Blade Implants Research Articles

Immediate Loading of Endosseous Implants Is Not New

For practitioners trained within the past 20 years in oral implantology, the accepted protocol for implant placement required a significant and trauma-free healing period before prosthetic loading. The majority of implant procedures performed today use this 2-stage protocol. With the evolution of new implant designs, immediate loading of implants has been used with success. Many practitioners, however, are unaware that the concept of immediately loading implants actually began 40 years ago with the contributions of Dr Leonard I. Linkow.As early as 1963, Dr Linkow had developed the first self-tapping endosseous root-form implant, known as the Ventplant.12 The protocol that was ultimately adopted was to immediately load these implants with overdentures or acrylic, provisional fixed bridges. In that year the implant aiguilles (needle implants)34 mandated immediate loading, and immediate loaded subperiosteal implants followed in 1964. In 1967, the endosseous blade implant, which also called for immediate loading (for splinting purposes), was introduced.5–9 Before 1967, Dr Linkow carefully established a protocol for immediate loading in root-form procedures. From 1967 to the latter part of 1999, myriad blade and plate-form implants were also placed into immediate function.10In a technique described over 3 decades ago, cut bone shavings were transported to areas within implant fenestrations rather than forced into peri-implant spaces, as most surgeons were doing. These attempts at offering support to newly placed root forms were sometimes responsible for local and occult osteolysis. One of the benefits accruing to those who followed the simple rules espoused and practiced by Dr Linkow was that their implants were capable of supporting immediate loading.In many unilateral situations where the molar abutments consisted of 1 or 2 implants and the anterior teeth were healthy, the cuspid and first bicuspid (when present) were used as the anterior abutments. A 4- or 5-unit prefabricated or chair-side, acrylic, interim prosthesis was inserted, thereby placing the reconstructed quadrant into immediate function (Figures 1A–C and 2A–D).1112The design of such a bridge should include a cuspid rise to ensure accompanying disclusion of the posterior implant-borne prosthesis during lateral movements. The buccal inclined planes and cusps should be flattened, and a hard cement is used if the patient is to wear the provisional prosthesis for several months. As a result, the bridge will require sectioning when it must be removed.The final fixed prosthesis should have a narrower occlusal table, and the cuspal inclines should be no greater than 15 degrees. It is advisable to stabilize these cases with a denture adhesive or a similar very soft cement for several weeks before permanent cementation.In totally edentulous cases, 4 endosseous root-form or blade implants were inserted, 2 on each side of the arch distal to the canines. Their abutments required parallelism, which could have been achieved by the use of diamonds or by supplying them with telescopic copings. Angle abutments may be used with 2-piece root-form systems.13 A prefabricated acrylic full-arch splint or chair-side cold-cured splint was fitted, trimmed, articulated, and cemented passively over the abutments with temporary cement.14The prosthesis should follow a very strict occlusal pattern, such as narrow occlusal tables, with planes inclined to no more than 15 degrees and with group function posteriorly in lateral excursions, as developed by Dr Charles English.13 The same postcementation rules apply for the full-arch interim prostheses as they do for the quadrant designs.15,16The final porcelain fused to the metal prosthesis must follow the same prosthetic and occlusal guidelines. Often, an acrylic-processed-to-metal bridge may be the prosthesis of choice (Figure 3A–D).The result of a biopsy study of a case in a totally edentulous mandible of 1 of 4 blade implants that were placed in immediate function verifies integration even after 19 years and 3 months of function. This is the longest state of function ever reported for endosseous implants.14Professor Carl Donath of the University of Munich performed the histopathology on this blade implant, which showed an average of 72% bone-to-metal contact (Figure 4).18 Most current journal articles on immediate load involve a single implant modality: the endosseous root-form implant. Few practitioners realize that over 40 years ago the practice of placing implant systems into immediate functional activity was a vital, comprehensive, and successful technique.

