Dental Implantology Research Articles

Introducing a novel educational training programme in dental implantology for pregraduate dental students.

This study aimed to determine whether implant surgery procedures can be implemented in the dental curriculum by designing novel courses for students. Additionally, this study assesses the perception of these courses and how they can be established in the future. Students from the third to fifth years participated in a programme consisting of 4 modules according to their academic year. The modules taught theoretical and practical content as well as clinical references. After participating, the students completed two questionnaires with research questions (RQ1 = evaluation of the relevance and effects; RQ2 = impact of modules 3 and 4) to evaluate the programme. The questionnaires consisted of 52 statements, each rated on a 6-point scale (1 'totally disagree' to 6 'totally agree'). Cronbach's alpha analysis was used, and median values, interquartile ranges and Pearson correlations (p-value) were statistically calculated. In total, 94 students completed the questionnaires. Cronbach's alpha exceeded 0.7 for all constructs except for one (skills training). The highest evaluated median was 6, and the lowest was 4.75. Pearson correlations were significant (<0.05) for perceived importance/lectures, perceived importance/tutor performance, lectures/skills training, skills training/tutor performance and tutor performance/lectures. Seventeen analysed free comments expressed strong interest in implantology courses for the curriculum. 88% of the students wished for more practical exercises in dental implantology during the curriculum or suggested expanding the programme in the future. The programme was highly accepted among dental students. The students wished for more practice in the future to perform supervised procedures on patients.

Surface assessment of CNC laser treated commercially pure Titanium and Ti 13 Zr 13 Nb alloy

This study aimed to evaluate the surface changes of commercial pure Titanium disks (CP Ti) and the Ti 13Nb 13 Zr (Alloy) with a zigzag pattern of laser surface treatment. In vitro, experimental study of CNC Laser treatment on the CP Ti and Alloy disks. Texturing the surfaces of CP Ti and Alloy disks via CNC laser, the sample disks were analyzed using surface roughness, wettability and FESEM. The FESEM revealed a proper increase in the surface texturing and roughness on macro and micro measures without crack formation or dramatic change of the core substance of the CP Ti and Alloy disks. The CNC laser is an effective and suitable method for surface texturing CP Ti and Alloy for dental implantology. Keywords: Commercial pure Titanium; Ti 13 Zr 13 Nb alloy; CNC Laser; Laser surface texturing; Dental implant and surface roughness

Diagnostic Significance of Proinflammatory Cytokines in Planning Dental Implantation in Patients with General Somatic Pathologies

INTRODUCTION: The current stage of development of dental implantology permits to perform a complete dental rehabilitation even in complicated clinical situations. However, there are some difficulties which prevent achievement of a high success of implantological treatment in certain somatic pathologies that manifest in the form of systemic inflammation, and present relative contraindications for implantation. Important general somatic pathologies include chronic obstructive pulmonary disease, atherosclerosis, non-insulin-dependent diabetes mellitus, osteoporosis, etc., they are associated with the risk of acute inflammatory response of an organism to surgical implantological intervention. The risk of unpredictable complications also increases because of insufficiently wide laboratory diagnostic spectrum for planning dental implantation that includes a biochemical blood test, coagulogram, reaction to the presence of specific infections and viral diseases. This list of diagnostic data is not always sufficient for a complete prognosis of success of planned treatment in patients with a complicated general somatic or dental status. Besides, the interrelation between dental chronic diseases and general somatic pathologies which in some cases have common etiopathogenetic factors, is often not taken into account, but without the adequate diagnostic range they often remain unnoticed and lead to persistent complications in different periods after completion of treatment. Development of technologies of surgical and orthopedic dentistry permits to provide full dental care to patients even with different pathologies of organs and systems. But in this case, of importance is extended laboratory diagnostics aimed at identification of factors of chronic systemic inflammation, vascular risk, bacterial threats, for example, evaluation of some interleukins, tumor necrosis factor, C-reactive protein.&#x0D; CONCLUSION: A complex of clinical, laboratory and instrumental diagnostic methods will permit to adequately evaluate risk for treatment failure and construct a prognostic tactics of complex therapy, thereby reducing the probability for unpredictable complications in dental implantation in patients with different somatic pathologies.

