The comparison of marginal bone loss around mandibular overdenture‐supporting implants with two different attachment types in a loading period of 36 months

doi:10.1111/j.1741‐2358.2009.00334.x
The comparison of marginal bone loss around mandibular overdenture‐supporting implants with two different attachment types in a loading period of 36 months Objective: The aim of this study was to assess the influence of attachment types on the marginal bone loss (MBL) around dental implants supporting mandibular overdentures (OVD). Background: There are a number of in vitro studies evaluating the influence of several factors on MBL around implants. Material and methods: Mandibular OVD patients appearing at routine recall sessions consecutively 6, 12, 24 and 36 months after loading were included in the study group. All patients received mandibular OVD with either ball or bar attachments. Measurements were obtained from images of successive radiographs, which were scanned and digitised before, and analysed at ×20 magnification. Statistical analyses were utilised in this study to assess the mean marginal bone level changes as well as to explore the potential effect of several parameters such as the cantilever or the attachment type on bone loss. Results: One hundred and twenty‐six implants in 51 patients with a mean age of 59.39 ± 9.99 years were evaluated. There was no statistical significant difference between the distal and mesial bone loss rates of single or splinted attachment types, whereas bone loss rates were statistically higher in cantilever situations. Conclusion: Within the limitations of this study, gender, age and diameter of the implants do not play a role in MBL. Length of the implant is an important factor in marginal bone level maintenance. The attachment type for OVD support seems not to influence MBL, but cantilevering of the bars increases bone loss significantly.     

Elders with implant overdentures: a 22-year clinical report

doi: 10.1111/j.1741‐2358.2012.00628.x Elders with implant overdentures: a 22‐year clinical report Objective: To report on the long‐term survival and prosthodontic maintenance of two edentulous adults with mandibular overdentures supported by hydroxyapatite (HA)‐coated implants. Background: Mandibular implant overdentures are a successful treatment option with positive impact on the quality of life of elderly edentulous adults. Long‐term survival of the implants requires continued rigorous prosthodontic maintenance. Clinical report: Two elderly edentulous adults with mandibular overdentures supported by 2 HA‐coated implants were presented for prosthodontic rehabilitation after 22 years of placement. The implants were osseo‐integrated and surviving at presentation based on accepted criteria. The mandibular implant overdentures suffered recurrent loss of retention and stability. Prosthodontic treatment involving the replacement of defective attachment systems and construction of new sets of mandibular implant overdentures opposing complete maxillary dentures is presented. Conclusion: The long‐term survival of mandibular 2‐implant overdentures requires continued prosthodontic maintenance. A conservative approach in the rehabilitation of two older edentulous adults with mandibular 2‐implant overdentures was described including proper selection of attachment systems.     

Long term follow-up of reconstruction with allogeneic mandibular bone crib packed with autogenous particulate cancellous bone marrow

Allogeneic mandibular bone processed by the deep frozen method was used as a biologic crib for mandibular reconstruction. The allogeneic mandible is biocompatible, bioresorbable, of low antigenicity and provides the morphology for symphysis contour, angle of mandible and dental arch form. The particulate cancellous bone marrow (PCBM) contains marked osteogenic potential of hematopoietic marrow, which promotes osteogenesis. The cancellous marrow graft lacks structure and requires a crib to house it during the bone regeneration to the consolidation phase. Fresh frozen mandible was hollowed out for packing with PCBM prior to securing it to the defect by a rigid fixation method. Four cases of large mandibular defects resulting from treatment of benign odontogenic tumors were reconstructed utilizing this technique. All cases showed excellent facial contour and function satisfactorily in mastication and pronunciation. Complete graft incorporation and restoration of the osseous continuities were observed for four to 12 years after the operation. This revised version was published online in July 2006 with corrections to the Cover Date.     

Predicting bone remodeling around tissue- and bone-level dental implants used in reduced bone width

The objective of this study was to predict time-dependent bone remodeling around tissue- and bone-level dental implants used in patients with reduced bone width. The remodeling of bone around titanium tissue-level, and titanium and titanium–zirconium alloy bone-level implants was studied under 100 N oblique load for one month by implementing the Stanford theory into three-dimensional finite element models. Maximum principal stress, minimum principal stress, and strain energy density in peri-implant bone and displacement in x- and y- axes of the implant were evaluated. Maximum and minimum principal stresses around tissue-level implant were higher than bone-level implants and both bone-level implants experienced comparable stresses. Total strain energy density in bone around titanium implants slightly decreased during the first two weeks of loading followed by a recovery, and the titanium–zirconium implant showed minor changes in the axial plane. Total strain energy density changes in the loading and contralateral sides were higher in tissue-level implant than other implants in the cortical bone at the horizontal plane. The displacement values of the implants were almost constant over time. Tissue-level implants were associated with higher stresses than bone-level implants. The time-dependent biomechanical outcome of titanium–zirconium alloy bone-level implant was comparable to the titanium implant.     

