Implants In Conjunction Research Articles

Clinical-statistical study on oral rehabilitation methods using dental implants.

The development of dental implantology is based on a thorough examination of the interaction of implants with the surrounding tissues, as well as methods of stimulating osteogenesis around implants. The most common approach to restore lost dentition in terms of function and aesthetics is now represented by implants. The objective of our study was to comparatively assess the efficiency of prosthetic treatments performed on implants alone versus on implants in conjunction with abutment teeth. The study was carried out over seven years (2016-2023), with evaluations at one, two, three, and five years. For this analysis, MedCalc® version 12.5.0.0 (MedCalc® Software, Mariakerke, Belgium) was utilised as the medical statistical software. When using dental implants and natural teeth abutments for prosthodontic reconstruction, the failure rates rise approximately 43 times when compared to dental implant rehabilitation; similarly, osteoporosis and diabetes mellitus increase failure rates by 32 and 20 times, respectively. Gingival inflammation is a frequent event (almost 50% frequency) observed during follow-up of patients who had prosthetic restoration using dental implants alone as well as implants and abutment teeth. For both groups, difficulties usually arise two years later.

All-on-4 Hybrid with Extra-Long Transnasal Implants: Descriptions of the Technique and Short-Term Outcomes in Three Cases.

Background/Objectives: There is a need for alternative approaches to full-arch rehabilitation of atrophic maxillae. The aim of this short case series was to describe the technique and assess the short term-outcomes of atrophic maxillae rehabilitation using transnasal implants in conjunction with zygomatic implants. Methods: Three female patients (average age: 62 years) presenting comorbidities and atrophic maxillae preventing the insertion of standard maxillary anchored implants received a full-arch fixed prosthesis supported by transnasal implants together with zygomatic implants, using the ad modum all-on-4 concept. Patients were followed during the functional osseointegration period. Primary outcome measures were prosthetic and implant survival based on function. Secondary outcome measures were complication parameters (biological and mechanical), plaque and bleeding levels, and probing pocket depths > 4 mm. Results: No implant failures were registered, and all prostheses remained in function. The only complication was a fracture of a provisional crown that was resolved. Plaque and bleeding scores were mild during the follow-up period. Conclusions: The present manuscript describes the use of extra-long transnasal implants in combination with zygomatic implants in immediate function for full-arch fixed prosthetic rehabilitation of atrophic maxillae, with the objective of promoting more research into this relatively recent technique. More studies are needed to validate the technique.

Treatment alternatives for the rehabilitation of the posterior edentulous maxilla.

Rehabilitation of the edentulous maxilla with implant-supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision-making processes and optimize the outcomes of therapy.

A Degradable Sustained-Release Drug Delivery System for Bleb-Forming Glaucoma surgery.

Fibrosis of the filtering bleb is one of the main causes of failure after bleb-forming glaucoma surgery. Intraoperative application of mitomycin C (MMC) is the current gold standard to reduce the fibrotic response. However, MMC is cytotoxic and one-time application is often insufficient. A sustained-release drug delivery system (DDS), loaded with MMC, might be less cytotoxic and equally or more effective. Two degradable (polycaprolactone (PCL) and polylactic-co-glycolic acid (PLGA)) MMC-loaded DDSs were developed. Release kinetics were first assessed in vitro followed by rabbit implants in conjunction with the PRESERFLO® MicroShunt. As a control, the MicroShunt was implanted with adjunctive use of a MMC solution. Rabbits were euthanized at postoperative day (POD) 28 and 90. The PLGA and PCL DDSs released (on average) 99% and 75% of MMC, respectively. All groups showed functioning blebs until POD 90. Rabbits implanted with a DDS showed more inflammation with avascular thin-walled blebs when compared to the control. However, collagen was more loosely arranged. The PLGA DDS showed less inflammation, less foreign body response (FBR) and more complete degradation at POD 90 when compared to the PCL DDS. Further optimization with regard to dosage is required to reduce side effects to the conjunctiva. This article is protected by copyright. All rights reserved.