Zirconia Facts and Perspectives for Biomaterials in Dental Implantology.

Dental implantology has witnessed remarkable advancements in recent years, and zirconia has emerged as a prominent biomaterial for dental implant applications. This review explores the multifaceted aspects of zirconia, focusing on its properties, processing methods, biocompatibility, mechanical performance, and clinical applications. Over the past few decades, the most popular choice of material for dental implantology has been titanium which has been found to have the highest success rate of implant treatment. However, recently, it has been observed that zirconia might replace titanium and eventually emerge as one of the gold-standard materials of dental implants. Analysis of biomechanical sciences and biomaterial sciences provides an opportunity for the refinement of design and material notions for surgical implants. However, the most important aspect and prime concern is how tissue at the implant site responds to biomechanical disturbances caused by foreign materials. The literature revealed that zirconia has certain characteristics that make it an excellent material for implants, including biocompatibility and osseointegration which depicts positive soft tissue response with low plaque affinity as well as aesthetics owing to light transmission and color.Additionally, this review discusses the current challenges and prospects of zirconia in dental implantology as well as aims to provide dental professionals and researchers with a comprehensive understanding of zirconia's potential as a biomaterial in dental implantology. The present overview of available literature intends to highlight and explore the biological characteristics of zirconia for applications in dental implantology. However, research is urgently required to fill in gaps over time for clinical assessments of all zirconia implants, consequently, the implementation of hybrid systems (a titanium screw with a zirconia collar) has recently been suggested.

Enhancement of Human Gingival Fibroblasts Bioactivity and Proliferation on Plasma Sprayed Yttria-Stabilised Zirconia/TiO2 Surface Coating of Titanium Alloys: An In-Vitro Study

Titanium-coated ceramic materials with varying roughness and surface topography have been developed and utilized in clinical trials within the realms of medical and dental implantology. The objective of this study was to assess how cellular attachment is affected by the surface porosity and roughness of the titanium alloy (Ti-6Al-4V) coated with titania (TiO2)-reinforced yttria-stabilized zirconia (YZP). Additionally, the wettability of different types of TiO2-coated YZP was also evaluated for its effect on cellular migration and attachment. The results showed excellent adhesion between fibroblast cells and the surface of the YZP/TiO2 coating, with TiO2 reinforcement exhibiting bioactive properties that promote rapid cell growth and reproduction. Despite its average micro surface roughness measuring 5.86 ± 0.36 µm, the YZP/TiO2 surface coating demonstrated superior suitability for both fibroblast cell adhesion and the promotion of osseointegration. The YZP coating with 30% TiO2 demonstrated the most desirable properties, significantly enhancing biocompatibility. This study can serve as a basis for determining the biocompatibility and bioactivity of the YZP/TiO2 coating, which holds promise as a new coating material.

A technical feasibility study on adaptation of a microsurgical robotic system to an intraoperative complication management in dental implantology: perforated Schneiderian membrane repair using Symani® Surgical System

The aim of the current study was to test the technical and clinical feasibility of a robotic system and investigate its potential in the surgical repair of perforated Schneiderian membranes using an ex-vivo porcine model. Eight pig heads were operated conventionally via a surgical loop and eight pig heads with the surgical robot “Symani® Surgical System” (Medical Microinstruments, Inc., Pisa, Italy). On each specimen, the Schneiderian membrane was incised over a length of 0.7 mm resembling a perforation. Operation time, the maximum sinusoidal pressure, the course of the pressure and the filling volume were measured. Additionally, adaptation of the wound edges has been detected via scanning electron microscopy. There were no significant differences for the pressure maximum (p = 0.528), for the time until the pressure maximum was reached (p = 0.528), or for the maximum filling volume (p = 0.674). The time needed for the suturing of the membrane via robotic surgery was significantly longer (p < 0.001). However, the scanning electron microscope revealed a better adaptation of the wound edges with robotic surgery. The technical feasibility of robot-assisted suturing of Schneiderian membrane laceration using the robotic system has been confirmed for the first time. No differences considering the pressure resistance compared to the conventional repair could be observed, but advantages in wound adaptation could be found with an electron microscope. Regarding the material and training costs and limited indications spectrum, robotic surgery systems still might not present financially feasible options in the daily dental practice yet.

