%, and 60.1% ± 12.44%, respectively. No recurrence of the pseudocyst was detected on radiographic examination.

Conclusions
The described technique could be successfully applied in clinical practice to perform sinus augmentation in the presence of pseudocysts.

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Merli, Moscatelli, Mariotti, Pagliaro, Raffaelli, Nieri, “Comparing membranes and bone substitutes in a one-stage procedure for horizontal bone augemtation. Three-year postloading results of a double-blind randomised controlled trial”,

J Oral_Impl, 2018, Vol. 11, Issue 4, pp 441-452

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The digital transformation is becoming more and more important in our profession. For more than twenty years, our dental technicians have used CAD/CAM to make zirconia, cobalt chromium, titanium and lithium disilicate frameworks. Plaster cast impressions are scanned with a lab scanner, and the prosthesis is digitally designed and machined. In 2015, following consultation with our dental technicians, we decided to transition to intraoral optical impressions. Our goal was to replace physical analogue impressions with intraoral optical impressions [1–3]. The focus of our activities is mainly on periodontology and oral implantology, so we had to address some shortcomings of our implant system and certain pitfalls caused to the complexity of taking optical impression in implantology [4,5]. This article documents how the abutments and scanbodies of our implant system (Thommen Medical, Grenchen, Switzerland) evolved to adapt to the specific requirements of optical impressions. It demonstrates the benefits of a close cooperation between practitioners and engineers.

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In the present study, a novel surgical technique, namely the sub-periosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant will be thoroughly described. The surgical buccal access at the time of implant placement first consisted of a split-thickness flap to raise the most superficial mucosal layer, followed by the elevation of the periosteal layer which was detached from the buccal cortical bone plate (BCBP). A full-thickness flap was elevated on the oral aspect. A xenograft was used to fill the space between the periosteal layer and the BCBP, and the periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At implant uncovering at 4 months, an increase in the thickness (>2 mm) of the buccal peri-implant tissues was observed. A free gingival graft was used to enhance the dimensions of buccal keratinized mucosa. The SPAL technique may represent a surgical option for the horizontal augmentation of periimplant tissue thickness.

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Aim: To compare need for bone augmentation, surgical complications, periodontal,
radiographic, aesthetic and patient reported outcomes in subjects receiving implant
placement at the time of extraction (Immediate Implant) or 12 weeks thereafter.

Methods: Subjects requiring single tooth extraction in the anterior and premolar
areas were recruited in seven private practices. Implant position and choice of
platform were restoratively driven. Measurements were performed by calibrated
and masked examiners.

Results: IMI was unfeasible in 7.5% of cases. One hundred and 24 subjects were
randomized. One implant was lost in the IMI group. IMI required bone augmentation
in 72% of cases compared with 43.9% for delayed (p = 0.01), while wound
failure occurred in 26.1% and 5.3% of cases, respectively (p = 0.02). At 1 year,
IMI had deeper probing depths (4.1
1.2 mm versus 3.3
1.1 mm, p < 0.01). A
trend for greater radiographic bone loss was observed at IMI over the initial 3-
year period (p-trend < 0.01). Inadequate pink aesthetic scores were obtained in
19% of delayed and in 42% of IMI implant cases (p = 0.03). No differences in
patient reported outcomes were observed.

Conclusions: Immediate implant placement should not be recommended when
aesthetics are important, IMI should be limited to selected cases. Longer followup
is needed to assess differences in complication rates.

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Background: An in vitro model for peri-implantitis treatment was used to identify areas that are clinically difficult to clean by analyzing the pattern of residual stain after debridement with commonly employed instruments.

Methods: Original data from two previous publications, which simulated surgical (SA) and non-surgical (NSA) implant debridement on two different implant systems respectively, were reanalyzed regarding the localization pattern of residual stains after instrumentation. Two blinded examiners evaluated standardized photographs of 360 initially ink-stained dental implants, which were cleaned at variable defect angulations (30, 60, or 90°), using different instrument types (Gracey curette, ultrasonic scaler or air powder abrasive device) and treatment approaches (SA or NSA). Predefined implant surface areas were graded for residual stain using scores ranging from one (stain-covered) to six (clean). Score differences between respective implant areas were tested for significance by pairwise comparisons using Wilcoxon-rank-sum-tests with a significance level α=5%.

Results: Best scores were found at the machined surface areas (SA: 5.58±0.43, NSA: 4.76±1.09), followed by the tips of the threads (SA: 4.29±0.44, NSA: 4.43±0.61), and areas between threads (SA: 3.79±0.89, NSA: 2.42±1.11). Apically facing threads were most difficult to clean (SA: 1.70±0.92, NSA: 2.42±1.11). Here, air powder abrasives provided the best results.

Conclusion: Machined surfaces at the implant shoulder were well accessible and showed least amounts of residual stain. Apically facing thread surfaces constituted the area with most residual stain regardless of treatment approach. 

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Objective: The purpose of this clinical study was to evaluate the effect of implant body form (cylindrical and conical implants) on crestal bone levels during 6 months’ follow-up after loading.

Materials and Methods: A total of 32 SPI implants (19 conical implants/13 cylindrical implants) were randomly placed in 12 male patients using a submerged approach. None of the patients had compromising medical conditions or parafunctional habits. Periapical radiographs using the parallel technique were taken after clinical loading and 6 months later. Clinical indices including pocket depth and bleeding on probing (BOP) were recorded on 6-month follow-up. Data were analyzed by independent samples t‑test and Chi‑square test with a significance level of 0.05.

Results: Six months after loading, crestal bone loss was 0.84 (±0.29) mm around the cylindrical implants and 0.73 (±0.62) mm around the conical types, which was not significantly different (P = 0.54). Pocket depth around the cylindrical and conical implants was 2.61 (±0.45) mm and 2.36 (±0.44) mm, respectively (P = 0.13). BOP was observed among 53.8% and 47.4% of the cylindrical implants and conical (P = 0.13). Bone loss and pocket depth in the maxilla and mandible had no significant difference (P = 0.46 and P = 0.09, respectively).

Conclusion: In this study, although bone loss and clinical parameters were slightly higher in the cylindrical implants, there was no significant difference between the conical‑ and cylindrical‑shaped implants.

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Abstract 
OBJECTIVE:

Extraction-socket resorption is considered a major problem that can limit implantological rehabilitation options and compromise the esthetic outcome. Surgical techniques to reduce remodeling are of restricted predictability and commonly require several surgical interventions and grafting. This increases the treatment cost and places a physical and psychological strain on the patient. This clinical case report presents a replacement of an upper canine using the socket-shield technique (SST) with a CAD/CAM surgical guide, resulting in a predictable, high esthetic, and functional result.

CLINICAL CONSIDERATIONS:

The SST is an alternative approach to curbing remodeling and resorption by retaining the facial part of the root during tooth extraction. An immediately placed implant supports the facial root fragment, preventing the collapse of the buccal wall. The SST with digital precision planning in combination with a CAD/CAM surgical guide benefits patients by preserving their tissue architecture and causing only insignificant trauma. Furthermore, the SST reduces the number of surgical and prosthetic interventions required to one each for pre-operative planning, surgical procedures, and prosthetic rehabilitation.

CONCLUSIONS:

The socket shield technique is a minimally invasive implantological approach offers patients and clinicians multiple benefits.

CLINICAL SIGNIFICANCE:

The socket-shield technique (SST) represents an alternative approach to intervene remodeling and resorption processes by the maintenance of the facial part of the root during tooth extraction. The immediate placement of an implant supports the facial root fragment and thereby prevents a collapse of the buccal wall. The SST associated with a CAD/CAM fabricated surgical guide, can reduce the amount of appointments, due to the immediate fabrication of the definitive restoration with the existing model. Therefore, no further necessary appointments are required apart from first pre-operative planning, second for surgical treatment, and third for prosthetic rehabilitation.

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Makowiecki A, Botzenhart U, Seeliger J, Heinemann F, Biocev P, Dominiak M, “A comparative study of the effectiveness of early and delayed loading of short tissue-level dental implants with hydrophilic surfaces placed in the posterior section of the mandible – A preliminary study”.

Ann. Anatomy (2017), dx.doi.org/10.1016/j.aanat.2017.02.009

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Background: In successful replacement of a tooth with a dental implant, soft tissue esthetic is as important as stability and function of the implant. Quality and quantity of the peri-implant mucosa can influence esthetic outcomes. This study assessed implant esthetic success of two different implant systems. In this regard the interdental papilla was evaluated and the relationship between implant type and crestal bone loss adjacent to implant was assessed.

Methods: Eighteen patients (11 males, 7 females) with a total of 18 implants participated in this historical cohort study. Patients were divided into two groups based on the type of implants: Implantium group and SPI group; 36 interproximal papillae were evaluated photographically, using Jemt’s papillary presence index (PPI). Radiographic analysis was carried out to find out the relation between bone loss and type of implant. Analysis of data was performed with SPSS 18, using Fisher's exact test, independent t-test, Spearman's correlation coefficient and ANOVA. Results. Comparison of photographs did not show a statistically significant difference in PPI between the two groups (P=0.94). Radiographic evaluation of crestal bone loss adjacent to implant shoulder did not reveal significant differences between the two groups (P=0.30).

Conclusion: Implant therapy in the anterior maxilla, using Implantium or SPI system, did not result in significant differences in esthetics. In this study, there was an inverse relationship between the distance of contact point to bone crest and papilla index (P=0.002 in the SPI group) (P=0.02 in the Implantium group).

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PURPOSE: To evaluate the clinical outcome of four to five implants immediately restored with metal-resin screw-retained cross-arch fixed prostheses in edentulous jaws 1 year after loading.

MATERIALS AND METHODS: In total, 104 consecutive patients received four 11 × 4.5 mm implants with a torque superior to 35 Ncm. If one implant did not reach a torque superior to 35 Ncm a fifth implant was added. If two implants did not reach a torque superior to 35 Ncm, loading was postponed after 3 months. A total of 127 metal-resin screw-retained fixed prostheses (59 mandibular and 68 maxillary) were to be delivered within 3 days. Outcome measures, evaluated by the treating clinician, were: prosthesis and implant failures, as well as complications.

RESULTS: In total, 549 implants were placed (195 immediate post-extractive implants). Twelve maxillary prostheses were delayed loaded, whereas all others were loaded immediately. One year after loading, six patients dropped out, 12 implants failed in eight patients (two patients lost three implants each), and 87 prostheses were remade in 68 patients, one because of three implant failures and then again in the recall programme (replaced twice), one because of tree implant failures and five prosthesis fractures, 10 because of prostheses fractures and 74 in a recall programme for prosthesis replacement. All patients were wearing the planned fixed prostheses at the end of the first year in function. Ninety-eight complications occurred in 66 patients, but all were successfully solved.

CONCLUSIONS: Immediately loaded cross-arch prostheses supported by four to five implants are a viable therapeutic option, if prostheses are made with resistant frameworks. Conflict of interest statement: This study was partially supported by Thommen Medical (Grenchen, Switzerland), the manufacturer of the implants evaluated in this investigation, however data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results.

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Abstract 
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION:

Immediate versus delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial. Tonetti MS, Cortellini P, Graziani F, Cairo F, Lang NP, Abundo R, Conforti GP, Marquardt S, Rasperini G, Silvestri M, Wallkamm B, Wetzel A. Journal of Clinical Periodontology 2017;44(2):215-24.

SOURCE OF FUNDING:

Nonprofit, Foundations: European Research Group on Periodontology, Genova, Italy Industry: Thommen Medical AG, Switzerland and Geistlich AG, Switzerland (biomaterials).

TYPE OF STUDY/DESIGN:

Randomized controlled trial.

