Intraosseous Implants Research Articles

Development of an anti-infective coating on the surface of intraosseous implants responsive to enzymes and bacteria

BackgroundBacterial proliferation on the endosseous implants surface presents a new threat to the using of the bone implants. Unfortunately, there is no effective constructed antibacterial coating which is bacterial anti-adhesion substrate-independent or have long-term biofilm inhibition functions.MethodsDrug release effect was tested in Chymotrypsin (CMS) solution and S. aureus. We used bacterial inhibition rate assays and protein leakage experiment to analyze the in vitro antibacterial effect of (Montmorillonite/Poly-l-lysine-Chlorhexidine)10 [(MMT/PLL-CHX)10] multilayer film. We used the CCK-8 assay to analyze the effect of (MMT/PLL-CHX)10 multilayer films on the growth and proliferation of rat osteoblasts. Rat orthopaedic implant-related infections model was constructed to test the antimicrobial activity effect of (MMT/PLL-CHX)10 multilayer films in vivo.ResultsIn this study, the (MMT/PLL-CHX)10 multilayer films structure were progressively degraded and showed well concentration-dependent degradation characteristics following incubation with Staphylococcus aureus and CMS solution. Bacterial inhibition rate assays and protein leakage experiment showed high levels of bactericidal activity. While the CCK-8 analysis proved that the (MMT/PLL-CHX)10 multilayer films possess perfect biocompatibility. It is somewhat encouraging that in the in vivo antibacterial tests, the K-wires coated with (MMT/PLL-CHX)10 multilayer films showed lower infections incidence and inflammation than the unmodified group, and all parameters are close to SHAM group.Conclusion(MMT/PLL-CHX)10 multilayer films provides a potential therapeutic method for orthopaedic implant-related infections.

MTORC2 regulates hierarchical micro/nano topography-induced osteogenic differentiation via promoting cell adhesion and cytoskeletal polymerization.

Surface topography acts as an irreplaceable role in the long‐term success of intraosseous implants. In this study, we prepared the hierarchical micro/nano topography using selective laser melting combined with alkali heat treatment (SLM‐AHT) and explored the underlying mechanism of SLM‐AHT surface‐elicited osteogenesis. Our results show that cells cultured on SLM‐AHT surface possess the largest number of mature FAs and exhibit a cytoskeleton reorganization compared with control groups. SLM‐AHT surface could also significantly upregulate the expression of the cell adhesion‐related molecule p‐FAK, the osteogenic differentiation‐related molecules RUNX2 and OCN as well as the mTORC2 signalling pathway key molecule Rictor. Notably, after the knocked‐down of Rictor, there were no longer significant differences in the gene expression levels of the cell adhesion‐related molecules and osteogenic differentiation‐related molecules among the three titanium surfaces, and the cells on SLM‐AHT surface failed to trigger cytoskeleton reorganization. In conclusion, the results suggest that mTORC2 can regulate the hierarchical micro/nano topography‐mediated osteogenesis via cell adhesion and cytoskeletal reorganization.

Determination of the Anatomical Features of the Temporal Bones at the Stage of Planning Extraoral Implantation in Ectoprosthetics of the Auricle

At the present stage of the development of maxillofacial surgery, the treatment of patients with defects in the auricles is one of the most difficult. Defects of the auricles, characterized by its absence, are divided according to the etiological factor into two main groups: congenital (microtia) and acquired (as a result of injuries of various origins). Microtia (including anotia the complete absence of the auricle) is a malformation of the auricle and the external auditory canal caused by anomalies of the first and second zygomatic arch and the first sulcus.Congenital malformations of the auricle occur in 1 out of 700–15 000 newborns and more often have a right-sided localization. In 15 % of cases, they are hereditary, and in 85 % they are sporadic, in boys they are detected on average 2–2,5 times more often than in girls.Currently, much attention is paid to the prosthetic reconstruction of the auricle with fixation by means of cranial intraosseous implants. At the same time precise diagnostics of the state of the temporal bones in the area of the proposed implantation and the correct positioning of the intraosseous supports are the basis of an effective fixation system. Among the methods of radiological diagnostics used for planning ectoprosthetics of the auricles, radiography has long been preferred. However, the introduction of computed tomography into clinical practice has provided a high-quality assessment of the temporal bones state, which has increased the efficiency of surgical intervention planning and treatment.

