bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic evaluation of maddibular posterior implant sites; correlation between panoramic and tomographic determinations
Authors: Bolin Anders , Ellasson Sören , Von Beetzen Maria , Jansson Leif
Published: March 2003

The purpose of the present study was to compare bone height determinations of implant sites by different radiographic techniques. Available bone height was measured in regions posterior to the mental foramen on panoramic radiographs, and on tomographs where the faciolingual dimensions was at least 5mm. The one heights were recorded at 401 edentulous and denate sites in 100 patients. The overall mean bone height ±SD) was 11.25±3.29mm on panoramic radiographs and 8.81±3.38mm on tomographs. The correlation between the two radiographic techniques ranged from 0.36 to 0.91 if the material was stratified according to factors such as height of available bone, age, gender and the presence of teeth. Gender was significantly correlated to panoramic and tomographic measurements in all regions. However, the precision of predicted tomographic measurements by using a linear regression model was not significantly increased by including gender as an explanatory variable. For evaluation of available bone height in mandibular regions posterior to the mental foramen, tomography is recommended for all prospective implant sites.
Orthodontic anchorage capacity of short titanium screw implants in the maxilla. An experimental study in the dog.
Authors: Wehrbein H. , Glatzmaier J. , Yildirim M.
Published: March 2003

The aim of this study was to investigate experimentally the effect of long term orthodontic loading on the stability as well as on the peri‐implant bone findings of short titanium screw implants (Bonefit®, submersion depth 6 mm, Ø 4 mm) inserted in regions with reduced vertical bone height. For this purpose, 6 maxillary premolars (1P1, 2P2, 3P3) were extracted from each of 2 foxhounds and reduction of alveolar bone height was performed by osteotomy. After a l6‐week healing period, 8 implants (4 per dog) were inserted in the edentulous areas. Simultaneously, 2 implants (1 per dog) were positioned in the palatal suture (one‐stage surgery). After an 5‐week implant healing period, the fixtures in the Pl/P2 areas (n= 4) and the palate (n= 2rpar; were loaded (test implants) by means of transpalatal bars running anteriorly, fixed on the implants in the Pl/P2 areas, and Sentalloy traction springs (‐2 N continuous force) inserted midsagittally between palatal implants and bars (force application period: 26 weeks). The fixtures in the P2/P3 areas served as controls (n= 4). Clinical measurements and histological evaluation revealed no implant dislocation of the loaded fixtures. These results suggest that short titanium screw implants inserted in the alveolar bone and palatal suture region retain their stability during long‐term orthodontic loading, even following a relatively short unloaded implant healing period. Furthermore, it seems that long‐term orthodontic loading may induce marginal bone apposition adjacent to the implants.
Force distribution on implants supporting overdentures: the effect of distal bar extensions. A 3‐D in viva study.
Authors: Mericske‐stern R.
Published: March 2003

Force distribution on mandibular implants supporting overdentures was registered in viva by means of piezo‐electric transducers that allow for simultaneous force measurements in 3 dimensions. The anchorage device for connecting the overdenture to the implants was a Ushaped bar to which distal extensions were soldered bilaterally. Force patterns were analyzed under different test conditions such as maximum force when biting in centric occlusion, maximum biting with the unilateral use of a bite plate, parafunction and chewing bread. Maximum force measured in centric occlusion and on the ipsilateral implant with the use of bite plate was increased in the vertical dimension, compared to transverse dimensions. On the contralateral implant, equally low values were found, in all 3 dimensions. Transverse force components reached 5 to 35% of the vertical magnitudes. With the use of the bite plate on the ipsilateral implant, force magnitudes in the vertical direction and in the backward‐forward direction were significantly higher (P<0.01, P<0.00) compared to measurements in centric occlusion. Chewing and grinding resulted in lower vertical forces compared to maximum biting, while transverse forces in the backward forward direction reached force magnitudes that resembled the vertical component (50 to 100%). The prevalent (>95%) or exclusive force direction in the vertical dimension, registered on both implants was downward. However, with the unilateral use of the bite plate, upward directions were found on the contralateral implant as an effect of distal bar extensions. This was in contrast to previous results where upward force directions were not found. In transverse dimensions, the specific influence of bar extensions was recognised in backward directions on the contralateral implant. In comparison with previous results, it was concluded that, in vivo, the effect of distal bar extensions was of much lesser influence regarding force magnitudes and force directions than was expected.
Measurements of stability changes of titanium implants with exposed threads subjected to barrier membrane induced bone augmentation. An experimental study in the rabbit tibia.
Authors: Rasmusson Lars , Meredith Neil , Sennerby Lars
Published: March 2003