Implant Placement With Graftless Sinus Floor Elevation via the Lateral Approach: A Case Series With 4 Years Post-Loading Radiographical Outcomes and Implant Survival Rate.

The purpose of the present study was to evaluate the radiographical outcomes, survival rate, and amount of bone formation around implants placed during graftless lateral sinus lift approach (GLSLA). Five patients (6 sinus augmentations) were consecutively treated with GLSLA. After Schneiderian membrane elevation and implant insertion, only blood clot was left to fill the new sinus compartment. After 4 months of healing, implants were functionally loaded. in all cases, samples were taken for biopsy at the time of second-stage surgery. The radiographical marginal bone variations and apical bone gain were assessed using cone beam- computed tomography taken 4 months after the surgery (at crown insertion) and after 4 years of loading. A total of 14 implants were placed in a mean initial residual bone height of 3.1 mm (range 1.64 mm). No failure was recorded, and all the implants were successfully loaded yielding a 100% survival rate. Vital bone formation was 33% according to the histomorphometry data. Four years after loading the mean radiographic bone remodeling was 1.3 mm. The mean ridge height was 7.6 mm and the mean apical bone gain amounted for 3.8mm. Within the limitations of this study, the placement of dental implants in conjunction with GLSLA seems to be feasible and accompanied by high implant survival rate.

Single-crown restorations supported by short implants (6 mm) compared with standard-length implants (13 mm) in conjunction with maxillary sinus floor augmentation: a randomized, controlled clinical trial

BackgroundThe purpose of the present study was to test the H0-hypothesis of no difference in the clinical and radiographical treatment outcome of single-crown restorations supported by short implants compared with standard length implants in conjunction with maxillary sinus floor augmentation (MSFA) after 1 year of functional implant loading. Forty patients with partial edentulism in the posterior part of the maxilla were randomly allocated to treatment involving single-crown restorations supported by short implants or standard length implants in conjunction with MSFA. Clinical and radiographical evaluation were used to assess survival of suprastructures and implants, peri-implant marginal bone loss (PIMBL), biological, and mechanical complications.ResultsBoth treatment modalities were characterized by 100% survival of suprastructures and implants after 1 year. Mean PIMBL was 0.60 mm with short implants compared with 0.51 mm with standard length implants after 1 year of functional loading. There were no statistically significant differences in survival of suprastructure and implants, PIMBL, and mechanical complications between the two treatment modalities. However, a higher incidence of biological complications was associated with standard length implants in conjunction with MSFA.ConclusionWithin the limitations of the present study, it can be concluded that single-crown restorations supported by short implants seems to be comparable with standard length implants in conjunction with MSFA. However, long-term studies are needed before final conclusions can be provided about the two treatment modalities.Trial registrationClinicaltrials.Gov ID: NCT04518020. Date of registration: August 14, 2020, retrospectively registered.

Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances

BackgroundThe purpose of this study was to analyze medium-to-long-term implant success and survival rates, and lower lip sensory disturbance after placement of dental implants with simultaneous inferior alveolar nerve (IAN) repositioning.MethodsFifteen patients (3 men, 12 women) treated in two centers were included in this retrospective study. The ages of the participants ranged from 19 to 68. A total of 48 dental implants were placed in 23 posterior mandibular segments simultaneously with IAN transposition or lateralization. The residual bone above the IAN ranged from 0.5 to 7.0 mm. Crestal bone changes were measured using cone beam computed tomography (CBCT) images. Disturbance of the IAN was evaluated subjectively using a modified questionnaire.ResultsThe healing process was uneventful in fourteen patients. In one patient, spontaneous fracture of the operated mandible occurred on tenth day after the surgery. The implant in the fracture line was removed at the time of open reduction and fixation. One more implant was lost after 5 years of loading. Therefore, the overall dental implant survival rate was 95.8%, whereas all implants in function were judged as successful after a follow-up period of 1 to 10 years. Transient neurosensory disturbances (ND) were observed in all patients who underwent IAN lateralization and IAN transposition. At follow-up times of 3 years, 5 years, and 10 years, weak hypoesthesia remained in two subjects treated with IAN transposition. None of the patients developed neuropathic pain after the procedure.ConclusionsWithin the limitations of this study, we conclude that reconstruction of severely resorbed mandibles with dental implants in conjunction with IAN repositioning is an effective and reliable technique. Although neurosensory disturbances are the most common complication after surgery, they tend to resolve over time. Advanced surgical skills are required to perform this technique.