ТЕРМОГРАФИЧЕСКИЙ КОНТРОЛЬ ТЕЧЕНИЯ ПОСЛЕОПЕРАЦИОННОГО ПЕРИОДА У ПАЦИЕНТОВ С ДЕНТАЛЬНОЙ ИМПЛАНТАЦИЕЙ

Subject. Thermal imaging provides an objective measurement of temperature changes that are clinically relevant for the detection of local inflammatory processes. The article examines the infrared radiation of the facial skin, its quantitative and qualitative characteristics, to predict the course of the postoperative period after dental implant placement. The aim is to evaluate changes in the parameters of contactless infrared thermography (CIT) of the facial skin before and after operation. Methods. A prospective randomized study was conducted in 17 patients aged 30 to 65 years (12 women, 5 men) who underwent surgery to install intraosseous screw dental implants (DI) under local anesthesia on one side of the jaw according to the delayed implantation technique. Before and after operation, as well as on the 1st, 3rd and 7th days of the postoperative period, patients underwent facial skin CIT using the FLIR One Pro device. Blood pressure, heart rate and body temperature were also monitored. The maximum and minimum temperature (T) of the facial skin on the side of the installed implant and the opposite side were compared. Results. The mean values of blood pressure and heart rate in the studied patients did not show deviations from the normal values before and after the operation of DI placement. The average values of body temperature were almost the same before and after the operation. In two patients, the body temperature was 37 °C during the day after the operation. The difference between average values of the skin temperature of the right and left half of the face did not exceed 0.6 °C, that is acceptable in the norm. Conclusions. The temperature relief of the facial skin after surgery changes in comparison with the preoperative values with a tendency to increase the average values of the maximum T. In the postoperative period, there is an increase in the average values of the maximum T on the side of the operation in comparison with the opposite side.

Effect of local immunotherapy on the indexes of mucosal immunity in patients with surgical dental pathology

Currently, inflammatory processes and injuries of maxillofacial region, occupy leading positions in the overall structure of surgical morbidity. Restoration of dentition integrity is based on intraosseous dental implants, being a widespread method of treatment in dentistry. The aim of the present work was to perform a comprehensive analysis of cytokine contents (IL- 1β, IL-1ra, IL-2, IL-8, IL-10, TNFα, IFNγ) in maxillary sinus discharges and mixed oral fluid in the patients with surgical dental pathology (chronic odontogenic maxillary sinusitis, complicated by mandibular fracture, as well as during simultaneous dental implantation) and to assess the effect of locally applied immunotherapy on the parameters studied. As a part of the two-stage study, 218 people were comprehensively examined, divided into groups depending on the type of disorder and methods of treatment. The patients with chronic odontogenic sinusitis (J 32.0, n = 44) were treated with topical immunotherapy with Cycloferon (meglumine acridonacetate), patients with a mandibular fracture (S 02.6, n = 70) and with a dental implant (K 08.1, n = 70) received Betaleucine (recombinant IL-1β). At the first stage of the study, examination of all the patients with surgical dental pathology showed immunological predictors of low-efficient acute inflammatory response associated with imbalance of the pro- and anti-inflammatory cytokine system. These predictors were primarily found in the patients with chronic odontogenic sinusitis, i.e., a decrease in IL-1β at high IL-1ra values in the maxillary sinus secretions. In the patients with complicated mandibular fractures, there was a pronounced dynamic decrease in IL-1β with consistently low values of TNFα in mixed saliva. There were distinct dynamic features of IL-1β, IL-8, and IL-1ra levels in oral fluid of the subjects undergoing implantological procedures. The second stage of the study, associated with the local use of Cycloferon and Betaleucine, and analysis of the data revealed different effects of the drugs on the studied parameters, presuming an integral effect of topical immunotherapy, i.e., some leveling of the previously detected imbalance of the cytokine system, due to normalization of their concentrations. Hence, the results obtained may indicate that the patients with surgical dental diseases treated with local immunotherapy had a higher adaptive potential of the local mucosal immunity.

