Bone Reformation and Implant Integration following Maxillary Sinus Membrane Elevation: An Experimental Study in Primates
Vinícius Canavarros PalmaOsvaldo Magro FilhoJosé Américo De OliveriaStefan LundgrenLuiz Antônio SalataLars Sennerby
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ABSTRACT Background: Recent clinical studies have described maxillary sinus floor augmentation by simply elevating the maxillary sinus membrane without the use of adjunctive grafting materials. Purpose: This experimental study aimed at comparing the histologic outcomes of sinus membrane elevation and simultaneous placement of implants with and without adjunctive autogenous bone grafts. The purpose was also to investigate the role played by the implant surface in osseointegration under such circumstances. Materials and Methods: Four tufted capuchin primates had all upper premolars and the first molar extracted bilaterally. Four months later, the animals underwent maxillary sinus membrane elevation surgery using a replaceable bone window technique. The schneiderian membrane was kept elevated by insertion of two implants (turned and oxidized, Brånemark System®, Nobel Biocare AB, Göteborg, Sweden) in both sinuses. The right sinus was left with no additional treatment, whereas the left sinus was filled with autogenous bone graft. Implant stability was assessed through resonance frequency analysis (Osstell TM , Integration Diagnostics AB, Göteborg, Sweden) at installation and at sacrifice. The pattern of bone formation in the experimental sites and related to the different implant surfaces was investigated using fluorochromes. The animals were sacrificed 6 months after the maxillary sinus floor augmentation procedure for histology and histomorphometry (bone‐implant contact, bone area in threads, and bone area in rectangle). Results: The results showed no differences between membrane‐elevated and grafted sites regarding implant stability, bone‐implant contacts, and bone area within and outside implant threads. The oxidized implants exhibited improved integration compared with turned ones as higher values of bone‐implant contact and bone area within threads were observed. Conclusions: The amount of augmented bone tissue in the maxillary sinus after sinus membrane elevation with or without adjunctive autogenous bone grafts does not differ after 6 months of healing. New bone is frequently deposited in contact with the schneiderian membrane in coagulum‐alone sites, indicating the osteoinductive potential of the membrane. Oxidized implants show a stronger bone tissue response than turned implants in sinus floor augmentation procedures.Keywords:
Sinus (botany)
Bone grafting
Resonance frequency analysis
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Achievement and maintenance of implant stability are prerequisites for long-term positive outcomes for osseointegrated implants. Thus, implant stability is the key to clinical success. Until recently, it was not possible for the clinician to predictably distinguish implants with different degrees of stability. Because there seems to be a correlation between implant failure and bone properties, it is possible that clinically firms implants with poor stability are more prone to failure than more stable implants. This article discusses the development and possible future use of a novel technique for clinical measurement of implant stability and osseointegration--resonance frequency analysis.
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This paper aims to establish the parameters necessary to monitor successful implant placement and osseointegration.Implant stability is considered to play a major role in the success of osseointegration. Primary implant stability at placement is a mechanical phenomenon that is related to the local bone quality and quantity, the type of implant and placement technique used. Secondary implant stability is the increase in stability attributable to bone formation and remodeling at the implant/tissue interface and in the surrounding bone. Techniques for measuring implant stability and osseointegration, including the clinical measurement of cutting resistance during implant placement and removal torque following osseointegration, are discussed. Nondestructive test methods, including impact-based techniques such as the Periotest and the Dental Fine Tester, are also discussed. An alternative method, resonance frequency analysis, is described in detail.It is clear that stability both at placement and during function is an important criterion for the success of dental implants. Quantitative methods, including resonance frequency analysis, can yield valuable information.
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The stability of the implant at the time of placement and during the development of the osseointegration process are the two major issues governing the implant survival. Implant stability is a mechanical phenomenon related to local factors such as bone quality, quantity, type of placement technique and type of implant used. The application of a user-friendly, clinically reliable, non-invasive method to assess implant stability and the osseointegration process is considered highly desirable. Resonance frequency analysis (RFA) is one such method which shows almost perfect reproducibility and repeatability after statistical analysis. The aim of this paper is to review the various methods used to assess implant stability and on the currently used RFA method which is being highly accepted in the recent times.