Penanggulangan Komplikasi dalam Perawatan Restorasi Implan Tulang

Clinical complications of endosseous implants are the effects of mal-treatments including patient selection, treatment planning, clinical execution and patient cooperation. This prospective and retrospective study consists of 24 patients nine women and 15 men with a mean age of 46.7 (range 14 to 70 years), rehabilitized with 33 implant restorations during 1985 - 2000. Nine single implant restorations were supported with nine cylinder implants, eight free standing implant restorations were supported with 14 cylinder implants, one blade implant and one screw implant, 16 tooth implant restorations were supported with nine blade implants, four solid screw implants, four cylinder implants and 18 natural teeth. The result of the study identified 51 complications, four altered sensations, 12 implants disintegration, 21 screw-loosening, three screw fracture, one abutment fracture, five marginal bone lost, and five caries. A total of 12 implant were removed 21 implant restoration were survived after re-treatments. Complication is a consequence of a fast developement of dental implant. However, it is not always considered a failure. The important thing to overcome the problem is a correct identification of the complication which leads to a proper re-treatment.

Overview of clinical trials on endosseous implants.

Early history of clinical trials on endosseous implants revolved around anecdotal reports on predominantly blade implants in the U.S. The first criteria to define success or failure were established at the National Institutes of Health (NIH)-Harvard Conference in 1978. This was followed by the multi-center trials from the Branemark group which described round, metallic implants. At the 1988 NIH Conference, questions dealt with the following: 1) the effectiveness of dental implants for the long-term; 2) indications and contra-indications of various types of implants; 3) requirements for management of dental implants; 4) health risks of dental implants; and 5) future directions in research. In the ensuing 7 years since the second NIH Conference, most of the data generated have been from non-controlled case reports, which describe a 90% success rate in 5 years or more with many types of endosteal systems in both partially and fully edentulous patients. Therefore, it can be said that there is evidence that dental implants are effective for the long-term. The other questions posed at the 1988 NIH Conference have not been as well described and have led to many controversies and future research areas. Two areas which will have a special future impact are 1) the establishment of a standard of care and risk-benefit ratio for implants and 2) the use of various factors to accelerate bone formation to allow greater access to dental implants by patients.

The Effect of Premature Loading to the Hydroxyapatite-Coated Blade Implants

The Effect of Premature Loading to the Hydroxyapatite-Coated Blade Implants

A histologic evaluation of retrieved hydroxyapatite-coated blade-form implants using scanning electron, light, and confocal laser scanning microscopies.

We histologically examined seven hydroxyapatite-coated (HA) blade implants removed from patients. Four of them radiologically showed severe bone loss and were easily removed with an elevator. Three radiologically showed vertical bone loss and were removed by surgical procedure. Our histological evaluation indicated that coating separation from the HA implants had occurred, and HA coating resorption by bone tissues was suspected in an implant left in situ for 8 years. Several multinucleated giant cells were seen with a few released particles of HA coating at the point lacking bone contact with the HA coating. The presence of microorganisms on and in the HA coating layer was also noted.

Fractures of Hydroxyapatite‐Coated Blade Implants Connected With Natural Teeth. A Histological Study Using SEM, Light Microscopy, and an Image Processing System

A clinical study was conducted of 59 patients treated with 78 hydroxyapatite (HA)-coated blade implants from August 1986. Five implants in 5 patients were broken at the neck portion, and one implant in one patient was removed from the jaw bone. The histological findings around a broken implant which was removed from the mandible are presented. These sections showed good adaptation of the bone to the implant without a fibrous layer. Histomorphometric evaluation of bone-to-implant contact showed 73.5%. The scanning electron microscopy image of the fractured surface revealed a fatigue fracture. The suspected cause of the fracture was stress concentration at the cervix portion, because of excessive mobility or deleterious change of abutment teeth. Consequently, the osseointegration/biointegration implants should not be connected with natural teeth.

Case of a Removal of the HA-Coated Blade Implant

Case of a Removal of the HA-Coated Blade Implant

Evaluation of Consecutively Placed Unloaded Root‐Form and Plate‐Form Implants in Adult Macaca mulatta Monkeys

The present paper describes 18 consecutively-treated non-human primates (Macaca mulatta) as part of a balanced block design study of 36 animals to examine osseointegration in root- and plate-form implants prepared by atraumatic preparation of bone. Clinical measurements around selected teeth and digital radiology were utilized to monitor periodontal disease and bone deposition around the unloaded implants. Once a month scaling procedures were utilized as a means of preventing further advance of periodontal disease. Results indicate that once-monthly regimen of scaling and root planing can prevent attachment loss of natural teeth and will not interfere with the healing of either type of implant; once-monthly scalings produce significant reduction in redness (P < .05) and reduced probing depths (P = .01). A second finding is that both root and blade implants show radiographic evidence of osseointegration in this primate model. The quantitative analysis demonstrates bone gain is not stabilized until 6 months after healing. The data may indicate that occlusal loading of mandibular implants at 3 months may be premature.

