Research and Technology: A Forum
&NA; · Implant Dentistry · 2002
Editors’ Note: The mission of Implant Dentistry is that it “is committed to the presentation of material which represents the knowledge and concerns of all implant team members—clinicians, researchers, educators, technicians, auxiliary personnel, and industry representatives. The intention is to represent the totality of the field.” It is in this vein that industry members are given the opportunity to share both basic and advanced education materials with readers of this Journal. At this time, for this issue, the 3i Implant Innovations, Inc. has submitted abstracts of a symposium. This segment does not imply the endorsement of products by Implant Dentistry or the ICOI. It is strictly a vehicle for the sharing and dissemination of implant-related materials. Bioengineering and Innovations in Implant Dentistry …A Global Research and Technology Forum, hosted by 3i on February 1–2, 2002 at the PGA National Resort in Palm Beach Gardens, Florida About the program: Significant advances are being made in the field of implant dentistry. The bioengineering of dental implant surfaces, together with new restorative and regenerative technologies, is providing exciting changes in protocol and approaches to treatment. Evidence-based research supporting performance claims should be continuously provided to give clinicians the opportunity to select clinical tools based on science and not marketing. Bioengineering and Innovations in Implant Dentistry, a Global Research and Technology Forum hosted by 3i, was held on February 1–2, 2002 at the PGA National Resort in Palm Beach Gardens, Florida. This 2-day program, moderated by Dr. Richard Lazzara, included presentations from 17 international clinicians and researchers representing research performed at 18 universities, in 13 countries, with over 28 investigators evaluating over 3,000 Osseotite implants in clinical studies. The presenters discussed their findings on the Osseotite implant in preclinical laboratories and animal models, as well as in human clinical trials. The Forum focused on the full circle of research covering all aspects of the Osseotite surface, from feasibility, development, animal and human histologic research, to long-term clinical trial results. Clinician experiences in a variety of settings and patient subsets were reviewed, validating research findings with results obtained in everyday clinical practice. The presentations and panel discussions provided the more than 250 attendees from around the globe with a stronger foundation and understanding of the evidence-based research available to support the Osseotite implant and stimulate insights into potential implications to patient treatment protocols. New technologies designed to increase the number of patients who are candidates for dental implants were also discussed. Presented in a case presentation format that allowed the audience to actively participate, these technologies included new implant types, new restorative systems, and new regenerative materials that have recently been introduced to help enhance clinical practice. The Basis of Osseointegration (1) Title: Mechanisms of Endosseous Integration: Basic Concepts of Early Healing Speaker: John E. Davies, BDS, PhD, DSc, FSBE Background: Rapid early healing is of critical importance for stabilization of endosseous implants placed in predominantly trabecular bone such as the posterior maxilla. Such early healing has been phenomenologically subdivided into two phases: osteoconduction and bone formation. Osteoconduction is defined as the migration of osteogenic cells to the implant surface. This migration occurs through the remnants of the blood clot at the implantation site. Methods: While migration occurs through the three-dimensional matrix provided by the fibrin of the clot, it can be accelerated by the release of cytokines by blood-borne cells, particularly platelets, which are trapped within the clot. If the fibrin clot is retained by the osteoconductive implant surface, then the osteogenic cells will form bone at the implant surface resulting in a bone/implant interface typical of “contact osteogenesis.” Alternatively, nonconductive implant surfaces allow retraction of the blood clot, and bone is formed on the surrounding bone surface instead of on the implant. This phenomenon is termed “distance osteogenesis.” Results: The performance article provides an overview of these phenomena and the influence of implant surface on these early healing events. Davies JE. Mechanisms of endosseous integration. Int J Prosthodont. 1998;11:391–401. (2) Title: The Göteborg Study on the Osseotite Bone Interface Speaker: Ingemar Abrahamsson, DDS, PhD Background: The aim of this experiment was to study the periimplant soft and hard tissues formed at titanium implants with different surface configurations. Methods: In this study, five beagle dogs, about 1-year old, were used. The mandibular premolars and the first, second, and third maxillary premolars were extracted. Three months later, eight titanium fixtures, four self-tapping machined-surfaced standard fixtures (SF) (3.75 × 8.5 mm), and four Osseotite fixtures (OF) (3.75 × 8.5 mm) were installed. Three months later, abutment connection was performed. A 6-month plaque control period was initiated. At the end of this period, a clinical examination regarding plaque and soft tissue inflammation was performed. Radiographs were obtained at the time of implant installation, abutment connection, and final examination. The animals were sacrificed and perfused by a fixative through the carotid arteries. The mandibles were removed and each implant region was dissected. From each animal, four units, two of each implant type (OF and SF), were processed and embedded in EPON. The remaining biopsies were processed for ground sectioning. The histometric measurements revealed figures describing (1) the height of the mucosa; (2) the length of the junctional epithelium; (3) the height and quality of the zone of connective tissue integration; and (4) the marginal level of bone-to-implant contact that was similar for the SF and OF sites. The ground sections were used for measurements, describing (1) “bone-to-implant contact,” and (2) “bone density.” The assessments were made in two different zones. Zone I represented the contact area measured from B, the marginal level of bone-to-implant contact, to a position 4 mm above the “apex” of the fixture, and zone II represented the apical 4 mm below of the fixture. Results: The analysis of bone-to-implant contact, ie, the length fraction (%) of mineralized bone that was in direct contact with the implant surface was for the SF sites 56.1% in zone II and 58.1% in zones I+II. The corresponding figures for the OF sites were 76.7% and 72.0%, respectively. These differences between the two implant types were statistically significant. When the periimplant bone density (proportion of mineralized bone) was assessed, similar values were found for the standard and the Osseotite fixtures in the areas between the threads as well as outside the threads. These similarities were consistent within zone I as well as zone II. Abrahamsson I, Zitzmann NU, Berglundh T, et al. Bone and soft tissue integration to titanium implants with different surface topography: An experimental study in the dog. Int J Oral Maxillofac Implants. 