Comparative assessment of the processes of adaptation of supporting tissues in prosthetics with the use of implants

The study of the adaptation processes of supporting tissues during removable prosthetics with the use of implants according to the data of microhemodynamics and oxygenation in the supporting tissues. A clinical and functional study of the state of supporting tissues was carried out in 60 people aged 50 to 65 years with a diagnosis of complete loss of teeth in the lower jaw during orthopedic treatment based on dental implants, which were divided into 2 groups: group 1 (29 people) - with the use of removable structures with locking with a lock attachment (type locator). Group 2 (31 people) - in which orthopedic treatment was carried out with the production of removable prostheses with fixation on telescopic crowns. Implantation was performed using intraosseous implants from Astra-Tech (Sweden). Orthopedic treatment was carried out according to the generally accepted method. To study the state of microcirculation in the mucous membrane of the alveolar ridge, the method of laser Doppler flowmetry (LDF) was used using a LAKK-M device (NPP Lazma, Russia). The state of microcirculation was assessed by the index of microcirculation (M), which characterizes the level of tissue blood flow; parameter «σ», which determines the fluctuations in the flow of erythrocytes. According to the Wavelet analysis of LDF-grams, the shunting index (PS) of blood flow was determined. Using the multifunctional diagnostic laser complex «LAKK-M» in the «LDF + spectrometry» mode, we studied oxygenation in periodontal tissues by optical tissue oximetry (OTO), the results of which were used to determine the oxygenation index in the mucous membrane of the alveolar ridge (SpO2) and the specific consumption index oxygen (U,%). According to LDF data, it was established that the level of microcirculation in the mucous membrane of the alveolar ridge in response to the functional load after fixation of the removable prosthesis with fixation on locators (group 1) and on telescopic crowns (group 2), it is accompanied by an increase in the level of M and σ by 37% and 66%, and by 2.2-2.4, respectively, which indicated the development of hyperemia in the microcirculatory bed, which is associated with functional load and persists up to 3 and 6 months, respectively. Restoration of microcirculation occurs after 6 and 12 months, respectively, after prosthetics, depending on the supporting elements. After fixation of the removable prosthesis, SpO2 and U decreased, which characterized the development of hypoxia in the tissues due to functional load, which stopped after 3 and 6 months, respectively. The study showed that in orthopedic treatment based on implants, adaptation processes according to microhemodynamics and oxygen metabolism in supporting tissues occur 3-6 months after prosthetics, depending on the design of the supporting elements.

Макро- и микропористость трехмерных капиллярно-пористых композиционных покрытий

An analysis of the surface of a plasma three-dimensional capillary-porous (TCP) Ti coating with an additional bioactive hydroxyapatite coating formed by microplasma oxidation (MPO) has been performed. Scanning electron microscopy (SEM) analyzed the open porosity of these composite coatings. The surface of the TCP Ti coating consists of ridges and depressions. The porosity of the TCP Ti coating of the depressions reaches 43 %. The presence of macro- and micropores with a size of 0.08 – 600 µm makes the TCP Ti coatings promising for use in a number of areas, including on the surface of intraosseous implants.