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Abstract
To ensure that similar primary implant stability measured by resonance frequency analysis (RFA) could be obtained in different jawbone densities by using a specific surgical drilling protocol and, to correlate those RFA measurements with actors related to the implant design, width and length, we are performed a one-year prospective clinical study was carried out using 27 subjects. A total of 67 hydrophilic titanium implants were placed using a standard two-stage implant placement protocol. The bone type at each implant site was determined by evaluation of a preoperative, highresolution cone beam computed tomography (CBCT) scan. A modified drilling protocol was used in softer bone (types 2, 3 and 4) that allowed for greater implant thread contact with the surrounding bone. The implant stability quotient (ISQ) was measured at four different times during the study: initially it was determined immediately after implant placement, then again at stage two uncovering surgery, then at six months' post-placement and, and finally at one-year post-placement. Data collected immediately after implant surgery demonstrated a high correlation (R2=0.99) between the ISQ and bone type classification. An overall trend towards a higher ISQ was found over the one-year study period for all types of bone. Implants remained clinically and radiographically stable during the one-year study period. Our data allow conclude that the primary stability of two-staged loaded implants placed in different bone types can be optimized by applying this surgical drilling protocol during the implant placement. The ISQ method was found to be a reliable predictor of implant stability.

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Abstract
Blood clots stop bleeding and provide cell-instructive microenvironments. Still, in vitro models used to study implant performance typically neglect any possible interactions of recruited cells with surface-adhering blood clots. Here we study the interaction and synergies of bone marrow derived human mesenchymal stem cells (hMSCs) with surface-induced blood clots in an in vitro model by fluorescence microscopy, scanning and correlative light and electron microscopy, ELISA assays and zymography. The clinically used alkali-treated rough titanium (Ti) surfaces investigated here are known to enhance blood clotting compared to native Ti and to improve the healing response, but the underlying mechanisms remain elusive. Here we show that the presence of blood clots synergistically increased hMSC proliferation, extracellular matrix (ECM) remodelling and the release of matrix fragments and angiogenic VEGF, but did not increase the osteogenic differentiation of hMSCs. While many biomaterials are nowadays engineered to release pro-angiogenic factors, we show here that clot-entrapped blood cells on conventional materials in synergy with hMSCs are potent producers of pro-angiogenic factors. Our data might thus not only explain why alkali-treatment is beneficial for Ti implant integration, but they suggest that the physiological importance of blood clots to create pro-angiogenic environments on implants has been greatly underestimated. The importance of blood clots might have been missed because the pro-angiogenic functions get activated only upon stimulation by synergistic interactions with the invading cells.

Infographic study

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Abstract 
OBJECTIVES:

Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes.

MATERIAL AND METHODS:

This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs).

RESULTS:

All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded.

CONCLUSION:

Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.

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The present study aimed to evaluate primary stability (PS) and osseointegration of dental implants in polylactide [70/30 poly(L-lactide-co-D, L-lactide); (PLDLA)] modified bone in 30 Goettingen minipigs. Each animal received three implants per jaw quadrant. In a split-mouth design, one side of the maxilla and mandible was randomly allocated to the experimental treatment (PLDLA applied into the drill hole before implantation), while the contralateral sides served as intraindividual controls (no PLDLA applied). The required insertion torque and the implant stability quotient (ISQ) were measured during implantation. ISQ, volume density (VD) of new bone formation (NBF), and the bone-implant contact (BIC) were evaluated at the end of the observation period (1, 3, 6, 12, and 24 months, respectively) in six animals each. Across all study groups, the PLDLA treatment resulted in a) a comparable insertion torque, b) an equivalent ISQ, c) a reduced BIC, and d) a reduced VD of NBF, as opposed to the untreated controls. In conclusion, the PLDLA treatment did not affect the PS, but rather led to an impaired osseointegration, which was particularly strong in the compact mandibular bone, and decreased in the spongious maxillary bone. PLDLA induced anchoring in spongious bone should be evaluated in further investigations.

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Burkhardt M A, Waser J, Milleret V, Gerber I, Emmert M Y, Foolen J, Hoerstrup S P, Schlottig F, Vogel V, “Synergistic interactions of blood-borne immune cells, fibroblasts and extracellular matrix drive repair in an in vitro peri-implant wound healing model”.

Scientific Reports, 6:21071, Doi:10.1038/srep21071

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Aim: Based on the hypothesis that maxillary sinus floor elevation with a transcrestal approach (tSFE) does not increase the morbidity of implant surgery, the study evaluated the patient-reported outcomes as well as the type and incidence of complications when implants are placed either concomitantly with tSFE (performed according to Trombelli et al. 2008, 2010a,b) or entirely in native bone.

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Despite recent advancements in ridge preservation techniques, complete tissue regeneration remains difficult to achieve when managing multiple tooth loss in the esthetic zone. Guided bone regeneration has been shown to be effective in creating sufficient bone support, but post-surgical complications including soft tissue deficiencies have been reported. Obtaining “natural” esthetic results has proven challenging, especially when restoring adjacent implants in patients with a high smile line. The addition of extrusion and palatal positioning of the implant facilitates
ridge preservation surgery as well as the esthetic outcome, but requires an additional treatment phase devoted to orthodontics.
Case Presentation: A healthy 43-year-old female with a longstanding history of smoking presented with terminal periodontal disease on teeth #7 and #8 together with a wide diastema between teeth #8 and #9. Comprehensive dental treatment
included smoking cessation, oral hygiene instruction, full-mouth scaling and root planing, orthodontic realignment, and implant placement to manage those teeth with a hopeless prognosis. Orthodontic therapy included forced eruption of teeth #7 and #8 to create optimum implant receptor sites. One year after prosthetic restoration, interproximal papillae height proved stable and similar to the contralateral side.
Conclusion: A multidisciplinary approach proved beneficial in achieving an improved esthetic outcome in a challenging situation in implant therapy. Clin Adv Periodontics 2016;6:146-152.
Key Words: Bone regeneration; esthetics, dental; heterografts; humans; orthodontic extrusion; tissue transplantation.

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This article describes a direct technique for communicating implant abutment and pontic intaglio surface forms with the dental laboratory. The technique uses a matrix and a screw-retained custom interim restoration. The matrix is used to transfer the interim restoration and periimplant tissue forms from the patient's mouth to an implant position-verified cast. After being connected to this cast, a silicone soft tissue replicating material is injected into the matrix. The result is a definitive cast with accurate implant position and soft tissue forms.

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This case illustrates an experimental technique for preserving a buccal root segment in conjunction with immediate implant placement and provisionalisation. The socket shield technique may be a valuable technique to minimise buccal contour changes after tooth extraction, leading to increased volume stability of the mucosa adjacent to the inserted implant. However, it is important to note that this technique should not be used in daily practice until long-term multicentre studies are available.

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Aim: The ligature-induced defect model still remains the model of first choice to
experimentally investigate the cause, effect and treatment approaches of periimplantitis. It was the aim of the present in-vivo trail to revisit the ligature-induced
peri-implantitis minipig model regarding its current scientific value and ethical
justification in implant research.
Materials and methods: Six minipigs were used for the analysis of peri-implant hard
and soft tissue structures. Animals were randomly allocated to an experimental
silk ligature-induced peri-implantitis group (n=4 animals) and a reference healthy
group (n=2 animals). After six weeks mean pocket depths (PD) and bleeding on
probing (BOP) measurements were performed just before animals were sacrificed.
Results: Overall, ligature-induced peri-implantitis provoked a local inflammation
around the experimental implants. Additionally, a loss of crestal bone surrounding
the implants could be detected. Mean pocket depths (PD) were 2.2 ± 1.1 mm for
healthy animals and 5.4 ± 1.9 mm for peri-implantitis sites. Healthy sites showed
a BOP of 60%, whereas peri-implantitis sites disclosed a BOP of 90% within 10 s
after probing.
Conclusion: Clinical, radiological and histological findings of the present animal
experiment supported the overall applicability of the ligature-induced periimplantitis
minipig model. A rapid breakdown of peri-implant hard tissues could
be detected mainly on the buccal side.
Keywords: Mucositis; Bone loss; Inflammation; Dental implant; Animal model

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There is little evidence of the effect of implants restored with fixed partial dentures on oral health-related quality of life (OHRQoL) in partially edentulous Kennedy class II and III patients. The aim of this study was to determine the change in OHRQoL in Kennedy classification II and III patients treated with a two-implant-supported fixed dental prosthesis (FDP). Kennedy class II and III patients received dental implants and an FDP. Oral health-related quality of life was measured by administration of the Oral Health Impact Profile-14 (OHIP-14NL) questionnaire at intake (T1), 2 weeks after surgery (T2) and after 1 year of loading (T3). The mean OHIP score at T1 was 6
5  1
2, 2
4  1
0 at T2, and 0
9  0
3 at T3. There was a statistically significant difference between T1 and T2 (P = 0
002) and T1 and T3 (P < 0
001) but not between T2 and T3 (P = 0
407). The OHIP score in Kennedy II patients decreased from 4
8  3
2 at T1 to 1
5  2
0 at T2 and 1
1  1
8 at T3, and that in Kennedy III patients decreased from 8
9  9
6 at T1 to 3
6  8
9 at T2 and 0
8  2
2 at T3. There were no statistically significant differences in the reductions in Kennedy II and III patients. Oral health-related quality of life changed positively in patients treated with implants and an FDP in both groups. There was no change in OHRQoL between the times of implant placement and FDP placement.

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Objective: The objective of this study was to evaluate crestal bone changes around bone- and tissue-level implants related to initial mucosal thickness.
Materials and methods: Patients received at least 2 implants: one with the prosthetic abutment connection at the crestal bone level (MC) and one with the prosthetic abutment connection at 2.5 mm supra crestal (LC). Flap thickness measurements were taken using a periodontal probe after raising the buccal flap. Patients were divided into 2 groups according to the mucosal thickness— Group A (thickness, ≤2 mm) and Group B (thickness, >2 mm).
Results: Our study included 33 patients and 78 implants. Each patient received at least 1 implant of each type: Group A (MC), 17 implants, with a mean bone change of
0.6  0.5 mm; Group B (MC), 20 with a mean bone change of
0.2  0.4 mm; Group A (LC), 15 with a mean bone change of
0.1  0.5 mm; and Group B (LC), 22 with a mean bone change of
0.2  0.4 mm. A pairedsamples t-test for groups A (MC) and B (MC) yielded a statistically significant difference (P = 0.003); there was no statistically significant difference for groups A (LC) and B (LC) (P = 0.518).
Conclusion: If the initial mucosal thickness surrounding bone-level implants is more than 2 mm, there is significantly less crestal bone change compared with bone-level implants placed in initial mucosal thicknesses of 2 mm or less. This difference is not statistically significant when tissue-level implants are used and the implant–abutment connection is 2.5 mm above the crestal bone level.

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Abstract
Objective: The objective of this study was to evaluate crestal bone changes around bone- and tissue-level implants related to initial mucosal thickness.
Materials and methods: Patients received at least 2 implants: one with the prosthetic abutment connection at the crestal bone level (MC) and one with the prosthetic abutment connection at 2.5 mm supra crestal (LC). Flap thickness measurements were taken using a periodontal probe after raising the buccal flap. Patients were divided into 2 groups according to the mucosal thickness— Group A (thickness, ≤2 mm) and Group B (thickness, >2 mm).
Results: Our study included 33 patients and 78 implants. Each patient received at least 1 implant of each type: Group A (MC), 17 implants, with a mean bone change of
0.6  0.5 mm; Group B (MC), 20 with a mean bone change of
0.2  0.4 mm; Group A (LC), 15 with a mean bone change of
0.1  0.5 mm; and Group B (LC), 22 with a mean bone change of
0.2  0.4 mm. A pairedsamples t-test for groups A (MC) and B (MC) yielded a statistically significant difference (P = 0.003); there was no statistically significant difference for groups A (LC) and B (LC) (P = 0.518).
Conclusion: If the initial mucosal thickness surrounding bone-level implants is more than 2 mm, there is significantly less crestal bone change compared with bone-level implants placed in initial mucosal thicknesses of 2 mm or less. This difference is not statistically significant when tissue-level implants are used and the implant–abutment connection is 2.5 mm above the crestal bone level.

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Yu H, Wang X, Qiu L. “Outcomes of 6.5-mm Hydrophilic Implants and Long Implants Placed with Lateral Sinus Floor Elevation in the Atrophic Posterior Maxilla: A Prospective,  Randomized Controlled Clinical Comparison”.

