Alessandro Quaranta

A 16-year study of the microgap between 272 human titanium implants and their abutments.

A microgap has been described at the level of the implant-abutment connection. This microgap can be colonized by bacteria, and this fact could have relevance on the remodeling of the peri-implant crestal bone and on the long-term health of the peri-implant tissues. The authors report on 272 implants with screw- or cement-retained abutments retrieved from humans for different causes during a 16-year period. In the implants with screw-retained abutments, a 60-microm microgap was present at the level of implant-abutment connection. In some areas the titanium had sheared off from the surface and from the internal threads. The contact between the threads of the implant and those of the abutment was limited to a few areas. Bacteria were often present in the microgaps between implant and abutment and in the internal portion of the implants. In implants with cement-retained abutments, a 40-microm microgap was found at the level of the implant-abutment connection. No mechanical damage was observed at the level of the implant or of the abutment. All the internal voids were always completely filled by the cement. No bacteria were observed in the internal portion of the implants or at the level of the microgap. The differences in the size of the microgap between the two groups were statistically significant (P < .05). In conclusion, in screw-retained abutments the microgap can be a critical factor for colonization of bacteria, whereas in cement-retained abutments all the internal spaces were filled by cement. In these retrieved implants, the size of the microgap was markedly variable and much larger than that observed in vitro.

The microbiota associated with implants restored with platform switching: a preliminary report.

BACKGROUND It was demonstrated that implants restored according to a platform-switching concept presented less crestal bone loss than implants restored with standard protocols. The aim of this study is to examine differences between the composition of the peri-implant microbiotas associated with implants restored with the platform-switching approach and implants restored with a standard internal connection protocol. METHODS A total of 48 implants were examined in 18 subjects: 33 implants were restored with platform switching, and 15 implants were restored using the traditional approach. Thirty-six months after prosthetic loading, subgingival plaque samples were taken from the mesio- and disto-buccal aspects of each implant and from one tooth adjacent to one of the implants in each subject. The levels of 40 subgingival species were measured using checkerboard DNA-DNA hybridization. Microbiologic parameters were averaged within each subject and across subjects in each clinical group (platform switching versus control) and site category (implants versus teeth) separately. The significance of differences between clinical groups and site categories was determined using the Mann-Whitney test and the Wilcoxon test, respectively. RESULTS There were no statistically significant differences between groups for any of the species. The platform-switching group showed a small trend for lower levels of early colonizer members of the Actinomyces, purple and yellow complexes, Campylobacter species, Tannerella forsythia (previously T. forsythensis), and Porphyromonas gingivalis. Teeth and implants presented similar microbial profiles. CONCLUSION The results of the study suggest that the difference in bone crest resorption between implants restored with platform switching compared to traditionally restored implants is not associated with differences in the peri-implant microbiota.

Technical and biological complications related to crown to implant ratio: a systematic review.

Aim:To review the occurrence of prosthetic failure and biological complications with respect to the crown to implant (C/I) ratio. Methods:Accurate search was made on the subject C/I ratio with the following criteria: (1) studies on humans with data on prosthetic failure and/or biological complications related to C/I ratio; (2) partial edentulous patients; (3) randomized clinical trials, prospective, longitudinal, retrospective, and multicenter studies with a minimum of 48 months mean follow-up; (4) language: English; (5) radiographic measurements by peri-apical x-ray; (6) implant material: titanium; and (7) no implant type selection was applied. Results:Six articles were considered eligible for full-text analysis. Unfavorable C/I ratio can be considered a potential risk factor for single crown and abutment loosening (C/I ratio ≥1.46) and abutment fractures in posterior areas (C/I ratio ≥2.01). Conclusions:Despite the limited data, high C/I ratio may be related to some prosthetic failures. Unfavorable C/I ratio does not affect biological complications and implant failure.