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For a desired osseointegration to take place, implant stability plays an expository role. Hence to achievea functional dental implant, successful osseointegration is a necessity. The two major factors affect thesurvival of implants that is the stability of the implant during placement and the event of osseointegration.Two separate phases determine the stability of implant: Primary implant stability as well as secondaryimplant stability. Mechanical grip withthe cortical bone determines the primary stability whereas Secondarystability is due to regeneration as well asremodelling of the surrounding bone and surrounding tissue aroundthe implant after loading. Implant stability is a mechanical phenomenon which is in association with localfactors such as quality of bone, type of placement technique used, quantity and the type of implant used. It isconsidered highly advisable for implementation of a user-friendly, non-invasive, clinically reliable methodto assess the stability of the implant and the osseointegration process. Resonance frequency analysis (RFA)is one of the method thats how almost perfect consistency after statistical analysis. Therefore, the focus ofthis currentre view article is particularly on presently used RFA method which are highly followed in thecurrent times to elicit oral implant stability.
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Objective To study the effect of different insertion torque values on implant stability and osseointegration by the means of Resonance Frequency Analysis. Methods 49 patients were chosen randomly according to the following standards,with 86 screws implanted. Furthermore,the same experienced clinician finished all surgeries. All implants were divided into three groups based on the insertion torque values: Group A,Itv 0 ~ 15 N·cm; Group B,Itv 20 ~ 40 N·cm; Group C,Itv 40 N·cm. The dental implant stability was measured to evaluate the osteointegration by Resonance frequency analysis when implants were placed immediately and at the time point of 8 weeks and 12 weeks after the surgeries. Results 1ISQ improved as the time extended in all groups. Statistical difference was shown in low and medium group while there' s no significant difference in high insertion torque value groups. 2 Low ISQ group showed the most obvious increase during 8 weeks; there was no significant difference among the three groups in 8 week and 12 week.Conclusions The 8-week time point is a critical time for implants healing to develop a high-quality osseointegration. What is more,there was no obvious difference of the osseointegration observed at the 8-week time point when ISQ changed among the groups.
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Dental implant treatment is an excellent option for prosthetic restoration that is associated with high success rates.Implant stability is essential for a good outcome.The clinical assessment of osseointegration is based on mechanical stability rather than histological criteria, considering primary stability (absence of mobility in bone bed after implant insertion) and secondary stability (bone formation and remodelling at implant-bone interface).The aim of this study was to review the literature on Resonance Frequency Analysis (RFA) as a method for measuring dental implant stability.An online search of various databases was conducted on experimental and clinical research published between 1996 and 2008.The studies reviewed demonstrate the usefulness of RFA as a non-invasive method to assess implant stability.Further research is required to determine whether this system is also capable of measuring the degree of dental implant osseointegration.
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Osseointegration is defined as the direct structural and functional connection between neo-formed bone and dental implants. Among the parameters suggested to predominantly influencing the establishment of a successful osseointegration is the quality of the implant surface, which may enhance the strength and speed of this biomechanical process.The purpose of this study was to evaluate the ability of a novel laser-treated surface, compared to sandblasted, large-grit, acid-etched (SLA) surfaces, to enhance and accelerate implant integration in delayed implant placement.Methods: Thirty patients with two missing posterior teeth were enrolled in this study. Each patient received, at a randomly allocated site, an implant with a conventional SLA surface, and at a second site, an implant with laser-textured surface. A total of 60 tissue-level implants were subsequently placed. Implant stability (ISQ) was measured using resonance frequency analysis (RFA). ISQ was assessed at baseline (T0), 8 weeks (T1), and 12 weeks (T2) following implant placement. Results: There was a statistical difference in implant stability between laser-textured and SLA group at 12 weeks postoperatively. Implant stabilization showed a successful osseointegration with both surface types.Both laser and SLA surface treatments had positive impacts on implant stabilization following delayed placement. Laser-treated surfaces presented higher values of osseointegration at 3 months postoperatively.
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