Ultra-short versus standard-length dental implants in conjunction with osteotome-mediated sinus floor elevation: A randomized controlled clinical trial.

The ability to restore missing teeth with dental implants is dictated by the available bone and by the presence of anatomical structures. The potential to insert ultrashort implants avoids additional surgical procedures and its inherent complications. The last European Association of Dental Implantologists consensus in 2016 defined ultrashort implants and standard-length dental implants as <6 and >8 mm, respectively. The present study aimed to investigate whether single standing ultrashort dental implants (US) could provide a viable therapeutic alternative to osteotome mediated sinus floor elevation in combination with standard-length dental implants (SL) 10 mm in posterior maxillary rehabilitation with reduced bone height. The study was conducted as a prospective parallel group controlled clinical trial with a 12 month follow-up, where 48 implants were randomized into two groups; US-group (5.5 mm) and SL-group (10 mm) implants placed with osteotome-mediated sinus floor elevation. Crestal bone loss (CBL) was defined as the study's primary outcome, while implant survival, buccal bone thickness, implant stability, probing depth, gingival recession, and adverse effects were assessed as secondary outcomes. Mesial CBL was 1.13 ± 0.52 mm in SL- and 0.72 ± 0.52 mm in US-group (P=.021), while distal CBL was 1.44 ± 0.72 mm in SL- and 0.91 ± 0.69 mm in US-group at 12 months (P=.0179). Regarding implant stability, probing depth, and gingival recession there was no statistically significant difference between the two groups. Regarding implants' survival, three implants were lost in the US-while only one implant was lost in the SL-group (P=.6085; Fisher's exact test). Nevertheless, the ultrashort implants were associated with a tripling of the failure rate and uncertainty where the true failure rate is uncertain (relative risk 3.0; confidence interval 0.3-26.8). Within the current trial's limitations, US-appear appear promising as they are associated less postoperative discomfort, minimal invasiveness and less CBL. However, larger sample size is required to determine whether the ultrashort have an acceptable survival rate.

Integration of Dental Implants in Conjunction with EDTA-Conditioned Dentin Grafts: An Experimental Study.

This study was undertaken to investigate the integration of titanium micro-implants installed in conjunction with previously dentin-grafted areas and to study the morphological appearance, mineral content, and healing pattern of xenogenic EDTA-conditioned dentin blocks and granules grafted to cavities in the tibial bone of rabbits. Demineralized and non-demineralized dentin blocks and granules from human premolars were implanted into cavities prepared on the lateral aspects of the tibias of rabbits. After a healing period of six months, micro-implants were installed at each surgical site. Histological examinations were carried out after 24 weeks. Characterization of the EDTA-conditioned dentin blocks was performed by means of light microscopy, dental X-rays, scanning electron microscopy, and energy dispersive X-ray analysis (EDX). No implants were found to be integrated in direct contact with the dentin particles or blocks. On the EDTA-conditioned dentin surface, the organic marker elements C and N dominated, as revealed by EDX. The hydroxyapatite constituents Ca and P were almost absent on the dentin surface. No statistically significant difference was observed between the EDTA-conditioned and non-demineralized dentin, as revealed by BIC and BA. The bone-inductive capacity of the dentin material seemed limited, although demineralization by means of EDTA indicated higher BIC and BA values in conjunction with the installed implants in the area. A 12 h EDTA treatment did not fully decalcify the grafts, as revealed by X-ray analysis.

Survival Rate of Zygomatic Implants for Fixed Oral Maxillary Rehabilitations: A Systematic Review and Meta-Analysis Comparing Outcomes between Zygomatic and Regular Implants.

