Implant Fixture Placement Research Articles

Implant Fixture Fracture Related To Angulation Path Compounded By Implant Width

Accurate implant placement is vital to the proper function and life of not only the implant fixture but also the implant-restoration structural unit. Less than 1% of implant failures occur primarily due to fracture of the implant fixture. Though the principle of implant placement today is prosthetic-driven, proper implant fixture placement is fundamental to the life of the implant-prosthesis unit and includes factors such as selection of key factors such as expertise of dentist or specialist placing the implant fixture, length, and diameter, angulation or path of insertion, length and of implant fixture. Research indicates that among the factors listed, diameter and angulation or proposed path of insertion of the implant fixture play an important role in the long-term stability of the implant fixture. In this case report, we describe a patient who underwent implant therapy, bilaterally, in the mandible. Implant fixtures were placed in the region of missing tooth #19 and #30 which were previously extracted due to pulpal disease of carious origin. In both cases, a 5.0 mm diameter implant fixture was selected to replace the missing #19 and 30. The implant placed in the #19 region was placed with the ideal angulation and subsequently restored, while the implant fixture placed in the missing #30 location was inserted at an off-angle, then subsequently restored. Three years following restoration, the patient presented with a fractured implant replacing #30. This case report emphasizes the importance of selection of appropriate implant fixture features such as diameter and angulation for the long-term survival of the entire implant-prosthesis unit. As the report would further indicate, in the region of tooth #30, it was difficult to ascertain the cause of implant therapy failure. The case report also underpins the need to pay increased attention to all factors on an individual basis that essentially compound to improve the survivability of the implant-prosthesis unit.

Complications following alveolar ridge augmentation procedures.

Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in alveolar ridge deficiencies. Although RAP-related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post-surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post-surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.

A Study to Determine the Accuracy of Various Clinical Techniques of Ridge Mapping before Implant Fixture Placement

The most important parameter to assess prior to implant fixture placement is the available bone width. Radiographic techniques have been found to be inadequate in providing this valuable information, unlike clinical techniques. The purpose of the present study was to determine the accuracy of various clinical techniques of ridge mapping before implant fixture placement. Ten patients with at least two missing teeth adjacent to each other were selected for the study. Direct and indirect techniques of ridge mapping were carried out to assess the available bone width. The data obtained were statistically analyzed using ANOVA and Tukey's Post Hoc analysis. The results indicate that there is no significant difference between direct and indirect technique of ridge mapping. Either direct or indirect technique of ridge mapping can be used to assess the width of available bone before implant fixture placement. Clinical techniques of ridge mapping are handy and can be carried out chairside with ease and less cost and no radiation exposure. Indirect techniques of ridge mapping provide adequate and reliable data regarding bone width just like direct technique. In the absence of a bone mapping caliper, this technique can be used as a diagnostic procedure before implant placement. And during the indirect technique, any material can be utilized with equal efficacy for the fabrication of the guides.

Perioperative management in a patient with type 1 diabetes mellitus who presented severe hypoglycemia during dental implant surgery: a case report

BackgroundPatients with type 1 diabetes mellitus (DM) have poor glycemic control owing to extreme impairments in glucose tolerance. There are few reports regarding dental implant surgery in patients with type 1 DM. We describe herein the perioperative glycemic management in an outpatient with type 1 DM who experienced a rare case of severe hypoglycemia during dental implant surgery. Only one such case has previously been reported.Case presentationA 60-year-old male patient diagnosed with type 1 DM was scheduled for dental implant primary surgery. Premedication with peroral antibiotics was carried out to prevent possible systemic infection as a complication of DM. The patient was treated to control intraoperative hypertension with diligent attention to cardiovascular conditions by using a bolus administration of nicardipine and diltiazem. During surgery, he abruptly complained of hypoglycemic symptoms and had a blood glucose level of 32 mg/dL. Following oral administration and electrolyte-combined infusion of glucose, he immediately recovered from the critical situation. The surgical procedure, involving a lower jaw implant fixture placement, was performed as planned and resulted in less invasion, limited to the area of implant fixture placement within the right mandibular region of the two molars, compared to implant surgery that spans the entire lower jaw.ConclusionsThe present case suggests that it is essential to promptly monitor possible signs of hypoglycemia-precipitated acute symptoms in patients with DM. In addition, it is also necessary to appropriately administer insulin with an electrolyte-combined infusion of glucose for deliberate glycemic control; this is particularly true in patients with type 1 DM undergoing relatively highly-invasive oral surgical manipulation such as commonly performed dental implant surgery spanning the entire jaw.