Clinical Implant Dentistry and Related Research Volume 00, Number 00, 2016

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BACKGROUND:
The “socket-shield technique” has shown its potential in preserving buccal tissues. However, front teeth often have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines.
PURPOSE:
The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the remaining buccal root segment in two pieces before immediate implant placement.
MATERIAL AND METHODS:
Three beagle dogs were selected in the study. The third and fourth premolars on both sides of the upper jaw were hemisected and the clinical crown of the distal root was removed. Then, the implant bed preparation was performed into the distal root so that a buccal segment of healthy tooth structure remained. This segment was then separated in a vertical direction into two pieces and implants placed lingual to it. After 4 months of healing, the specimens were processed for histological diagnosis. In a clinical case, the same technique was applied and impressions taken for volumetric evaluation by digital superimposition.
RESULTS:
The tooth segments showed healthy periodontal ligament on the buccal side. New bone was visible between implant surface and shield as well as inside the vertical drill line. No osteoclastic remodeling of the coronal part of the buccal plate was observed. The clinical volumetric analysis showed a mean loss of 0.88 mm in labial direction with a maximum of 1.67 mm and a minimum of 0.15 mm.
CONCLUSION:
The applied modification seems not to interfere with implant osseointegration and may still preserve the buccal plate. It may offer a feasible treatment option for vertically fractured teeth.

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Während die Anfänge der Implantologie durch das "chirurgisch orientierte" Implantieren geprägt waren, etablierte sich später der Begriff des "prosthetically driven implant placement". Dieser schaffte durch eine optimierte Implantatposition technische Vorteile sowie die bestmöglichen Voraussetzungen hinsichtlich biologischer Langzeitkomplikationen, die gerade hinsichtlich des Risikos periimplantärer Erkrankungen besondere Beachtung verdienen. Dadurch können Suprastrukturen derart gestaltet werden, dass sie die optimale Reinigungsmöglichkeit durch den Patienten und in der Erhaltungstherapie (Sondierbarkeit) erlauben. Neben dem positiven Effekt für die Reinigbarkeit der Suprastrukturen eröffnet sich auch die Möglichkeit zur Wahl der präferierten Befestigungsart. Im Falle verschraubter Suprastrukturen, die durch neuartige implantatprothetische Komponenten an Attraktivität gewinnen, können Zementreste mit ihren biologischen Risiken vermieden sowie Schwierigkeiten bei technischen Langzeitkomplikationen reduziert werden. Zudem kann eine Vereinfachung des klinischen Prozedere erreicht werden.

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Background:
Current strategies to reduce medical device-associated infections propose zirconia as a potential implant material which may limit bacterial adhesion. Because multinucleated giant cells (MNGCs) have been detected on these implant surfaces, concerns have been raised regarding tissue integration.

Purpose: 
The present study examined the presence of MNGCs and their subsequent effect upon tissue integration. Surface-modified implants made of yttria-stabilized (TZP) and alumina-toughened zirconia (ATZ) were compared with commercially pure titanium (Ti).

Materials and Methods: 
Seven miniature pigs received three implants on either side of the maxilla. After healing periods of 4 and 8 weeks, the tissue response at the implant surfaces was characterized according to three specific parameters: bone-to-implant contact (BIC), MNGC-to-implant contact (MIC), and the peri-implant bone density (BD).

Results: 
Despite being present on all tested implant surfaces, MNGCs were not associated with an inflammatory cell infiltrate or with fibrous encapsulation. MNGCs were less numerous on the Ti implants (range: 3.9–5.2%) compared with the ceramic implants (range: 17.6–30.3%, p < .0001). Even though the values of newly formed bone and pristine bone in direct contact with the implant surfaces were high at 4 weeks (tBIC: Ti = 82.3%, TZP = 64.3%, ATZ = 70%), a negative correlation was observed between the presence of MNGCs and newly formed  bone at the implant surface (p < .001). Interestingly, the newly formed peri-implant bone density, defined as the percentage of new bone area inside the screw threads (nBD), was not diminished by the presence of MNGCs.

Conclusions: 
Differences in the presence of MNGCs and the BIC parameters between Ti and the ceramic implants appear to be a local cellular phenomenon which is restricted to the implant-bone marrow interface and do not affect the peri-implant bone formation. Factors triggering MNGC differentiation and their persistence in response to biomaterial surface need to be investigated in future studies.

KEY WORDS: 
biomaterials, endosseous dental implantation, giant cells, macrophages, osteogenesis, surface chemistry,
titanium, zirconium oxide

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Franceschetti G, Trombelli L, Minenna L, Franceschetti G, Farina R. “Learning Curve of a Minimally Invasive Technique for Transcrestal Sinus Floor Elevation: a Split-Group Analysis in a Prospective Case Series With Multiple Clinicians”.

Implant Dent. 2015 Oct;24(5):517-26

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Objectives:
The aim of the present observational medical device performance study was to test whether implants with an intra-operatively conditioned hydrophilic surface can be safely reconstructed when applying an early loading protocol after 21 days in partially edentulous posterior mandibles.

Material and Methods: 
Partially edentulous patients with missing teeth in the posterior mandible were recruited. Immediately after implant placement, the implant position was indexed using a pickup impression technique. ISQ values were measured after 21 days of healing. When ISQ values were ≥70, the implants were directly restored with provisional reconstructions in occlusal contact allowing an early loading protocol. ISQ values were repeated again at 1, 3, and 6 months postloading. Clinical parameters (mPLI, mSBI, PPD, DIM, and CAL) were assessed. Standardized periapical radiographs were obtained after surgery, at implant loading and 3 and 6 months later. Changes over time were analyzed for statistical significance using the nonparametric method by Brunner & Langer (SAS Proc Mixed).

Results: 
Fifteen partially edentulous patients with healed sites in the posterior mandible received 20 implants. All implants healed uneventfully. At 21 days, all implants achieved an ISQ value of ≥70 (mean of 3 measurements) and were reconstructed at this time point with provisionals. ISQ values showed a gradual increase from baseline to 3 and 6 months postloading. The assessment of clinical parameters revealed stable tissue integration. The evaluation of the radiographs showed that 3 and 6 months after loading the median mesial and distal marginal bone levels had stabilized at the border between the rough surface and the 1-mm machined implant collar.

Conclusion: 
Functional occlusal loading of implants with a hydrophilic, moderately rough endosseal surface 3 weeks after placement appears to be a safe and predictable treatment option in healed sites in the posterior mandible without need of bone augmentation procedures.

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The aim of this chart review was to obtain an objective, quantitative assessment of the clinical performance of an implant line used in an implantological office setting. Implants with hydrophilic (INICELL) and hydrophobic (TST; both: Thommen Medical AG, Grenchen, Switzerland) enossal surfaces were compared and the cumulative implant survival rate was calculated. The data of 1063 patients that received 2918 implants (1337 INICELL, 1581 TST) was included. The average follow up time was 2.1 (1.1–5.4) years for INICELL and 4.5 (1.3–5.9) years for TST implants (Thommen Medical AG, Switzerland). In the reported period 7 implants with INICELL (0.5%) and 23 TST implants (1.5%) failed. This difference was statistically significant. The analysis of cases treated and followed up in a single implantological office for 6 years confirmed the very good clinical outcome that was achieved with both used implant lines. Within the limitations of this retrospective analysis, the overall early failure rate of the hydrophilic implants was significantly lower than that of hydrophobic implants. The use of hydrophilic implants allows the clinician to obtain less early failures, hence the interest of an up-to-date surface for the daily work of an implant practice.

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This study presents a novel bone reconstructive technique based on guided bone regeneration for localized three-dimensional hard tissue augmentation. This two-stage technique utilized a titanium osteosynthesis plate and a collagen membrane to form a physical barrier resembling a fence that contains bone graft biomaterial composed of a combination of deproteinized bovine bone matrix and autologous bone grafted from intraoral sites. Six patients were treated. At 6 months postsurgery, an increase in bone volume of 953 mm³ was shown. Mean maximum linear augmentation in the vertical direction was 6.75 mm. Histologic analysis of the regenerated area revealed the presence of compact newly formed bone with no sign of inflammation. A total of 13 implants were placed. Peri-implant marginal bone level was 0.94 mm at implant placement and 1.30 mm after 6 months. The patients were satisfied with the procedure and no complications were observed.

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Merli M, Moscatelli M, Mariotti G, Pagliaro U, Breschi L, Mazzoni A, Nieri M. “Membranes and Bone Substitutes in a One-Stage Procedure for Horizontal Bone Augmentation. A Histologic Double-Blind Parallel Randomized Controlled Trial”.

Int J Periodontics Restorative Dent. 35 (2015), No. 4; 462-471

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Zunehmend stellen periimplantäre Entzündungsprozesse nach der prothetischen Versorgung für den Behandler besondere Herausforderungen dar. Doch einen Standard für die Therapie der periimplantären Mukositis oder Periimplantitis gibt es bis heute nicht.
Periimplantitis-Prävention beginnt daher schon mit der Planung der Versorgung und der Auswahl des Implantats.

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Purpose: Accurate torque application and determination of the applied torque during surgical and prosthetic treatment is important to reduce complications. A study was performed to determine and compare the accuracy of manual wrenches, which are available in different designs with a large range of preset torques.

Materials and Methods: Thirteen different wrench systems with a variety of preset torques ranging from 10 to 75 Ncm were evaluated. Three different designs were available, with a spring-in-coil or toggle design as an active mechanism or a beam as a passive mechanism, to select the preset torque. To provide a clinically relevant analysis, a total of 1,170 torque measurements in the range of 10 to 45 Ncm were made in vitro using an electronic torque measurement device.

Results: The absolute deviations in Ncm and percent deviations across all wrenches were small, with a mean of -0.24 ± 2.15 Ncm and -0.84% ± 11.72% as a shortfall relative to the preset value. The greatest overage was 8.2 Ncm (82.5%), and the greatest shortfall was 8.47 Ncm (46%). However, extreme values were rare, with 95th-percentile values of -1.5% (lower value) and -0.16% (upper value). A comparison with respect to wrench design revealed significantly higher deviations for coil and toggle-style wrenches than for beam wrenches.

Conclusion: Beam wrenches were associated with a lower risk of rare extreme values thanks to their passive mechanism of achieving the selected preset torque, which minimizes the risk of harming screw connections.

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The aim of this study was to obtain a randomized, clinical and radiological comparison of implants with and without platform switching (PFS). The two compared titanium implant types differed only in the microgap position: test (PFS) or control (StE, no PFS). All implants were inserted in posterior regions and followed up for six months after abutment connection (AC). Twenty one patients with 21 PFS and 18 StE implants completed the six-month evaluation. No implant failed. One complication (exposed cap screw) was reported at AC. No statistically significant difference was observed between the marginal bone level of PFS and StE implants. Their bone level stabilized approximately 1 mm below the microgap. Based on the outcome of this short-term study with a limited number of patients, it seems unlikely that the optimal clinical and radiological outcome obtained with the tested standard implant (no PFS) can be improved by introducing an inward microgap shift (PFS).

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Trombelli L, Franceschetti G, Trisi P, Farina R, “Incremental, Transcrestal Sinus Floor Elevation With a Minimally Invasive Technique in the Rehabilitation of Severe Maxillary Atrophy. Clinical and Histological Findings From a Proof-of-Concept Case”.

American Association of Oral and Maxillofacial Surgeons, J Oral Maxillofac Surg 73:861-888, 201

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Van Eekeren P, Tahmaseb A, Wismeijer D. “Crestal bone changes in macro geometrically similar implants with the implant-abutment connection at the crestal bone level or 2.5 mm above: a prospective randomized clinical trial”.

Clinical Oral Implants Research, 2015; vol 0, no. 1, 1-6.

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van Eekeren P, Said C, Tahmaseb A, Wismeijer D. “Resonance Frequency Analysis of Thermal Acid-Etched, Hydrophilic Implants During First 3 Months of Healing and Osseointegration in an Early-Loading Protocol”.

The International Journal of Oral & Maxillofacial Implants, Volume 30, Number4, 2015

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Statement of Problem:
Limited information is available regarding the accuracy of mechanical torque-limiting devices (MTLDs) after their clinical use. PURPOSE:
The purpose of this study was to determine the accuracy of 2 types of MTLDs (friction-style and spring-style) after clinical use. MATERIAL AND METHODS:
Twenty-seven MTLDs in clinical service at The Ohio State University College of Dentistry were collected. Thirteen were friction-style and 14 were spring-style. A total of 6 different dental implant companies were represented (Astra Tech, Zimmer Dental, Biomet 3i, Straumann, Nobel Biocare, and Thommen Medical). All MTLDs had been in use for at least 6 months without being recalibrated, and all were tested to determine their accuracy in delivering target torque values. Statistical analysis used nonparametric tests to determine the accuracy of the MTLDs in delivering target torque values, and Bonferroni post hoc tests were used to assess pairwise comparisons. RESULTS:
After clinical service, spring-style MTLDs were significantly more accurate than friction-style MTLDs (P<.05). CONCLUSIONS:
Within the limitations of this study, it was concluded that after clinical service, spring-style MTLDs were more accurate than friction-style MTLDs. All MTLDs delivered torque values within 10% of the target torque value.