The purpose of the present study was to evaluate in a rabbit model the changes in stability of implants that had been subjected to barrier membrane induced bone augmentation, as compared to untreated controls. One titanium implant was inserted in each proximal tibial metaphysis of 10 rabbits. The implants were placed in such a way that 4–5 threads on one side of the implant were left uncovered by bone. On the test side, the exposed implant surface was treated by means of a barrier membrane technique to provide for bone augmentation, while the contralateral side was untreated. The stability evaluations were made by means of resonance frequency measurements (RIM) at Day 0 and after 8, 16 and 24 weeks of healing. In addition, changes in the area of exposed implant threads were documented and measured on photographs. Removal torque measurements were performed at the day of sacrifice. In this study it was not possible to demonstrate a statistically significant better stability of implants subjected to barrier induced bone augmentation as compared to control implants still having exposed threads as evaluated by RIM and removal torque measurements.
Associations between clinical parameters assessed around implants and teeth
Authors: Brägger Urs , Bürgin Walter B. , Hämmerle Christoph H. F. , Lang Niklaus P.
Published: March 2003

The aim of the present study was to clinically assess the peri‐implant and periodontal conditions 1 year after placement of oral implants (ITI® Dental Implant System) in partially edentulous patients. In all, 127 patients (median age 50 years, range 17 to 79) were examined. They were all treated according to a concept of comprehensive dental care and had received fixed partial dentures (FPD). Significant differences were observed between implants and contralateral control teeth with respect to mean pocket probing depth (PPD)(2.55 mm at implants/2.02 mm at teeth), mean probing attachment level (PAL)(2.97 mm/253 mm) and bleeding on probing (BOP)(24%/12%)(Wilcoxon matched pairs sign rank test, P≥0.0l), whereas mean modified plaque index (0.22/0.30), mean modified bleeding index (0.351 0.44) and mean recession (−0.42 mm/−0.51mm) did not significantly differ between implants and teeth. Compared to control teeth, the width of keratinized mucosa at implants was significantly smaller at lingual, but not at buccal aspects. Regression analyses showed no significant association between the amount of keratinized mucosa and degree of inflammation. Recession, PPD and PAL were slightly influenced by the amount of keratinized mucosa indicating greater resistance to probing. Grouping the implants according to various lengths, type of fixation of the FPD or combination with natural teeth did not result in statistically significant different clinical parameters, whereas grouping according to different localization within the oral cavity did. For example, the mean PAL in 83 anterior implants was 2.52mm, whereas 175 posterior implants had a mean PAL of 3.18mm (Mann‐Whitney U‐test, P≤0.01). Regression analyses between the mean PAL for all implants in each patient and the mean PAL of the corresponding dentition revealed an r² of 0.23 (P≤0.01). Using multiple regression analysis, the mean PAL of the implants showed to be significantly influenced by the combined factors “fullmouth” PII, “fullmouth” BOP and mean PAL of all teeth. The resuhs of this study suggest that in partially edentulous patients the overall periodontal condition may influence the clinical condition around implants and thus reinforces the importance of periodontal treatment prior to and supportive periodontal therapy after the incorporation of osseointegrated oral implants.
Maxillary sinus augmentation using different grafting materials and osseointegrated dental implants in monkeys. Part IV Evaluation of hydroxyapatite‐coated implants.
Authors: Quiñones Carlos R. , Hürzeler Markus B. , Schüpbachs Peter , Arnold Dirk R. , Strub Jörg R. , Caffesse Raul G.
Published: March 2003

The aim of this study was to evaluate clinically, histologically and histometrically the use of hydroxyapatite‐coated dental implants in conjunction with maxillary sinus augmentation procedures. In 4 adult male Rhesus monkeys (Mucaca muluttu) the 3 maxillary molars on 1 side of the jaws were extracted and the remaining bone between the alveolar crest and the floor of the sinus was reduced to 3–4 mm. After 3 months, maxillary sinus augmentation procedures were performed in each monkey and the sinuses were grafted with a porous hydroxyapatite bone graft (Interpore‐200®). At the same time, 2 hydroxyapatite‐coated cylinder implants (IMZ®) were immediately placed into the augmented sinuses (i.e. simultaneous‐implants‐loaded group). Four months later, 2 additional similar implants were placed into the previously augmented sinuses (i.e. delayed‐implants‐loaded group). After 4 months, the abutment connection was performed, and all 4 implants were loaded with a gold‐alloy bridge for 6 months (i.e. until sacrifice of the animals). The contralateral side of each monkey received the same treatment with the exception that removal of the maxillary molars was performed 7 months after those in the opposite side, and that the implants in this side were not loaded. Thus, 2 additional study groups (i.e. simultaneous‐implants‐unloaded group and delayed‐implants‐unloaded group) were obtained. Clinically, all loaded and unloaded implants were stable the day of sacrifice. Histologically, the grafted sinuses exhibited a significant amount of new bone formation, with integration of the porous hydroxyapatite graft particles and hydroxyapatite‐coat of the dental implants to the new bone. Histometric analysis indicated that on the loaded side the implants placed simultaneously with the sinus lift procedure exhibited greater direct mineralized bone‐to‐implant contact than the delayed placed implants. In addition, the percentage of direct mineralized bone‐to‐implant contact was significantly greater in the residual bone in comparison to the augmented area in all groups. Loading of the implants exhibited a positive effect on the percentage of direct mineralized bone‐to‐implant contact in the augmented area. It could be concluded that hydroxyapatite‐coated implants may be of benefit when used in conjunction with sinus augmentation procedures.
Endoscopically controlled sinus floor augmentation. A preliminary report.
Authors: Engelke Wilfried , Deckwer Isabell
Published: March 2003

