Makoto Ogiso

A histologic comparison of the functional loading capacity of an occluded dense apatite implant and the natural dentition

A histologic comparison of the functional loading capacity of an occluded dense apatite implant and the natural dentition at a ratio of one implant to three natural teeth was carried out on six monkeys. Single implants were placed in the maxillary left second molar and mandibular right second molar of each monkey. Four months later, the vertical dimension of occlusion was raised at the contacting areas between the implant and the connected first, second, and third opposing molar teeth by placing metal crowns on them. The three connected molars gradually intruded over time, whereas the supporting bone of the mandibular and maxillary implants showed no abnormalities and was able to bear the load because of thickening and remodeling of the surrounding bone.

The Process of Physical Weakening and Dissolution of the HA-coated Implant in Bone and Soft Tissue

Hydroxyapatite (HA)-coated implants were developed to promote osseointegration of titanium implants and to overcome the mechanical drawbacks of solid HA implants. Although many clinical reports on the prognosis of HA-coated implants have reported high success rates, the risks of dissolution and weakening of the coating have been noted. We hypothesized that the chemical and mechanical stability of HA coating are affected by its microstructural characteristics. The present study investigates differences in the microstructures of available HA-coated implants, before and after implantation into the coxal bones of dogs for periods ranging from 3 weeks to 10 months and under the coxal periosteum of dogs for 10 months. The results of transmission electron microscopy and energy-dispersive x-ray analysis revealed that crystallization of super-fine HA crystals occurred in the amorphous phase of the HA coating and progressed over time. This crystallization weakens HA-coated implants by making the amorphous phase brittle, causing stress accumulation within the coating, and causing a decrease in the binding strength between the coating and the substrate. Furthermore, the HA coating dissolved in soft tissue. Dissolution started with the super-fine HA crystals in the crystallized portion that was originally part of the amorphous phase.

Reassessment of long-term use of dense HA as dental implant : Case report

Dense hydroxyapatite (HA) is widely believed to be unsuitable for clinical use as dental implants due to its poor mechanical properties, although it has excellent biocompatibility and is chemically stable and nonresorbable in vivo. However, the case in this article is one in which the patients dense HA implants are still stable and in good functional condition 16.5 years after he received four pieces of a one-piece dense HA implant in both sides of his lower molar regions. Furthermore, almost no radiolucency is evident along the root portions of the implant sites in the bone. These findings imply that dense HA can be clinically useful and should be reevaluated as a dental implant material.

Comparative push‐out test of dense HA implants and HA‐coated implants: Findings in a canine study

Two types of hydroxyapatite (HA) implants have been developed: an HA-coated implant and a dense HA implant. For a longer in situ life span, the HA implant must remain chemically stable and possess high resistance to occlusal force. To determine which type of HA implant shows better durability, this comparative dog study was done to evaluate push-out test results of HA-coated implants and dense HA implants of approximately the same size after implantation in the mandibular and coxal bones for periods ranging from 3 weeks to 10 months. The findings revealed that for the mandibular implants, the push-out values of HA-coated implants were significantly higher than those of dense HA implants at 2 and 4 months after implantation, with significance levels of p < .001 and p < 0.05, respectively. However, there was no significant difference between the two implant types at 10 months. As for the coxal implants, no significant differences were noted for any period. Furthermore, the ratio of push-out values of the dense HA implants to those of the HA-coated implants situated in the same position bilaterally in each bone of the body for each implantation period rose with the passage of time, especially in the mandible. In the mandibular implants, the correlation coefficient of the relationship between the ratio and duration of implantation was highly significant (p < 0.001). Push-out testing caused detachment of the surface portion of the HA coating that was bound to the dense bone from the HA-coated implant at 2, 4, and 10 months after implantation. Furthermore, at 10 months the HA-coated layer in the wide areas of the implants had completely detached from the metal substrate, in contrast to the dense HA implants, which remained durable throughout the test period.

Microstructural changes in bone of HA-coated implants

In our previous comparative push-out test of HA-coated implants and dense HA implants in dog bone, the ratio of the push-out value of the HA-coated implant to that of the dense HA implant decreased with time due to weakening of the HA coating as compared to the dense, more durable HA. The aim of this study was to investigate by histological examination of HA-coated implants in dog bone, using TEM, how this weakening of the HA coating occurs. The HA coating before implantation is composed of an amorphous glassy phase and a crystal phase scattered within the glassy phase. After implantation, the crystal phase remained almost unchanged. However, in the glassy phase, crystallization occurred and progressed with time. By 3 weeks after implantation, this crystallization already had started in the surface portion of the HA coating where it was covered by bone and also where it still touched the soft tissue. By 10 months, the crystallization had progressed to the deeper portion of the HA coating and had expanded to most of the glassy phase except for the narrow portions along the substrate-coating interface. These findings suggest that a progression of crystallization in the glassy phase causes stress accumulation within the HA coating, especially in the interface between the HA coating and the substrate, and that this stress accumulation results in a weakening of the HA-coated implant.