Implant Placement Is More Accurate Using Dynamic Navigation

The purpose of this prospective study was to measure and compare the accuracy and precision of dynamic navigation with freehand (FH) implant fixture placement. The authors hypothesized that the evaluated dynamic navigation system would have high accuracy and precision and would be superior to FH methods. The authors designed and implemented a prospective cohort study and enrolled patients who had implants placed from December 2014 through December 2016. The predictor variable was implant placement technique comparing fully guided (FG) and partially guided (PG) dynamic navigation with FH placement. The outcome variables were accuracy measured as deviation from the virtual plan, and precision was represented as the standard deviation of the measurements. Analysis of variance (ANOVA) was used to compare measurements. Virtual implant placement was compared with post-implant placement using mesh analysis. Deviations from the virtual plan were recorded for each implant for each surgeon. FH implant placement was evaluated by comparing a virtual plan with postoperative scans for patients who did not have the navigation system used for their implant placement. One-way ANOVA was performed to determine within-group and between-groups differences to determine whether there were meaningful differences among surgeons and methods (FG, PG, and FH) of placement. Prospective data from 478 patients involving 714 implants were evaluated. There were no demographic differences among surgeons. The sample size differed by the number of implants placed by each surgeon. Within each method group, the only difference among surgeons was angular deviation. All surgeons' data were combined. For FG navigation, the mean angular deviation was 2.97±2.09°, the mean global platform position deviation was 1.16±0.59mm, and the mean global apical position deviation was 1.29±0.65mm. For PG navigation, the mean angular deviation was 3.43±2.33°, the mean global platform position deviation was 1.31±0.68mm, and the mean global apical position deviation was 1.52±0.78mm. For FH placement, the mean angular deviation was 6.50±4.21°, the mean global platform position deviation was 1.78±0.77mm, and the mean global apical position deviation was 2.27±1.02mm. Differences in measurements comparing FG and PG navigation with FH indicated significantly less deviation from the virtual plan (P<.05) using navigation. Accuracy and precision for implant placement were achieved using dynamic navigation. The use of this type of method results in smaller deviations from the planned placement compared with FH approaches.

Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone.

The aim of this study was to prospectively evaluate the clinical efficacy and histological outcome of the autogenous tooth graft material (AutoBT) compared to that of anorganic bovine bone (Bio-Oss® , Geistlich, Switzerland) in post-extraction alveolar bone augmentation. A total of 33 graft sites in 24 patients were included in this study. AutoBT was used in 21 sites of 15 patients and Bio-Oss® was used in 12 sites of 9 patients for alveolar bone augmentation 2-4weeks after dental extraction. Vertical dimension of grafted bone was measured both at the time of graft placement and at implant fixture placement after 6months. Trephine cores were harvested for the histomorphometric evaluations during implant placement when feasible. The primary stability of implant fixture was also measured. Infection of graft material or graft bed was not observed and graft sites healed without any notable complications in both groups. The vertical dimensions of alveolar bone increased by 5.38±2.65mm in AutoBT group and 6.56±3.54mm in Bio-Oss® group at 6months post-extraction. Histomorphometrically, new bone formation of AutoBT-grafted site was 31.24±13.87% while that of Bio-Oss® was 35.00±19.33%. The implant stability quotient (ISQ) of implants placed in AutoBT-grafted sites measured 72.80±10.81 while those placed in Bio-Oss® -grafted sites measured 70.0±12.86. There were no statistically significant differences between measurements of the two groups. Autogenous demineralized dentin matrix from extracted tooth grafted to extraction sockets for the augmentation of vertical dimension was as effective as augmentation using anorganic bovine bone. Both groups showed favorable wound healing, similar amount of implant stability, and histologically confirmed new bone formation. Thus, the results of this study suggest that autogenous tooth graft material is a viable option for alveolar bone augmentation following dental extraction.