Sinus augmentation has been advocated to be a surgical technique with predictable results in peri‐implant surgery. Endoscopic surgery of the maxillary sinus so far has been used as diagnostic procedure. In this paper, the use of endoscopy is described as a low invasive adjunctive technique in sinus floor augmentation. After preparation of the mucoperiosteum, bone grafts can be placed under endoscopic control between sinus floor and mucoperiosteum. A laterobasal approach via a small osteotomy and a transalveolar approach are possible for mucosal elevation and graft placement. First clinical results are reported. Endoscopic sinus lift may contribute to a reduction of perioperative morbidity, reduction of oroantal fistulae and control of graft position. The less invasive technique may allow to extend the indication for sinus augmentation.
Comparison of Brånemark fixture integration and short‐term survival using one‐stage or two‐stage surgery in completely and partially edentulous mandibles
Authors: Collaert Bruno , De Bruyn Hugo
Published: March 2003

The aim of this prospective study was to compare the clinical integration and survival of Brånemark fixtures when using the conventional 2‐stage surgical procedure to a 1‐stage surgical approach in completely and partially edentulous mandibles. A total of 85 patients were consecutively treated for partial (n=35) or complete (n=50) mandibular edentulousness. Fixtures removed because of mobility, pain or infection were counted as failures. The first 10 patients of each group were selected for radiographical analysis of crestal bone changes 1 year after prosthesis insertion. In 33 patients with edentulous mandibles, 170 fixtures were placed in a 1‐stage approach. In this group, 4 fixtures (2.4%) were lost prior to prosthetic restoration. Seventeen edentulous patients received a total of 70 fixtures in a 2‐stage procedure. Out of these, 5 fixtures (7.1%) were lost at abutment connection. In 17 partially edentulous patients, 41 fixtures were inserted in a 1‐stage approach. Two fixtures (5%) were lost in this group. Finally, 18 partially edentulous patients received a total of 49 fixtures in a 2‐stage procedure. Out of these, 6 fixtures (12%) were lost at abutment connection. In total 313 of the 330 installed mandibular implants were loaded between 6 and 12 months (94.8% success). No further losses occurred in the implants functioning at least 1 year (267 implants) or at least 2 years (59 implants). Statistical analysis (Chi square test) revealed no difference in fixture survival between the treatment modalities. Radiographical analysis after 1 year of functional loading showed the typical bone resorption changes up to the most coronal implant thread in both modalities. Although this study pertains to relatively early loading of 2 years, the results seem to indicate that in the mandible a 1‐stage surgical approach with Brinemark fixtures may be as predictable as the conventional 2‐stage procedure.
Peri‐implant microflora of implants with cemented and screw retained suprastructures
Authors: Keller Wanda , Brägger Urs , Mombelli Andrea
Published: March 2003

The aims of this study were to compare clinical and microbiological features in the peri‐implant area of implants carrying either screw retained or cemented suprastructures, and to investigate the relationship between the peri‐implant microflora, the microbiota on the inner surface of removable suprastructures, and the periodontal microflora within the same subject. In 15 partially edentulous patients with ITI® implants used as abutments for crown and bridge reconstructions, microbial samples were taken i) from the deepest periodontal pocket of each quadrant, ii) from the sulcus of the implants and iii) from the internal surface of the screw retained suprastructures. The samples were cultured using continuous anaerobic techniques. Five patients were found with both screw retained (S) and cemented (C) suprastructures. In these subjects the mean total cultivable counts were significantly higher in peri‐implant samples from group C than in samples from group S. Furthermore, peri‐implant samples of group S yielded a higher proportion of coccoid cells in the darkfield microscope and demonstrated absence of large spirochetes. From the 15 patients, Porphyromas gingivalis was detected in 10% of the periodontal samples and in only one peri‐implant sample. Prevotella intermedia was detected in 33% of the periodontal and in 30%% of the peri‐implant samples. Fusobacterium spp. had a prevalence of 58% in the periodontal samples and was recovered from 50% of the peri‐implant samples. Actinobncillus actinomycetemcomitans was not detected in any dental or peri‐implant sample. In 1 case, however, the organism was recovered from the internal surface of the suprastructure. Linear regression analysis showed a significant relationship between the frequency of micro‐organisms in peri‐implant samples of group S and in samples from the inner surface of the suprastructure. Furthermore, there was a significant correlation between the incidence of micro‐organisms in dental samples and i) in peri‐implant samples of group S and iirpar; in samples from the internal suprastructure surface. These findings indicate, that the microbial leakage through the gap between the suprastructure and the abutment plays an important role in the bacterial colonization of the internal part of screw retained crowns and bridges. The study furthermore confirms the impact of the dental microflora on the microbial colonization of implants. This factor appears to be more important than the mode of fixation of the suprastructure.
Influence of barrier occlusiveness on guided bone augmentation. An experimental study in the rat.
Authors: Lundgren Anna Karin , Lundgren Dan , Taylor Åsa
Published: March 2003