Interaction of Telomere Length and Inflammatory Biomarkers Following Zirconia Implant Placement: A Case Series.

Zirconia implants have gained popularity for their aesthetic appeal and biocompatibility, making them a preferred choice for anterior teeth replacement. This study explores the interaction between telomere length and inflammatory biomarkers in seven cases of zirconia implant placement to gain insights into postoperative cellular aging, inflammatory responses, and long-term outcomes. Zirconia implants offer advantages over titanium implants, as they do not corrode or release metal ions, leading to potential inflammation and implant failure. Monitoring immune and inflammatory biomarkers is essential to assess inflammation initiation, severity, and progression. C-reactive protein (CRP) and pro-inflammatory cytokines, like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), play crucial roles in host immune responses, while anti-inflammatory cytokines, including interleukin-10 (IL-10), regulate and dampen immune responses. Achieving a delicate balance between pro- and anti-inflammatory cytokines is vital for maintaining a healthy immune response and preventing chronic inflammatory conditions. Telomeres, protective structures present at chromosome ends, influence cellular aging and mitochondrial function. Shorter telomeres are associated with impaired mitochondrial function, increased oxidative stress, and cellular senescence, while longer telomeres are linked to reduced inflammation and improved immune function. Understanding these mechanisms is essential for addressing age-related conditions and promoting overall well-being. In this case series, we investigated the interaction between telomere length and inflammatory biomarkers in patients who received zirconia dental implants. The study aims to improve our understanding of postoperative cellular aging, inflammatory responses, and the biocompatibility of zirconia implants, potentially leading to improved treatment protocols and patient outcomes. This innovative assessment of telomere length and inflammatory biomarkers in the context of zirconia implants provides novel insights into the field of dental implantology. By exploring the effects of zirconia implants on cellular health and inflammation, this study contributes to advancements in implant technology and patient care.

Zirconia Dental Implants: A Closer Look at Surface Condition and Intrinsic Composition by SEM-EDX.

Modern dental implantology is based on a set of more or less related first-order parameters, such as the implant surface and the intrinsic composition of the material. For decades, implant manufacturers have focused on the research and development of the ideal material combined with an optimal surface finish to ensure the success and durability of their product. However, brands do not always communicate transparently about the nature of the products they market. Thus, this study aims to compare the surface finishes and intrinsic composition of three zirconia implants from three major brands. To do so, cross-sections of the apical part of the implants to be analyzed were made with a micro-cutting machine. Samples of each implant of a 4 to 6 mm thickness were obtained. Each was analyzed by a tactile profilometer and scanning electron microscope (SEM). Compositional measurements were performed by X-ray energy-dispersive spectroscopy (EDS). The findings revealed a significant use of aluminum as a chemical substitute by manufacturers. In addition, some manufacturers do not mention the presence of this element in their implants. However, by addressing these issues and striving to improve transparency and safety standards, manufacturers have the opportunity to provide even more reliable products to patients.

Prosthetic management of peri-implantitis: Analyzing risk factors and advancing preventive strategies

Dental implantology has transformed restorative dentistry by providing effective solutions for tooth replacement. However, challenges like peri-implantitis, involving inflammation and bone loss around dental implants, have emerged. This article explores the prosthetic management of peri-implantitis, emphasizing risk analysis and preventive strategies. Peri-implantitis's definition, clinical signs, and causes are outlined, encompassing local and systemic risk factors. Prosthodontists play a key role in removing prosthetic components, enabling thorough treatment. Mechanical and chemical methods for implant surface debridement are highlighted, focusing on infection removal and tissue healing. Preventive measures, such as patient evaluation, hygiene education, and treatment planning, are crucial for pre- and post-implant placement. Structured maintenance schedules, interdisciplinary collaboration, and customized prosthetic designs are pivotal in preventing recurrence. This comprehensive approach ensures implant longevity and elevates implant dentistry standards.

Rhamnolipid 89 Biosurfactant Is Effective against Streptococcus oralis Biofilm and Preserves Osteoblast Behavior: Perspectives in Dental Implantology.