Options for temporization in the aesthetic zone after implant fixture placement.

Dental UpdateVol. 41, No. 4 Technique TipsOptions for temporization in the aesthetic zone after implant fixture placementArijit Ray-Chaudhuri, Zaman Mirza, Lloyd SearsonArijit Ray-ChaudhuriSearch for more papers by this author, Zaman MirzaSearch for more papers by this author, Lloyd SearsonSearch for more papers by this authorArijit Ray-Chaudhuri; Zaman Mirza; Lloyd SearsonPublished Online:29 Jun 2017https://doi.org/10.12968/denu.2014.41.4.377AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article

A Randomized Clinical Trial to Evaluate and Compare Implants Placed in Augmented Versus Non‐Augmented Extraction Sockets: 3‐Year Results

The alveolar ridge undergoes reabsorption and atrophy subsequent to tooth removal and thus exhibits a wide range of dimensional changes. Preservation of the alveolar crest after tooth extraction is essential to enhance the surgical site before implant fixture placement. The aim of this randomized clinical study is to investigate and compare the need for additional augmentation procedures at implant insertion, as well as the success rate and marginal bone loss for implants placed in the grafted sites versus those placed in naturally healed sites. Forty patients with ≥1 hopeless tooth were randomly allocated to: 1) a test group, receiving extraction and grafting corticocancellous porcine bone; and 2) a control group, receiving extraction without any graft. After 7 months of healing, implants were inserted in each of the sites. The implants were submerged and loaded after 4 months with metal-ceramic rehabilitation. The follow-up included evaluation of implant diameter and length, the need for additional augmentation procedures at implant placement, implant failure, and marginal bone level changes. All patients were followed over a 3-year period. One implant failed in the control group at the second stage of surgery (6 months after placement); one implant failed in the test group after 2 years of loading. The cumulative implant success rate at the 3-year follow-up visit reached 95% for both groups. No statistically significant differences were detected for marginal bone changes between the two groups. It was concluded that implants placed into grafted extraction sockets exhibited a clinical performance similar to implants placed into non-grafted sites in terms of implant survival and marginal bone loss. However, grafted sites allowed placement of larger implants and required less augmentation procedures at implant placement when compared to naturally healed sites.

Comparison of Crestal Bone Loss and Implant Stability Among the Implants Placed With Conventional Procedure and Using Osteotome Technique: A Clinical Study

To overcome the limitations of implant placement in knife-edge ridges, Summer introduced the osteotome technique in 1994. It has been claimed that using bone condensing to prepare the implant site in soft maxillary bone avoids the risk of heat generation, and implants can be placed precisely with increased primary stability. The purpose of this clinical study was to evaluate the crestal bone loss exhibited by the bone around early nonfunctionally loaded implants placed with conventional implant placement technique and with Summer's osteotome technique and to evaluate whether the bone-compression technique provides better primary stability than the conventional technique. A total of 10 Uniti implants were placed in the maxillary anterior region of 5 patients. One implant site was prepared using the conventional technique with drills (control group A), and second site was prepared using the osteotome technique (experimental group B) and an MIS bone compression kit. Resonance frequency measurements (RFMs) were made on each implant at the time of fixture placement and on the 180th day after implant fixture placement. The peri-implant alveolar bone loss was evaluated radiographically. Differences between the alveolar crest and the implant shoulder in radiographs were obtained immediately after implant insertion and on the 180th day after implant placement. The RFMs demonstrated a significantly higher stability of implants in control group A than in experimental group B on the day of surgery (P = .026). However, no statistically significant difference in stability was found between both groups on 180th day after implant placement (P = .076). A significant difference was found in the crestal bone levels after 180 days of surgery between two groups (P = 0) with less crestal bone loss with group A. Within the limitations of this study we concluded that the osteotome technique is good for the purpose for which it was introduced, that is, for knife-edge ridges, and it should not be considered a substitute for conventional procedures for implant placement.

