Library

Notes: Abstract Osteoblasts respond to surface topography with altered morphology, proliferation, and differentiation. The effects observed vary with cell culture model and the topographical features of the surface. In general, increased surface roughness is associated with decreased proliferation and increased differentiation. Cell responses to hormones, growth factors, and cytokines are altered as well, as is autocrine production of these factors. The cells interact with the surface via integrin receptors, and their expression is also surface roughness-dependent. Integrin binding to cell attachment proteins activates signal transduction cascades, including those mediated by protein kinase C and phospholipase A2. These signaling pathways are also used by regulatory factors, which results in synergistic responses. Prostaglandins are important mediators of the surface effects, and both constitutive and inducible cyclooxygenase are involved.

Notes: Abstract: Prostaglandin E2 (PGE2) and transforming growth factor-beta1 (TGF-β1) production are increased in cultures of osteoblasts grown on rough surfaces and prostaglandins are involved in osteoblast response to surface roughness. In the present study, we examined the effect of inhibiting cyclooxygenase on this response. MG63 osteoblast-like cells were cultured on cpTi disks with Ra values of 0.60 μm (PT), 3.97 μm (SLA), and 5.21 μm (TPS) in the presence or absence of 10−7 M indomethacin. Treatment was begun on days 1, 2, 3, or 4 after seeding, and all cultures were harvested on day 5. Indomethacin decreased PGE2 release by the cells to less than 50% of basal levels when the cells were cultured on plastic. Cell number decreased with increasing surface roughness and indomethacin treatment abrogated the surface roughness effect over time. Alkaline phosphatase specific activity (ALP) increased with surface roughness; after one day with indomethacin, ALP was decreased on smooth surfaces, but increased on rough surfaces. Over time, ALP decreased on all surfaces examined and remained greater than plastic only in cultures on TPS. Indomethacin also caused a time-dependent decrease in osteocalcin production on rough surfaces, eventually abrogating the increases due to surface roughness, but had no effect on osteocalcin production on smooth surfaces. TGF-β1 levels in the cell layer and media were sensitive to surface roughness; on rougher surfaces, TGF-β1 shifted from the media to the matrix. Indomethacin reduced TGF-β1 levels over time, but the surface roughness effect was still evident at 4 days. This indicates that prostaglandin production mediates the effects of surface roughness, since indomethacin causes a time-dependent abrogation of the response, but has no effect on proliferation, osteocalcin release, or TGF-β1 levels on smooth surfaces. Indomethacin’s effect was not immediate, suggesting that clinical protocols could be designed that would reduce inflammation without preventing osteoblastic differentiation. The effect of indomethacin was not complete, since TGF-β1 and ALP remained elevated on rough surfaces, suggesting that pathways or factors other than prostanoids are involved. TGF-β1 is preferentially stored in the matrix, acting on the cells through autocrine signaling, and may contribute to ALP even in the presence of indomethacin. These results demonstrate the importance of local factors in the autocrine regulation of osteogenesis and the potential for factors released in response to surface morphology to act in a paracrine manner.

Notes: Summary: ITI® dental implants are available with two bone-anchoring surfaces, a titanium plasma-sprayed (TPS) surface, and a recently introduced sandblasted and acid-etched (SLA) surface. Cell culture and animal tests demonstrate that the SLA surface stimulates bone cell differentiation and protein production, has large amounts of bone-to-implant contact, and results in large removal torque values in functional testing of the bone contact. As a result of these studies, a prospective human clinical trial was initiated to determine whether the 4.1 mm diameter SLA ITI® solid screw implants could be predictably and safely restored as early as six weeks after implant placement surgery. The protocol restricted the use of the reduced healing time to a) healthy patients with sufficient bone volume to surround the implant, and b) those patients who had good bone quality (classes I-III) at the implant recipient site. Patients with poorer bone quality (class IV) did not have restorations until 12 weeks after implant placement. The clinical trial is an ongoing multicenter trial, with six centers in four countries, and with follow-up over five years. The primary outcome variable was abutment placement with a 35 Ncm force, with no countertorque and no pain or rotation of the implant. A secondary outcome was implant success, as defined by no mobility, no persistent pain or infection, and no peri-implant radiolucency. To date, 110 patients with 326 implants have completed the one-year post-loading recall visit, while 47 patients with 138 implants have completed the two-year recall. Three implants were lost prior to abutment connection. Prosthetic restoration was commenced after shortened healing times on 307 implants. The success rate for these implants, as judged by abutment placement, was 99.3% (with an average healing time of 49 days). Life table analyses demonstrated an implant success rate of 99.1%, both for 329 implants at one year and for 138 implants at two years. In the 24-month period after restoration, no implant losses were reported for the 138 implants. These results demonstrate that, under defined conditions, solid screw ITI® implants with an SLA endosseous surface can be restored after approximately six weeks of healing with a high predictability of success, defined by abutment placement at 35 Ncm without countertorque, and with subsequent implant success rates of greater than 99% two years after restoration.