Background: Zygomatic implants have been proposed alone or in combination with premaxillary conventional implants for severe resorbed maxillary atrophy rehabilitation. The aim of the present investigation was to evaluate through a qualitative systematic review and meta-analysis the survival rate of zygomatic implants in conjunction with regular fixtures for maxillary rehabilitation. Methods: The article screening was conducted on the PubMed/Medline and EMBASE electronic databases according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. The scientific papers were included for qualitative analysis and risk-of-bias evaluation. Only the papers that included rehabilitation with zygomatic implants in combination with regular implants were considered for the meta-analysis comparative evaluation of the implant survival rate. Results: The paper search screened a total of 137 papers. After the initial screening, a total of 32 articles were considered for the qualitative analysis. There was a similar implant survival rate between zygomatic and premaxilla regular implants (p = 0.02; Z: 2.26). Conclusions: Zygomatic and conventional implants showed a high long-term survival rate for fixed maxillary rehabilitations, but few included studies reported the marginal bone loss after loading. Further studies are necessary to evaluate the pattern of marginal bone loss between zygomatic and conventional implants after long-term functional loading.

Implant Committee Approval as a Protective Factor Against Peri-implantitis

Dental implants are expected to improve the quality of life of a patient by providing a fixed, long-term replacement for missing teeth. Development of peri-implantitis, however, is a major hindrance for a patient, as it requires additional treatment to rectify bone loss and replace teeth. Patient screening prior to implant placement is becoming paramount as life expectancy increases and comorbid conditions continue to rise. Risk factors, such as smoking, diabetes, anti-resorptive agents, and other individual patient factors, should be considered while evaluating a patient for treatment.1 Contraindications for treatment, such as a recent myocardial infarction or in-progress chemotherapy, should also be considered.2 We sought to investigate whether a multidisciplinary team discussion for implant treatment planning would reduce poor dental implant outcomes. In order to assess whether a patient was a good candidate for implant treatment, an implant committee was created in 2012 at the Philadelphia VA Medical Center to discuss prospective implant cases. This team consisted of restorative dentists, prosthodontists, periodontists, and oral and maxillofacial surgeons. The committee took a wholistic approach to patient care by focusing on certain risk factors it believed could decrease implant success. Risk factors assessed included medical history, smoking status, medications, and certain laboratory tests, such as hemoglobin A1c (HbA1c) levels. After thorough review, the committee decided whether an implant would be appropriate at that time or whether specific factors needed to be improved before treatment. A retrospective cohort study was performed to evaluate implants placed between 2006 and 2013. Medical and dental encounter notes were used to determine whether a case was approved by an implant approval committee, among other factors such as medications and HbA1c levels. Peri-implantitis was defined as radiographic evidence of bone loss of osseointegrated implants in conjunction with inflammatory signs, such as bleeding on probing, peri-implant probing depth of 5 or more millimeters, with or without suppuration. A minimum follow-up period of 5 years after placement was necessary to be included in the analysis. Of the 1362 implants in 398 unique patients, 889 implants in 285 patients met the inclusion criteria. Descriptive statistics were computed using the SAS system (SAS Institute Version 9.4, 2002-2012, Cary, NC). The predictive variable was implant committee approval. The primary outcome variable was peri-implantitis, with P < .05 used to define statistical significance. Of the 889 implants that met the inclusion criteria, 220 (24.7%) were approved prior to placement by the implant committee established in 2012. For the 669 implants that were not reviewed and approved by the implant committee, 166 (24.8%) developed peri-implantitis. Patients who had implant committee approval had a 34.7% decreased risk of peri-implantitis (OR 0.653; 95% CL 0.443, 0.963) compared to patients who did not receive approval by the committee of experts (P = .0313). The results from this retrospective cohort study reveal that a group of experts analyzing patient health status before placing implants is a protective factor against peri-implantitis. This finding is clinically significant because it decreases the chance of implant complications, presumptively improving patient quality of life and satisfaction. Ideally, similar implant approval committees could be implemented in other hospitals. Further studies should be conducted to confirm this association as well as develop more criteria for implant committees to analyze before treatment.