The present study was designed to test perforated and non‐perforated barriers for their ability to promote augmentation of bone tissue. More specifically, 1 totally occlusive barrier and 6 barriers with perforation sizes of about 10, 25, 50, 75, 100, and 300 μm and 1 group with no barriers placed (open test chambers) were used to test the effect of a barrier's occlusiveness on the amount and composition of augmented tissue over time. The skull of the rat was used as the experimental area. Prefabricated, flexible silicone frames with an inferior flange for peripheral sealing to the bone surface and a central vertical through hole with a diameter of 3.6 mm and a height of 2 mm were used as test chambers. The barriers were inserted to cover the superior opening of the through hole. The healing periods were 4, 8, and 12 weeks. All test chambers exhibited newly formed skull bone which was augmented over time. The placement of totally occlusive barriers resulted in the slowest rate of bone tissue augmentation but in a highly predictable manner, i.e., there were only small individual variations. Placement of barriers with perforations exceeding 10 pm, on the other hand, resulted in a faster rate of bone augmentation with larger individual variations and a totally different augmentation pattern. A pronounced augmentation of calvarial soft tissue from the sagittal suture of the skull as well as ingrowth of supra‐bony connective tissue through the barriers were also observed. After 12 weeks of healing, no differences in the amount of augmented mineralized bone related to perforation sizes >lO μm were found. The open test chambers also showed bone augmentation, although most of their volume was occupied by suprabony connective tissue.
Dental implants in the atrophic maxilla: measurements of patients' satisfaction and treatment experience
Authors: Kaptein Maarten L. A. , Hoogstraten Johan , De Putter Cornelis , De Lange Gett L. , Blijdorp Peter A.
Published: March 2003

Maxillary bone reconstruction in combination with placement of dental implants is a treatment modality reported since 1980 for patients suffering from maxillary atrophy and difficulties with wearing removable prosthesis. This study reports on patient experience and satisfaction among 88 consecutive patients concerning surgical and prosthetic aspects of their treatment. A questionnaire was used to gather the data. Patient satisfaction was measured on a scale from 1 to 5 (1=bad/few, 5=very good/much). The satisfaction index with regard to the total treatment was 4.1 ± 0.9. A total of 90% of the patients responded that they would go through the treatment again or recommend the treatment to a friend if necessary. The post‐operative pain index scored 2.6 ± 1.2. The acceptation of the post‐operative pain at the crista iliaca was 86.1% and of the maxilla 89.9%. It is concluded that the results of measurements of patient satisfaction after maxillary bone reconstruction in combination with placement of dental implants were acceptable.
Guided bone regeneration with barrier membranes ‐ a clinical and radiographic follow‐up study after 24 months
Authors: Lorenzoni Martin , Pertl Christof , Polansky Raoul , Wegscheider Walther
Published: March 2003

The present follow‐up study evaluated clinical and radiographic parameters of dental implants placed with simultaneous guided bone regeneration with expanded polytetrafluoroethylene (e‐PTFE) membranes. All implants were functioning well 24 months after insertion. In all, 63 patients with a total of 91 e‐PTFE‐augmented implants were integrated in a regular maintenance protocol. Modified periodontal data of 85 implants in 59 patients were recorded at 24 months and indicated no difference to implants placed in sufficient pristine bone. The mean plaque score (mpl1) was 0.29, 74% of the sites showed no plaque. The sulcular probing depth ranged from 1 to 7 mm with a mean of 2.4 mm (SDk0.8). Of the sites 96.5% were 14 mm deep, in 49% of them probing resulted in bleeding. Periotest values 6 and 24 months (mean: −3.4 and −3.4) after placement revealed stable peri‐implant conditions and sustained osseointegration. The radiographic evaluation performed 6, 12 and 24 months post insertion yielded a mean bone loss of 0.93, 1.36 and 1.51 mm ranging from 0 to 4 mm. The short‐term results of our clinical study demonstrated stable peri‐implant conditions 2 years after membrane‐protected osseous regeneration. The newly formed bone seemed to be able to withstand functional loading in a predictable manner after 18 months.
Implant placement and simultaneous ridge augmentation using autogenous bone and a micro titanium mesh: a prospective clinical study with 20 implants
Authors: von Arx Thomas , Kurt Beat
Published: March 2003

This prospective clinical study evaluated bone regeneration around 20 dental implants placed in 15 patients (mean age 39.7 years). Peri‐implant bone defects were augmented with autogenous bone grafts harvested intraorally from the mandible (chin or retromolar area). Augmented sites were covered with an individually trimmed micro titanium mesh which was rigidly affixed with microscrews to the residual jaw bone. Height of implant exposure (mean 6.5 mm), i.e. dehiscencies (80%) or fenestrations (20%) and graft height (mean 6.2 mm) were measured in an apico‐coronal direction using a periodontal probe. At re‐entry (mean interval 6.6 months) the titanium mesh and microscrews were removed and bone regeneration assessed. The mean height of the integrated bone graft was 5.8 mm corresponding to a mean bone fill of 93.5%. The over‐all postop healing course was excellent with only one site developing a soft tissue dehiscence with subsequent mesh exposure (complication rate 5%). This study demonstrated that a micro titanium mesh in combination with autogenous bone grafts is effective for treatment of peri‐implant 1 bone defects.
Guided bone regeneration using titanium grids: report of 10 cases
Authors: Leghissa G. C. , Zaffe D. , Assenza B. , Botticelli A. R.
Published: March 2003

