Issue 3

Icon Issue 2013;1(3)

POSEIDO, Volume 1, Issue 3, December 2013(Published on January 31st, 2014)

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Special Theme: New perspectives in dental implant surfaces (Part 1)

Table of Contents POSEIDO. 2013;1(3):131-94.

Review: editorial of the POSEIDO SIREN

In dental implant surfaces, NanoWar has begun… but NanoQuest is still at stake! By Jamil Awad Shibli, and David M. Dohan Ehrenfest.

Pages 131-40

Abstract. Dental implant surface characteristics are defined by a quartet of parameters, respectively at the macro-, micro-, nano- and chemical scale. Many companies are now claiming to use nanofeatures on their implant surface, while in fact only a minority of products really displays significant nanostructures. In this article, the exact terminology of nanostructures was described, and many technologies developed to produce nanostructures on titanium implants were reviewed. Practically, only a few techniques are applicable on dental implants. The most frequent forms of nanofeatures encountered in dental implant surfaces are the nanoroughness (eg Intra-Lock Ossean, AstraTech Osseospeed) and the nanoparticles in various crystalline forms (eg 3I NanoTite, Straumann SLActive). Very little is known about the real impact of these nanocharacteristics, as an element of the quartet of parameters that influence the osseointegration. The first step is to clarify the definitions to avoid the commercial confusion.

Research articles

Interfaces in osseointegrated dental implants and a new inverted approach to their microscopic and histological study. By Marsel Z. Mirgazizov, Rais G. Hafizov, Ayrat M. Mirgazizov, Ruslan M. Mirgazizov, Fanilya A. Hafizova, and Dmitry E. Zyplakov.

Pages 141-7

Abstract. Background and objectives. The various techniques for the analysis of the bone/implant interface in vivo are incomplete and do not allow to have a full vision of the osseointegration process. In this article, we present a new inverted approach for the study of the osseointegration of dental implants, based on the chemical deep etching of titanium-made implants prior to microscopic and histological evaluation. Materials and Methods. The method was tested on 18 implants placed in 6 dogs. Bone/implant blocks were collected at 1, 3 and 6 months after implantation respectively. The titanium was chemically removed from the interface, leaving bone tissue intact. Once metal was removed, bone tissue was analyzed macroscopically and microscopically with a Scanning Electron Microscope, and then decalcified and used for histological analysis. Results.The process of implant integration into the bone tissue was followed and analyzed, and clear patterns were observed at 1 month, 3 months and 6 months after implantation respectively. After 1 month, the bone/implant interface was still very immature. After 3 months, the bone was already quite mature and organized. After 6 months, the external bone layer on the bone/implant interface appeared in its final osseointegrated form.Discussion and Conclusion. This inverted method of analysis of osseointegration offers interesting results and a new insight in the illustration of the healing of the bone/implant interface after implantation. Further research is needed to use this approach for a quantitative evaluation of different implant surfaces and designs.

Histomorphometric evaluation of Direct Laser Metal Forming (DLMF) implant surface in the type IV bone: a controlled study in human jaw. By Jamil Awad Shibli, Carlo Mangano, Francesco Mangano, Osvaldo Brasil, Bruno Lins, Fabio Cozzolino, Samy Tunchel, Alberto Blay, Giovanna Iezzi, and Adriano Piattelli.

Pages 149-56

Abstract. Background and objectives. Direct laser metal forming (DLMF) is a procedure in which a high power laser beam is directed on a metal powder bed and programmed to fuse particles according to a CAD file, thus generating a thin metal layer. This surface produces structures with complex geometry and consequently allows better osteconductive properties. This study evaluated the influence of two different implant surfaces on the % bone-to-implant contact (BIC%) and bone density in the human type IV bone after 2 months of unloaded healing. Materials and Methods. The micro-implants utilized presented DLMF surface and a machined (As-M) surface serving as test and control, respectively. Sixteen subjects (67.54.3 years of age) received one implant each during conventional implant surgery in the posterior maxilla. After 8 weeks, the micro-implants and the surrounding tissue were removed and prepared for histomorphometric analysis. Results. Two As-M implants were found to be clinically unstable at time of retrieval. Histometric evaluation showed significantly higher BIC% and bone density for the test compared to the control surface (p<0.05). Discussion and Conclusion. The histologic data suggests that the DLMF surface implants positively modulated bone healing at early implantation times compared to the As-M, at least after 2 months unloaded healing.

Soft tissues around an acid-etched healing abutment: a histological and histomorphometrical analysis. By Marco Degidi, Adriano Piattelli, Antonio Scarano, Vittoria Perrotti, and Giovanna Iezzi.

Pages 157-63

Abstract. Background and objectives. A healthy peri-implant soft tissue has been reported to play a relevant role in the long-term success of a dental implant. The underlying mechanisms of attachment and the factors that affect the integrity of this biological seal are not well understood. The aim of this report was an evaluation of the peri-implant soft tissues around a human submerged acid-etched healing cap. Materials and Methods. Four implants were inserted in the posterior maxilla. The most distal implant lacked primary stability and, while the other 3 implants were immediately loaded the same day of surgery, it was decided to submerge this implant. An acid-etched healing cap was inserted on this implant to favor the soft tissue attachment. After 6 months, the patient asked, against the advice of the clinicians, to carry out the prosthetic rehabilitation without this implant. The implant, with the surrounding soft tissues was then retrieved after a 6 months healing period. Results. A tight connection between the soft tissues and the healing abutment was found all around its perimeter. Only in a small portion of the interface a detachment of the tissues was present. Histomorphometry showed a close connection in 97% of the healing abutment perimeter. A close connection was also present at the level of the implant-abutment junction. Discussion and Conclusion. Roughened surfaces can improve the attachment of the connective tissue to the metal surface. However, further research is required to determine the optimal surface treatment to improve peri-implant soft tissue sealing.