Peri-Implantitis Risk in Patients Taking Statins and Antihypertensives

Managing modifiable risk factors, such as cholesterol and blood pressure, is the conventional strategy to combat heart disease, the number 1 cause of death in the United States. Medications for lowering cholesterol and blood pressure have also been shown to play a role in bone metabolism. As such, these medications are of potential interest to the osseointegration and health of dental implants. Given the widespread use of these medications, it is imperative to understand their role in enhancing or deteriorating the health of dental implants. The most common class of cholesterol-lowering medications (known as statins) lower serum cholesterol by inhibiting the rate-limiting enzyme in the hepatic cholesterol biosynthesis pathway. Animal studies have shown statins to increase osteogenesis around dental implants, which has been explained by increased expression of bone morphogenic protein-2 and osteoblast differentiation. The applicability of these results to dental implant health in humans, however, remains unclear.1 Many pharmacologic mechanisms exist for lowering blood pressure, and as such, antihypertensives can affect bone physiology in different ways. For example, thiazide diuretics increase renal calcium absorption, beta adrenergic blockers inhibit osteoclasts, and drugs targeting the renin-angiotensin-aldosterone system block the bone resorptive activity of angiotensin II. These mechanisms have been used to explain an association between decreased implant failure and antihypertensive medications.2 This study aims to elucidate how cholesterol-lowering and antihypertensive medications affect long-term peri-implant health. A retrospective cohort study was performed to evaluate implants placed between 2006 and 2013. Medical and dental encounter notes were used to determine which medications a patient had been prescribed. Peri-implantitis was defined as radiographic evidence of bone loss of osseointegrated implants in conjunction with inflammatory signs, such as bleeding on probing, peri-implant probing depth of 5 or more millimeters, with or without suppuration. A minimum follow-up period of 5 years after placement was necessary to be included in the analysis. Of the 1362 implants placed in 398 patients, 881 implants in 284 unique patients met the inclusion criteria. Descriptive statistics were computed using the SAS system (SAS Institute Version 9.4, 2002-2012, Cary, NC). The predictive variables were prescriptions for cholesterol-lowering and antihypertensive medications. The primary outcome variable was peri-implantitis, with P < .05 used to define statistical significance. Of the implants that met the inclusion criteria, 456 (52%) were placed in patients’ prescribed statins. Risk of developing peri-implantitis was 77% higher in patients’ prescribed statins (OR: 1.772; 95% CL 1.285-2.445) compared to non-users (P = .0005). Peri-implantitis risk was not associated with overall antihypertensive medications or specific classes of antihypertensives, including angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, beta adrenergic blockers, calcium channel blockers, diuretics, or clonidine. Peri-implantitis risk was also not associated with other cholesterol-lowering medications, fibrates, or ezetimibe. The results from this retrospective cohort study reveal an increased risk of peri-implantitis in patients taking statins. This finding is clinically significant because there is substantial overlap between patients in need of dental implants and patients taking statins for cardiovascular protection, as evidenced by the numbers in our study. Further studies are needed to expound this association and establish recommendations for increasing long-term implant success in patients taking statins.

Implant placement with sinus floor elevation via the lateral approach using only absorbable collagen sponge: 12-month post-loading radiographical outcomes and implant survival rate.

The purpose of the present study was to evaluate the radiographical outcomes and survival rate of implants placed during graftless lateral sinus lift approach (GLSLA) using an absorbable collagen sponge. Fourteen patients (14 sinus augmentations) were consecutively treated with GLSLA. After Schneiderian membrane elevation and implant insertion, only collagen sponges were used to fill the new sinus compartment. After 4months of healing, implants were functionally loaded. The radiographical marginal bone variation and apical bone gain were assessed on periapical radiographs taken 4months after the surgery (at crown insertion) and at 12months post-loading. A total of 41 implants were placed in a mean initial residual bone height of 3.5mm (range 1.6-6.7mm). No failure was recorded and all the implants were successfully loaded with fixed prosthesis. Twelve months post-loading the mean radiographic bone remodeling was 2.22mm. The mean ridge height was 8.4mm and the mean apical bone gain amounted for 4.4mm. Within the limitations of this study, the placement of dental implants in conjunction with GLSLA using only a collagen sponge to fill the sinus compartment seems to be feasible and accompanied by a high implant survival rate. Further studies on a large population and with a longer follow-up are warranted to drawn definitive conclusions.