COMPARISON OF THE CONDITION OF THE PERI-IMPLANT ORAL MUCOUS ACCORDING TO THE RESULTS OF DIGITAL MICROSCOPY

The object of the study there is a level of hyperemia of the mucous membrane around the installed intraosseous dental implants with different coating material according to the results of histogram analysis of digital microscopy. The problem to be solved – evaluation of the degree of hyperemia of the periimplant mucosa around intraosseous dental implants coated with rutile, in comparison with titanium implants of VT-6 alloy after prosthetics. Main scientific results: Analysis of digital images using histogram evaluation of the red component of the spectrum showed that 1 month after prosthetics in group 1, which included 20 patients who had intraosseous implants made of titanium alloy TiV6Al (VT-6), the above indicator increased to 191 (St.Err. 4.45). The difference was 4 conventional units. Similarly, in group 2 (16 people) who had intraosseous zirconium implants, there was an increase in the quantitative rate after prosthetics by 9 conventional units, and its value was 194 conventional units (St.Err. 3.64). Since increasing numerical values ​​and shifting the digital histogram to the right is an objective criterion for reducing the intensity of redness, it can be concluded that there is a reduction of mucosal irritation after orthopedic treatment with a predominance of this process in the group of patients who received intraosseous dental implants coated with rutile. The area of practical use of research results: Since the authors first studied the reaction of the peri-implant mucosa in contact with various implant materials at the stages of orthopedic treatment, this is the basis for the introduction into general medical practice of intraosseous dental implants made in Ukraine using rutile application technology. The area of application of an innovative technological product - it is a dental implant practice. The obtained results will allow to use more widely Ukrainian implants of non-demountable construction with a high level of surface preparation, for the purpose of further orthopedic treatment with the use of non-removable metal-ceramic dentures.

Results of stress-strain states study in prosthetics of different types of atrophy of edentulous mandible

Complete dentures remain still popular due to the economic component of such prosthetic treatment. However, additional fixation on intraosseous implants provides a greater clinical and functional effectiveness and a greater level of satisfaction with the results of prosthetics in edentulous patients. At the moment, the biomechanical aspects of complete denture prosthetics and prosthetics with fixation on implants, taking into account the degree of atrophy of the edentulous jaws, are not complete understood. Such studies make it possible to create recommendations on the choice of prosthetic tactics for edentulous patients. The aim of the research was to study the distribution of stress-strain states in prosthetics of the edentulous mandible with complete dentures and with designs supported on intraosseous implants, taking into account the type of atrophy. It was carried out computer simulation of 8 virtual finite element models of mandible with different types of atrophy. According to Keller they were 4 models: of the biomechanical system simulation "complete denture – mandible" and 4 ones – "denture – intraosseous implants – mandible". In each of the models, a chewing load of 100 N was simulated (symmetrically and asymmetrically). The ANSIS 12.1 finite element analysis was used to calculate the stress-strain states in the described calculation systems. It was estimated the distribution of stresses in cortical bone and displacements of the dentures on the prosthetic bed. Under using complete dentures, the maximum stresses in the bone tissue of the prosthetic bed were observed for the third type of mandible atrophy with all types of power load, the smallest ones – for the fourth type. Additional fixation of removable dentures in simulation models of biomechanical systems “denture – intraosseous implants – mandible” lead to a significant increase in stresses in the alveolar bone. The maximum stresses were observed in the area of the marginal bone, while their greatest values were in the well-expressed alveolar part of the mandible for first and third types by Keller. The movements of bases of complete dentures were insignificant and fluctuated within hundredths of a millimeter for all types of atrophy. The use of intraosseous implants for fixation of dentures caused increase in movements by several times. Besides, displacement fields were characteristic: they were uniform for complete dentures but in the use of implants – not. The expressed alveolar process in the first and third types of atrophy of the edentulous mandible caused an increase in the displacements of the distal sections of the dentures on both sides with a symmetrical force load and on one side – with an asymmetric one. It can be assumed that such a distribution of stress-strain states accelerates atrophy of prosthetic bed tissues. As a result of prosthetics of complete defects of lower dentitions, both with traditional complete dentures and with additional support on implants, different distribution of stress-strain states occurs in different phases of the chewing act in the bone of the prosthetic bed, the character of which is determined by the shape of the alveolar part described by Keller's classification. The results allow us to develop an algorithm for determining the kind of prosthetics for edentulous patients, depending on the type of mandible atrophy.