Tomographic volume evaluation of submandibular fossa in patients requiring dental implants

The aim of this study was to evaluate submandibular fossa volume from multislice CT scans of patients requiring endosseous implants. One hundred spiral computed tomographic (CT) preoperative examinations of patients requiring assessment the lower jaw before implant placement were retrospectively evaluated to determine anatomical variations in bone morphology in the submandibular fossa region. Reformatted cross-sectional images tangential to the mandibular dental arch and distal to the mental foramen border were selected. The deepest area of submandibular fossa or concavity depth was measured on all of the images. To measure the concavity depth, a tangent line was first derived to the lingual surface of the fossa and the deepest point was then selected by moving a perpendicular line across the tangent line. Within our sample we could classify the depth of the submandibular gland fossa as a function of the lingual concavity depth over a range up to a maximum value of 6.6 mm. Mandibular lingual concavity depth could be divided into 3 groups. A lingual concavity (depth > or =2 mm) was observed in 80% of the jaws. In 20% of the cases, there were flat depressions less than 2 mm in depth (Type I) and in 52% of the cases the concavities were 2 to 3 mm deep (Type II). About 28% of the examined regions showed significant concavities of more than 3 mm (Type III). The obtained distribution as a function of the depth did not reveal any dependence on age and gender of patients examined by this study (P > .05). Mandibles with any lingual concavity pose a potential increased risk of lingual cortical perforation during surgery, particularly endosseous implant placement. Cross-sectional imaging provides excellent delineation of mandibular anatomy and important information on the depth of the submandibular gland fossa in the preoperative assessment of the posterior mandible for dental implant fixture placement and other surgical procedures.

Histological Evaluation of Autogenous Iliac Particulate Cancellous Bone and Marrow Grafted to Alveolar Clefts—A Preliminary Report of Five Young Adult Cases

Abstract Objective: We histologically evaluated iliac particulate cancellous bone and marrow (PCBM) grafted to alveolar clefts in five young adults with cleft lip and palate. Patients and Methods: Five young adults with cleft lip and palate underwent secondary alveolar bone grafting. The mean age of the patients was 21.2 years (range = 17 to 27 years). Bone specimens were taken from the graft site 5 to 10 months after the surgery simultaneously with implant fixture placement (two cases), vestibuloplasty (two cases), and rebone grafting (one case). These five bone specimens were prepared and stained with hematoxylin and eosin and examined microscopically. Result: One specimen, taken 5 months after surgery, showed immature trabecular bone partially lined by osteoblasts. The remaining four specimens showed well-mineralized trabeculae and fatty change in the marrow space. Conclusion:> In young adult cases, PCBM remodeled after grafting and became mature bone about 5 to 6 months after the surgery.

Histological Evaluation of Autogenous Iliac Particulate Cancellous Bone and Marrow Grafted to Alveolar Clefts—A Preliminary Report of Five Young Adult Cases

We histologically evaluated iliac particulate cancellous bone and marrow (PCBM) grafted to alveolar clefts in five young adults with cleft lip and palate. Five young adults with cleft lip and palate underwent secondary alveolar bone grafting. The mean age of the patients was 21.2 years (range = 17 to 27 years). Bone specimens were taken from the graft site 5 to 10 months after the surgery simultaneously with implant fixture placement (two cases), vestibuloplasty (two cases), and rebone grafting (one case). These five bone specimens were prepared and stained with hematoxylin and eosin and examined microscopically. One specimen, taken 5 months after surgery, showed immature trabecular bone partially lined by osteoblasts. The remaining four specimens showed well-mineralized trabeculae and fatty change in the marrow space. In young adult cases, PCBM remodeled after grafting and became mature bone about 5 to 6 months after the surgery.

Presurgical Prosthetics and Surgical Templates

An overview has been presented of the prosthodontic procedures used prior to the first stage of implant surgery, the procedures used between the first and second stages of surgery, and the prosthetic appliances fabricated prior to insertion of the definitive implant prosthesis. In addition, the need for suggestions to the surgeon for optimal implant fixture placement using surgical templates has been discussed. The design and fabrication of a preferred mandibular surgical template has been presented. In addition, it has been recommended that the surgeon and restorative dentist should employ a team approach to implantology for the best results.