Biofilm-related peri-implant diseases represent the major complication for osteointegrated dental implants, requiring complex treatments or implant removal. Microbial biosurfactants emerged as new antibiofilm coating agents for implantable devices thanks to their high biocompatibility. This study aimed to assess the efficacy of the rhamnolipid 89 biosurfactant (R89BS) in limiting Streptococcus oralis biofilm formation and dislodging sessile cells from medical grade titanium, but preserving adhesion and proliferation of human osteoblasts. The inhibitory activity of a R89BS coating on S. oralis biofilm formation was assayed by quantifying biofilm biomass and microbial cells on titanium discs incubated up to 72 h. R89BS dispersal activity was addressed by measuring residual biomass of pre-formed biofilms after rhamnolipid treatment up to 24 h. Adhesion and proliferation of human primary osteoblasts on R89BS-coated titanium were evaluated by cell count and adenosine-triphosphate quantification, while cell differentiation was studied by measuring alkaline phosphatase activity and observing mineral deposition. Results showed that R89BS coating inhibited S. oralis biofilm formation by 80% at 72 h and dislodged 63-86% of pre-formed biofilms in 24 h according to concentration. No change in the adhesion of human osteoblasts was observed, whereas proliferation was reduced accompanied by an increase in cell differentiation. R89BS effectively counteracts S. oralis biofilm formation on titanium and preserves overall osteoblasts behavior representing a promising preventive strategy against biofilm-related peri-implant diseases.

Vertical Bone Augmentation Using Two Bioactive Glasses in a Rabbit Tibia Model: A Comparative Study with Literature Review

Background: Recently, synthetic materials based on bioactive glasses have been in special demand in dental implantology, which, according to the mechanism of their action, are not only osteo-conductors, but also osteo-inductors. Of even greater interest is the fact that the biological degradation of these materials causes alkalization of the area and inhibits the growth of many pathogens. Considering the unique properties of this group of osteoplastic fillers and the problems associated with healing after guided bone regeneration, this study aimed to compare the effectiveness of using bioactive glasses S53P4 and 45S5 when performing vertical bone augmentation in an experiment applying a rabbit tibia model. Methods and Results: Six adult outbred rabbits aged from 1.5 to 2 years and weighing from 2.5 kg to 3.2 kg were used in the study. A titanium mesh was used to perform a true vertical guided bone regeneration technique. In each animal, two titanium tents were placed: one on the left tibia and one on the right tibia. On the left limb, empty spaces were filled with bioactive synthetic bone filler NovaBone® Morsels (USA); on the right limb, we used a mixture of bioactive glass Bonalive® granules CMF (Finland) and mineralized bone MedPark Bone-D XB (Bovine Xenograft, South Korea) in a ratio of 1:1. The quantity and quality of regenerated tissues were assessed after 8-10 weeks. The NovaBone application has allowed a gain of 2.6±2.67 mm in extra-skeletal hard tissue growth. No signs of guided bone regeneration were observed in all cases of application of an osteoplastic mixture of Bonalive and Bone-D XB granules. Conclusion: Within the limits of this study, it was found that the use of a mixture of bioactive glass Bonalive (S53P4) with bovine hydroxyapatite in a 1:1 ratio was not effective in vertically guided bone regeneration, but the application of NovaBone (45S5) could promote a new bone formation.

The Curved Presplitting Technique in a Totally Edentulous Atrophic Mandible: A Surgical Case Report.

The management of horizontally fully edentulous atrophic ridges is a common problem in dental implantology. This case report describes an alternative modified two-stage presplitting technique. The patient was referred for an implant-supported rehabilitation of their edentulous mandible. CBCT scans showed a mean available bone width of about 3 mm. At the first stage, four linear corticotomies were performed using a piezoelectric surgical device. At the second surgical stage 4 weeks later, bone expansion was performed, and four implants were placed in the interforaminal area. The healing process was uneventful. No fractures of the buccal wall and no neurologic lesions were observed. Postoperative CBCT scans showed a mean bone width gain of about 3.7 mm. Implants were uncovered 6 months after the second surgery, and 1 month later, a fixed provisional screw-retained prosthesis was delivered. This approach could be used as a reconstructive technique that avoids using grafts and reduces treatment times, possible complications, postsurgical morbidity, and costs by exploiting the patient's native bone as much as possible. Considering the limitations of a case report, randomized controlled clinical trials are needed to confirm the results and validate this technique.

