Design of prosthetic cantilever bridgework supported by osseointegrated implants using the finite element method.

OBJECTIVES: The aim of the present work was to establish a design procedure for fixed metal prostheses supported by osseointegrated implants in order to prevent permanent deformation and hence failure following loading. Previously, the cantilever cross-sectional shape in the buccal lingual plane has been based on clinical experience and subjectivity. METHODS: This work has relied on the use of linear elastic finite element analysis in order to generate a maximum effective stress at which permanent deformation commences on loading. A number of different cross-sectional shapes were investigated, both of conventional design as well as new innovative possibilities. Both straight and curved cantilever beams 26 mm long were examined. RESULTS: The design failure chosen was based on a von Mises plastic collapse principle by comparing the calculated effective stresses with the yield stress of the metal in simple tension. It was found that the "L" shaped design was more rigid than other designs for a given mass, while a framework based on an open "I" section offers good possibilities particularly when used as curved shapes. SIGNIFICANCE: Assuming a failure criterion based on the von Mises principle, then "L" shaped Co/Cr or stainless steel frameworks, typically 26 mm of cantilever span, undergo permanent deformation at end loadings between 130 and 140 N depending on section curvature. Since it is known biting loads can exceed these values, good design is critical if such failures are to be avoided.

The effectiveness of topical anesthesia and vibration in alleviating the pain of oral injections.

The goal of the research was to compare the effectiveness of vibration with that of a topical anesthetic in reducing the pain of local anesthetic injections. Injections were given adjacent to maxillary premolars in four locations in 61 patients. Before injection, sites received either placebo or topical anesthetic with or without vibration. Patients rated the injection pain on a five-point scale. The topical anesthetic caused a statistically significant decrease in pain values; however, the amount of decrease was of questionable clinical significance.

Effects of indomethacin on bone ingrowth.

The effects of indomethacin, a nonsteroidal antiinflammatory agent, on bone ingrowth were studied using a rabbit animal model and a porous cylindrical implant system. Bone ingrowth was found to be independent of pore size in the range tested (0.6-1.0 mm). In the control (placebo-treated) group, there was a significant increase in bone ingrowth between the 2- and 8-week groups of animals. However, in the indomethacin-treated group, there was no increase in bone ingrowth with time.

Future directions in dental implant materials research.

There are literally thousands of published accounts of the performance of medical and dental implants that employ metals and ceramics for which little or no materials characterization has been accomplished. Before the current decade, the level of sophistication of research was such that many materials did not even receive postprocessing analysis of the "bulk" composition, a minimal characterization we now realize is inadequate. Instead, research focused upon mechanical properties and corrosion studies at the macroscopic level, along with the search for a mythical property called biocompatibility. There were sound scientific reasons for this focus. The state of knowledge of the biology associated with implants did not allow the creation of experiments at the cellular or molecular level. Experiments progressed slowly from clinical observations to histologic observations, from which inferences of past events were made. The complete characterization of implant surfaces was virtually impossible because the analytical instrumentation and the associated understanding of physical and chemical processes occurring at surfaces were lacking. Materials were selected because of their apparently inert state, as defined by corrosion studies and histological examination of implant specimens. The focus in the 1970s was on micron-sized surface features. Porosity, grooves, textures, etc., were emphasized along with the macroscopic design features. A proliferation of designs, many of which were based on inspiration, rather than experimentation and optimization, were brought to the marketplace. Perhaps the exception to this lack of surface analysis was the development of the surface-active biomaterials based on calcium phosphates, the tricalcium phosphates, hydroxylapatites, and surface active glasses. Unfortunately, investigators did not pursue the same analyses for the "inert" materials.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative bone remodelling resulting from the use of porous dental implants.

Histomorphometric analyses were used to quantitatively determine the patterns of bony ingrowth which resulted from the placement of porous-surfaced dental implants into the mandibles of Rhesus monkeys for up to 74 months utilizing a two-stage approach. Quantitative histopathologic evaluations were made using ground section microscopy. Implant stability resulting from bone remodelling and ingrowth occurred to varying degrees with all implants. Bone ingrowth occurred from medullary trabeculae and contact with the adjacent cortical plates. Quantitative histomorphometric analyses revealed that in only one case was the bone ingrowth into the available internal pores less than 45%. Minimal fibrous connective tissue ingrowth was observed in the implant crypts and was not thought to be due to micro-motion. The observed bone remodelling indicated a favorable prognosis for long-term implant performance.

Comparison of subjective lens preference to objective refractive error measurements in pigtail macaques.

Two measurements can be taken to determine the refractive error in human beings: a subjective, lens preference measurement and objective retinoscopy. This study determined the subjective refractive error in eight pigtailed monkeys by placing lenses of different powers in front of peepholes in a solid wall cage and recording the amount of time each subject used the holes. Retinoscopy measurements were then taken and compared to the subjective findings to determine the degree of similarity between these two refraction methods. The results showed a high correlation between the subjective measurements and the vertical ocular refraction (VOR) and spherical equivalent (SE) (rho = 0.96), further supporting generalizations made from nonhuman primate vision studies to human beings.

Houston Myopia Control Study: a randomized clinical trial. Part I. Background and design of the study.