CHOICE OF PROSTHODONTIC TREATMENT OF COMPLETE ANODONTIA IN MANDIBULAR ARCH ACCORDING TO THE PATIENT’S PSYCHOLOGICAL TYPE

About 30 – 60% of patients complain on malfunctioning removable laminar dentures whatever the manufacturing method was chosen. An alternative method to correct complete anodontia is the construction of fixed implant-retained prostheses. Plan of prosthetic treatment for individuals with complete anodontia is elaborated based on a number of factors including initial examination, analysis of clinical and additional laboratory findings, and choosing the optimal and accessible option for a patient. The objective of this study was to analyze the impact of the patient’s psychological type on selecting the treatment tactics to correct complete anodontia in the lower jaw and on the level of the patient’s motivation regarding the choice of the prosthetic restoration. Materials and methods. 45 patients with compete anodontia who required prosthodontic treatment were included into the study. The clinical examination was performed in 2 stages. The patient’s psychological type was determined according to the House classification (1950) during the primary clinical examination. The patients were distributed into the groups according to the data obtained. We evaluated the decisions on the proposed priority options of the treatment plan made by the patients of each groups. Results. Our study demonstrated 62.2% of the patients (28 people), who sought help at the prosthetic dentistry clinic, had clearly defined needs. An option of intraosseous dental implants placement and then fixed denture placement without extensive reconstructive interventions was chosen by 8 patients (66.7%) of the study group 1. The patients classified as exacting mind conduct themselves in conformity with the personality characteristics typical for this class in the process of elaborating the treatment plan. 88.9% of people classified as indifferent psychological type tended to choose the simplest and the least expensive treatment options. Conclusions: 1. A key character trait of the patients classified as philosophical minds is the credibility to dentists. Decision making on choosing the optimal option is only possible when patients are completely aware of possible risks and complications. 2. Adherence to a clear treatment plan according to the established requirements is a priority for the patients classified as exacting minds. 3. When making a decision on the treatment plan for the patients with an indifferent psychological type, it is necessary to ensure the patient’s ability to follow all recommendations and prescriptions. 4. When dealing with the patients with hysterical psychological type, the doctor-patient mutual understanding should be built up taking into account the emotional instability of the patients.

Application of Finite Element Analysis in Oral and Maxillofacial Surgery-A Literature Review.

In recent years in the field of biomechanics, the intensive development of various experimental methods has been observed. The implementation of virtual studies that for a long time have been successfully used in technical sciences also represents a new trend in dental engineering. Among these methods, finite element analysis (FEA) deserves special attention. FEA is a method used to analyze stresses and strains in complex mechanical systems. It enables the mathematical conversion and analysis of mechanical properties of a geometric object. Since the mechanical properties of the human skeleton cannot be examined in vivo, a discipline in which FEA has found particular application is oral and maxillofacial surgery. In this review we summarize the application of FEA in particular oral and maxillofacial fields such as traumatology, orthognathic surgery, reconstructive surgery and implantology presented in the current literature. Based on the available literature, we discuss the methodology and results of research where FEA has been used to understand the pathomechanism of fractures, identify optimal osteosynthesis methods, plan reconstructive operations and design intraosseous implants or osteosynthesis elements. As well as indicating the benefits of FEA in mechanical parameter analysis, we also point out the assumptions and simplifications that are commonly used. The understanding of FEA’s opportunities and advantages as well as its limitations and main flaws is crucial to fully exploit its potential.

The stability coefficient of dental implants and its relationship with biomarkers of bone metabolism