Ｈｙｄｒｏｘｙａｐａｔｉｔｅ ｃｏａｔｅｄ ｂｌａｄｅ ｉｍｐｌａｎｔの破折症例について 第１報： 臨床例と組織学的観察

This study consisted of clinical observations of 59patients who have been treated with 78 hydroxyapatite (HA) blade implants since August 1986. Four implants of 4 patients were removed from the jaw because of pain and mobility, and 5implants of 5 patients were broken at the neck portion. We examined histologically one broken implant which was removed from a human mandible.These sections showed good adaptation between bone and implant without a fibrous layer. The fracture was suspected to be due to the stress concentrationat the neck portion because of the increasing mobility or the troubles of abutment teeth.

A Comparative Study of Titanium Blade Implants and H.A.-Coated Blade Implants

A Comparative Study of Titanium Blade Implants and H.A.-Coated Blade Implants

術後５年目のＨｙｄｒｏｘｙａｐａｔｉｔｅ‐ａｌｕｍｉｎａ ｃｏａｔｅｄ ｂｌａｄｅ ｉｍｐｌａｎｔの臨床成績

This study consisted of a retrospective clinical observation of 30 patients treated with 40 hydroxyapatite (HA)-alumina blade implants (Sumicikon) from August 1986 through February 1987. Nineteen single-headed implants and 21 double-headed implants were used in the maxilla and mandible as free-end and intermediate abutments for fixed bridgeworks. Two implants of 2 patients were removed, one implant was broken at the neck portion, and 3 implants of 2 patients were bropped from this investigation. Thirty-four implants were in function, but one implant had a remarkably radiolucent area at the shoulder section. In addition to this, one shallow-inserted implant that showed no radiographic change as compared with 5 years ago. Five year clinical results of this implant are good with 89% success and 92% survival rates.

生体内吸収性膜を用いた組織誘導再生法のブレード・インプラントへの応用

生体内吸収性膜を用いた組織誘導再生法のブレード・インプラントへの応用

Comparative implant research in dogs: A prosthodontic model

One-hundred twenty endosteal dental implants were inserted bilaterally in the mandibles of 30 adult mongrel dogs after bilateral extraction of all premolars. The 120 implants were evenly divided into one- and two-stage systems and included ceramic and titanium cylindrical root-form implants and titanium blade implants. The research design of this investigation divided the 30 animals into 10 groups of three dogs. This article describes an animal model that is useful in evaluating dental implant designs and compares the results with those from humans. In particular, this article delineates the prosthodontic approach appropriate for this model using one- and two-stage titanium implants. Rexillium alloy fixed prostheses were placed on 32 endosteal implants and 16 natural mandibular molar teeth. The implants and prosthetic components of the Sterio-Oss implant system were used. All prostheses are functional with minimal maintenance. To date, after 1-year of follow-up, none of the implants have been lost and none of the fixed prostheses have required recementation or maintenance other than normal hygiene. Histologic and survival data as well as results with other implant systems will be presented in other reports.

A semi-automated computer-assisted method for measuring bone loss adjacent to dental implants.

The purpose of this study was to develop a repeatable method for measurement of bone support around root form and blade implants suitable for use in high-quality but unstandardized radiographs. 10 phantoms were fabricated to simulate progressive osseous defects around implants. Radiographs were taken in triplicate and digitized. Specialized software was written which placed a grid of known dimensions over the implant so that the top and the bottom of the grid were at the neck and the base of the implant, respectively. The investigators selected the edge of the bone at each point where the grid intersected the implant and the software automatically detected the implant edge. The software also outlined and displayed the defect on the computer monitor. Measurements were performed 5 times and the standard deviation was taken as a measure of the repeatability of the method. Repeatability for blades and root forms was 0.19 +/- 0.07 mm and 0.08 +/- 0.03 mm, respectively. There was no significant difference in the ability to measure bone loss in the blade versus the root form (p = 0.17, NS). These results indicate that this semi-automated computer-assisted method for measuring bone loss around implants is repeatable and may be of value for clinical trials using either root form or blade implants.