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Fillion M, Aubazac D, Vasconcelos M. „Prothèse transvissée directement sur l’implant: armature CFAO usinée transvissée ou pilier hydride transvissé/collé ?” Titane 11 (1) (2014) : 43-50.
 

Abstract
Objectives: To evaluate the association between smoking status and the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive technique (Smart Lift).

Methods: Forty-five implants were placed in 25 non-smoker (NS) and 20 smoker (S) patients in conjunction with the tSFE procedure. In all cases, an additional graft, chosen among different hydroxyapatite-based or ß-tricalcium phosphate-based biomaterials, was pushed into the sinus by gradual increments. Immediately after surgery, residual bone height, implant penetration into the sinus, extent of sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs. At 6 months after surgery, SL and aGH were reassessed.

Results: (i) The Smart Lift procedure resulted in substantial 6-month SL and aGH in both treatment groups; (ii) smoking status did not significantly affect the 6-month radiographic outcomes; (iii) a similarly low incidence of intra- and postoperative complications was observed in NS and S patients.

Conclusions: Smoking has a limited impact on the outcomes of tSFE performed with the Smart Lift technique.

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Hasson J-N, Hassid J, Aubazac D, Zeman F & P. „Clinical and radiological performance of short implants – a clinical study with two years follow up.“ Implants 2014; 4:6-12

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Held U. „Verkürzte Einheildauer von Titanimplantaten mit hydrophiler Oberfläche bei Patienten mit reduzierter Knochenqualität – eine prospektive Pilotstudie.”

Deutscher Ärzte-Verlag, Z Zahnärztl Impl (2014); 30: 134-142. Doi : 10.3238/ZZI.2014.0134-0142.

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Hinkle RM, Rimer SR, Morgan MH, Zeman P. „Loading of titanium implants with hydrophilic endosseal surface 3 weeks after insertion : clinical and radiological outcome of a 12 month prospective clinical trial.”

Journal of Oral and Maxillofacial Surgery (2014) : 72(8): 14951502

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Jaquiéry C, Ilgenstein B, Jungo M, Rüeger K, Chenaux S, Papadimitropoulos A, Jäger K. “Clinical and Radiological outcome of Titanium Implants in Clinical Practice: A 5 Year, Prospective, Multicenter Case Series.”

Dentistry journal, 2014, 2: 106-117.

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Purpose: The aim of this retrospective chart review was to evaluate the four-year survival rate of a titanium implant system.

Methods: A total of 352 sand-blasted, thermally acid-etched titanium implants were inserted into 181 partially or completely edentulous patients. Their cumulative survival rate was evaluated retrospectively. Associated factors, such as the implant distribution and treatment type were included in the evaluation.

Results: The implants were equally distributed between the maxilla (52.3%) and the mandible (47.7%). 48 implants (13.6%) were placed in the anterior region and 304 implants (86.4%) in the posterior region. The majority of the implants were inserted into bone of type II and III quality (89.8%) and volume (quantity B and C, 87.2%). Most of the implants (70.7%) were restored as single crowns; 28.7% supported a bridge construction and 0.6% a full denture. Only one implant failed, resulting in a four-year cumulative survival rate of 99.7%.

Conclusions: The implant system showed an excellent four-year survival rate. It proved to be a safe and predictable means for restoration of the dentition in partially or completely edentulous patients.

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Stübinger S, Waser J, Hefti Th, Drechsler A, Sidler M, Klein K, von Rechenber B, Schlottig F. „Evaluation of local cancellous bone amelioration by poly-L-DL-lactide co-polymers to improve primary stability of dental implants: a biomechanical study in sheep.“

Clinical Oral Implants Research (2014) : 1-9. Doi : 10.1111/clr.12445

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Abstract: The aim of the present study was to evaluate a new multi-phosphonate surface treatment (SurfLink®) in an unloaded sheep model. Treated implants were compared to control implants in terms of bone to implant contact (BIC), bone formation, and biomechanical stability. The study used two types of implants (rough or machined surface finish) each with either the multi-phosphonate Wet or Dry treatment or no treatment (control) for a total of six groups. Animals were sacrificed after 2, 8, and 52 weeks. No adverse events were observed at any time point. At two weeks, removal torque showed significantly higher values for the multi-phosphonate treated rough surface (+32% and +29%, Dry and Wet, respectively) compared to rough control. At 52 weeks, a significantly higher removal torque was observed for the multi-phosphonate treated machined surfaces (+37% and 23%, Dry and Wet, respectively). The multi-phosphonate treated groups showed a positive tendency for higher BIC with time and increased new-old bone ratio at eight weeks. SEM images revealed greater amounts of organic materials on the multi-phosphonate treated compared to control implants, with the bone fracture (from the torque test) appearing within the bone rather than at the bone to implant interface as it occurred for control implants.

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Devant une nuée de systèmes implantaires, il est parfois difficile de faire un choix qui ne se base pas simplement sur l’aspect pragmatique du coût financier ou celui subjectif du capital sympathie du délégué médical. Le système Thommen MédicalTM propose une gamme d’implants répondant aux critères indispensables au choix d’un implant dentaire. Le succès d’une reconstruction implanto-prothétique se juge après 10 ans de fonction. Bien loin de se contenter d’un taux de survie implantaire, il est indispensable de vérifier la bonne stabilité osseuse péri-implantaire, l’absence de dévissage ou de descellement prothétique.

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Hassid J, Hasson J. „Agénésies dentaires et implants. A propos d’un cas clinique.“ Titane 10 (3) (2013): 233-238.

Abstract

Introduction: Pure titanium is the material of choice for contemporary dental implants. However, superficial reaction of the moderately rough titanium surface with atmospheric components decreases its hydrophilicity. INICELL® represents a chemical alteration and hydrophilization of a moderately rough i. e. sand-blasted and acid-etched titanium surface. The hydrophilicity leads to a more homogenous adsorption of proteins on the implant surface in-vitro, supporting the activation of a higher number of platelets and the generation of a homogenous, complete fibrin matrix in the early phases of osseointegration. This in turn helps to reduce the healing time and enhances the predictability of osseointegration in compromised bony situations.

The objective of this case series trial was therefore to investigate if early loading (after 8 weeks) of hydrophilic INICELL implants is feasible in patients with reduced bone quality.

Methods: In 10 patients, 35 hydrophilic implants were placed in sites revealing bone quality class 3 and 4, and uncovered after 4 weeks. Eight weeks later implants were released for loading if the tactile resistance was ≥35 Ncm. Lower resistances resulted in 12 weeks initial healing period. Insertion torque, ISQ, tactile resistance and vertical bone level were evaluated at implant installation, after 4 weeks (uncovering), 8 or 12 weeks (loading), and 12 weeks and one year after loading.

Results: Mean implant insertion torque was 21 Ncm. 31 (88.6%) showed a tactile resistance of >35 Ncm after eight weeks and were released for prosthetic loading. Eight weeks after insertion, one implant (2.9%) had to be removed following a soft tissue complication. One implant had to be removed after 4 weeks due to a technical complication (fractured Osstell-abutment), it was therefore excluded from the analysis.

33 of 34 implants (97%) were loaded to occlusion and were in situ/functional one year after implantation. ISQs increased from 43 at baseline to 63 at eight weeks, and 72 at three months after loading. Then, ISQ remained constant until one year after loading.

Conclusions: Within the limitations of this prospective case series, hydrophilic implants may allow for shortening of the initial healing period even in bone with compromised density.

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Höckl K, Stoll P, Stoll V. “Sorfortimplantate – ja aber…” Dent Implantol 17/7 (2013): 552-555.

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OBJECTIVE: The aim of this study was to use intra-oral radiographs to evaluate changes in marginal bone levels around three different implant designs after 1 year.

MATERIALS AND METHODS: Three implant designs; two with a straight and one with a conical design, were placed adjacent to each other in the partially edentulous areas of 25 patients. The patients received 46 implants with a straight design (All fit SSO and SPI-element) and 29 implants with a conical design (SPI-contact). Two-way repeated analysis of variance (ANOVA) was used to evaluate the marginal bone changes in each group at 12 months follow-up (p < 0.05).

RESULTS: None of the implants had failed by the end of this study. After 12 months, significant differences were noted in the amount of alveolar bone loss recorded between the All fit SSO and SPI implants (p < 0.05). Mean crestal bone loss was 0.88 ± 0.43 mm for the All fit, 0.61 ± 0.34 mm for the SPI contact and 0.54 ± 0.27 mm for the SPI element implants.

CONCLUSIONS: The results of this study demonstrate that straight (cylindrical) implants with shorter high polish surface displayed less bone resorption.

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Introduction: This paper describes the treatment of horizontal osseous defects around implants in a one-stage split-mouth approach in a middle-aged female patient.

Method and Material: The same identical reconstruction technique was performed in both surgical sites using different biomaterials: a ? -tricalciumphosphate (Ceros TCP granules) grafting material and a porcine, collagen pericardium resorbable membrane (Remotis) were employed on the test side and a deproteinized, bovine bone matrix (Bio-Oss) and a porcine, collagen resorbable membrane (Bio-Gide) on the control side. Bone substitutes were mixed with autologous bone (approximately 10 %) harvested during implant insertion procedures.

Results: Substantial bone regrowth was evident in both ridges, although only the test side underwent complete regeneration. Histological examination of the regenerated areas showed the presence of mature bone organized around particles of biomaterial during the incorporation phase.

Conclusion: Both therapeutic approaches have proved favorable in terms of covering the initially exposed implant threads.

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Pfeil M, Brakel V. Implantaterhaltung – der Langzeiterfolg beginnt mit der Implantatplanung. Dent Implantol 17/8 (2013): 634-637. 

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Aim: The loss of maxillary posterior teeth leads to a dimensional reduction of the bone crest, which is partly due to the pneumatization of the maxillary sinus. Transcrestal sinus floor elevation (tSFE) is a bone augmentation procedure based on the creation of an access through the edentulous bone crest. To date, several techniques for tSFE have been proposed and validated. Recently, we proposed a simplified, minimally invasive technique for tSFE (namely, the Smart Lift technique) which is based on the use of specifically designed drills and osteotomes. The present paper describes the postextraction dimensional alterations of the alveolar crest in the maxillary posterior sextants focusing on the contribution of sinus pneumatization,
illustrates the operative steps of the Smart Lift technique and presents available data on clinical and patient-centered outcomes of tSFE when performed with this specific technique.

Conclusion: The Smart Lift technique represents a simplified, user-friendly option, since it allows for a substantial extent of sinus lift at limited operation times along with limited morbidity.

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Rebele S, Zuhr O, Hürzeler M. “Pre-extractive interradicular implant bed preparation: Case presentations of a novel approach to immediate implant placement at multirooted molar sites.” Int J Periodontics Restorative Dent 33 (2013): 88-96.  

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Objectives: To evaluate the association between smoking status and the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive technique (Smart Lift).

Methods: Forty‐five implants were placed in 25 non‐smoker (NS) and 20 smoker (S) patients in conjunction with the tSFE procedure. In all cases, an additional graft, chosen among different hydroxyapatite‐based or ß‐tricalcium phosphate‐based biomaterials, was pushed into the sinus by gradual increments. Immediately after surgery, residual bone height, implant penetration into the sinus, extent of sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs. At 6 months after surgery, SL and aGH were reassessed.

Results: (i) The Smart Lift procedure resulted in substantial 6‐month SL and aGH in both treatment groups; (ii) smoking status did not significantly affect the 6‐month radiographic outcomes; (iii) a similarly low incidence of intra‐ and postoperative complications was observed in NS and S patients.

Conclusions: Smoking has a limited impact on the outcomes of tSFE performed with the Smart Lift technique.