Достижение и поддержание стабильности имплантата являются предпосылками для успешного клинического результата. Важным является измерение стабильности имплантата (ISQ) и дальнейшее изучение щелочной фосфатазы (ЩФ) и остеокальцина как показателей активности репаративных процессов. Цель — измерение ISQ в период заживления с использованием метода резонансного частотного анализа (РЧА) и исследование связи между значениями ISQ с маркерами формирования кости. Материалы и методы. Дентальная внутрикостная имплантация проведена у 67 пациентов, средний возраст составил 51,8±3,08 года. Установлено 98 винтовых внутрикостных имплантатов системы MIS (Medical Implant System). Определены выживаемость имплантатов по критериям Бузер, индексы зубного налета и кровоточивости. Применен РЧА, аппарат Osstell ISQ. В ротовой жидкости определены ЩФ и остеокальцин. Измерения проводили сразу после установки, через 14 дней, 3 и 6 месяцев. Рассчитан коэффициент корреляции Пирсона. Результаты. Средний балл индексов Silness — Loe и Мюллемана — Коуэлла составил 0,79±0,28 и 0,50±0,30 балла соответственно. Через 14 дней ISQ по сравнению с начальным уменьшился на 2,14%. Спустя 3 месяца ISQ увеличился по сравнению с исходным на 11,7% и по сравнению с величиной, отмеченной через 14 дней, на 12,93%. Через 6 месяцев ISQ превышал исходное значение на 12,70%. Активность ЩФ сразу после лечения и через 14 дней не различалась. Спустя 3 и 6 месяцев активность ЩФ в сравнении с исходным значением возросла в среднем на 2,9% соответственно. Максимальная величина остеокальцина отмечалась через 14 дней, через 3 и 6 месяцев она незначительно снизилась. Отмечалась очень слабая корреляция ISQ с биомаркерами: +0,375 сразу после лечения, через 14 дней — +0,351, через 3 и 6 месяцев — +0,304 и +0,141 соответственно (p=0,23). Заключение. Значения ISQ показали высокую стабильность имплантатов. Успешную интеграцию имплантатов подтверждали изменения концентраций ЩФ и остеокальцина, положительная динамика которых свидетельствовала о позитивной минерализации и репарации. В течение периода заживления значения ISQ слабо коррелировали с ЩФ и остеокальцином. Настоящее исследование подтверждает значимость мониторинга значений ISQ и маркеров костного метаболизма при дентальной имплантации.

Possibility of determining patients with chronic obstructive pulmonary disease at ambulatory treatment by dentist

Detection of persons suffering from chronic obstructive pulmonary disease was carried out among patients who received scheduled and urgent surgical dental care on an outpatient dental appointment. At the first stage, a questionnaire was conducted for patients with dentition defects that needed orthopedic treatment, and patients who planned surgical manipulations with subsequent planned prosthetics, including those based on intraosseous implants. Patients with previously verified COPD, clinical signs of the disease (respiratory symptoms) and a high probability of its presence were sent to the physician-therapist for targeted standardized screening and diagnosis clarification. 978 patients were questioned, 256 patients were identified, subject to targeted standardized screening. COPD was verified in 95 patients (n = 95), which was 9,7 % of the total number of questionnaires (n = 978) and 37 % of the number of patients who underwent targeted screening (n = 256).

Comparative Efficiency of Removable Mini-Implant Retained Dentures Using Different Attachments in Edentulous Patients

Aim. To compare the efficiency of removable mini-implant retained dentures using different types of attachment.Materials and methods. The study included 51 edentulous patients. The patients were divided into three groups according to the attachment type and abutment shape: 1) ball-and-socket attachment, ball abutment (n = 26); 2) locator attachment, equator abutment, XiVE LOCATOR system (n = 14); 3) bar attachment (n = 11). Removable dentures were made of ordinary acrylic plastic. The placement of intraosseous dental implants with their sublingual engraftment was performed according to the traditional two-stage delayed-load procedure. The efficiency of implants was evaluated using the method of M.Z. Mirgazizov and the eponymous index. The dynamics of vertical bone resorption around implants was determined using dental panoramic radiography (6 months, 1 and 2 years after the treatment). A periotest was performed 6 months after the end of the orthopaedic treatment.Results. The one-year survival rate of implants reached 96.2% in group 1, amounting to 100% in groups 2 and 3. The two-year survival rate came to 92.3% in group 1, reaching 92.9% and 100% in groups 2 and 3, respectively. Inflammatory phenomena characteristic of peri-implantitis were noted one year after the implant placement in 7.7% (n = 2) of patients in group 1 and in 7.1% of patients in group 2, with no inflammatory phenomena being observed in group 3. Two years after the implant placement, peri-implantitis was observed in 19.2% and 21.4% of patients in groups 1 and 2, respectively, coming to 9.1% in group 3. The periotest revealed that six months after the placement, implant stability was higher in group 3 for both the lower and upper jaw (in comparison with groups 1 and 2), as evidenced by the shift in periotest values towards the negative part of the scale.Conclusion. The study revealed that bar attachment, as well as locator attachment (equator abutments), of removable dentures supported by mini implants is more efficient as compared to the ball-and-socket attachment.