Outcomes Using Dynamic Guided Dental Implants in Conjunction with Osseodensification for Reduced Height in the Posterior Maxilla

IRB info: BioMed IRB protocol number 2014-10-15p

Freeze-Dried Chitosan-Platelet-Rich Plasma Implants for Rotator Cuff Tear Repair: Pilot Ovine Studies.

Rotator cuff tears are a very common shoulder pathology. Different suturing techniques have been used for surgical cuff repair, but failure of healing remains a significant clinical challenge. The objective of this study was to establish and compare chronic and acute ovine rotator cuff tear models in our laboratory and investigate the feasibility of using chitosan (CS)-platelet-rich plasma (PRP) implants in conjunction with suture anchors to treat rotator cuff tears in large animal models. Repair with suture anchors only was used as control. In two preliminary pilot studies, unilateral full-thickness tears were created in the infraspinatus (ISP) tendon of mature female Texel-cross sheep. In the chronic model (n = 4 sheep), the tendons were capped with silicon and allowed to retract for 6 weeks, leading to degenerative changes, whereas the tendons were immediately repaired in the acute model (n = 4 sheep). Transected ISP tendons were reattached with suture anchors and, in the case of treated shoulders, implants composed of freeze-dried CS solubilized in autologous PRP were additionally applied to the tendon-bone interface and on top of the repaired site. The chronic defect model induced significant tendon degeneration and retraction, which made repair more challenging than in the acute defect model. Half the tendons in the chronic repair model were found to be irrepairable at 6 weeks. In the other half, the tendons could not be reattached to the footprint due to significant retraction, which made this a model of tissue formation in a gap. In contrast, the acute tendon repair model was executed easily. Extensive bone remodeling and tissue ingrowth at the tendon-bone interface were observed in the case of treatment with anchors + CS-PRP in both models, suggesting that CS-PRP implants could potentially modulate rotator cuff healing processes in large animal models.

Immediate full-arch rehabilitation of the severely atrophic maxilla supported by zygomatic implants: a prospective clinical study with minimum follow-up of 6 years

The aim of this study was to evaluate the outcomes of immediate full-arch prostheses supported by zygomatic implants alone or in combination with standard fixtures after a minimum of 6 years of loading. From October 2008 to April 2010, 15 patients with severely atrophic maxillae were treated using four zygomatic implants or two zygomatic implants in conjunction with two conventional fixtures. All subjects received a fixed screw-retained prosthesis within 3hours of surgery, while the final restoration was delivered after 6 months. Follow-up examinations were scheduled to evaluate zygomatic implant survival, conventional dental implant success, prosthetic success, plaque and bleeding scores, marginal bone loss for conventional dental implants, and patient satisfaction. Forty-two zygomatic fixtures and 18 standard implants were placed. Patients were followed up for a minimum of 79 months (range 79–97 months, average 90.61 months). No implant was lost, leading to implant and prosthetic survival rates of 100%. Bone loss for conventional implants averaged 1.39±0.10mm after 6 years of function, leading to a 100% implant success rate. High levels of patient satisfaction were recorded. These medium-term results indicate that immediate full-arch rehabilitation supported by zygomatic implants could be considered a viable treatment modality for the severely atrophic maxilla.

Removal Rates of Dental Implants Placed in Conjunction With Autologous Bone and Xenogeneic and Synthetic Alloplastic Materials in Finland Between 1994 and 2012.