In order to ensure an adequate space where new bone can be formed in guided bone regeneration (GBR), most surgeons fill bone defects with biomaterials. In this work we evaluated new bone regeneration in 10 patients using only a blood clot protected with titanium grids and non‐resorbable membranes, without any filling material. A manual measurement of the size of the bone defect, using a plastic probe, was performed at 2 surgical steps. After 5 months of treatment, a biopsy was taken from each patient, fixed and embedded in PMMA, examined microradiographically and morphologically to evaluate the newly‐formed bone. Our results showed a good repair of the defects by bone regeneration (about 85% overall), high mineral density of new bone around the implants after 5 months, and steady state deposition processes. These results in GBR, without filling material, apear very promising for implantology and reconstructive odontostomatology practice.
BMP stimulation of bone response adjacent to titanium implants in vivo
Authors: Bessho Kazuhisa , Carnes David L. , Cavin Renee , Chen Hsin‐yi , Ong Joo L.
Published: March 2003

The objective of this study was to evaluate the effect of bone morphogenetic protein (BMP) on the bond strength of titanium (Ti) implants at the bon‐implant interface. Thirty‐six Brånemark screw implants (3.75 mm diameter by 15 mm long) were implanted for 3 and 12 weeks. At 3 weeks after implantation, the mean reverse torque value for implants stimulated with BMP delivered using an atelopeptide type‐1 collagen carrier (74.2±5.2 N cm) was observed to be statistically greater (P<0.000016) than the mean reverse torque value for control Ti implants (32.8±1.1 N cm). Similarly, at 12 weeks after implantation, the mean reverse torque value for implants stimulated with BMP (89.2±2.7 N cm) was statistically greater (P<0.0042) than the mean reverse torque value for control Ti implants (75.8±2.4 N cm). In addition, hisiomorphometric evaluations indicated more bone contact with the BMP stimulated implant surfaces compared to the controls after 3 weeks implantation. It was concluded from this study that the use of BMP‐atelopeptide type‐1 collagen mixture is an effective means of obtaining greater bond strength at the bone‐implant interface within a shorter time period than Ti implants without BMP.
Adherence of periodontopathic bacteria to bioabsorbable and non‐absorbable barrier membranes in vitro
Authors: Sela Michael N. , Steinberg Doron , Klinger Avigdor , Krausz Amir A. , Kohavi David
Published: March 2003

Guided tissue regeneration (GTR) techniques are increasingly used for the treatment of periodontal defects, or in conjunction with dental implant procedures. As adhesion of bacteria to barrier membranes used in these techniques may lead to failure, a prerequisite for treatment success is an infection‐free healing process. The present study examined the adhesion of 3 periodontal pathogenic bacteria: Actinobacillus actinomycetemcomitans, Treponema denticolu and Porphyromonas gingivalis, to 3 barrier membranes: Collagen, (Biomend™) e‐PTFE, (TefGen‐FD™) and e‐PTFE, (Gore‐Tex®). The membranes were incubated with 3[H]‐thymidine labeled bacteria, and the number of adherent bacteria was calculated using a scintillation counter. The effect of albumin coating on bacterial adherence to the membranes was also studied. Bacterial adherence to the membranes was further examined by scanning electron microscopy (SEM). The results show that the adherence of all bacterial strains to collagen membranes was significantly higher than to the other membranes tested. Precoating of the membranes with albumin did not change the bacterial adherence significantly. These findings are of importance in evaluating the ability of periodontal bacteria to colonize and infect different types of barrier membranes.
Public awareness, information sources and evaluation of oral implant treatment in Norway
Authors: Berge Trond I.
Published: March 2003

A nation‐wide survey from a representative sample of the general Norwegian population was made in co‐operation with Statistics of Norway, to assess public awareness, sources of information and evaluation of oral implants. A response rate of 70.8% was obtained. Of the general population 70.1% (95% confidence interval: 68.6–71.6%) had heard of oral implants. No specific demographic variables were associated with unawareness of

oral implants. Of the general population 60.4% (95% confidence interval: 57.9–62.8%) evaluated oral implants positively and 56.7% (95% confidence interval: 54.7%–58.7%) would consider oral implants as treatment for themselves if needed, while 18.0% gave negative evaluation and 23.0% would not consider implant treatment. Logistic regression analyses indicated that young males in urban areas with high income and high educational level were most positive to oral implants. News media like newspapers and TV/radio were together with personal communications the most frequently indicated sources of information. News media were associated with negative evaluation of implants. The overall positive evaluation of oral implants suggests however that the Norwegian general public utilises several sources of information, and are able to evaluate them critically.
Alternative to the median region of the palate for placement of an orthodontic implant
Authors: Bernhart Thomas , Vollgruber Alexander , Gahleitner Andre , Dörtbudak Orhun , Haas Robert
Published: March 2003