Removal of a maxillary tumor with simultaneous placement of intraosseous zygomatic implants

The study objective is to report a case of successful placement of intraosseous zygomatic implants for functional and aesthetic rehabilitation of a patient with a maxillary defect resulted from maxillary resection for right-sided stage IIB maxillary sarcoma (сT2N0M0, G3). Materials and methods . A 34-year-old male patient visited a doctor in P.A. Herzen Moscow Oncology Research Institute with complaints of maxillary tumor. During the examination of the oral cavity, we found a dense endophytic tumor in the area of two missing teeth (17 and 18) involving the alveolar process and palatine process of the maxilla. Computed tomography revealed destruction of the alveolar process, lateral, medial, and posterior walls of the maxillary sinus on the right, and tumor invasion into the right iliac fossa, pterygopalatine fossa, and right maxillary sinus. We also observed tumor destruction of the right palatine process of the maxilla. The patient was diagnosed with osteogenic sarcoma. Results. The patient received 4 courses of polychemotherapy with cisplatin and doxorubicin, which resulted in disease stabilization. Then the patient underwent en-block resection of the fragment of the right maxilla with alveolar and palatine processes, fragments of the zygomatic bone, wings of the sphenoid bone on the right side, and adjacent soft tissues. Simultaneously, we placed two zygomatic implants to provide supportfor the maxillary plate denture. To create an additional supporting point, we extracted tooth 11 and installed an implant with external hexagonal connection. Later, we produced and installed a specially designed palatal obturator. Conclusion. Installation of removable dentures supported by implants ensures complete and rapid rehabilitation, allowing a patient to chew, swallow, and speak normally. A palatal obturator on implants supports the soft tissues of the medial face, thus ensuring complete aesthetic rehabilitation.

Cortically Fixed at Once Implants for the Treatment of the Atrophic Maxilla - A Case Report

The CF@O, Cortically Fixed at Once, implant system is a recent innovation aimed at the rehabilitation of difficult and failed implant cases within a short period of time without the need for extensive surgical operation. The use of conventional intraosseous implants may be limited or inapplicable in restoring some edentulous spaces due to various anatomical reasons. The Cortically Fixed at Once approach uses the remaining cortical bone to fix specially designed implants.

Surface bioactivation of PEEK by neutral atom beam technology

Polyetheretherketone (PEEK) is an alternative to metallic implants and a material of choice in many applications, including orthopedic, spinal, trauma, and dental. While titanium (Ti) and Ti-alloys are widely used in many intraosseous implants due to its biocompatibility and ability to osseointegrate, negatives include stiffness which contributes to shear stress, radio-opacity, and Ti-sensitivity. Many surgeons prefer to use PEEK due to its biocompatibility, similar elasticity to bone, and radiolucency, however, due to its inert properties, it fails to fully integrate with bone. Accelerated Neutral Atom Beam (ANAB) technology has been successfully employed to demonstrate enhanced bioactivity of PEEK both in vitro and in vivo. In this study, we further characterize surfaces of PEEK modified by ANAB as well as elucidate attachment and genetic effects of dental pulp stem cells (DPSC) exposed to these surfaces. ANAB modification resulted in decreased contact angle at 72.9 ± 4.5° as compared to 92.4 ± 8.5° for control (p < 0.01) and a decreased average surface roughness, however with a nano-textured surface profile. ANAB treatment also increased the ability of DPSC attachment and proliferation with considerable genetic differences showing earlier progression towards osteogenic differentiation. This surface modification is achieved without adding a coating or changing the chemical composition of the PEEK material. Taken together, we show that ANAB processing of PEEK surface enhances the bioactivity of implantable medical devices without an additive or a coating.