The Houston Myopia Control Study is a 3-year randomized clinical trial in which each of 213 myopic children was placed in either a single vision (standard treatment) group, a +1.00 D add treatment group, or a +2.00 D add treatment group, on the basis of a randomized procedure. Subjects for the three treatment groups were matched on the basis of sex, age, and the initial amount of myopia. The study involves two groups of investigators: an evaluation team, whose task has been to evaluate candidates before entering the study and to reevaluate each subject on a yearly basis for the 3-year period, and a patient care team, whose task has been to prescribe glasses for each subject as well as to counsel subjects and their parents in the correct use of the glasses and to provide a follow-up examination every six months for the duration of the study. Once the glasses had been prescribed, members of the evaluation team were not permitted to know which subjects wore single vision lenses and which wore bifocals. In the interest of good patient care, members of the patient care team knew which subjects wore single vision lenses and which wore +1.00 D add or +2.00 D add bifocals. In this report, the authors discuss theories concerning the etiology of myopia, methods that have been used in an attempt to control the progression of myopia, and the design of the current study. Further reports will present the results of the study on the basis of the data collected by each of the two study teams.

Preliminary studies of the histopathological responses to Ti-13% Cu casting alloys.

A preliminary study of some of the biological properties of a new dental casting alloy (Ti-13% Cu) was undertaken by employing the skeletal muscle implantation test in rabbits. Routine histopathological and chemical analysis techniques were utilized to study in vivo tissue reactions of skeletal muscle to this alloy. A moderately thick, somewhat cellular fibrous connective tissue capsule surrounded the implants after 2 wk. Remodelling of the fibrous tissue into a thin acellular tissue capsule occurred at 52 wk after implantation. Chemical analyses failed to detect deposition of either Ti or Cu corrosion products at the implant sites or within major organs.

Histological evaluation of porous titanium cardiac pacemaker electrode tips.

An investigation of the tissue reaction to five porous titanium alloy pacemaker electrode tips inserted in sheep hearts was made. Attachment of the electrode tips to the endocardial wall was facilitated by fibrous tissue ingrowth into the porous material. Vascularized fibrocollagenous tissue was found within the pores of the tips. One tip was found to be infected. The presence of occasional multinucleated foreign-body giant cells within the porosity was related to the particulate features of the porous tip. The electrode tips had a reduced sensing impedance compared with conventional solid platinum tips. The present findings are consistent with previous observations relating to porous cobalt-chromium alloy and porous platinum-iridium alloy tips and suggest that porous titanium alloy may be a suitable pacemaker electrode tip material.

Screening of solid and porous materials for pacemaker electrodes.

Several different materials, including one which was porous, were studied to assess their properties as pacemaker electrode tips. Leads were implanted in sheep for periods up to one year. Electrical measurements were made during the implant period and histopathological examination performed after sacrifice. Although titanium vapor-deposited carbon, and silver did not lower the chronic stimulation threshold below that of platinum, their electrical characteristics were within generally acceptable limits. Zinc evoked a severe tissue reactions and a high threshold. Porous titanium alloy electrodes demonstrated reduced dislodgement, more frequent attachment and a lower sensing impedance than other electrodes.

Primate myopia.

Studies dealing with the development of myopia in primates are considered as they contribute to our understanding of myopia. Myopia appears to develop in two stages. The first is a lenticular change in eyes which have been focused at nearpoint for long periods; the lens remains continuously accommodated. Since accommodation in monkeys results in an increase in vitreous chamber pressure, a comparable increase in children could induce the second stage--an increase in the size of the vitreous chamber and a corresponding increase in axial length or true myopia. Behavior and personality appear to be related to myopia.

Linear dimensional changes in elastic impression materials.

Four classes of elastomeric impression materials (polysulfide, polyether, silicone, and agar-agar) were evaluated on the basis of linear dimensional stability as a function of time between taking and pouring an impression of mounted teeth. Four polysulfide materials produced dies which were larger than the teeth and generally increased in size with impression storage time. One silicone material produced dies slightly smaller than the teeth, and the dies from another silicone were dramatically smaller with increasing storage times. A polyether material produced slightly smaller dies for up to four hours' storage time, then increasingly larger dies up to 24 h. The dies from a reversible hydrocolloid were larger than the teeth for storage times up to 30 min, and then decreased rapidly at longer times.

Porous titanium endosseous dental implants in Rhesus monkeys: microradiography and histological evaluation.

Artificial tooth roots with porous surface coatings were fabricated by sintering spherical powder of titanium alloy to solid cylindrical cores. The tooth roots were implanted subgingivally in healed mandibular premolar extraction sites of fifteen Rhesus monkeys. Supracrestal abutments were screwed into pretapped holes in the superior aspect of the primary subgingival stage four to eight weeks after implantation of the root. Clinical evaluations were performed monthly. Ten animals were sacrificed for histological evaluation of the functioning free standing implants. Of twenty-nine implants placed, three were lost and four were rated failures on the basis of histological evaluation. Postmortem evaluations revealed bone growth into the porous surface coating of the primary stage of all the implants. The most characteristic features which could be used to describe differences in the implant histology were the buccal and lingual crestal bone heights measured in relation to the root porosity. Twelve of sixteen implants had crestal bone heights within one millimeter of the superior aspect of the root. Four other implants displayed excessive bone recession, revealing as much as one half of the root porosity supracrestally. The four implant failures could be related to unfavorable features of recipient bone sites. The results demonstrate that the bone growth into the porous surface coatings of artificial tooth roots is an efficacious method of dental implant fixation.