A Histomorphometric Study of Nanothickness and Plasma-Sprayed Calcium-Phosphorous-Coated Implant Surfaces in Rabbit Bone

BACKGROUND Novel implant surface treatments with a nanothickness bioactive ceramic deposition onto rough surfaces have been recently introduced. This study aims to evaluate histologically and histomorphometrically (bone-to-implant contact [BIC] and bone area fraction occupancy [BAFO]) the early bone response to plasma-sprayed calcium-phosphate (PSCaP)-coated versus a 300- to 500-nm thickness bioactive ceramic nano-coated plateau root form implants in a rabbit femur model. METHODS A total of 48 plateau root form implants were bilaterally placed in the distal aspect of the femur of 12 white New Zealand rabbits, remaining for 20, 30, and 60 days in vivo (n = 4 animals per time in vivo, n = 2 implants per surface per animal). After sacrifice, the implants in bone were non-decalcified processed to slides of approximately 30 mum thickness, and were morphologically and morphometrically (BIC and BAFO) evaluated. RESULTS Higher degrees of bone structural organization were temporally observed for the PSCaP surface compared to the nano surface over time. BIC and BAFO was significantly higher (P <0.05) for PSCaP at all implantation times evaluated. CONCLUSIONS Within the limits of this study it is possible to state that bioactive ceramic coatings of both thicknesses were biocompatible and osteoconductive. However, the early bone response was favored by the presence of the thicker PSCaP coating.

Randomised study for the 1-year crestal bone maintenance around modified diameter implants with different loading protocols: a radiographic evaluation

This study evaluated by standardised digitised periapical radiography the crestal bone maintenance around modified diameter internal hex implants with variable thread design and narrow neck loaded with different procedures. Forty implants were placed in 25 patients. Twenty implants were conventionally loaded, 20 ones immediately loaded. Radiographs were taken with a customised bite record and processed with software. Measurements of bone from the fixture–abutment junction to mesial and distal marginal bone levels were made. Student’s t test statistical analysis was adopted. Baseline data were variable; at 1-year follow-up, there were no significant differences for marginal bone loss between immediately and conventionally loaded maxillary implants (p = 0.1031), whilst there were slight significant differences between immediately and conventionally loaded implants in the mandible (p = 0.0141). Crestal bone maintenance around conventionally and immediately loaded modified diameter implants was similar, with slight significant differences in mandible where a lower marginal bone loss was observed.

Correlation between implant stability quotient (ISQ) with clinical and histological aspects of dental implants removed for mobility.

Dental implants are a successful treatment modality for missing teeth; however, failures do occur. These failures can occur early in the healing process after primary stability has been achieved at the time of implant placement, or after initial bone remodeling and new bone growth have taken place. The ability to detect implants that are failing or will fail is still not possible. The aim of the present study is to see if correlations exist between RFA values and histologic and histochemical evaluation of the human retrieved implants for failure. In a 5 year period, 37 root form implants were retrieved because of mobility and underwent histological examination. Thin ground sections were obtained from each implant. All the implants had been removed with a 5 mm trephine. In all cases a peri-implant radiolucency was present. Before implant retrieval, the implant stability was evaluated with OsstellTM (Integration Diagnostics AB, Gothenburg, Sweden). All the implants were not osseointegrated clinically and mobility was present. Radiographically, bone loss was observed around the implants and the mean ISQ values was 37 (+/- 2.7). A scarce inflammatory cell infiltrate was present in the connective tissue of some specimens. In about 10% of specimens, the epithelium tended to surround the total perimeter of the implant. These data suggest that implants with an ISQ <40 are irretrievably lost and there is no possibility to save them. A statistically significant correlation was found between an ISQ<36 and irretrievably failed implants.

A Comparison between Endodontics and Implantology: An 8-Year Retrospective Study

PURPOSE The aim of this study was to compare endodontic and implant treatments and to evaluate their predictability over an 8-year period on the basis of an analysis of survival data and a retrospective clinical study. MATERIALS AND METHODS A group of 40 partially edentulous patients were selected for this study. Their teeth had been endodontically treated and rehabilitated using gold alloy and ceramic restorations. In these patients, 65 osseointegrated implants were restored with single gold alloy-ceramic crowns and monitored on a yearly basis for 8 years with standardized periapical radiographs, using a polivynilsiloxane occlusal key as a positioner. A total of nine patients who did not attend the yearly follow-up were excluded from the study. The Melloning and Triplett criteria were used to evaluate the clinical results obtained in the implant sites. The clinical results of the 56 endodontically treated teeth, restored with the fixed prosthesis of 40 patients, were analyzed according to probing depth as well as an assessment of the correct apical and coronal seals. The survival rate was calculated using the Kaplan-Meier method and the statistical significance was calculated using the chi-square test. RESULTS During the follow-up of the endodontically treated elements, seven failures were detected (83.34%) and the success rate of implants inserted in the same patients was equal to 80.8%, with nine implants lost in 8 years. The survival analysis of the elements treated with both therapies was not statistically significant (p = .757) and the confidence interval was between 0.2455 and 2.777. CONCLUSION In view of the superimposable results between the two therapies, it should be noted that the endodontically treated teeth could be interested by different pathologies while the restoration of the atrophic edentulous ridge with an implant support is predictable when patients comply with correct oral hygiene and when the occlusal loads are axially distributed in implant-protected occlusion.