Immediate versus delayed restorations for implants placed in fresh extraction sockets: a 1-year comparative cohort study. By Antonio Barone, Valentina Borgia, Fortunato Alfonsi, Paolo Toti, and Ugo Covani.

Pages 165-75

Abstract. Background and objectives. Immediate implant placement can be considered a predictable protocol, even in esthetic areas. The objective of this study was to compare the clinical outcomes and the total costs of immediate and delayed restoration of implants with a specific design placed into fresh extraction sockets after 1 year from the implant placement. Materials and Methods. Blossom implants (Ossean, Intra-lock, Boca-Raton, FL, USA) were used. In this prospective cohort study, marginal bone level, facial soft tissue, width of keratinized gingiva and papilla index were compared in both groups; correlations with pristine buccal bone thickness were also investigated. Results. Marginal bone level records were different in the two groups, while no significant differences were registered in facial soft tissue and keratinized gingiva width. In the delayed group, a loss and reassessment of the papillary tissue was recorded at the time of restoration. The immediate restoration group seemed to show better results in terms of healing time and total costs. Discussion and Conclusion. The immediate restoration protocol of immediately placed implant seemed to have the same efficiency as the delayed restoration, besides offering other clinical advantages.

The Flat One Bridge technique for full-arch edentulism: long term results from a prospective cohort study. By Vincenzo Bucci-Sabattini, Alberto Minnici, Daniele Manfredini, Andrea Mascolo, and Fabio Zaina.

Pages 177-85

Abstract. Background and objectives. Immediate loading of dental implants was developed in the last years to treat edentulism. In selected clinical situations, the implants can be loaded successfully immediately or just after their placement, although not all clinicians may achieve optimal results. The aim of the present study is to report the success rate of a new technique, the Flat One Bridge (FOB) in a cohort of patients requiring full arch rehabilitation, with a subgroup analysis according to the their clinical status. Materials and Methods. The study was designed as a prospective cohort study. 48 consecutive patients (24 females), average age 45 years, requiring full arch rehabilitation, were divided into 4 Groups according to their clinical status: 24 in the Native Bone Group (NBG), 8 in the Periodontitis Group (PEG), 2 in the Guided Bone Regeneration Group (GBRG), and 14 in the Fresh Extraction Group (FEG). All patients were treated with FOB on Ossean implants (Intra-Lock, Boca-Raton, FL, USA), and were followed-up for an average of 8 years. The outcome results were measured with the success, survival and failure rates. The statistical analysis was performed with a Fisher’s Exact test. Results. The overall success and implant survival rate of the study population was 95.8%. There were only 2 failures (4.2%), both in the PEG group. Patients in the NBG and GBR groups had a 100% success rate. The PEG showed in majority success. The FEG showed some implant survivals (p<0.05). Discussion and Conclusion. This study shows the effectiveness of the Flat One Bridge to treat full arch edentulism. Most patients had a positive result, that was maintained on the long term.

Bone characteristics following osteotomy surgery: an in vitro SEM study comparing traditional Lindemann drill with sonic and ultrasonic instruments. By Matteo Simonetti, Giorgio Facco, Fabrizio Barberis, Giuseppe Signorini, Marco Capurro, Alberto Rebaudi, and Gilberto Sammartino.

Pages 187-94

Abstract. Background and objectives. Osteotomy surgery is widely used in dental surgery for implant site preparation, bone grafting and GBR. In this study, the characteristics of bone surfaces were examined after bone osteotomy surgery performed with the Lindemann bur, sonic (Komet Sonosurgery) and ultrasonic (Mectron Piezosurgery) instruments. Materials and Methods. Anatomic integrity and osteotomic precision were analyzed using Scanning Electron Microscopy (SEM) to observe vascular canals, microfractures, exfoliations and bone debris on cortical and cancellous surfaces cut with the 3 types of instruments. Results. The use of ultrasonic instruments resulted in extremely precise cuts and reduced bone damage. The sonic instrument was precise in cortical bone but showed minor signs of bone damage in cancellous bone. Lindemann bur showed less precision and higher bone damage both in cortical and in cancellous bone. In cortical bone, ultrasonic and sonic cuts showed nicely opened bone vascular canals, while Lindemann bur showed many canals closed by abrasions, exfoliation and cracks by dragging attrition. In cancellous bone, ultrasonic cut showed intact trabeculae and trabecular spaces free of debris, while sonic cut showed more debris accumulation in trabecular spaces. Lindemann bur showed huge quantity of bone debris that filled trabecular spaces. Discussion and Conclusion. For all parameters, the ultrasonic cut offered the most precise and atraumatic bone cut. Ultrasonic and sonic instruments both showed more precise and less traumatic results than the Lindemann bur.

This issue of the POSEIDO Journal is supported by a grant from the National Research Foundation of Korea (NRF) funded by the Korean government-MEST (No. 2011-0030121) and by the LoB5 Foundation for Research, France.

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