Tooth‐borne anchorage may be one of the greatest limitations of modern orthodontic treatment, because teeth move in response to forces. Previous investigators have placed temporary implants in the median‐sagittal palate in order to establish maximum anchorage. This area, however, may be characterized by relatively low vertical bone support. The aim of this study was therefore to find an alternative palatal implant site which offers a higher amount of bone support. This study comprised 22 patients wishing for maximum anchorage underwent presurgical diagnostic evaluation by means of low‐dose dental CT. The measuring results regarding vertical bone volume and the position of the neighbouring tooth roots were used as the basis for further treatment. The statistical data analysis indicated an area suitable for implant placement in the group of patients examined. This area was located 6 to 9 mm posterior to the incisive foramen and 3 to 6 mm paramedian, under avoidance of the mid‐palatal suture. The patients showed such a great range of variation in vertical bone volume that a preoperative diagnostic evaluation also seems to be recommendable when very short implants are used in order to avoid perforations of the lower nasal duct.
The development of the ITI® DENTAL IMPLANT SYSTEM
Authors: Scacchi Marcel
Published: March 2003

In a short trip through more than twenty years, the development of the ITI® DENTAL IMPLANT SYSTEM is described. The systematic unfolding and continuous advancement of the system, permanently supported and accompanied by scientific work in clinical and general practice, is outlined in short paragraphs. Some major milestones are emphasized and characterized.
The development of the ITI® DENTAL IMPLANT SYSTEM
Authors: Scacchi Marcel , Merz, Beat R. , Schär Alex R.
Published: March 2003

In 1998 and 1999, the ITI® DENTAL IMPLANT SYSTEM underwent its greatest modification since it came into existence. Prosthetic possibilities with regard to implant position transfer and master‐cast manufacturing have been considerably enlarged by synOcta®, surgical instruments have been improved in a multitude of ways and, by introducing SLA, the sand‐blasted, large grit, acid‐etched surface for oral implants which shortens time to loading by 50%, the ITI and Straumann have achieved a major breakthrough in surface technology.
Basic surgical principles with ITI implants Note
Authors: Buser Daniel , Von Arx Thomas , Ten Bruggenkate Christiaan , Weingart Dieter
Published: March 2003

The basic surgical principles governing the placement of ITI implants are based on research‐oriented developments in harmony with evidence‐based and outcome‐oriented clinical procedures. In the past 15 years, the range of implant indications has been significantly widened, and partially edentulous patients clearly represent the majority of patients seeking treatment with dental implants today. An important aspect of the successful rehabilitation of patients with ITI implants is the careful selection of implant candidates with respect to systemic and local risk factors. These factors are presented based on current knowledge. Today, solid‐screw implants in various screw dimensions and neck configurations comprise the ITI Dental Implant System. These different implant types are necessary to handle the full range of implant indications, in particular in partially edentulous patients. The main clinical factors are presented for the selection of the appropriate implant type, length and diameter. These implants are utilized both in a non‐submerged and in a submerged approach. The main goal of surgical therapy is low trauma and the least demanding surgical procedure for patient and clinician to optimize the cost‐effectiveness of implant therapy. Hence, a non‐submerged approach is preferred in all sites without esthetic priority, such as in fully edentulous patients or in posterior sites of partially edentulous patients. These indications clearly represent the majority of implant patients. In esthetic sites, a submerged approach is utilized to satisfy the specific esthetic demands. The possibility to successfully utilize short implants (6 and 8 mm) and a reduced healing period of 3 months are further advantages of ITI implants due to favorable properties of the rough TPS surface. With the introduction of the microrough SLA surface, a reduction of the healing period to 6 weeks facilitates further progress towards simplification of implant therapy. In summary, the ITI Dental Implant System represents a scientifically well‐documented, complete implant system for the treatment of fully and partially edentulous patients, offering straightforward surgical concepts based on predictable treatment outcome and excellent cost‐effectiveness.
Single stage surgery combining transmucosal implant placement with guided bone regeneration and bioresorbable materials
Authors: Hämmerle Christoph H. F. , Lang Niklaus P.
Published: March 2003