The level of bone metabolism in patients with dental implants

The aim of the study was to determine the activity of alkaline phosphatase (AP), tartrate-resistant acid phosphatase (TRAP) and osteocalcin in oral fluid (OF) in patients with dental implants. Dental intraosseous implantation was performed in 164 patients, aged 45 to 60 years (mean age 54.6±4.17 years), 78 (47.6%) males and 86 (52.4%) females. In 75.6% of patients more than 3 teeth were absent. A total of 641 screw intraosseous implants of the MIS system were installed. Studies were performed prior to implant placement, at 7, 14, 21 days and 3 and 6 months. The control group consisted of 20 volunteers of comparable age, 9 (45.0%) males and 11 (55.0%) females. An increased activity of AP and TPAP was revealed, but the activity change of AP in comparison with the control group was not statistically significant. Activity of TRAP in patients before implantation was higher than in controls by 40.5% (p<0.05) in group without complications and by 61.9% (p<0.05) in patients with mucositis. After implantation, the activity of TPAP remained elevated for 6 months, the maximum activity was observed after 14 days and was 3 times higher than at baseline (p<0.01). The amount of osteocalcin increased, especially in the complicated course after the implantation. The highest values of osteocalcin were observed 14 days after implantation. Determination of the activity of TPAP in the OF after implantation can be used as an indicator of the state of bone metabolism.

Cultivo celular de una apatita bovina como sustituto óseo: pruebas preliminares

Las pérdidas óseas limitan la posibilidad de rehabilitaciones odontológicas, siendo necesario en muchas ocasiones realizar procedimientos de reconstrucción ósea para la colocación de implantes intraóseos y mejorar los perfiles protésicos, para lo cual se indican los sustitutos óseos. El sustituto ideal es el hueso autólogo, pero existen alternativas como el tejido proveniente de donantes (homólogo), el de origen animal (xenólogo) y el sintético (aloplástico). En la Escuela de Ingeniería de Materiales de la Universidad del Valle se está desarrollando un sustituto óseo a partir de hidroxiapatita bovina, la cual fue obtenida de huesos de ternera procedentes de la industria cárnica, los cuales fueron lavados para eliminar grasa y tejidos blandos, fraccionados, molidos y sometidos a tratamiento térmico a 800 °C. Las muestras fueron caracterizadas mediante difracción de Rayos X (DRX) y espectroscopía de infrarrojos por transformada de Fourier (FTIR); en este trabajo se evaluó la capacidad osteoconductora del material realizando pruebas preliminares a 15 muestras que fueron cultivadas con osteoblastos por 15 días. Se determinaron las características de superficie de dichas muestras con Microscopía Electrónicade Barrido (SEM) y Espectroscopia por Energía Dispersiva (EDS), con lo que se determinaron las funciones celulares como adhesión, maduración y formación de matriz extracelular. Los resultados mostraron adhesión y crecimiento celular, además de presencia de depósitos compatibles con matriz ósea extracelular con contenido orgánico e inorgánico, lo cual es un indicador de maduración.

Early results of medial opening wedge high tibial osteotomy using an intraosseous implant with accelerated rehabilitation.

Accelerated rehabilitation protocols for medial opening wedge high tibial osteotomy (MOW HTO) using intraosseous implants have not previously been described. The present study provides early clinical and radiological outcomes of MOW HTO using a polyetheretherketone (PEEK) intraosseous system, in combination with an early weight-bearing protocol. Twenty consecutive knees (17 patients) underwent navigated MOW HTO using a PEEK implant with accelerated rehabilitation. Time to union and maintenance of correction were assessed radiographically for 12months post-operative. Patient outcomes were monitored for a mean follow-up of 38months (range 23-42) using standardised instruments (WOMAC, IKDC and Lysholm scores). All knees were corrected to valgus. The mean time to unassisted weight-bearing was 55days (SD 24, range 21-106). Bone union occurred in 95% of knees by 6months, with correction maintained for 15 knees at 12months post-operative. Knees for which correction was lost within 1year of surgery had significantly greater preoperative varus alignment. Implant survivorship was 95% and 80% at 12 and 38months post-operative, respectively. Significant improvements in patient-reported satisfaction, knee function and return to daily activities from preoperative to 38months post-operative were reported (WOMAC 36 v 0; IKDC 35.6 v 96; Lysholm 44.5 v 100). Accelerated rehabilitation following MOW HTO with an intraosseous PEEK implant did not delay bone union, with significantly improved functional outcomes within 3months post-operative. Early findings suggest that this approach may be suitable for a defined patient subset, with consideration for the extent of preoperative genu varum.