Dental implants, what's to consider?

November 15, 2018

Dental implants, what's to consider?

"Nowadays implants are a consistent form of dental treatment. Clinical studies have led to advancements in the biomechanical aspects of implants, implant surface features and componentry"
More than 1 million implants are inserted each year by North American dentists. [Ref. 1.5pag 3
With so many dental implant products on the market today, how do you know which to choose?
The overall implant design and the surface condition will affect, 1-Surgical integration, 2-Healing dynamics, 3-Early loading period
& 4-Mature loading period. [Ref. 1.5page 599
Below are points to consider  

  

 

The stability of soft tissue around implants is considered a very important piece for successful implant placement; connective tissue is key to support epithelium, block its apical migration, and avoid pocket formation and gingival recession. 
The following study evaluated the stability of buccal soft tissue around implants connected with a concave design abutment
A data set consisting of 96 patients with 225 implants (mean follow-up: 10.9 years) was utilized. Implants were divided into bone level and tissue level groups and radiographs were analyzed to determine the restoration emergence angles, as well as restoration profiles (convex or concave).
Eighty-three patients with 168 implants met inclusion criteria. The prevalence of peri-implantitis was significantly greater in the bone level group when the emergence angle was >30 degrees compared to an angle ≤30 degrees (31.3% vs 15.1%, P=0.04). 
For bone level implants, when a convex profile was combined with an angle of >30 degrees, the prevalence of peri-implantitis was 37.8% with a statistically significant interaction between emergence angle and profile (p = 0.003) in conclusion emergence angle of >30 degrees is a significant risk indicator for peri-implantitis and convex profile creates an additional risk for bone level implants [1.3].

Image [1.6] 

 

Long-term radiographic follow-up of "platform-switched" restored wide-diameter dental implants has demonstrated a smaller than expected vertical change in the crestal bone height around these implants than is typically observed around implants restored conventionally with prosthetic components of matching diameters [1.1]. 
Ten studies with 1,239 implants were included. The marginal bone loss around platform-switched implants was significantly less than around platform-matched implants (MD: -0.37; 95% CI: -0.55 to -0.20; P <0.0001). No statistically significant difference was detected for implant failures between the two groups (RR: 0.93; 95% CI: 0.34 to 2.95; P = 0.89). Subgroup analyses showed that an implant-abutment diameter difference > or= 0.4 was associated with a more favorable bone response [1.2].

 

Another important factor to take into consideration is The surface of an implant and the type of alloy used in the fabrication of the implant which determines its ultimate ability to integrate into the surrounding tissue surface

Many studies of sandblasting (to produce macrotexture) followed by acid etching (to produce a final microtexture) showed greater osteoconductive and higher capability to induce cell proliferation, in fact sandblasted and acid etching implants tend to promote greater osseous contact at earlier time points when compared with coated implants at 3 and after 12 months of loading.

The implant surfaces are blasted with titanium dioxide and subjected to a dilute hydrofluoric acid solution at a constant pH and temperature. Fluoride ions bind to the titanium forming fluoroxides. The fluoride constituent stimulates bone growth along the implant-bone interface, so you have bone matrix growing from the walls of the implant as well as bone growing from the lateral walls of the osteotomy. This is similar to the use of titanium hexafluoride to stimulate the remineralization of enamel, and as matter of dental implant surface this is the future and best option for osseo-integration.

Implant bodies and components are prone to fatigue fractures, with incidence reported between 1% to 4%, after 10 years of loading .

 [1.5] (pag 609)   

Different materials have varying degrees of resistance to repeated loading and subsequent fatigue-related fractures. The fatigue strenght of titanium alloy Ti-6Al-4V is four times grater and safer than grade 1 titanium and and almost two time greater than grade 4 titanium. In conclusion titanium alloy Ti-6Al-4V has been shown to exhibit the most attractive combination of mechanical and physical properties, corrosion resistance and general biocompatibility of all metallic biomaterials. 

 [1.5] pag 223  

Consider our AXIS implant
A Conical screw-type implant designed to ensure superior primary stability and fast osseo-integration in the most complicated cases

Features
Advanced design to ensure superior primary stability
Enables accurate and firm insertion using dedicated tools.
Geometry based on platform switching allows for biological space
Available in a complete range of lengths and diameters
Connection
Internal hexagon dia. of 2.44mm
Prevents implant/abutment rotation
Provides positioning indication
Provides accurate and firm insertion using dedicated tools
Top
4 micro threads at the top of the implant decrease the stress in the crestal zone
and increase the contact area in the cortical bone.
Geometry
Wide pitch progressive thread enables bone compression during insertion,
ultimately improving the bone's volume support, and positively affecting cancellous bone.
Surface
The micro surface achieved by blasting technology followed by acid etching results
in improved mechanical anchorage for better primary stability, and is optimal for cellular adhesion.
Apical
Self-tapping allows for exceptional cutting capabilities, and is responsible for increased stability
during insertion as the implant carves, fills, and compresses the bone.
 

References:

1.1  2006 Feb;26(1):9-17.

1.2  2010 Oct;81(10):1350-66. doi: 10.1902/jop.2010.100232.

1.3 Restoration contour is a risk indicator for peri-implantitis: A cross-sectional       radiographic analysis. Katafuchi M, Weinstein BF, Leroux BG, Chen YW, Daubert DM.

J Clin Periodontol. 2017 Oct 6. doi: 10.1111/jcpe.12829.

1.4 . 2010; 11(4): 1580–1678.

Published online 2010 Apr 12. doi:  10.3390/ijms11041580
 
1.5 Misch, 2008, Third Edition Contemporary Implant Dentistry, Mosby.  ( pag.3, 223,599, 609)
1.6 Journal of Cosmetic Dentistry, spring 2011/ vol 27 No. 1 Issue. The Integration of Critical Steps: Diagnosis, Treatment Planning, Workflow, and Teamwork in Anterior Restorations

 

               

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