Abstract: The aim of the present clinical study was to test whether peri‐implant bone defects can successfully be filled with bone by applying bioresorbable materials for guided bone regeneration (GBR) procedures in conjunction with implants in the transmucosal healing position. Three women and 7 men ranging in age from 32 to 68 years (median 54.5) needed tooth replacement with dental implants. Eight to 14 weeks following careful tooth extraction, implants of the ITI® Dental Implant System were placed at the extraction sites. At this time, all implants presented dehiscence defects of the alveolar bone partly exposing the rough titanium plasma sprayed (TPS) surfaces. GBR procedures were performed using deproteinized bovine bone mineral (Bio‐Oss®) as a membrane‐supporting material and a bioresorbable collagen membrane (Bio‐Gide®) as a barrier. The membranes and the flaps were adjusted to fit around the necks of the implants, thus leaving the implants extending transmucosally into the oral cavity. Clinical measurements were taken at 6 sites around each implant (mesio‐buccal, buccal, disto‐buccal, disto‐lingual, lingual, mesio‐lingual) using a calibrated periodontal probe. These included: i) defect depth measured from the shoulder of the implant to the first bone‐to‐implant contact, ii) infrabony defect component measured from the bone crest to the first bone‐to‐implant contact, iii) defect width measured from the crest to the implant body in a direction perpendicular to the long axis of the implant. The Wilcoxon Matched Pairs Signed Rank Test was applied to detect differences over time. At baseline, the mean defect depth per patient amounted to 3.6 mm (Standard Deviation 1.6 mm, range 1.8–6.8 mm). The deepest extensions of the defects were located at the buccal aspects (mean 7.8 mm, SD 1.9 mm). At re‐entry, the mean defect had decreased to 2.5 mm (SD 0.6 mm). This difference was statistically significant (P<0.01). Initially, in 62% of sites the depth ranged from 0–3 mm, in 23% it ranged from 2–4 mm, and in 15% it amounted to more than 6 mm. Six to 7 months later, at re‐entry, 95% of sites were 3 mm and less in depth and 5% ranged from 4–6 mm. Defect resolution, as assessed by the amount of coverage of the initially exposed rough implant surface, reached a mean value of 86% (SD 33%). One hundred percent resolution was accomplished at 8 out of 10 implants, 60% at one and 0% at another implant. The tissue at the latter implant showed signs of infection and inflammation during the healing phase. It is concluded that bioresorbable materials in GBR procedures at transmucosal implants can lead to successful bone regeneration into peri‐implant defects.
Histologic evaluation of the bone integration of TiO2 blasted and turned titanium microimplants in humans
Authors: Ivanoff Carl‐Johan , Widmark Göran , Hallgren Carin , Sennerby Lars , Wennerberg Ann
Published: March 2003

Abstract: Twenty‐seven patients received 2 microimplants each during implant surgery. One microimplant was blasted with 25 μm sized particles of TiO2; the other was left as machined i.e. a turned surface. Before insertion the surface topography was characterized with an optical confocal laser profilometer. The surface roughness was greater than standard implants, and was similar for both surface modifications averaging over all parts of the implant i.e. tops, valley and flanks. The mean surface roughness from flank measurements only replicated previously reported findings: i.e. significantly rougher surfaces on blasted implants. After a mean healing period of 6.3 months in the maxillae and 3.9 months in the mandible, the microimplants and surrounding tissue were removed with a trephine burr. The histomorphometrical evaluation demonstrated significantly higher bone‐to‐implant contact for the blasted implants, inserted in the maxilla or in the mandible. Significantly more bone was found inside the threaded area for the blasted implants in the mandible, but there was no difference for implants positioned in maxillae.
Optimal implant stabilization in low density bone
Authors: Martinez Henry , Davarpanah Mithridade , Missika Patrick , Celletti Renato , Lazzara Richard
Published: March 2003

Abstract: Initial stability of the implant is one of the fundamental criteria for obtaining osseointegration. An adequate primary anchorage is often difficult to achieve in low density bone (type IV). Various surgical suggestions were advanced in the 1980s which were aimed at achieving optimal osseous integration in poor quality bone. They offered satisfactory short‐term results. Recently, as a result of surgical and technological innovations, new therapeutic proposals have shown very interesting results in their initial studies.
Implant versus tooth‐implant supported prostheses in the posterior maxilla: a 2‐year report
Authors: Lindh Tomas , Gunne Johan , Nyström Elisabeth , Bäck Tomas
Published: March 2003

Abstract: When implants are used for restoration of a jaw with a residual dentition, the possibility of combining implants with natural abutments may be considered. In a longitudinal comparative study, 26 patients (15 women & 11 men, age 49–84 years) with residual anterior dentitions were treated with two different designs of fixed partial dentures bilaterally in the posterior maxilla. On one side the reconstruction was supported by implants only, while on the contralateral side an implant and a tooth in combination were used. The patients were followed at intervals of 3, 6, 12 and 24 months after loading of the implants. 95 implants were placed, of which 11 non‐loaded. A total of 10 implants failed, 7 prior to loading and three within the first three months of service (88.0±SE 6.7% cumulative survival for tested implants after two years’ follow‐up). There was no difference in failure rate for the implants in the two different prosthesis designs. The total mean loss of marginal bone height close to the implants was within acceptable standards, but was more pronounced at the implants not combined with teeth. The results indicate a correlation between the prosthesis design and the loss of marginal bone.
The effects of an immediately pre‐surgical chlorhexidine oral rinse on the bacterial contaminants of bone debris collected during dental implant surgery
Authors: Young Malcolm P. J. , Carter Duncan H. , Worthington Helen V. , McCord James F. , Korachi May , Drucker David B.
Published: March 2003