Notes: Abstract: Lateral ridge augmentation has become a standard treatment option to enhance the bone volume of deficient recipient sites prior to implant placement. In order to avoid harvesting an autograft and thereby eliminating additional surgical procedures and risks, bone grafting materials and substitutes are alternative filler materials to be used for ridge augmentation. Before clinical recommendations can be made, such materials must be extensively studied in experimental models simulating relevant clinical situations. The present pilot study was conducted in three dogs. Different grafting procedures were evaluated for augmentation of lateral, extended (8×10×14 mm) and chronic bone defects in the mandibular alveolar ridge. Experimental sites received tricalcium phosphate (TCP) granules or demineralized freeze-dried bone allograft (DFDBA) particles. Barrier membranes (ePTFE) were placed for graft protection. These approaches were compared to ridge augmentation using autogenous cortico-cancellous block grafts, either with or without ePTFE-membrane application. After a healing period of six months, the sites were analyzed histologically and histomorphometrically. Autografted sites with membrane protection showed excellent healing results with a well-preserved ridge profile, whereas non-protected block grafts underwent bucco-crestal resorption, clearly limiting the treatment outcome. The tested alloplastic (TCP) and allogenic (DFDBA) filler materials presented inconsistent findings with sometimes encapsulation of particles in connective tissue, thereby reducing the crestal bone width. The present pilot study supports the use of autografts with barrier membranes for lateral ridge augmentation of extended alveolar bone defects.

Notes: Successful endosseous implant therapy requires integration of the implant with bone, soft connective tissue and epithelium. This report from a consensus conference on Straumann dental implants including the ITI® Dental Implant System documents the interaction of these nonsubmerged one-piece implants with the oral tissues and reviews clinical studies supporting the high success achievable with these implants in patients. Light and electron microscopy reveal that epithelial structures similar to teeth are found around the implants. A connective tissue zone exists between the apical extension of the junctional epithelium and the alveolar bone. This connective tissue comprises a dense circular avascular zone of connective tissue fibers surrounded by a loose vascular connective tissue. The histologic dimensions of the epithelium and connective tissue comprising the biologic width are similar to the same tissues around teeth. The nonsubmerged one-piece design of the Straumann implants, which have been used for over 20 years, has set a standard in implant dentistry, with other implants now being manufactured and placed using similar techniques. Straumann implants have an endosseous portion that is either coated with a well-characterized and well-documented titanium plasma-sprayed surface or is sandblasted and acid attacked. Both surfaces have been shown to have advantages for osseous integration compared to machined and other smoother implant surfaces. These advantages include greater amounts of bone-to-implant contact, more rapid integration with bone tissue, and higher removal torque values. The lack of component connection at or below the alveolar crest provides additional benefits. Component connection at the alveolar crest, as seen with submerged implants, results in microbial contamination, crestal bone loss and a more apical epithelial location. Numerous human clinical trials document the successful use of Straumann implants in a variety of indications and areas of the mouth. These include prospective long-term trials using strict criteria of success and life table analyses. Taken together, the clinical studies reveal that Straumann implants can be used predictably in partially edentulous and completely edentulous maxilla and mandibles with high success rates. Furthermore, the animal and microscopic studies reviewed provide a scientific basis for the integration of Straumann implants with bone, connective tissue and epithelium.

Notes: This study examined the effect of re-using coverscrews for dental implants (Brånemark) and the influence of re-use on clinical outcome. Nine patients, each receiving 3 implants in either the maxilla or the mandible, received 1 new coverscrew, 1 re-used coverscrew, and a third coverscrew that had been used multiple times. In all cases, the re-used coverscrews had been washed, mechanically cleaned, and steam-sterilized prior to re-implantation. Clinical outcome was assessed by X-ray analysis of the mandible/maxilla and light microscopy of histologically prepared sections of the overlying tissue. The surfaces of the coverscrews were characterized by profilometry, scanning electron microscopy (SEM), Auger electron spectroscopy (AES), and atomic force microscopy (AFM). There was no difference in clinical outcome whether the coverscrews were new or re-used multiple times. Histological evaluation showed no influence of re-use on the overlying epithelial and connective tissues at the time the coverscrew was removed. Surface topography and roughness changed with increasing number of uses, but surface chemistry was virtually unchanged. SEM and AFM analyses revealed the presence of machining marks, as well as deep scratches, across the surface of the re-used coverscrews. This study shows that coverscrews can be cleaned and re-used without any apparent adverse affect on clinical outcome. However, the cleaning procedures, as well as the surgical procedure, change the surface characteristics. If this approach were applied to the implant itself, it might affect osseointegration.