This study aimed to assess the use of bone augmentation materials in Finland from 1994 to 2012 by assessing removal rates of implants placed in combination with autologous bone, xenogeneic grafts, and synthetic alloplastic materials. The National Institute for Health and Welfare in Finland granted permission to access raw data of the Finnish Dental Implant Register for implant augmentation materials and removal rates of implants placed in augmented sites from April 1994 to April 2012. A total of 198,538 implants were placed in Finland between 1994 and 2012 in 110,543 operations. A total of 3318 (1.7%) of the placed implants were removed during the observation period. Augmentations were performed on 20,812 (18.8%) operations during 1994-2012. The removal rates of implants placed at sites augmented with autologous bone were 2.31%, xenogeneic materials 0.91%, and synthetic alloplastic materials 2.80%. The removal rate was 1.87% when no augmentation material was used. The placement of dental implants in conjunction with bone augmentation materials is predictable with a low complication rate.

Smartphone Applications for Providing Ubiquitous Healthcare Over Cloud with the Advent of Embeddable Implants

The world we live in today has been defined by the rise of the smartphone and smartphone apps. There is a huge potential for these apps to have an impact in healthcare via the use of the emerging field of biosensor technology in the form of wearables and implants. This paper discusses the future of healthcare from a technological standpoint, looking specifically at the use of these wearables and implants in conjunction with the power of cloud computing to provision healthcare in efficient and effective ways. There is also a discussion involving a specific example of how an app currently in development can be augmented with biosensor technology in the near future.

Reverse engineering of mandible and prosthetic framework: Effect of titanium implants in conjunction with titanium milled full arch bridge prostheses on the biomechanics of the mandible

This study aimed at investigating the effects of titanium implants and different configurations of full-arch prostheses on the biomechanics of edentulous mandibles. Reverse engineered, composite, anisotropic, edentulous mandibles made of a poly(methylmethacrylate) core and a glass fibre reinforced outer shell were rapid prototyped and instrumented with strain gauges. Brånemark implants RP platforms in conjunction with titanium Procera one-piece or two-piece bridges were used to simulate oral rehabilitations. A lateral load through the gonion regions was used to test the biomechanical effects of the rehabilitations. In addition, strains due to misfit of the one-piece titanium bridge were compared to those produced by one-piece cast gold bridges. Milled titanium bridges had a better fit than cast gold bridges. The stress distribution in mandibular bone rehabilitated with a one-piece bridge was more perturbed than that observed with a two-piece bridge. In particular the former induced a stress concentration and stress shielding in the molar and symphysis regions, while for the latter design these stresses were strongly reduced. In conclusion, prosthetic frameworks changed the biomechanics of the mandible as a result of both their design and manufacturing technology.

Effects of Setting Bone Cement on Tissue-Engineered Bone Graft

Strategies to improve mechanical strength, neovascularization, and the regenerative capacity of allograft include both the addition of skeletal stem cells and the investigation of novel biomaterials to reduce and ultimately obviate the need for allograft altogether. Use of bone cement is a common method of stabilizing implants in conjunction with impacted allograft. Curing cement, however, can reach temperatures in excess of 70°C, which is potentially harmful to skeletal stem cells. The aim of this study was to investigate the effects of setting bone cement on the survival of human adult skeletal stem cells within tissue-engineered allograft and a novel allograft substitute. Milled allograft and a polymer graft substitute were seeded with skeletal stem cells, impacted into a graduated chamber, and exposed to curing bone cement. Sections were removed at 5-mm increments from the allograft-cement interface. A quantitative WST-1 assay was performed on each section as a measure of remaining cell viability. A second stage of the experiment involved assessment of methods to potentially enhance cell survival, including pretreating the allograft or polymer by either cooling to 5°C or coating with 1% Laponite, or both. There was a significant drop in cellular activity in the sections taken from within 0.5 cm of the cement interface in both the allograft and the polymer (p < 0.05), although there was still measurable cellular activity. Pretreatment methods did not significantly improve cell survival in any group. While the addition of bone cement reduced cellular viability of tissue-engineered constructs, this reduction occurred only in close proximity to the cement and measurable numbers of skeletal stem cells were observed, confirming the potential for cell population recovery.