Abstract: Dental implant surgery produces bone debris that can be used in the “simultaneous augmentation” technique. Although this debris is contaminated with oral bacteria, a stringent aspiration protocol has been shown to reduce the levels of contamination. Chlorhexidine mouthrinse is a well‐proven antibacterial rinse that has been shown to reduce infectious complications associated with dental implants. This study examined the effect of pre‐operative rinsing with a 0.1% chlorhexidine digluconate mouthrinse on the bacterial contaminants present in collected bone debris bone (CBD). Twenty partially edentate patients were randomly allocated into equal groups and underwent bone collection using the Frios Bone Collector® (FBC) during the insertion of two dental implants. In group T a pre‐operative chlorhexidine rinse was used, whilst in group C sterile water was used. For both groups, a stringent bone collection protocol was used. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilised for identification of the isolated microbes. Thirty‐nine species were identified including a number associated with disease, in particular Actinomyces odontolyticus, Clostridium bifermentans, Prevotella intermedia, and Propionibacterium propionicum. Samples from group T (chlorhexidine mouthrinse) yielded significantly fewer organisms (P<0.001) than in group C (sterile water mouthrinse). Gram‐positive cocci dominated the isolates from both groups. It is concluded that if bone debris is to be used for the purpose of immediate simultaneous augmentation, a preoperative chlorhexidine mouthrinse should be utilised in conjunction with a stringent aspiration protocol to reduce further the bacterial contamination of CBD.
A long‐term follow‐up of 76 Brånemark single‐tooth implants
Authors: Haas Robert , Mailath‐Pokorny Georg , Dörtbudak Orthun , Watzek Georg , Polak Christian , Fürhauser Rudolf
Published: March 2003

Abstract: In a previous study (Haas et al. 1995), we reported on preliminary results of 76 Brånemark implants placed in 71 patients with single‐tooth gaps. The present study examines the results of the same group over a longer period of time: 55 implants were followed for more than 5 years, 12 for a period between 4 and 5 years and 1 implant for 46 months. One patient died 3 years after implant placement. Five patients lost their implant within 24 months after insertion. The drop‐out rate was 2 implants in 2 patients. The recall rate was thus 97%. Of the 5 implant failures, 2 were located in the maxilla and 3 in the mandible. The Kaplan‐Meier survival probability was 93% after 120 months. 74% of the sites showed healthy peri‐implant soft tissue conditions. At 15 implants (22%) a bone resorption of more than 2 mm was observed on intraoral radiographs. The mean bone resorption was 1.8 mm in the maxilla and 1.3 mm in the mandible and did not increase with time (Pearson correlation coefficient: r=−0.06, P=0.59). Abutment loosening occurred in 7 implants (10%), however all abutments that were fixed with a defined torque subsequently remained stable. Thus the favourable preliminary results could be maintained over an average 66 months, indicating that if implant loss happens it seems to occur during the first 2 years after insertion.
Bone level changes proximal to oral implants supporting fixed partial prostheses
Authors: Wyatt Chris C. L. , Zarb George A.
Published: March 2003

Abstract: The success of oral implant treatment relies on the presence and maintenance of bone adjacent to implants. The monitoring of radiographic bone level changes provides valuable insight into the longevity of oral implants. The purpose of this study was to measure radiographic bone level changes proximal (mesial and distal) to Brånemark System® implants (Nobel Biocare AB, Göteborg, Sweden) supporting fixed partial prostheses. Measurements were used to determine mean bone loss for the first year of loading by the prosthesis and the mean annual bone loss for subsequent years. These results were then compared and contrasted with various characteristics of the individuals, treatment, and treatment outcomes. Fifty‐five subjects with 69 fixed partial prostheses supported by 160 implants were followed over a 1 to 12‐year period. A mean bone loss of 0.33 mm (SD 0.59) was measured for the first year of loading and a mean annual bone loss of 0.00 mm (SD 0.11) after the first year. The radiographic bone loss calculated for implants at the first year of loading was positively correlated with the mean annual bone loss thereafter. Males, younger individuals and those implants supporting distal extension prostheses lost significantly more bone in the first year of loading. Larger numbers of implants followed for longer periods of time are needed to further explore the effects of various aspects of treatment on bone loss.
Elastase, α2‐macroglobulin and alkaline phosphatase in crevicular fluid from implants with and without periimplantitis
Authors: Plagnat Dominique , Giannopoulou Catherine , Carrel Anne , Bernard Jean‐Pierre , Mombelli Andrea , Belser Urs C.
Published: March 2003

Abstract: The aim of this investigation was to determine the presence of selected enzymes and enzyme inhibitors in crevicular fluid collected from implants with and without clinical, radiographic and microbiological signs of periimplantitis. Eleven implants with symptoms of periimplantitis in eight patients (four men and four women) were compared to eleven implants in seven subjects (one man and six women) without periimplantitis. Periimplant crevicular fluid (PICF) was collected at the mesial and distal sites of each implant. Alkaline phosphatase activity (ALP) was measured by using p‐nitrophenyl‐phosphate as substrate, elastase activity (EA) by the use of a low molecular weight fluorogenic substrate, and the inhibitor α2‐macroglobulin (α2M) by ELISA. ALP, EA and α2M were detected in the majority of samples in both groups. In comparison to the clinically healthy implants, total amounts of each of these substances were significantly higher in PICF collected around implants with periimplantitis. The mean total amounts of EA, α2M and ALP in the healthy group were: EA: 1.8 ng, α2M: 3.1 ng, ALP: 24.1 U, and in the periimplantitis group EA: 23.1 ng, α2M: 25.2 ng and ALP: 142.3 U. In addition, all three mediators were correlated with the clinical parameters. The results confirm the similarity of the inflammatory response of tissues surrounding implants and natural teeth, and suggest that ALP and EA could be promising markers of bone loss around dental implants.