Osseointegration of ultrafine-grained titanium with a hydrophilic nano-patterned surface: an in vivo examination in miniature pigs.

Advances in biomaterials science and implant surface technology have made dental implants more predictable and implant therapy more attractive to patients. Surgical interventions are becoming less invasive, and patients heal faster and suffer less morbidity. In this preclinical in vivo study, we compared a new ultra-fine grained titanium (ufgTi) implant material with a hydrophilic nano-patterned surface to commercially pure titanium (cpTi) in a well-established animal model. CpTi grade 4 was subjected to Equal Channel Angular Pressing (ECAP), followed by a cold drawing process that provided ultra-fine-grained titanium (ufgTi) with a mean grain size of 300 nm. After metallographic assessment, the surface topography was characterized by laser confocal microscopy and atomic force microscopy. UfgTi and cpTi implants were inserted in the mandible and maxilla of miniature pigs that healed for 4 and for 8 weeks. Osseointegration was assessed by biomechanical torque out analysis, histomorphometric evaluation, and micro-CT analysis. The metallographic properties of UfgTi were significantly better than those of cpTi. Their surface topographies had similar hydrophilic nano-patterned characteristics, with no significant differences in the nanometre range. Histomorphometric and biomechanical torque out analysis revealed no significant differences between ufgTi and cpTi in environments of either low (maxilla) or high (mandible) bone density. We obtained high bone-to-implant contact values irrespective of the bony microarchitecture even when the bone mineral density was low. Overall, this investigation suggests that ufgTi forms a hydrophilic nano-patterned surface with superior metallographic properties compared to cpTi and high levels of osseointegration. Thus, ufgTi has therapeutic potential as a future strategy for the development of small diameter implants to enable less invasive treatment concepts, reduce patient morbidity and may also lower the costs of patient care.

Development of Implant Stability Quotient values of implants placed with simultaneous sinus floor elevation - results of a prospective study with 109 implants.

OBJECTIVES: In patients with implant placement and simultaneous sinus floor elevation (SFE), healing periods of 6 months have been the standard of care for more than 25 years. The primary objective of this prospective case series study was to determine what percentage of implants placed with SFE reach a threshold Implant Stability Quotient (ISQ) of ≥70 after 8 weeks of healing using Resonance Frequency Analysis (RFA). MATERIAL AND METHODS: A total of 109 dental implants were placed in 97 patients. SFE was carried out with a lateral window approach and a mixture of autogenous bone chips and deproteinized bovine bone mineral (DBBM). Titanium screw-type, tissue-level implants with a chemically modified SLA surface were used. ISQ values were measured after implant insertion (ISQBL ) and after 8 weeks of healing (ISQ8 wk ). Patients showing ISQ8 wk  ≥ 70 subsequently underwent restoration. Implants with an ISQ value < 70 were recalled at 2-week intervals. RESULTS: The ISQ at baseline had a mean value of 68.3 (SD ± 9.8). At 8 weeks, the mean ISQ value was 73.6 (SD ± 6.4). This increase was statistically significant (P < 0.001). An ISQ8 wk value ≥70 was observed for 91 implants (83%). One implant (0.9%) with a peri-implant infection and severe bone loss at 8 weeks was considered an early failure. CONCLUSIONS: This study showed that 83% of implants reached the threshold level of ISQ ≥ 70 after 8 weeks, allowing an early loading protocol. The early failure rate was considered low with 0.9%. The RFA technology is a suitable method to objectively monitor implant stability longitudinally.

Guided implant surgery with modification of the technique involving the raising of a semicircular miniflap: A preliminary study

Objective: An evaluation is made of pain, swelling and peri-implant attached mucosal width after implant-based rehabilitation involving guided surgery and a modification of the technique with the raising of a semicircular miniflap, in single and partial replacements.Study design: A case-control study was carried out. The study group consisted of 12 patients with the placement of 19 implants using a guided surgery and miniflap technique. The control group consisted of 12 patients with the placement of 22 implants using the conventional technique. Each patient scored postoperative swelling and pain by means of a visual analog scale (VAS). Attached vestibular mucosa width was evaluated 12 weeks after implant placement. Results: Twelve operations were carried out in each group. Immediate aesthetics were established for all implants of the study group. One implant failed in each group. Maximum pain was recorded after 6 hours in both groups (mean VAS score 4 and 4.9 in the study and control group, respectively). Maximum swelling was recorded after 24 hours (mean VAS score 2.5) in the study group and on the second day (mean VAS score 3.4) in the control group. The mean attached vestibular mucosa width was 2.9 mm in the study group and 3.2 mm in the control group. Conclusion: In this preliminary study, guided implant surgery with a semicircular miniflap in single and partial replacements resulted in slightly less postoperative pain and swelling than with the conventional implant technique. The attached vestibular mucosa width was greater in the control group, though the differences were very small (AU)

Guided implant surgery with modification of the technique involving the raising of a semicircular miniflap: a preliminary study.

OBJECTIVE: An evaluation is made of pain, swelling and peri-implant attached mucosal width after implant-based rehabilitation involving guided surgery and a modification of the technique with the raising of a semicircular miniflap, in single and partial replacements. STUDY DESIGN: A case-control study was carried out. The study group consisted of 12 patients with the placement of 19 implants using a guided surgery and miniflap technique. The control group consisted of 12 patients with the placement of 22 implants using the conventional technique. Each patient scored postoperative swelling and pain by means of a visual analog scale (VAS). Attached vestibular mucosa width was evaluated 12 weeks after implant placement. RESULTS: Twelve operations were carried out in each group. Immediate aesthetics were established for all implants of the study group. One implant failed in each group. Maximum pain was recorded after 6 hours in both groups (mean VAS score 4 and 4.9 in the study and control group, respectively). Maximum swelling was recorded after 24 hours (mean VAS score 2.5) in the study group and on the second day (mean VAS score 3.4) in the control group. The mean attached vestibular mucosa width was 2.9 mm in the study group and 3.2 mm in the control group. CONCLUSION: In this preliminary study, guided implant surgery with a semicircular miniflap in single and partial replacements resulted in slightly less postoperative pain and swelling than with the conventional implant technique. The attached vestibular mucosa width was greater in the control group, though the differences were very small.

Bilateral vertical ridge augmentation with block grafts and guided bone regeneration in the posterior mandible: a case report.

The aim is to describe bilateral vertical ridge augmentation with intraoral block grafts and guided bone regeneration in the posterior mandible in preparation for implant placement. A 61-year-old woman, edentulous in the posterior mandible, presented for implant rehabilitation. The radiographic study showed 3 to 6 mm of bone height from the ridge to the mandibular canal. Autogenous bone block grafts from the chin and the mandibular ramus, harvested with ultrasonics, were used to augment the alveolar ridge. To reduce resorption, the grafts were covered with particulate alloplastic material and a collagen membrane. Delayed implants were placed 6 months after vertical augmentation, and 3 months later implants were loaded with a fixed prosthesis. A temporary sensory complication occurred, but 12 months after implant loading, there were no failures. In this case report block bone grafting was a feasible option to vertically augment the alveolar ridge in the posterior mandible.