The Surgical Management of Osseous Defects Associated with Endosteal Hydroxyapatite-Coated and Titanium Dental Implants

As more and more patients choose implant therapies it will be incumbent upon the dentists placing, restoring, and maintaining endosseous implants to be armed with the most current information. There is a need for further research to answer the many significant questions in the management of osseous defects associated with dental implants. Some of these questions include: Which grafting materials yield the greatest repair? If resorbable materials (for example, DFDB) are not replaced by bone, are residual defects and peri-implant tissues similar to those which existed prior to osseous grafting procedures? If so, perhaps the combination of a nonresorbable graft like HA with DFDB may yield the wound-healing potential of both materials; for example, osseoinduction by DFDB and the benefits of a radiographic marker and defect filler provided by HA. Can reintegration occur on previously pathologically exposed implant surfaces? Do biodegradable barriers yield significant GTR, and do they resorb predictably? Is complete detoxification of the infected HA-coated surface possible or necessary for regeneration to occur? Which chemotherapeutic modality detoxifies HA-coated surfaces best clinically and at the histologic level? Or should infected HA coatings be removed before attempting implant repair? Are regenerative techniques (for example, GTR) predictable enough to treatment plan for them when we know there will be residual osseous defects after placing fixtures in their most ideal prosthetic position? If so, what defect types resolve most predictably following surgical correction? Should barriers be used in conjunction with grafting when placing 2-stage blade implants to generate bone in the slot preparation coronal to the shoulder of the blade? It is evident from the growing popularity and acceptance of implant therapies that these and other questions will need to be answered to continue the evolution of the science of this discipline. This author would encourage practitioners to keep abreast of the current research and developments in this field as new techniques, materials, and therapies are in a constant state of flux.

Selection of Blade Implants from the Point of Stress Analysis on Endosseous Implants

Selection of Blade Implants from the Point of Stress Analysis on Endosseous Implants

A Long Term Observation of Blade Implants by X-rays

A Long Term Observation of Blade Implants by X-rays

Veterans administration cooperative dental implant study—comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part III: Comparisons of masticatory scores between two treatment modalities

Five Veterans Administration Medical Centers participated in a study to determine the comparative influence of fixed partial dentures (FDPs) supported by endosteal blade implants and removable partial dentures (RPDs) on masticatory performance. The study design, methodology, and success rates have been described in Parts I and II. A total of 232 patients received comprehensive dental care, including RPDs for 118 patients and FPDs for 114. Three standardized masticatory tests were made with peanuts and carrots before treatment. These tests were repeated at 16 weeks following RPD or implant insertion and thereafter at 6, 18, 36, and 60 months. At entry, there were no significant differences in performance scores and chewing time and strokes taken to reach the swallowing threshold between the RPD and FPD groups ( p > 0.05). After treatment completion, FPDs and RPDs significantly improved the masticatory ability of patients with Kennedy class I or class II edentulous conditions ( p < 0.001). The improvements in performance scores for both test foods were slightly better in the RPD group than in the FPD group, although none of the 30 mean differences was significant ( p > 0.05). After the baseline period to 60 months, only slight changes in performance scores were observed for both groups. RPDs and FPDs were comparable in improving the chewing efficiency of patients with Kennedy class I and class II partially edentulous conditions.

Histological Observation of a Cremated Mandible with an Inserted Blade Implant

Histological Observation of a Cremated Mandible with an Inserted Blade Implant

A survey of dentists practicing implant dentistry in Israel

Due to the increasing interest in the field of implant dentistry, a first survey of dentists in Israel who used implants was conducted. Out of a total of 312 dentists questioned, 97 reported using dental implants in their practice. In spite of the team approach advocated in the literature, 40% of the dentists in the survey conducted both the surgical and the prosthetic phases of treatment. Over 60% of the respondents had less than 3 years' experience in the field, which is in keeping with the worldwide trend. A smaller number than expected regarded red gingival color and bone resorption based on radiographic findings as grounds for implant failure. In the view of at least 10 respondents, pain, discomfort, exudate, and fistulization did not indicate unsuccessful implants. A disparity was revealed between the dentists' practice methods and their hypothetical choice of self-treatment. Although the Core-Vent method was the most widely employed, only 50% of those using this system preferred it for themselves. Even fewer (25%) of those using blade implants considered it their self-treatment of choice. In contrast, although only 10% of the dentists had used the Branemark method, 30% preferred it for their own treatment.