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PURPOSE: Sinus elevation via the lateral approach for implant rehabilitation of atrophic posterior maxillae is considered a safe and predictable therapy. Several xenogeneic biomaterials of different biologic origin have been used as valid and predictable alternatives to autogenous bone. This multicenter randomized controlled double-blind prospective clinical trial aimed to compare histomorphometrically two xenogeneic grafting materials used for sinus elevation with simultaneous implant placement.

MATERIALS AND METHODS: Seven private practices in Italy were involved. Patients presenting at least one site with a residual bone crest height between 2 and 4 mm were treated. Control sites were grafted with 100% deproteinated particulated bovine bone (DPBB), while test sites were grafted with prehydrated corticocancellous porcine bone (PCPB). Root-form implants were placed simultaneously. Insertion torque and clinical stability were assessed and recorded. At 6 months, a biopsy specimen was harvested from each site, and histomorphometric analyses were performed.

RESULTS: Thirty-seven patients received 42 sinus elevations (24 test and 18 control). Eighty-two implants with adequate primary stability were placed. Fifty-five implants were placed in residual bone crests greater than 2 mm but less than 4 mm (average 2.7 mm) and achieved an average insertion torque of 22.8 ± 11.3 N/cm. Nineteen implants were placed in ridges greater than 3 mm but less than 5 mm, and eight were placed in ridges with more than 5 mm remaining. After 6 months, three implants had failed to integrate, leading to a survival rate of 96.34%. Forty-two specimens were analyzed histomorphometrically. No significant differences in total bone volume (PCPB 37.43%, DPBB 37.52%) or residual grafting material (PCPB 13.55%, DPBB 16.44%) were detected.

CONCLUSIONS: In this study, PCPB compared well with DPBB as a grafting material for lateral sinus elevation.

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Introduction: The purpose of this report is to evaluate survival rates of 2 implants with slightly different machined collar height and body design (1.0 mm vs. 1.5 mm, cylindrical vs. cylindric-conical) but with the same enossal surface. The implants were placed in partially and fully edentulous patients in three centers. A retrospective chart review study was undertaken to evaluate the performance of implant based restorations. Mesial and distal alveolar bone heights were evaluated radiographically.

Material and Methods: Data were collected by 3 practitioners on 2 different design implants. Implant survival was calculated. Change in alveolar bone level was measured from periapical radiographs.

Results: 154 treated patients were followed up for 1.8 years. Included were 18 patients with 64 implants that had a minimum of 60 Gy radiation to the area due to treatment for their previous malignant disease. Failure to obtain osseointegration was seen in 3 patients who received 4 implants. The overall implant survival rate was 99.0%, implant failure rate 0.7% prior to and 0.2% after the restoration.

Discussion: Both implant types appear to be a satisfactory choice for treatment of either the totally or partially edentulous patients in both simple and complex situations. This conclusion is supported by the outcome obtained in a patient edentulous both in the upper and lower jaw. Eight years after surgery both overdentures were intact and stable with normal function. No difference was observed in the previously irradiated patients.

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Smart Lift : tecnica mininvasiva per il rialzo di seno mascellare con approccio transcrestale

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AIMS: To evaluate the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of deproteinized bovine bone mineral (DBBM) or β-tricalcium phosphate (β-TCP).

METHODS: In a multicenter randomized controlled trial, 38 sites in 38 patients were treated with the Smart Lift technique in association with DBBM (n = 19) or β-TCP (n = 19). The extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery.

RESULTS: (i) Substantial aGH and SL were observed immediately after surgery and at 6 months, with no significant differences between DBBM and β-TCP groups; (ii) a significant graft remodelling was observed from post-surgery to 6-months in the β-TCP group and (iii) limited incidence of complications as well as limited post-operative pain and discomfort were associated with the use of both graft materials.

CONCLUSIONS: The Smart Lift technique in conjunction with the additional use of either DBBM or β-TCP may provide a substantial elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort.

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OBJECTIVE: The first objective of this pilot study was to evaluate the impact of the hydrophilicity on the early phases of osseointegration. The second objective was to compare two hydrophilic implant surfaces with different geometries, surface roughness, and technologies achieving hydrophilicity.

MATERIAL AND METHODS: Twelve weeks after extraction, all four quadrants of nine minipigs received three dental implants, alternating between hydrophilic microrough surfaces (INICELL and SLActive) and a conventional hydrophobic microrough surface. After 5, 10, and 15 days of submerged healing, ground sections were prepared and subjected to histologic and histomorphometric analysis.

RESULTS: The histologic analysis revealed a similar healing pattern among the hydrophilic and hydrophobic implant surfaces, with extensive bone formation occurring between day 5 and day 10. With BIC values of greater than 50% after 10 days, all examined surfaces indicated favorable osseointegration at this very early point in healing. At day 15, the mean new bone-to-implant contact (newBIC) of one hydrophilic surface (INICELL; 55.8 ± 14.4%) was slightly greater than that of the hydrophobic microrough surface (40.6 ± 20.2%). At day 10 and day 15, an overall of 21% of the implants had to be excluded from analysis due to inflammations primarily caused by surgical complications.

CONCLUSION: Substantial bone apposition occurs between day 5 and day 10. The data suggest that the hydrophilic surface can provoke a slight tendency toward increased bone apposition in minipigs after 15 days. A direct comparison of two hydrophilic surfaces with varying geometries is of limited relevance.

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A technique for fabricating a definitive immediate fixed implant-supported prosthesis to rehabilitate the edentulous mandible is described. Temporary abutments were used first as impression copings, later modified to achieve parallelism, and finally incorporated in the definitive framework. The metal framework was fabricated with holes for the abutments and connected to the abutments with composite resin cement intraorally to obtain passive fit. This technique reduced the number of steps, thereby decreasing insertion time of the definitive prosthesis to 2 days.

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The present report describes a minimally invasive technique for transcrestal sinus floor elevation, namely the Smart Lift technique, which is based on the controlled use of drills and osteotomes. The rationale of this technique is to provide predictable vertical bone augmentation into the sinus cavity by (1) using the existing residual bone as a viable graft and (2) limiting the incidence of membrane perforation and postsurgery morbidity. Surgical steps of the procedure are thoroughly illustrated by means of a paradigmatic case. The Smart Lift procedure was compatible with sinus floor elevation and implant stability for up to 1 year following surgery. No complications occurred during or after surgery. On periapical radiographs, a radiopaque area corresponding to the augmented sinus floor was present above the apical portion of the implant.

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Background: A cursory review of the current socket preservation literatures well depicts the necessity of further esthetic considerations through the corrective procedures of the alveolar ridge upon and post extraction. A new technique has been described here is a rotational pedicle combined epithelialized and connective tissue graft (RPC graft) adjunct with immediate guided tissue regeneration (GBR) procedure.

Results: We reviewed this technique through a case report and discuss it’s benefit in compare to other socket preservation procedures.

Conclusion: The main advantages of RPC graft would be summarized as follows: stable primary closure during bone remodeling, saving or crating sufficient vestibular depth, making adequate keratinized gingiva on the buccal surface, and being esthetically pleasant.

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Bridge complet implant-porté - Presentation d'un protocole original utilisant la robotique passive (système Robodent). Implant 18 (2012): 109-120.

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PURPOSE: To determine the change in stability of three different implant systems using resonance frequency analysis (RFA) and to correlate RFA measurements with factors related to implant design, length, and diameter, patient gender, and dental arch. Clinical and radiologic evaluations were performed up to 1 year after loading.

MATERIALS AND METHODS: Three different types of implants from three different manufacturers were inserted in the posterior maxilla and mandible. RFA measurements were performed at implant placement and weekly up to 8 weeks postoperatively and were compared with respect to implant type, length, and diameter and dental arch. The implants were loaded after 8 weeks. All implants were examined radiographically at baseline and at 6 and 12 months. Plaque Index, Sulcus Bleeding Index, peri-implant probing depths, and marginal bone loss were recorded. Repeated-measurements analysis of variance, two-tailed mixed-model analysis of variance, the Least Significant Differences and Mann-Whitney U tests were used for statistical analyses.

RESULTS: All the groups showed high stability values at all time points (above 71). There were statistically significant differences between groups at all time points except 1 and 2 weeks. Mandibular implants showed statistically higher stability values than maxillary implants. Wide implants showed statistically higher stability values than narrow implants. Mean marginal bone loss was 0.22 ± 0.47 mm after 1 year.

CONCLUSIONS: All three implant systems showed clinically acceptable stability values prior to early loading. The success rates and bone loss were similar to the values reported in the literature.

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Purpose: In current practice, two types of burs are typically used: stainless steel (SS) and alumina-toughened zirconia (ATZ). The present study evaluated the durability of these two burs in relation to osteotomy creation for implant placement. In addition, the effects of the two types of burs on a bone model were examined. Materials and Methods: SS and ATZ burs were compared under controlled conditions in a swine rib osteotomy. The heat generated and time necessary for perforation were measured and analyzed with repeated-measures one-way analysis of variance. The burs and bone samples were evaluated using scanning electron microscopy. Results: New ATZ and SS burs showed greater bone disruption compared to burs that had been used 80 times. Brand new burs of either material showed small manufacturing defects, which increased in number with use. No clinically or statistically significant differences were found between burs with respect to temperature and time for perforation. Conclusions: SS and ATZ burs can be used several times for implant site preparation under controlled conditions without reaching a temperature that is harmful to the bone. Both burs wear under repeated use, but not to an excessive degree. The duller burs produced smoother perforations than did the new ones. Int J Oral Maxillofac Implants 2012;27:1023–1028

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Preextractive interradicular implant bed preparation - case presentations of a novel approach of immediate implant placement at multirooted molar sites. The International Journal of Periodontics and Restorative Dentistry (2012): accepted.

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PURPOSE: The principle of guided tissue and bone regeneration has long been established for treating bone and periodontal defects. In addition to nonabsorbable barriers, various collagens have become accepted as membrane materials for separating the graft from soft tissue. However, collagen membranes differ significantly in their barrier function and biocompatibility. The objective of this pilot study was to examine, in vitro and in vivo, a novel native collagen membrane extracted from porcine pericardium.

MATERIALS AND METHODS: The morphologic structure of two different native collagen membranes (Remotis, Thommen Medical; Bio-Gide, Geistlich Biomaterials) was examined using a scanning electron microscope. For biocompatibility testing, membranes were incubated with SaOs-2 osteoblastlike cells. After 2 hours, 3 days, and 7 days, proliferation of the cells on the membranes was determined. Evaluation of the biodegradation pattern was performed in a dog model with simultaneous bone augmentation with Bio-Oss (Geistlich Biomaterials) or Cerabone (Botiss Biomaterials) in the lateral anterior maxilla in eight animals with histologic examination after 4, 8, 12, and 24 weeks.

RESULTS: An interconnective pore system was identifiable for Remotis, while Bio-Gide displayed a more fibrous structure. In vitro, Remotis showed considerable cell proliferation, which was significantly superior to that observed with Bio-Gide, especially after 7 days (2,910 ± 1,273 and 707 ± 706, respectively). In vivo, both membranes integrated into the surrounding tissue without any inflammatory reaction. Both membranes allowed early vascularization. However, considerable biodegradation was noted within 4 to 8 weeks with Bio-Gide, while Remotis resorbed generally within the first 8 to 12 week. Both membranes supported underlying bone formation.

CONCLUSION: Both examined membranes indicate a high level of biocompatibility. Both are resorbed without inflammation within 8 weeks (Bio-Gide) or 12 weeks (Remotis). The compact interconnective pericardium collagen of Remotis may have stabilized the resorption process.

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When Teamwork is the Best Way. A multidisciplinary approach to a patient’s surgery and prosthodontic rehabilitation. Journal of Dental Technology (2012): 36-40.

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Two groups of titanium dental implants, identical in geometry but different in the treatment of their surfaces, were tested in an in vivo minipig model of the mandible. The surfaces that were tested were, first, sandblasted and acid-etched; and secondly, sandblasted, acid-etched, and conditioned. The removal torque was assessed at 2, 4, and 8 weeks after implantation (n=6 animals in each healing period). The interfacial stiffness was also evaluated. All dental implants were well-integrated at the time of death. Removal torque values increased significantly over the course of 8 weeks. Removal torque and interfacial stiffness were increased for conditioned surfaces after 2 weeks, but there were no significant differences between the two surfaces. The sandblasted and acid-etched implants are the standard, and conditioning of the surface showed a tendency to increase early peri-implant formation of bone.