2001; 16:323–332. (3) Title: Human Histologic Comparison of Osseotite and Machined Surfaces in Different Bone Qualities Speaker: Paolo Trisi, DDS, PhD Background: A human histologic study was conducted to compare the percentage of bone-to-implant contact (BIC) at 6 months for Osseotite and machined, commercially pure titanium implant surfaces in the same patient. Methods: To eliminate potential influences caused by differences in bone density of different intraoral locations, 2 × 5 mm threaded, two-surfaced titanium implants were manufactured. the Osseotite surface and the a surface. In each of implant was placed in the posterior and bone) dental implant 6 months of the implants were and the implants and surrounding hard tissue were Results: Histologic analysis that at 6 months of the for the Osseotite surface was statistically than the for the surface When the values for the and Osseotite surface were from to based on the of to was for the Osseotite surfaces and for the surfaces, in the or quality bone surface In the or bone quality surface the was for the Osseotite surfaces and for the between values for the two surfaces in both the and were statistically The results of this study that in the quality bone found in the posterior a statistically percentage of bone Osseotite surfaces with surfaces on the same in the same patient. T, et al. A human histologic analysis of Osseotite and surfaces implants with two Int J The of Osseotite (1) Title: of Implant and Bone on Speaker: DDS, Background: The of this study is to the of Osseotite implants placed to support Methods: Osseotite implants were placed a and the healing time for the and 6-month healing time for the maxilla. implants were with Results: The study of patients with The of the patients at implant was of the patients were and of the patients and of the implants were placed in the posterior in locations, in the and in the mandibular the implants were placed in soft in and in 4 of with a time of a was in the implants that were implant was with a of patients with two implants were to with of implants the This study that Osseotite implants have a of supporting in both the and posterior of the the implant that was a of is et al. 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A study evaluating of Osseotite implants two months results. 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This the implant surface to a blood clot and form an The of the implant surface to the clot is to an have a implant of Osseotite implants with which the clinical of implant surface in to implant (4) Title: for Speaker: DDS, Background: an in the long-term and of dental implants and the clinicians to implant is an in implant for clinicians to implants with abutment can be into (1) (2) and (3) with each type and Methods: An of the abutment is the or titanium This type of abutment provides the the control of abutment and the to the position of the final as it through the soft The abutment is an with the of to a that is and to the of materials and this is the type of of the abutment to the implant can be the and To the of the area of the abutment that the not should be used to from these should not be used of the in by the and the for a between the implant and the This abutment as a titanium The is than the final abutment to allow for of the abutment a The final of this abutment is through the of material This of abutment is available with that can be to the of the with an abutment that is than the final of the abutment the to abutment and height and the position of the final by more material from of the abutment and material from the of the titanium abutment (1) (2) as is or used in (3) can be to and (4) can be at the of titanium can have a on soft 3i has introduced the titanium abutment that soft tissue by the titanium all are to be used in the new abutment be such as the and the are to be used in their form as are to their of the and the to the abutment or position of the Results: type of abutment has of and by the is based on the of each of these abutment types to the clinical Title: to Healing Speaker: Background: have been as the of all The and of which These have been to influence and The has been that the of into and will To as well as case to support the quality human research has to Methods: A for the of with a was The the of of blood with 6 of The blood is to a soft at of the interface a hard at and the of the in a of The of in of 2 is with this can be by the of a of in the form of a of be to the of to Results: the of dental implants as to that of the regenerative to case with of the clinical in of 4 sites and cells to to and to their the of bone materials that not cells of to the be such time as human are the of in the regenerative or for bone be as the standard of areas of for the of soft tissue healing as well as in and Title: of Implant Speaker: Richard Lazzara, Background: An was made of a new implant which of a mm) with an of the implant were also which included with standard mm and mm) with 6 mm The from these implant (1) in the for in and (2) the to implant for restorative and these allowed which the of implant are Methods: The clinical that were the of a Osseotite implant in in the mandibular area were as a of of the implant the for and allowed a to be placed within 2 months of in to a This implant is also being placed in mandibular the standard was to be placed within the bone between the of the and the into the A protocol and time to were to be and the for the for was also in the maxillary bone were and the of a with a standard mm allowed a of this were in the Results: In the areas were than 5 mm of bone the maxillary and implant was made of the to into the This allowed the of bone and implant the same which the patient an and at 6 months of treatment The provides the with that healing time, and This is of to the implant and of the of patients who will implant of the of the