Early host–microbe interaction in a peri‐implant oral mucosa‐biofilm model

The host‐microbe relationship is pivotal for oral health as well as for peri‐implant diseases. Peri‐implant mucosa and commensal biofilm play important roles in the maintenance of host‐microbe homeostasis, but little is known about how they interact. We have therefore investigated the early host‐microbe interaction between commensal multispecies biofilm (Streptococcus oralis, Actinomyces naeslundii, Veillonella dispar, Porphyromonas gingivalis) and organotypic peri‐implant mucosa using our three‐dimensional model. After 24 hr, biofilms induced weak inflammatory reaction in the peri‐implant mucosa by upregulation of five genes related to immune response and increased secretion of IL‐6 and CCL20. Biofilm volume was reduced which might be explained by secretion of β‐Defensins‐1, ‐2, and CCL20. The specific tissue reaction without intrinsic overreaction might contribute to intact mucosa. Thus, a relationship similar to homeostasis and oral health was established within the first 24 hr. In contrast, the mucosa was damaged and the bacterial distribution was altered after 48 hr. These were accompanied by an enhanced immune response with upregulation of additional inflammatory‐related genes and increased cytokine secretion. Thus, the homeostasis‐like relationship was disrupted. Such profound knowledge of the host‐microbe interaction at the peri‐implant site may provide the basis to improve strategies for prevention and therapy of peri‐implant diseases.     

Approaches to promoting bone marrow mesenchymal stem cell osteogenesis on orthopedic implant surface

Bone marrow-derived mesenchymal stem cells(BMSCs) play a critical role in the osseointegration of bone and orthopedic implant. However, osseointegration between the Ti-based implants and the surrounding bone tissue must be improved due to titanium's inherent defects. Surface modification stands out as a versatile technique to create instructive biomaterials that can actively direct stem cell fate. Here, we summarize the current approaches to promoting BMSC osteogenesis on the surface of titanium and its alloys. We will highlight the utilization of the unique properties of titanium and its alloys in promoting tissue regeneration, and discuss recent advances in understanding their role in regenerative medicine. We aim to provide a systematic and comprehensive review of approaches to promoting BMSC osteogenesis on the orthopedic implant surface.     

A novel rapid prototyping and finite element method-based development of the patient-specific temporomandibular joint implant

Objective: The objective of this study was to fabricate a successful implant for temporomandibular joint (TMJ) disorder patients who could not be treated through conventional surgeries.

Methods: A custom-made implant was fabricated using rapid prototyping (RP) for the TMJ surgery. The stability of the metallic implant was validated using a finite element analysis.

Results: The results of finite elements were stable and the design of the TMJ implant was suitable as per the patient's need. The customised implant was made using a fused deposition modelling method of RP and a vertical machining centre. The implant has provided normal jaw function for over 2 years since surgery.

Conclusions: The approach utilised will be helpful in providing successful treatment to the deformed mandible and the mandible joints. This method allows to customise and to accurately fabricatie the implant. Advantages of this approach are that the physical model of the implant was tested for stability before the implantation, the surgeon can plan and rehearse the surgery in advance, it is a less invasive and less time-consuming surgical procedure.     

Modelling the early phases of bone regeneration around an endosseous oral implant

The objective of this study was to see whether a mathematical model of fracture healing was able to mimic bone formation around an unloaded screw-shaped titanium implant as it is well-believed that both processes exhibit many biological similarities. This model describes the spatio-temporal evolution of cellular activities, ranging from mesenchymal stem cell migration, proliferation, differentiation to bone formation, which are initiated and regulated by the growth factors present at the peri-implant site. For the simulations, a finite volume code was used and adequate initial and boundary conditions were applied. Two sets of analyses have been performed, in which either initial and boundary condition or model parameter values were changed with respect to the fracture healing model parameter values. For a number of combinations, the spatio-temporal evolution of bone density was well-predicted. However reducing cell proliferation rate and increasing osteoblast differentiation and osteogenic growth factor synthesis rates, the simulation results were in agreement with the experimental data.     