Fabrication and characterization of PEKK nanocomposites: An in vitro study

Although the number of implants has increased gradually and consistently over the years to around one million per year globally, there is still far more potential for advancement in the field of dental implantology which is typically growing quickly. This study investigates the effect of nanofiller reinforcement high-performance polymer matrix to enhance mechanical and physical characteristics. Calcium silicate (CS)/Polyetherketoneketone (PEKK) biomedical composite (G0 as a control group) is reinforced with different weight percentages (G1-G4) of tellurium dioxide nanoparticles (TeO2 NPs) ( n = 5). This research uses ethanol as a binder for mixing various weight percentages (wt%) of TeO2 NPs with CS/PEKK biomedical composite. The combination is then dried at 120°C in a forced convection oven before being put into special molds and compressed for 20 min Holding period at 310°C and 15 MPa. The composites were prepared via the compression molding technique. Morphological, mechanical, and physical characteristics were studied. The findings of this study suggested improvement in the interfacial interaction between TeO2 NPs (G1 and G2) and CS/PEKK bioactive composite resulting in better mechanical and physical properties, especially at 1 w% of TeO2 NPs (G2).

A comparative review one-stage and two-stage dental implants

Dental implants have been used as an effective treatment for missing teeth. Dental implantology has a long history that reaches back to ancient times when attempts were made to replace missing teeth with various materials. Modern dental implants are designed to osseointegrate, where the implant fixture fuses with the jawbone. The surgical procedure involves placing the implant, followed by the adaptation of the surrounding tissue. There are two main surgical techniques: one-stage surgery and two-stage surgery. One-stage surgery involves placing the implant and allowing a healing abutment to protrude through the gums. This eliminates the need for a second surgery but carries the risk of overloading the implant during the healing phase. Two-stage surgery is the standard approach, where the implant is initially submerged, and a second surgery is performed to connect the abutment. The choice between one-stage and two-stage surgery depends on many factors, including bone quality, clinical parameters, and aesthetic considerations. One-stage surgery offers quick aesthetics but can pose a higher risk of implant failure due to early loading. Two-stage surgery provides a higher success rate but requires two surgical procedures.

All-On-Four Concept Literature Review

The All-on-4 concept is a dental implant technique that provides a solution for patients who have lost or are about to lose all of their teeth in one or both jaws. This concept was developed to simplify the implant process and make it more accessible for individuals with extensive tooth loss. In the review performed in Pubmed and Cochrane Library between 2005 and 2023, Full arch implant-supported prosthesis, 4-implant full arc, osseointegration, inclined implant, total edentulism and different combinations in which some of these keywords were used together were chosen. 100 of the articles achieved from the review were evaluated with respect to the subject we examined. The inclusion criteria for articles were as follows: 1-Articles were related to the all-on-four concept. 2-Abstracts were obtained when the full texts could not be obtained. The All-on-4 concept in dental implantology offers several advantages, making it a popular and effective solution for patients with extensive tooth loss. The All-on-4 concept allows for the immediate loading of prostheses onto the implants shortly after surgery. Compared to traditional implant approaches, All-on-4 reduces treatment time significantly. The concept utilizes tilted posterior implants, which take advantage of available bone and reduce the necessity for bone grafting in areas with insufficient bone volume. All-on-4 may be more cost-effective than traditional implant-supported restorations due to the reduced number of implants and the associated surgical procedures. The concept aims to provide a fixed, full-arch prosthesis that closely resembles natural teeth. Numerous studies have reported high success rates for the All-on-4 concept, with the majority of patients experiencing successful osseointegration and long-term stability of the implants. All-on-4 often results in a more comfortable experience for patients, with fewer surgical interventions and reduced healing periods. The tilted posterior implants increase the contact between bone and implant, enhancing stability and support for the prosthesis.

Dental Implantology and Undergraduate Curricula

Dental Implantology and Undergraduate Curricula

Accuracy Analysis of Computer-Assisted and Guided Dental Implantology by Comparing 3D Planning Data and Actual Implant Placement in a Mandibular Training Model: A Monocentric Comparison between Dental Students and Trained Implantologists.