Effect of enamel matrix derivative (Emdogain) on bone defects in rabbit tibias.

The aim of this study was to assess the effect of an enamel matrix derivative (Emdogain, Biora, AB, Malmö, Sweden) on bone healing. Ten New Zealand rabbits, weighing about 2.5 kg, were used. One 8-mm bone defect was created in each tibia. The defect on the right leg was filled with Emdogain, whereas the defect on the opposite leg was left unfilled as control. A total of 20 defects were created. Five rabbits each were killed at 4 and 8 weeks with an overdose of Tanax. Block sections containing the defects were retrieved and the specimens processed for light microscopy examination. The slides were stained with acid and basic fuchsin and toluidine blue. Histologically, no differences were noted in both groups at each observation period; in the test group, remnants of the implanted Emdogain were not present at 4 weeks. Newly formed bone was detectable in both groups at all observation times. At 8 weeks, both groups showed mature bone, and in the test group the material implanted was not visible. No inflammatory cells were visible in both groups. In conclusion, our results indicate that Emdogain implanted in bone defects is fully resorbed after 4 to 8 weeks and does not adversely affect bone formation.

Removal torque values of titanium implants inserted into bone defects filled with hydroxyapatite: a histologic and histomorphometric analysis in rabbit.

The successful clinical use of implants with microrough titanium surfaces has paved the way for the further development of surface topographies to promote enhanced peri-implant bone apposition during the early stages of bone regeneration. The aim of this study is to determine the torque resistance of the implant-bone interface of plasma sprayed titanium endosseous implants placed in the rabbit tibia in three different situations. Hydroxyapatite (HA) particles with a size ranging from 250 to 450 μm were used in the present study to fill out 6 mm bony defects created in rabbit tibia. Fourteen mature New Zealand white male rabbits, weighing about 2.5 Kg., were used in this study. The test sites were filled with HA and the non-grafted sites were used as control. A total of 28 bone defects (14 without HA and 14 with HA.) were created. Implants with plasma-spray surface were subsequently inserted. Six additional rabbits were used; in these animals no bone defects were created. The implant sites were divided into three groups: 1) implants inserted in the tibia without bone defects; 2) implants inserted in the tibia with bone defects not filled with HA; 3) implants inserted in the tibia with bone defects filled with HA particles. The purpose of this study is to measure reverse-torque in three different situations of clinically similar implant geometry in the articulation of rabbits. The null hypothesis stated that there is a difference in reversal torque between the bone regeneration with HA, native bone and bone defect without bone regeneration. Additionally, comparison between these 6-month data and the 3-month data from a previous study led to the following conclusions: a significant difference exists in the removed torque for the TPS implants in the bone regenerated by HA and native bone; increase in removal torque values was seen for the implant inserted in bone regenerated by HA compared to the implant nated in bone without biomaterials. In conclusion, bone regenerated with biomaterials possesses different mechanical characteristics to native bone.

Active Implant Peri-Apical Lesion: A Case Report Treated Via Guided Bone Regeneration With a 5-Year Clinical and Radiographic Follow-Up

Implant peri-apical lesion (IPL) is a periapical lesion, usually asymptomatic, in which the coronal portion of the implant achieves a normal bone to implant interface. A case of IPL following immediate implant placement and treated with guided bone regeneration (GBR) principles is described. Five-year clinical and radiographic follow-up with cone-beam assessment showed complete healing of the bone. GBR principles applied to IPL could completely solve the lesion.Abstract Implant peri-apical lesion (IPL) is a periapical lesion, usually asyntomatic, in which the coronal portion of the implant achieves a normal bone to implant interface. A case of IPL following immediate implant placement and treated with GBR principles is described. Five year clinical and radiographic follow-up with cone-beam assessment showed complete healing of the bone. GBR principles applied to IPL could completely solve the lesion.