Finite element analysis of peri-implant bone volume affected by stresses around Morse taper implants: effects of implant positioning to the bone crest

Abstract

Objectives: The purpose of the present study was to evaluate the distribution and magnitude of stresses through the bone tissue surrounding Morse taper dental implants at different positioning relative to the bone crest. Materials and Methods: A mandibular bone model was obtained from a computed tomography scan. A three-dimensional (3D) model of Morse taper implant-abutment systems placed at the bone crest (equicrestal) and 2?mm bellow the bone crest (subcrestal) were assessed by finite element analysis (FEA). FEA was carried out on axial and oblique (45°) loading at 150 N relatively to the central axis of the implant. The von Mises stresses were analysed considering magnitude and volume of affected peri-implant bone. Results: On vertical loading, maximum von Mises stresses were recorded at 6-7?MPa for trabecular bone while values ranging from 73 up to 118?MPa were recorded for cortical bone. On oblique loading at the equiquestral or subcrestal positioning, the maximum von Mises stresses ranged from 15 to 21?MPa for trabecular bone while values at 150?MPa were recorded for the cortical bone. On vertical loading, >99.9vol.% cortical bone volume was subjected to a maximum of 2?MPa while von Mises stress values at 15?MPa were recorded for trabecular bone. On oblique loading, >99.9vol.% trabecular bone volume was subjected to maximum stress values at 5?MPa, while von Mises stress values at 35?MPa were recorded for >99.4vol.% cortical bone. Conclusions: Bone volume-based stress analysis revealed that most of the bone volume (>99% by vol) was subjected to significantly lower stress values around Morse taper implants placed at equicrestal or subcrestal positioning. Such analysis is commentary to the ordinary biomechanical assessment of dental implants concerning the stress distribution through peri-implant sites.     

The influence of implant number and abutment design on the biomechanical behaviour of bone for an implant-supported fixed prosthesis: a finite element study in the upper anterior region

It is always recommended to use more implants for supporting a prosthesis in the immediate loading condition than in the classical two-stage treatment procedure. By means of the finite element (FE) method, the influence of the number of implants used in immediately loaded fixed partial prosthesis (FPP) on the load distribution was investigated, considering the abutment geometry. Two 3D FE models were studied employing four implants to support a FPP in the premaxilla. One model was designed with straight abutments and the other with 20°-angled abutments. The results concerning implant displacements, stresses and strains were compared with those of two implant-supported FPPs, obtained in a previous study. A noticeable reduction in the determined biomechanical bone loading was observed with the use of more implants in supporting an immediately loaded prosthesis. This study confirms that the use of additional numbers of implants in an immediately loaded prosthesis is highly recommended.     

Influence of connection type on the biomechanical behavior of distal extension mandibular removable partial dentures supported by implants and natural teeth

Few studies are performed to evaluate the influence of connection type on the stress distribution of distal extension mandibular removable partial dentures (RPDs) supported by both implants and natural teeth. In this study, five three-dimensional finite element models were prepared to simulate mandibular bilateral partially edentulous arches. Four were RPDs supported by both implants and natural teeth, and the other one was RPDs supported only by natural teeth. The maximum equivalent (EQV) stress values of bone around implants, the abutments, and the mucosa displacements of the related supporting structures were measured. It was found that a non-rigid telescopic coping was more favorable to protect the implant than a rigid telescopic coping. Compared with other connection types, the easy resilient attachment (ERA) system seemed to be effective to associate implant without complications. However, the results obtained in the present study should be cautiously interpreted in the clinic.     

Mechanical response comparison in an implant overdenture retained by ball attachments on conventional regular and mini dental implants: a finite element analysis

This study investigates the bone/implant mechanical responses in an implant overdenture retained by ball attachments on two conventional regular dental implants (RDI) and four mini dental implants (MDI) using finite element (FE) analysis. Two FE models of overdentures retained by RDIs and MDIs for a mandibular edentulous patient with validation within 6% variation errors were constructed by integrating CT images and CAD system. Bone grafting resulted in 2 mm thickness at the buccal side constructed for the RDIs-supported model to mimic the bone augmentation condition for the atrophic alveolar ridge. Nonlinear hyperelastic material and frictional contact element were used to simulate characteristic of the ball attachment-retained overdentures. The results showed that a denture supported by MDIs presented higher surrounding bone strains than those supported by RDIs under different load conditions. Maximum bone micro strains were up to 6437/2987 and 13323/5856 for MDIs/RDIs under single centric and lateral contacts, respectively. Corresponding values were 4429/2579 and 9557/5774 under multi- centric and lateral contacts, respectively. Bone micro strains increased 2.06 and 1.96-folds under single contact, 2.16 and 2.24-folds under multiple contacts for MDIs and RDIs when lateral to axial loads were compared. The maximum RDIs and MDIs implant stresses in all simulated cases were found by far lower than their yield strength. Overdentures retained using ball attachments on MDIs in poor edentulous bone structure increase the surrounding bone strain over the critical value, thereby damaging the bone when compared to the RDIs. Eliminating the occlusal single contact and oblique load of an implant-retained overdenture reduces the risk for failure.