Notes: Objectives: The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) on periodontal healing following nonsurgical periodontal therapy (scaling and root planing – SRP).Material and methods: The study was performed as an intraindividual, longitudinal trial of 3 months duration with a double-blinded, split-mouth, controlled, and randomized design. Twenty-two patients with moderate to severe chronic periodontitis were enrolled in the study. In each patient, two sites with pocket depths 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE374:ges" location="ges.gif"/〉5 mm and with radiographic angular bone defects 〉3 mm were selected. Baseline examination included measurement of probing pocket depth (PPD) and clinical attachment levels (CAL). The presence or absence of plaque and bleeding on probing at selected sites was also recorded. Following initial examination, full-mouth SRP was performed. Study sites were then treated with 24% EDTA for 2 min, followed by thorough irrigation with sterile saline. The sites were then randomized. The experimental site received subgingival application of enamel matrix derivative (Emdogain®, BIORA AB, Malmo, Sweden). The control site received no additional treatment. At 3 months, all sites were re-examined. The response to therapy in experimental and control sites was evaluated, using change in probing depth and CAL as the primary outcome variables. Statistical analysis (paired t-tests) was used to compare response to treatment in control versus experimental sites.Results: Statistically significant changes in PPD and CAL were seen in both treatment groups from baseline to 3 months. The mean PPD reduction was 2.3±0.5 mm for control sites and 2.0±0.3 mm for experimental sites. The mean CAL gain was 1.8±0.4 mm for control sites, and 1.4±0.3 mm for experimental sites. Statistical analysis, however, revealed no significant difference in PPD reduction or CAL gain between experimental and control groups (p〉0.4). In addition, no difference was found between treatment groups in bleeding or plaque indices at 3 months.Conclusion: The findings from the present study do not support the use of EMD during routine, nonsurgical debridement of periodontal pockets as measured 3 months post SRP.

Notes: Research in implant dentistry has mainly focused on hard tissue integration with much less data available with regards to soft tissue integration involving epithelium and connective tissue. In the present study, the implantogingival junction of unloaded and loaded non-submerged titanium implants has been analyzed histometrically in the canine mandible. In 6 foxhounds, 69 implants were placed. Dogs in the unloaded group were sacrificed 3 months after implant placement. Loaded implants were restored with gold crowns and those dogs were sacrificed after 3 months and 12 months of loading. Non-decalcified histologic sections were analyzed histometrically measuring the dimensions of the Sulcus Depth (SD), the Junctional Epithelium (JE), and the Connective Tissue Contact (CTC). Histometric evaluation revealed that significant changes within tissue compartments (SD, JE, CTC) occurred over time (P〈0.05). Sulcus Depth had a mean of 0.49 mm and 0.50 mm after 3 months and 6 months of healing, but after 15 months was 0.16 mm which was significantly different. Similarly, the length of the Junctional Epithelium after 3 months and 6 months of healing was 1.16 mm and 1.44 mm, respectively, and these values were significantly different from measurements taken after 15 months (1.88 mm). The area of Connective Tissue Contact showed a different pattern of change in that after 3 months of healing (1.36 mm) it was significantly different from the same area after 6 months and 15 months which were 1.01 mm and 1.05 mm, respectively. Interestingly, the sum of SD, JE, and CTC, forming the Biologic Width, did not change over the observation period (P〉0.05). These data indicate that the Biologic Width is a physiologically formed and stable structure over time in the case of non-submerged, one-piece titanium implants as evaluated histometrically under unloaded and loaded conditions. Dynamic changes did occur, however, within the overall Biologic Width dimension. Thus, the use of non-submerged, one-piece implants allow for stable overall peri-implant soft tissues as evaluated under loaded conditions for up to 12 months.

Notes: Abstract: Gingival esthetics around natural teeth is based upon a constant vertical dimension of healthy periodontal soft tissues, the Biologic Width. When placing endosseous implants, however, several factors influence periimplant soft and crestal hard tissue reactions, which are not well understood as of today. Therefore, the purpose of this study was to histometrically examine periimplant soft tissue dimensions dependent on varying locations of a rough/smooth implant border in one-piece implants or a microgap (interface) in two-piece implants in relation to the crest of the bone, with two-piece implants being placed according to either a submerged or a nonsubmerged technique. Thus, 59 implants were placed in edentulous mandibular areas of five foxhounds in a side-by-side comparison. At the time of sacrifice, six months after implant placement, the Biologic Width dimension for one-piece implants, with the rough/smooth border located at the bone crest level, was significantly smaller (P〈0.05) compared to two-piece implants with a microgap (interface) located at or below the crest of the bone. In addition, for one-piece implants, the tip of the gingival margin (GM) was located significantly more coronally (P〈0.005) compared to two-piece implants. These findings, as evaluated by nondecalcified histology under unloaded conditions in the canine mandible, suggest that the gingival margin (GM) is located more coronally and Biologic Width (BW) dimensions are more similar to natural teeth around one-piece nonsubmerged implants compared to either two-piece nonsubmerged or two-piece submerged implants.