The aim of this study was to investigate how precisely implantation can be realized by participants on a phantom head according to preliminary planning. Of particular interest here was the influence of participants' previous knowledge and surgical experience on the precision of the implant placement. The placed implants were scanned using an intraoral scanner, saved as STL files, and superimposed with the 3D-planned implant placement. Deviations from the planning were indicated in millimeters and degrees. We were able to show that on average, the deviations from computer-assisted 3D planning were less than 1 mm for implantologists, and the students also did not deviate more than 1.78 mm on average from 3D planning. This study shows that guided implantology provides predictable and reproducible results in dental implantology. Incorrect positioning, injuries to anatomical structures, and implant positions that cannot be prosthetically restored can thus be avoided.

Surface treatment of Ti and Ti composites using concentrating solar power and laser

Titanium and its composites are widely used in implants of bones and teeth. Besides mechanical properties also surface characteristics are very important in these biomaterials. Very important are properties such as surface topography, roughness, chemistry, and surface energy, wettability, and Ti oxides or Ti nitride layers thickness. The concentrated solar power was used successfully to nitride Ti Grade 2 and powder metallurgical Ti prepared from hydrogenated dehydrogenated Ti powder. The nitriding experiments were performed under nitrogen atmosphere at different temperatures and time in SF40 (40kW horizontal solar furnace) at PSA, Spain. Concentrated solar energy has been shown to be an economical alternative to conventional gas nitriding techniques in electric furnaces, CVD, PVD, plasma nitriding, or laser treatments. It has been observed that the solar process represents a significant reduction of the heating time to several minutes (up to 5 minutes at temperature range 500-1000 °C), a clean and non-polluting high-temperature process. The formation of continuous and homogeneous surface layers of TiN, Ti2N and their mixture according to the nitriding temperature was investigated using X-ray diffraction and electron microscopy. Laser surface treatment is of great significance in modifying surface morphology and surface and near-surface region microstructures. Effects of lase treatment parameters on machined surface morphology, surface roughness and chemistry are analyzed in this study and discussed from the point of view of application in dental implantology. The current advances of our research group in application of laser-treated powder metallurgy prepared Ti-based materials are analyzed and discussed.

Opportunities for artificial intelligence and telemedicine in implantology

Artificial Intelligence (AI) has been making significant strides in various fields, including healthcare. One such area is dental implantology. AI can assist in accurate diagnosis, treatment planning, in the execution of the procedure, and predict implant success based on various factors like bone density, implant site, patient's medical history, etc. Despite the promising potential, the application of AI in dental implantology is still in its nascent stages. Research in this area of medicine is limited, but there has been an increase in recent years. This trend is related to the possibility of improving patient outcomes, including shorter treatment times, prevention of complications and improved quality of care in general.

Nanohydroxyapatite in dentistry: A comprehensive review

Enamel, being the hardest and the highest mineralized tissue of the human body, contains nearly 96% inorganic components and 4% organic compounds and water. Dentin contains 65% inorganic components and 35% organicand water content. The translucency and white appearance of enamel are attributed to Hydroxyapatite (HA), which constitutes the major part of the inorganic component of dental hard tissue. With the advent of nanotechnology, the application of Nanohydroxyapatite (nHA) has piqued interest in dentistry due to its excellent mechanical, physical, and chemical properties. Compared to HA, nHA is found to have superior properties such as increased solubility, high surface energy and better biocompatibility. This is due to the morphological and structural similarity of nanosized hydroxyapatite particles to tooth hydroxyapatite crystals. These nanoparticles have been incorporated into various dental formulations for different applications to ensure comprehensive oral healthcare. To prevent dental caries, several nHA based dentifrices, mouth rinsing solutions and remineralizing pastes have been developed. nHA-based materials, such as nanocomposites, nano impression materials, and nanoceramics, have proven to be very effective in restoring tooth deformities (decay, fracture, and tooth loss). The nHA coating on the surface of the dental implant helps it bind to the bone by forming a biomimetic coating. A recent innovative strategy involves using nHA to reduce dentinal hypersensitivity and to reconstruct periodontal bone defects. The purpose of the present review is to discuss the different applications of nHA in dentistry, especially in preventive and restorative dentistry, dental implantology, bleaching and dentine hypersensitivity management.