Differences in microstructural characteristics of dense HA and HA coating

Two implant types of hydroxyapatite (HA) currently are available for dental implants: dense HA-cemented titanium (Ti) and HA-coated. It has been shown in previous reports that there are differences in the chemical and mechanical stabilities between the dense HA and HA coated. The differences are thought to be due to structural differences between the two ceramic types. The aim of this study was to investigate the differences in microstructural characteristics of currently available dense HA and HA coated implants before implantation and at periods of 3 weeks and 10 months after implantation in canine bone. X-ray diffractometry, infrared analysis, transmission electron microscopy, and energy dispersive X-ray analysis were used. The dense HA is composed of crystal grains, with a well crystallized structure of HA, closely bound to each other and approximately 0.4-0.6 micron in size. Implantation did not change the original sintered structure of the dense HA. The HA coating was composed of an amorphous phase with a Ca/P ratio of 1.46 and a crystal phase consisting of oxyhydroxyapatite, tricalcium phosphate, tetracalcium phosphate, and CaO, with a Ca/P ratio of 1.57. In the amorphous phase, compared to other portions in the amorphous phase, there were some layers with lower atomic density and with no significant difference in Ca/P ratio. After implantation, the crystallization of super fine crystals of approximately 4-5 nm in thickness occurred in the amorphous phase, and with time it progressed and spread from the surface to the deeper portion of the HA coating. A Ca/P ratio of 1.58 in the crystallized portion was close to the ratio (1.60) in the dense HA, suggesting that the super fine crystals were HA. This crystallization cannot significantly decrease the solubility of the amorphous phase portion and poses risks of stress accumulation within the coating and a decrease of binding strength between the HA coating and the substrate.

Examination of hydroxyapatite filled 4‐META/MMA‐TBB adhesive bone cement in in vitro and in vivo environment

Bone response to hydroxyapatite (HA) fillers in the cured-4-methacryloyloxye-thyl trimellitate anhydride (4-META)/methyl methacrylate (MMA)-tri-n-butyl borane (TBB) adhesive bone cement was examined mechanically and histologically. A two-component system, consisting of powder and liquid, was formulated. The liquid portion was 5% 4-META dissolved in MMA and TBB; the powder was composed of 50 wt% poly (MMA) (PMMA) and 50 wt% dense HA fillers. The results indicated that the tensile strength decreased with the increase of HA filler size. The bone-bonding behavior of the improved cement was examined by optical microscopy and scanning electron microscopy. Seventy-two implants in six dogs for up to 24 weeks showed 4-META cement filled with HA was stable in the cement-bone interface. Histologic examinations showed that the exposed HA particles at the surface of the cured cement were generally associated with intimate attachment to bone without fibrous tissue, as well as interdigitation of cement to bone. The results suggest the importance of HA fillers in inducing bone apposition that improves cement binding to bone for long-term stability, thereby complementing rapid initial bone fixation of the cement.

Adhesive improvement of the mechanical properties of a dense HA-cemented Ti dental implant.

We have been using dense, pure hydroxyapatite (HA) dental implants for the last 15 years and results have shown that dense HA is a chemically stable material with acceptable mechanical properties. However, due to HAs physical characteristics, particularly its brittleness, there is the risk that the implant will fail if the subsequent bone binding comprises less than one half of the root portion. To ensure greater implant success, a new cementing method has been developed that uses methacrylates for the bonding of the dense HA outer shell to the titanium (Ti) inner cylinder in a two-piece HA-cemented Ti implant. Mechanical property tests were conducted to compare the HA-cemented Ti implant bonded with this new acrylic cement with existing commercially available HA-cemented Ti implants bonded with a triethyleneglycol dimethacrylate (TEGDMA)-bisphenol-A diglycidyl ether (BisGMA compound). The vertical and horizontal compressive strength of this improved implant was respectively 3.4 and 6.1 times greater than the commercial implants. This increased strength of new acrylic cement is due to its ability to compensate for shrinkage that affects adhesion during curing, thereby providing stronger bonding.

Interactions between bone and hydroxyapatite filled 4 META/MMA-TBB adhesive cement in vitro and in physiological environment

These studies examined the effects of hydroxyapatite (HA) filled PMMA-4 META cement in bone. The cements liquid portion was of 4-methacryloyloxyethyl trimellitate anhydride (4-META), methyl methacrylate (MMA) monomer, and initiator tri-n-butyl borane (TBB). Powder was of 50 wt.% polymethyl methacrylate (PMMA) and 50 wt.% porous HA particles. In vitro study showed the tensile bond strength was reversibly proportional to HA filler content and size. All specimens were evaluated using light microscopy and scanning electron microscopy (SEM). In vivo study of 4 dogs for 4 and 12 weeks showed HA filled PMMA-4 META cement stabilizes the cement-bone interface. All microscopic examinations showed not only exposed HA particles at the surface of the apatite filled resin cement but demonstrated areas of direct bone apposition with no fibrous tissue, also in the resin portion. This reinforces the importance in inducing bone apposition and thus contributing to the overall implant-cement stability.

Implant Insertion into an Augmented Bone Region Using the Canine Mandible Augmented by the “Casing Method”: IMPLANT INSERTION INTO AN AUGMENTED BONE REGION

The purpose of this study was to examine the efficacy of bone augmentation using the “Casing Method,” which enables large‐scale osteogenesis, and the feasibility of using the augmented bone in dental implants. Three Beagle dogs were used. After tooth extraction, a polyethylene terephthalate case (20 mm × 5 mm × 10 mm) was placed on the buccal surface of the mandible. A mixture of hydroxyapatite and beta‐tricalcium phosphate (volume ratio = 1:1) was infiltrated into a suspension of autologous superfine bone powder and plasma, and the resulting mixture was packed into the case. After 16 weeks, the implant was inserted into the augmented bone and the original bone. Specimens of the mandible were collected at 2, 4, 8, and 16 weeks after implant insertion, and undecalcified sections were prepared. The integration of the implant into the surrounding bone tissue was observed histologically. Favorable bone formation was observed in the regions where bone augmentation was performed. The space between the cut bone surface and the implant was filled with newly formed bone in both the augmented and original bone regions. In addition, there was higher bone density in the augmented bone than that in the original bone at the coronal half of the implant at 16 weeks. As a result, bone‐to‐implant contact was significantly higher in the augmented bone region than in the original bone region. These results suggest that bone augmentation surgery using the “Casing Method” is an effective technique for expanding the application of dental implants. Anat Rec, 301:892–901, 2018.