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Objectives: The present study was performed to comparatively evaluate the effectiveness and post‐operative morbidity of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of two graft biomaterials.

Methods: Thirty sites in 30 patients were randomly assigned to tSFE in association with either deproteinized bovine bone mineral (DBBM) (n = 15) or synthetic hydroxyapatite in a collagen matrix (S‐HA) (n = 15). In both groups, the extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. Surgical and post‐surgical complications as well post‐surgical pain and discomfort were also assessed.

Results: The results of the study indicated that (i) immediately post‐surgery, both DBBM and S‐HA resulted in substantial SL and aGH, which were maintained at 6 months, (ii) greater aGH and SL were observed in S‐HA group compared with DBBM group at 6 months post‐surgery and (iii) limited surgical complications and post‐operative pain/discomfort were associated with the use of both graft biomaterials.

Conclusions: The Smart Lift technique in conjunction with the additional use of either S‐HA or DBBM may provide a predictable elevation of the maxillary sinus floor along with limited post‐surgical complications and post‐operative pain/discomfort. SL and aGH were significantly greater at 6 months for S‐HA than DBBM.

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Objective: The first objective of this pilot study was to evaluate the impact of the hydrophilicity on the early phases of osseointegration. The second objective was to compare two hydrophilic implant surfaces with different geometries, surface roughness, and technologies achieving hydrophilicity.

Material and methods: Twelve weeks after extraction, all four quadrants of nine minipigs received three dental implants, alternating between hydrophilic microrough surfaces (INICELL and SLActive) and a conventional hydrophobic microrough surface. After 5, 10, and 15 days of submerged healing, ground sections were prepared and subjected to histologic and histomorphometric analysis.

Results: The histologic analysis revealed a similar healing pattern among the hydrophilic and hydrophobic implant surfaces, with extensive bone formation occurring between day 5 and day 10. With BIC values of greater than 50% after 10 days, all examined surfaces indicated favorable osseointegration at this very early point in healing. At day 15, the mean new bone‐to‐implant contact (newBIC) of one hydrophilic surface (INICELL; 55.8 ± 14.4%) was slightly greater than that of the hydrophobic microrough surface (40.6 ± 20.2%). At day 10 and day 15, an overall of 21% of the implants had to be excluded from analysis due to inflammations primarily caused by surgical complications.

Conclusion: Substantial bone apposition occurs between day 5 and day 10. The data suggest that the hydrophilic surface can provoke a slight tendency toward increased bone apposition in minipigs after 15 days. A direct comparison of two hydrophilic surfaces with varying geometries is of limited relevance.

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This clinical report describes a case of maxillary dental rehabilitation using five implants placed simultaneously in three cortico-cancellous iliac bone blocks and rigidly fixed to the residual bone with titanium mini-screws 2-mm in diameter and mini-plates. All “empty spaces” between the bone segments were filled with iliac bone chips harvested from the diploe of iliac bone mixed by Bio-oss. The second surgery was performed 5 months later, when all five implants were integrated, and one cover screw was exposed to oral cavity. Two months after the second surgery, abutments were connected to the implants and loaded with a fixed partial denture.

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Complete maxillary implant-based bridgework is amongst the most challenging of restorative procedures. With TRIPOD, a new treatment protocol for planning and surgery, a radiographic template and a surgical guide are secured to three fixed reference points, such as natural teeth and previously placed dental implants. CT-based software enhances treatment by first validating the surgical guide, and then allowing chairside postmodification options. Open-flap surgery is initiated with sterile templates and impression trays. Implant sites are prepared with the surgical guide to a final depth with pilot drill and 2.8 mm diameter drill. Further site preparation involves implantspecific drills, piezosurgery and bone expanders. These developments improve the reliability of complex implant-based restorations.

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Complete maxillary implant-based bridgework is amongst the most challenging of restorative procedures. With TRIPOD, a new treatment protocol for planning and surgery, a radiographic template and a surgical guide are secured to three fixed reference points, such as natural teeth and previously placed dental implants. CT-based software enhances treatment by first validating the surgical guide, and then allowing chairside postmodification options. Open-flap surgery is initiated with sterile templates and impression trays. Implant sites are prepared with the surgical guide to a final depth with pilot drill and 2.8 mm diameter drill. Further site preparation involves implantspecific drills, piezosurgery and bone expanders. These developments improve the reliability of complex implant-based restorations.

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OBJECTIVES: Osseointegration is dependent on different parameters of the implant surface like surface roughness and physicochemical properties. In vitro studies using a wide variety of surface parameters and cell lines make it difficult to address the influence of a single parameter. With this study the influence of surface topography and energy on different osteoblast derived cell lines, namely MG-63 and SaOS-2 and of human mesenchymal stromal cells (hMSC) were investigated.

MATERIAL AND METHODS: Cells were cultured on polished (POL) and sandblasted/hot acid etched (SBA) titanium surfaces which were partly alkaline treated (SBA NaOH). Cell morphology, metabolic activity, tissue non-specific alkaline phosphatase (TNAP) activity and prostaglandin E(2) (PGE(2) ) formation were determined.

RESULTS: Impaired spreading was found on both SBA surfaces. Proliferation after 4 and 7 days increased on POL compared to both SBA surfaces. TNAP activity of hMSC and MG-63 was increased on POL compared to both SBA surfaces whereas SaOS-2 did not discriminate between the three surfaces. PGE(2) formation of hMSC and MG-63 was on both SBA surfaces after 2 days significantly higher than on POL.

CONCLUSIONS: The results of this study show that surface roughness has a distinct influence on proliferation and differentiation of osteoblasts. However, variations in physicochemical properties seem to have little influence under the used experimental conditions. It is suggested that more sever and long-lasting modifications of surface chemistry would have an influence on osteoblastic cells.

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Between 2001 and 2009 115 screw implants were inserted into fresh single root extraction sockets. The follow–up period ended at least 6 month after prosthetic treatment. In this prospective clinical multicenter study the results of two-piece titanium implants (Straumann, Thommen) and onepiece zirconium dioxide implants (Z-Systems) were compared in terms of osseous and soft tissue findings. Titanium implants showed the best ratio of osseo-integration (96 %) in comparison to zirconium dioxide implants (72,7 %), whereas all implants had a comparable success rate in terms of peri-implant soft tissue outcome at the end of the follow-up period.

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AIM: To compare immediate versus early non-occlusal loading of dental implants placed flapless in a 3-year, parallel group, randomized clinical trial.

MATERIALS AND METHODS: The study was conducted in a private dental clinic between July 2005 and July 2010. Patients 18 years or older were randomized to receive implants for fixed partial dentures in cases of partial edentulism. The test group was represented by immediate non-occlusal implant loading, whereas the control group was represented by early non-occlusal implant loading. The outcome variables were implant failure, complications and radiographic bone level at implant sites 3 years after loading, measured from the implant-abutment junction to the most coronal point of bone-to-implant contact. Randomization was computer-generated with allocation concealment by opaque sequentially numbered sealed envelopes, and the measurer was blinded to group assignment.

RESULTS: Sixty patients were randomized: 30 to the immediately loaded group and 30 to the early loaded group. Four patients dropped out; however, the data of all patients were included in the analysis. No implant failure occurred. Two complications occurred in the control group and one in the test group. The mean bone level at 3 years was 1.91 mm for test group and 1.59 mm for control group. The adjusted difference in bone level was 0.26 mm (CI 95% -0.08 to 0.59, p = 0.1232).

CONCLUSION: The null hypothesis of no difference in failure rates, complications and bone level between implants that were loaded immediately or early at 3 years cannot be rejected in this randomized clinical trial.

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Titanium implants are most commonly used for bone augmentation and replacement due to their favorable osseointegration properties. Here, hyperhydrophilic sand-blasted and acid-etched (SBA) titanium surfaces were produced by alkali treatment and their responses to partially heparinized whole human blood were analyzed. Blood clot formation, platelet activation and activation of the complement system was analyzed revealing that exposure time between blood and the material surface is crucial as increasing exposure time results in higher amount of activated platelets, more blood clots formed and stronger complement activation. In contrast, the number of macrophages/monocytes found on alkali-treated surfaces was significantly reduced as compared to untreated SBA Ti surfaces. Interestingly, when comparing untreated to modified SBA Ti surfaces very different blood clots formed on their surfaces. On untreated Ti surfaces blood clots remain thin (below 15 mm), patchy and non-structured lacking large fibrin fiber networks whereas blood clots on differentiated surfaces assemble in an organized and layered architecture of more than 30 mm thickness. Close to the material surface most nucleated cells adhere, above large amounts of non-nucleated platelets remain entrapped within a dense fibrin fiber network providing a continuous cover of the entire surface. These findings might indicate that, combined with findings of previous in vivo studies demonstrating that alkali-treated SBA Ti surfaces perform better in terms of osseointegration, a continuous and structured layer of blood components on the blood-facing surface supports later tissue integration of an endosseous implant.

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OBJECTIVES: the aim of the present study was to evaluate the dimensional changes of peri-implant tissues obtained by implant placement, bone and soft tissue augmentation, prosthetic reconstruction and 1 year of function using a new, non-invasive method for volumetric measurements.

MATERIALS AND METHODS: in 16 patients, the missing central or lateral maxillary incisor was reconstructed with an implant-supported single crown. Impressions were taken before (t1), after implant placement with guided bone regeneration using DBBM and a PTFE membrane (t2), after soft tissue augmentation (t3), immediately after crown placement (t4) and 1 year later (t5). The cast models were optically scanned and digitally superimposed allowing qualitative and quantitative analysis of alterations of the labial peri-implant tissue contour. In addition, the crown length and papilla height were measured at crown placement (t4) and after 1 year (t5).

RESULTS: fifteen patients were available for recall after 1 year. During therapy, a mean gain in distance in the labial direction of 1.27 ± 0.67 mm was observed after the surgical procedures. One year after crown insertion, a mean loss of 0.04 ± 0.31 mm in the labial direction was recorded. During the same period, the crown length increased by a mean of 0.22 ± 0.57 mm and the papilla height by 0.07 ± 0.61 mm. The degree and pattern of tissue change following crown insertion were highly variable between individuals, irrespective of the amount and quality of previously augmented tissues.

CONCLUSIONS: the clinical procedures were effective in augmenting peri-implant tissue volume that remained stable to a high degree within 1 year after crown insertion. Large inter-individual variations regarding the tissue alterations were observed.

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Between 2001 and 2009 115 screw implants were inserted into fresh single root extraction sockets. The follow–up period ended at least 6 month after prosthetic treatment. In this prospective clinical multicenter study the results of two-piece titanium implants (Straumann, Thommen) and onepiece zirconium dioxide implants (Z-Systems) were compared in terms of osseous and soft tissue findings. Titanium implants showed the best ratio of osseo-integration (96 %) in comparison to zirconium dioxide implants (72,7 %), whereas all implants had a comparable success rate in terms of peri-implant soft tissue outcome at the end of the follow-up period.

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Questo articolo descrive la Smart Lift technique, ovvero una tecnica mini-invasiva per il rialzo del seno con accesso attraverso la cresta ossea residua. Tale procedura è basata sull’uso controllato di frese e osteotomi. Il suo razionale è ottenere un rialzo prevedibile del pavimento osseo del seno mascellare sfruttando come innesto dotato di capacità osteoinduttiva [N.d.T.: di indurre attivamente la rigenerazione ossea a partire da cellule progenitrici] l’osso residuo presente in situ e2 limitando l’incidenza statistica della perforazione accidentale della membrana sinusale e il tasso di morbilità postchirurgica. Gli step chirurgici di tale procedura sono qui illustrati nei dettagli facendo riferimento a un caso clinico esemplare. La tecnica Smart Lift si è dimostrata adatta a ottenere l’elevazione del seno mascellare e a fornire una stabilità intraorale degli impianti per un periodo di follow-up di un anno dalla chirurgia implantare. Non si sono presentate complicazioni né intraoperatorie né  postchirurgiche. Alle indagini radiografiche periapicali si osservava un’area radio-opaca al di sopra della porzione apicale dell’impianto e quindi corrispondente alla zona del pavimento osseo del seno mascellare andata incontro a aumento volumetrico.

