Abstract
Objectives: The progressive peri-implant bone remodeling caused by dynamic cycles of microdamage may change peri-implant bone characteristics and volume after the functional loading. This prospective study was designed to evaluate the radiographic trabecular bone density and peri-implant vertical dimensional changes around the non submerged dental implant with a laser-microtextured collar (NSLI)s after 5 years of functional loading. Methods: Digital periapical radiographs of 58 NSLIs supported fixed single crowns and fixed partial dentures in 26 patients (14 men, mean age of 52 ± 3.8 years) were used for comparative evaluation between the implant placement [Baseline (BSL)], the definitive Crowns Delivery (CD) and the 5 years post-functional loading examination (T5). Regions of interest (ROI) were taken into consideration for the measurement of mean gray levels, standard deviation, and variation coefficient. The texture parameters, such as contrast, correlation, angular second moment and entropy, were investigated by using the software ImageJ (v.1.50i), by means of the Gray-level Co-occurrence Matrix (GLCM) Texture Tool plugin. Vertical Peri-implant Marginal Bone Level (VPMBL) was assessed at the mesial and the distal sides of each implant by subtracting the measure at BSL from the measure at T5 by means of dedicate software (VixWin Platinum Imaging Software). Mixed regression models were adopted to analyze data. The possible effects of some variables, such as the use of provisional denture, location, crown/implant ratio, type of prosthetic design (single or splinted), on radiographic dimensional vertical changes, gray levels and texture analysis variables were also evaluated. Results: From BSL to T5, mesial and distal VPMBL showed a statistically significant gain of 0.9 ±0.5, and 0.10 mm ±0.6, respectively (P<0.05). From CD to T5, mean gray levels increased from 94.4±26.8) to 111.8±27.1 (P<0.05), while the coefficient of variation decreased from 0.08±0,03 to 0.05±0.04) (P<0.05). Variables showed no statistically significant correlation with texture parameters (P > 0.05). Conclusion: NSLIs showed an increase in radiographic vertical peri-implant marginal bone levels and bone density up to 5 years of loading.
Highlights
Bone tissue responds positively and negatively to mechanical loads; modifications in terms of the mass of skeletal bone and mineral density are associated with mechanical stimuli and documented in the literature [1 - 3].Jaws are continuously subject to functional and parafunctional loads while mastication, swallowing, grinding, tapping and clanking: those factors could influence positively or negatively jaws’ status [4 - 7]
Patients were not admitted to the study if any of the following exclusion criteria were present: General contraindications to implant surgery; Subjected to irradiation in the head and neck area; Immunosuppressed or immunocompromised patients; Treated or under treatment with intravenous aminobisphosphonates; Affected by untreated periodontitis; Having poor or alhygiene and motivation; (full-mouth plaque (FMPS) and bleeding score (FMBS) ≥25%, recorded at the implant placement) Severe intermaxillary discrepancies; Smoking more than 10 cigarettes per day; Uncontrolled diabetes; Pregnant or lactating; Substance abusers; Psychiatric problems or unrealistic expectations; Lack of opposite occluding dentition/prosthesis; Acute/chronic infection/inflammation in the area intended for implant placement; Patients were participating in other trials, if the present protocol could not be properly followed; Extraction sites required bone augmentation or with less than 3 months of healing
From crowns delivery (CD) to T5, mean gray levels increased from 94.4±26.8 to 111.8±27.1 (P
Summary
Jaws are continuously subject to functional and parafunctional loads while mastication, swallowing, grinding, tapping and clanking: those factors could influence positively or negatively jaws’ status [4 - 7]. Peri-implants marginal bone remodeling has been associated with multiple factors, including surgical trauma, implant design, prosthetic considerations and patient habits [8 - 10]. Radiographic Trabecular Bone Density and Peri-Implant Marginal Bone. Peri-implant bone quantitative and qualitative characteristics could be modified by continuous cycles of microdamage and bone reparation that occur under functional loading [12 - 14]. The implant load can be represented by vertical and horizontal components; improper loads can stress the periapical bone and stresses are usually concentrated at the marginal third of the implant’s collar, inducing peri-implant bone remodelling [15]. The amount and the quality of the surrounding bone can influence the entity of the load transfer from implants to bone [6]; load transfer can be influenced by the implant geometry [17, 18]
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