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Aim: Recently, we proposed a minimally-invasive technique (Smart Lift) to limit the post-operative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially-designed drills and osteotomes. The aim of this work is to present data on the clinical outcomes and post-operative morbidity of sinus floor elevation procedures performed using the Smart Lift technique, in association with a hydroxypatite-collagen biomaterial.

Materials: 5 implants were placed in the posterior portions of the maxilla area of 4
patients using the Smart Lift technique in association with hydroxyapatite-collagen biomaterial. Post-operative pain and discomfort were assessed using a 100mm-VAS scale. The incidence of intra- and post-operative complications was recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs at 6 months post-surgery.

Results: The augmented sites had a pre-surgery residual bone height of 5.4 ± 1.1
mm, while the mean length of the implants inserted in augmented sites was 9.8 ± 0.7 mm. Immediately after surgery, VAS scores for pain and discomfort were 4.0 ± 5.2 and 13.0 ± 16.7, respectively. No complications were observed either during or after the surgical procedure. At 6 months after surgery, a newly formed mineralized tissue
entirely covered the portion of the implants exposed into the sinus cavity in all cases.

Conclusions: The Smart Lift technique associated with a hydroxyapatite-collagen
biomaterial represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity.

Surface-conditioned dental implants: an animal study on bone formation. Journal of clinical periodontology 36, no. 10 (October 2009): 882-891.

Full mouth restoration on dental implants utilizing titanium laser-welded frameworks. Journal of esthetic and restorative dentistry : 21, no. 4 (January 2009): 215-228.

There is a varying degree of hand torque abilities using finger drivers among clinicians. Calibrating one’s own abilities requires complicated instruments not readily available. This study evaluated a simple-to-use method that allows dental practitioners to have a quantifiable clinical assessment of relative torque ability using finger drivers to torque down dental implant components. A typodont that includes dental implants was mounted in a mannequin placed in a patient-reclined position. The subjects were asked to torque as tightly as they could a new healing abutment to an implant secured firmly in resin within the typodont. All participants wore moistened gloves when using a finger driver. The healing abutment was countertorqued using a certified precalibrated precision torque measurement device. The reading on the torque driver was recorded when the healing abutment disengaged. An average of torque values of dentists and dental students was calculated. Fifty subjects had an average maximum torque ability of 24 Ncm (male dentists: 28 Ncm; students: 22 Ncm; male students: 24 Ncm; female students: 19 Ncm). Maximum torque values for all participants ranged from 11 Ncm to 38 Ncm. There was no significant difference between groups. This study showed a varying degree of hand torquing abilities using a finger driver. Clinicians should regularly calibrate their ability to torque implant components to more predictably perform implant dentistry. Dental implant manufacturers should more precisely instruct clinicians as to maximum torque, as opposed to ‘‘finger tighten only.’’

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Abstract

A new strategy to render intrinsically hydrophobic microrough titanium implant surfaces superhydrophilic is reported, which is based on a rapid treatment with diluted aqueous sodium hydroxide solutions. The physicochemical characterization and protein interaction of the resulting superhydrophilic implant surfaces are presented. The superhydrophilicity of alkali treated microrough titanium substrates was mainly attributed to deprotonation and ion exchange processes in combination with a strong enhancement of wettability due to the roughness of the used substrates. Albeit these minor and mostly reversible chemical changes qualitative and quantitative differences between the protein adsorption on untreated and alkali treated microrough titanium substrates were detected. These differences in protein adsorption might account for the enhanced osseointegrative potential of superhydrophilic alkali treated microrough implant surfaces. The presented alkali treatment protocol represents a new clinically applicable route to superhydrophilic microrough titanium substrates by rendering the implant surface superhydrophilic "in situ of implantation".

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Abstract

Background: Recently, we proposed a minimally invasive technique to limit the postoperative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially designed drills and osteotomes. The purpose of the present study is to present data on the clinical outcomes and postoperative morbidity of sinus floor elevation procedures performed using the proposed technique.

Methods: Fourteen implants were placed in the posterior portions of the maxilla areas of 11 patients using the proposed technique. Postoperative pain and discomfort were assessed using a 100-mm visual analog scale (VAS). The incidences of intra- and postoperative complications were recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs 6 months post-surgery.

Results: The augmented sites had a presurgery residual bone height of 6.1 mm, whereas the mean length of the implants inserted in augmented sites was 10.3 – 0.9 mm. Immediately after surgery, VAS scores for pain and discomfort were 9.4 – 13.4 and 17.0 – 22.2, respectively. The 7-day VAS score for pain was 2.1 – 4.9. No complications were observed during or after the surgical procedure. Six months after
surgery, a newly formed mineralized tissue was found at or beyond the level of the implant apex in all cases.

Conclusion: The proposed technique represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity. J Periodontol 2010;81: 158-166.

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Abstract

The present report describes a minimally invasive technique for transcrestal sinus floor elevation, namely the Smart Lift technique, which is based on the controlled use of drills and osteotomes. The rationale of this technique is to provide predictable vertical bone augmentation into the sinus cavity by (1) using the existing residual bone as a viable graft and (2) limiting the incidence of membrane perforation and postsurgery morbidity. Surgical steps of the procedure are thoroughly illustrated by means of a paradigmatic case. The Smart Lift procedure was compatible with sinus floor elevation and implant stability for up to 1 year following surgery. No complications occurred during or after surgery. On periapical radiographs, a radiopaque area corresponding to the augmented sinus floor was present above the apical portion of the implant.

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Extent and Mechanism of Thrombocyte Activation on superhydrophilic microrough Titanium Dental Implant Surfaces. ESB Lausanne Bone (2009).

Implantatoberflächen – Stand der Technik. ZMK Online 26, no. 6 (2010): 2-6.

Abstract

AIM: To test the hypothesis that peri-implant bone formation and mechanical stability of surface-modified zirconia and titanium implants are equivalent.

MATERIALS AND METHODS: Twelve minipigs received three types of implants on either side of the mandible 8 weeks after removal of all pre-molar teeth: (i) a zirconia implant with a sandblasted surface; (ii) a zirconia implants with a sandblasted and etched surface; and (iii) a titanium implant with a sandblasted and acid-etched surface that served as a control. Removal torque and peri-implant bone regeneration were evaluated in six animals each after 4 and 13 weeks.

RESULTS: The titanium surface was significantly rougher than both tested zirconia surfaces. Mean bone to implant contact (BIC) did not differ significantly between the three implant types after 4 weeks but was significantly higher for titanium compared with both zirconia implants after 13 weeks (p<0.05). Bone volume density (BVD) did not differ significantly at any interval. Removal torque was significantly higher for titanium compared with both zirconia surfaces after 4 and 13 weeks (p<0.001). The sandblasted and etched zirconia surface showed a significantly higher removal torque after 4 weeks compared with sandblasted zirconia (p<0.05); this difference levelled out after 13 weeks.

CONCLUSIONS: It is concluded that all implants achieved osseointegration with similar degrees of BIC and BVD; however, titanium implants showed a higher resistance to removal torque, probably due to higher surface roughness.

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Abstract

The effect of two different etching procedures with inorganic acids (HSE and CSE)-one using additionally strongly oxidising conditions due to the presence of CrO(3) (CSE)-and consecutive storage conditions (dry methanol and air) for previous corundum blasted titanium surfaces is compared with respect to their wettability behaviour and the potential of the etching processes for removing remaining blasting material. The etching procedures result in distinct different surface morphologies. Whereas the HSE surface shows sub-mm to sub-mum structures but neither porosity nor undercuts, the CSE surface is extremely rugged and porous with structures protruding the more homogeneously attacked areas by several micrometers. By EDX analysis both remaining blasting material and chromium and sulphur from the etching treatment has been detected on the CSE surfaces only. Both surfaces states show super-hydrophilic behaviour immediately after etching and storage up to 28 days in dry methanol. Whereas contact with air does not change super-hydrophilicity for the CSE samples, wettings angles of the HSE samples increase within minutes and reach about angles of about 60 degrees and 90 degrees after one and 2 days exposure to air, respectively. The increasing hydrophobicity is discussed with respect to the formation of a surface coverage from hydrocarbons originating from aromatic compounds present in traces in air.

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Investigation of a unique nanostructured dental implant surface. European Cells and Materials Vol. 14. Suppl. 3, (2007): page 95.

Accuracy of Manual Torque-limiting Devices for Use in Oral Implantology. BDIZ EDI konkret no 3 (2008): 48-52.

Vergleich der Drehmomentgenauikeit von implantologischen Handratschen. BDIZ EDI konkret, no. 03 (2008): 84-88.

Immediate loading of the edentulous mandible using a definitive hybrid prosthesis. Inside Dentistry, no. July/August (2006): 76-77.

Influence of Hydrophilicity of Microrough Dental Implant Surfaces on Protein, Blood and Cell Interactions and its Impact on Osseointegration Physicochemical surface properties of NaOH treated microrough Ti Implants. ESB Lausanne Poster (2009).

Investigation of a unique nanostructured dental implant surface. TM Scientifics no. 1 (2008): 5.

Immediate versus early non-occlusal loading of dental implants placed flapless in partially edentulous patients. One-year results from a randomised controlled clinical trial. European Journal of Implantology 1, no. 3 (October 2008): 207-220.

Treatment of an avulsed maxillary central with the Thommen SPI system using an EASY abutment. Inside Dentistry, no. October (2007): 96-97.

Schweizer Pioniere der Implantologie. Swiss Dent 21, no. 11-12 (2000): 27-28.

Risiko der Bakteriendurchlässigkeit verschraubter implantatgetragener Suprastrukturen. Zeitschrift für Zahnärztliche Implantologie 17, no. 2 (2001): 71-75.

Stegverbundene HATI-Implantate und periimplantäre Gewebereaktion nach Versorgung des zahnlosen Unterkiefers. Dissertation (2002).

Abform und Versorgungstechniken für festsitzende Rekonstruktionen mit einem modernen Implantatsystem. Implantologie 8, no. 3 (2004): 210-216.

Etched implants_a comparative surface analysis of four implant systems. Journal of Biomedical Material Research Part B: Applied Biomaterials 69B (2004): 46-57.

Bone formation on dental implants in a sheep study Universität Zürich. European Cells and Materials, vol 14, suppl 1, (2007): 98.

Restoration of an Immediately placed Implant with the Thommen SPI® EASY Abutment in the Esthetic Zone. Inside Dentistry, no. April (2007): 74-75.

Comparison of bending strength of different implant-abutment connections. TM Scientifics no. 1 (2008): A.

Restoration of an Acquired Mandibular Defect Secondary to a Neoplasm Excision. Inside Dentistry 3, no. 8 (2007): 2-4.

Engineering strontium-coating titanium implant surfaces. Biomaterials (2007)

Abstract

L’elevazione del pavimento del seno mascellare eseguita utilizzando un accesso crestale è una procedura clinicamente consolidata. Diversi studi condotti su impianti posizionati in siti sottoposti ad elevazione del seno mascellare dimostrano una percentuale di successo a lungo termine sovrapponibile a quella degli impianti posizionati in osso nativo. Ad oggi, tuttavia, le tecniche chirurgiche disponibili presentano indubbi svantaggi (scarso controllo delle lunghezze di lavoro degli strumenti utilizzati, eccessivo traumatismo a livello dell’osso crestale residuo durante la preparazione del sito), che possono aumentare le probabilità di perforazione della membrana sinusale e/o aumentare l’incidenza postchirurgica di disturbi al sistema oto-vestibolare. Scopo del presente studio è quello di illustrare una metodica originale (Smart Lift) perottenere il rialzo del pavimento del seno mascellare per via crestale, elaborata nel tentativo di superare le limitazioni delle tecniche convenzionali. Verrà illustrata in dettaglio la sequenza operativa e descritto un caso chirurgico paradigmatico.

Abstract

Elevation of maxillary sinus floor with crestal approach
INTRODUCTION. The elevation of maxillary sinus floor with a crestal approach is a clinically consolidated surgical procedure. Implants positioned in augmented sinuses show a long-term success rate similar to implants positioned in native bone. CLINICAL ASPECTS. Unfortunately conventional surgical techniques are affected by important limitations, such as poor control of the working depth of surgical instruments and excessive trauma of residual osseous crest. These limitations could increase the risk of perforating the sinus membrane or increasing post-surgical adverse events affecting ear and vestibule. AIM OF WORK. The aim of this study is to describe a new method for sinus floor elevation with a crestal approach, developed in order to overcome the limitations of conventional techniques. CASE REPORT. The operative steps and a case report are illustrated in details.

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SPI® System Implant / Abutment Connection. TM Internal Publication (2008): 1-7.

Implant replacement of the maxillary central incisor utilizing a modified ceramic abutment (Thommen SPI ART) and ceramic restoration. Journal of esthetic and restorative dentistry, no. 20 (January 2008): 21-28.

TM Scientifics No. 1. TM Scientifics no. 1 (2008): 1-7.

Immediate placement, conventional provisionalization, state-of-the-art aesthetics. PPAD (2006): 13-14.

Abstract

AIM: To assess dimensional ridge alterations following immediate implant placement in molar extraction sites.

MATERIAL AND METHODS: Twelve subjects received 12 immediate transmucosal implants in molar extraction sites. Peri-implant defects were treated according to the principles of Guided Bone Regeneration by means of a deproteinized bone substitute and a bioresorbable collagen membrane. Changes in vertical (IS-BD, CREST-BD) and horizontal distances (EC-I, IC-I) of alveolar bony walls to the bottom of the defects (BD) and to the implant surfaces (I) were compared between implant placement and surgical re-entry at 6 months.

RESULTS: The implant survival rate at 6 months was 100%. Statistically significant differences (P<0.01) were observed in the mean changes in vertical distances IS-BD and CREST-BD between baseline and re-entry. At re-entry, all peri-implant marginal defects assessed from the internal socket wall to the implant surface (IC-I) were healed. The residual combined thickness of the buccal wall with the newly formed peri-implant bone at sites with an initial thickness of 1 mm was statistically significantly smaller (P<0.05) compared with that of sites with an initial buccal thickness of 2 mm (2.50 +/- 0.76 vs. 4+/-0 mm).

CONCLUSIONS: The marginal defects around immediate implants placed in molar extraction sites were completely filled after 6 months of healing through de novo bone formation. Bone resorption was observed from the external aspects of the buccal and oral socket walls. Dimensional changes of the external socket walls were mostly pronounced at the buccal aspects.

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Biomechanical and histomorphological results of hydrophilic surface modification. EAO Abstract (2007): EAO.

Osseointegration of Zirconia and Titanium Implants in different Animal Models. International Association for Dental Research (2009).

Osteoclast differentiation and cultivation: influence of different substrates. Interface Biology of Implants (2009).

Osteoclasts growing on Bone: Dimensions and Structure of Resorption Pits. European Society on Biomaterials, no. September (2009): Abstract.

Abstract

The use of small-diameter implants is indicated when small missing teeth have to be replaced, especially in esthetic zones. Nevertheless, the small diameter can pose a limiting factor with respect to what materials can be used for the final crown. In most cases, full-ceramic crowns in combination with a ceramic abutment are usually the material of choice for final reconstructions. To date, based on mechanical considerations, a 3.5 mm implant diameter has been a contraindication for using ceramic abutments. The authors describe here the development, in vitro testing, and clinical use of a zirconium abutment with a 3.5 mm diameter. The advantages of this small-diameter zirconia abutment include a minimum platform height that offers optimal prosthetic flexibility, and an accurate transfer of the implant position on to the master model. Furthermore, a precise rotational orientation for single-tooth restorations, optimal mechanical stability, and optimal fatigue resistance can be achieved. The microgap is minimized and protection against overload is afforded. In the reported case, high patient satisfaction was achieved due also to an esthetically pleasing final result.

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A practical and predictable clinical technique to pick up stud attachments for implant retained overdentures. PPAD 18, no. 10 (2006): 648-651.

Biomechanical comparison of different surface modifications for dental implants. International Journal of Oral & Maxillofacial Implants 23, no. 6 (2008): 1037-46.

Biomechanical comparison of different surface modifications for dental implants. TMscientifics, no. 1 (2008).

Abstract

OBJECTIVES: Zirconia is a suitable biomaterial for use in medicine (stomatology, orthopaedics) due to its good biocompatibility and outstanding mechanical properties. This study compares the effect of (i) zirconia to the widely used titanium and (ii) zirconia with two different surface topographies (sandblasted and sandblasted/etched) on the adhesion, proliferation and differentiation of SAOS-2 osteoblasts.

METHODS: SAOS-2 cells were cultured on either sandblasted or sandblasted/etched zirconia and compared with sandblasted/etched titanium. 2 and 24 h after plating, cell morphology was investigated by scanning electron microscope (SEM) and fluorescence imaging. At 24 and 48 h, cell number-relevant parameters were determined. Alkaline phosphatase (ALP) activity and mineral accumulation were measured at days 8, 11, 15 and day 22 of culture, respectively.

RESULTS: SEM and fluorescence images revealed a faster spreading as well as higher number of adherent cells after 24 h incubation on zirconia compared with titanium. Also, the cellular metabolic activity after 24 h and the proliferation rate after 48 h is higher with zirconia compared with titanium. Zirconia had a more pronounced effect compared with titanium on the differentiation of SAOS-2 cells: ALP activity, an early differentiation marker increased earlier and mineralization, a late differentiation marker was increased. Only minor differences were found between zirconia with two different surface topographies; etched zirconia promoted slightly greater the differentiation of SAOS-2 cells.

CONCLUSIONS: These data indicate that zirconia mediates a pronounced stronger effect on the adhesion, proliferation and differentiation compared with titanium; and that topographical differences of zirconia have minor effects on osteoblast biology.

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The effectiveness of immediate, early, and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clinical trials. The International Journal of Oral & Maxillofacial Implants 22, no. 6 (2007): 893-904.

Abstract

OBJECTIVES: To evaluate whether different implants placed immediately upon tooth extraction may affect the dimension and composition of the peri-implant soft tissues.

MATERIAL AND METHODS: Eight beagle dogs received implants randomly installed into the distal socket of 3P3 and 4P4. Four commercially available implant systems were evaluated: 3i Osseotite Certain straight; Astra MicroThread-OsseoSpeed; Thommen SPI Element; and Straumann ITI standard. Each animal provided four test implant sites. All animals were sacrificed 6 weeks after implant placement, providing specimens for the evaluation of the soft tissue dimensions by histometric analysis.

RESULTS: The biological width at 6 weeks after implant placement consisted of a junctional epithelium measuring between 2 and 2.7 mm and a connective tissue component between 1 and 1.8 mm with no statistical differences among the four implant systems.

CONCLUSION: This study failed to demonstrate differences in the soft tissue healing outcome when placing four different implant systems into fresh extraction sockets. Nevertheless, the length of the epithelium achieved with the four implant systems is longer than what has been reported when placing implants in healed-ridge experimental models.

Abstract

OBJECTIVES: To evaluate whether different implants placed immediately upon tooth extraction may affect the dimension and composition of the peri-implant soft tissues.

MATERIAL AND METHODS: Eight beagle dogs received implants randomly installed into the distal socket of 3P3 and 4P4. Four commercially available implant systems were evaluated: 3i Osseotite Certain straight; Astra MicroThread-OsseoSpeed; Thommen SPI Element; and Straumann ITI standard. Each animal provided four test implant sites. All animals were sacrificed 6 weeks after implant placement, providing specimens for the evaluation of the soft tissue dimensions by histometric analysis.

RESULTS: The biological width at 6 weeks after implant placement consisted of a junctional epithelium measuring between 2 and 2.7 mm and a connective tissue component between 1 and 1.8 mm with no statistical differences among the four implant systems.

CONCLUSION: This study failed to demonstrate differences in the soft tissue healing outcome when placing four different implant systems into fresh extraction sockets. Nevertheless, the length of the epithelium achieved with the four implant systems is longer than what has been reported when placing implants in healed-ridge experimental models.

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SPI - Ein modernes Implantatsystem für die Praxis. Implantologie 16, no. 1 (2008): 1-6.

Mise en charge immédiate avec l ’implant SPI® (Thommen Medical). Implant 14, no. 2 (2008): 1-8.

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Abstract

Osteoclasts resorb bone at surfaces, leaving behind pits and trails where both mineral and organic phases of bone have been dissolved. Rough surface structures are deliberately imparted to synthetic implants, in order to improve osseointegration. The aim of this study is to characterize osteoclastic resorption pits on native bone surfaces and to compare these with state-of-the-art titanium and zirconia implant surfaces. The size (i.e. length, width and depth) of resorption pits was compared to the size of surface features of sandblasted and etched titanium and zirconia surfaces. It was found that resorption pits from native bone and surface features of the sandblasted and etched titanium and zirconia surfaces were quite similar in their dimensions. Most structures showed a length between 5 and 40 mum, a width between 2 and 20 mum and a depth between 1 and 8 mum. Additionally, the wavelength-dependent surface roughness was measured, revealing an S(a) value of 60 nm in the resorption pits, 86 nm on zirconia and between 127 and 140 nm on titanium surfaces. The results of this study may provide some insight into structural requirements for the bone-remodeling cycle and help to improve the design of new implant surfaces for osseointegration applications.

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In vitro and in vivo Testing of a Novel Zirconia Implant Surface for Dental Applications. European Cells and Materials 17, no. Suppl. 1 (2009): 13.

Influence of Different Dental Implant Materials and Topographies on the Adhesion of Osteoblasts ,PDL Fibroblasts and Kerationcytes. Interface Biology of Implants (2009).

Das SPI System in der Praxis. Dentale Implantologie, no. 6 (2002): 296-298.

Aspekte der Rot-Weiss-Ästhetik - Eine Falldarstellung. Implantologie Journal no. 2 (2008): 8-14.

Rückblick und Ausblick nach über 30-jähriger Erfahrung mit der Sofortbelastung enossaler Implantate in der regio interforaminalis. Dentale Implantologie 5, no. 3 (2006): 526-536

Immediate Loading of Freshly Inserted Screw Implants: Translation of‘ Zur Frage der Sofortbelastung von frisch inserierten Schraubenimplantaten. Swiss Dent 24, no. 3 (2003): 5-14.

Zur Sofortbelastung von Immediatstegen auf Schraubenimplantaten. Teil II: Zur Frage der Osseointegration und die mikromechanisch präfabrizierten Elemente des Sofortsteges. Implantologie, no. 7 (2003): 100-108.

Zur Frage der Sofortbelastung von frisch inserierten Schraubenimplantaten: Der Sofortsteg unter spezieller Berücksichtigung des SPI-Konzepts. Swiss Dent 24, no. 3 (2003): 5-14.

Comparison of chemically and pharmaceutically modified titanium and zirconia implant surfaces in dentistry: a study in sheep. International Journal of Oral Maxillofacial Surgery 37, no. 12 (2008): 1125-1132.

Comparison of chemically and pharmaceutically modified titanium and zirconia implant surfaces in dentistry: a study in sheep. TM Scientifics, no. 1 (2008): F.

Abnehmbare verschraubte Zirkonrestaurationen - wie kann ein neues Material sinnvoll und sicher in die Implantatprothetik integriert werden? Dentale Implantologie 11, no. 3 (2007): 168-174.

Marginal fit and microgap measurements on polished micrograph sections. TM Scientifics no. 1 (2008).

Sofortimplantation und -versorgung im anterioren Unterkieferbereich. Implantologie Journal, no. 7 (2009): 34-38.

Langzeiterfolg bei der Sofortbelastung im zahnlosen Unterkiefer. Implantologie Journal, no. 8 (2010): 14-17.

Das SPI - Implantatsystem: Klinische Erfahrung und Ein-Jahres-Resultate. Schweizerische Monatsschrift der Zahnmedizin 116, no. 3 (2006): 259-264.

Frontzahnästhetik mit dem SPI Implantatsystem. Ein Fallbericht. Schweizerische Monatsschrift der Zahnmedizin 116, no. 3 (2006): 275-282.

Simvastatin releasing coatings for hard tissue implants. Interface Biology of Implants Rostock, Poster (2006)

Bisphosphonate based coatings for hard tissue implants. Biomaterials (2005)

Das SPI-Implantatsystem. BZB, no. Oktober 07 (2007): 59.