Extent and location of bone loss at dental implants in patients with peri-implantitis

Peri-implantitis is an infectious disease, which leads to loss of supporting bone around dental implants. To evaluate the extent and location of bone loss, 43 patients with peri-implantitis were examined. The bone loss was clinically measured at the time of dental surgery. Data revealed that 25% of subjects had bone loss associated with all their implants although the majority of the subjects had fewer than 50% of their implants affected by bone loss. A total number of 264 implants were examined and 131 of those had peri-implantitis associated bone loss. The pattern of bone loss at implants varied between and within subjects and location in the jaws. The highest proportion of implants with peri-implantitis was found in the upper jaw and within this group, at implants located in the incisor area of the upper jaw; the lowest was the canine area of the lower jaw. The highest proportion of implants that lost ≥ 2/3 of their bone support was found in the incisor area of the maxilla. We concluded that in the presence of peri-implant inflammation, bone quantity and characteristics may influence the progression of peri-implantitis bone loss at dental implants. We hypothesize that the ability of the bone to withstand occlusal forces will be altered as consequence of the loss of bone at the neck of the implants. To achieve an understanding of the local degradation of bone due to peri-implantitis, we need to analyze the microstructure of the bone as well the cellular biology of the peri-implant inflammation.     

A histological and biomechanical study of bone stress and bone remodeling around immediately loaded implants

Immediate loading(IL)increases the risk of marginal bone loss.The present study investigated the biomechanical response of peri-implant bone in rabbits after IL,aiming at optimizing load management.Ninety-six implants were installed bilaterally into femurs of 48 rabbits.Test implants on the left side created the maximal initial stress of 6.9 and 13.4 MPa in peri-implant bone and unloaded implants on the contralateral side were controls.Bone morphology and bone-implant interface strength were measured with histological examination and push-out testing during a 12-week observation period.Additionally,the animal data were incorporated into finite element(FE)models to calculate the bone stress distribution at different levels of osseointegration.Results showed that the stress was concentrated in the bone margin and the bone stress gradually decreased as osseointegration proceeded.A stress of about 2.0 MPa in peri-implant bone had a positive effect on new bone formation,osseointegration and bone-implant interface strength.Bone loss was observed in some specimens with stress exceeding 4.0 MPa.Data indicate that IL significantly increases bone stress during the early postoperative period,but the load-bearing capacity of peri-implant bone increases rapidly with an increase of bone-implant contact.Favorable bone responses may be continually promoted when the stress in peri-implant bone is maintained at a definite level.Accordingly,the progressive loading mode is recommended for IL implants.     

Modelling the effects of different fracture geometries and healing stages on ultrasound signal loss across a long bone fracture

The effect on the signal amplitude of ultrasonic waves propagating along cortical bone plates was modelled using a 2D Finite Difference code. Different healing stages, represented by modified fracture geometries were introduced to the plate model. A simple transverse and oblique fracture filled with water was introduced to simulate the inflammatory stage. Subsequently, a symmetric external callus surrounding a transverse fracture was modelled to represent an advanced stage of healing. In comparison to the baseline (intact plate) data, a large net loss in signal amplitude was produced for the simple transverse and oblique cases. Changing the geometry to an external callus with different mechanical properties caused the net loss in signal amplitude to reduce significantly. This relative change in signal amplitude as the geometry and mechanical properties of the fracture site change could potentially be used to monitor the healing process.     

间歇式轴向压应力对组织工程骨种子细胞的黏附增殖与成骨分化促进作用的研究

目的探究间歇式轴向压应力对组织工程骨种子细胞黏附、增殖与成骨分化能力的影响。 方法构建表达绿色荧光蛋白的兔骨髓间充质干细胞（rBMSCs）作为示踪种子细胞,运用旋转细胞培养仪将松质骨支架和种子细胞共培养7 d获得组织工程骨（TEB）,实验组在第7 ~ 14天施加大小10 N、频率1 Hz、4 h/d的间歇式轴向压应力刺激,对照组常规培养,14 d后胰酶消化法获取两组种子细胞并比较其黏附、增殖和成骨分化能力。采用两组独立样本t检验进行统计学分析。 结果（1）流式细胞术显示rBMSCs被成功提取分离。（2）倒置荧光显微镜及扫描电镜显示TEB中种子细胞与支架相容性良好。（3）活体荧光成像系统及扫描电镜显示应力刺激组种子细胞的生长状况要优于非应力刺激组,前者平均荧光密度及细胞数/500倍视野均大于后者,差异均具有统计学意义（平均荧光密度：（3.75±0.34）×10⁸ vs （2.91±0.22）×10⁸,t = 2.90,P = 0.04;细胞数/500倍视野：30.50±4.43 vs 21.00±5.13,t = 3.14,P = 0.01）。（4）细胞黏附实验显示,应力刺激组种子细胞的75%细胞贴壁时间短于非应力刺激组,两组时间分别为（3.00±0.41）h、（13.33±1.70）h,差异具有统计学意义（t = 8.20,P < 0.01）,前者的最终细胞贴壁率高于后者（99.97%±0.34% vs 85.83%±1.18%）,差异具有统计学意义（t = 11.31,P < 0.01）。（5）CCK-8检测显示,在培养第48 ~ 96 h,应力刺激组种子细胞的增殖能力优于非应力刺激组,将两者的450 nm吸光度值在第48小时（0.49±0.02、0.40±0.02）、72 h（0.76±0.07、0.64±0.04）和96 h（1.58±0.07、1.34±0.13）分别进行比较,差异均具有统计学意义（t = 5.15、2.57、2.86,P均< 0.01）。（6）在成骨诱导14 d后,应力刺激组种子细胞的ALP和Ca结节染色阳性率要强于非应力刺激组：两组ALP染色阳性率分别为26.73%±4.56%、16.68% ± 3.89%,差异具有统计学意义（t =3.33,P = 0.03）;两组Ca结节染色阳性率分别为41.81%±3.56%、27.40% ± 2.35%,差异具有统计学意义（t = 3.68,P = 0.02）。 结论间歇性轴向压应力可促进组织工程骨种子细胞的黏附、增殖与成骨分化。     

Effects of fibromyalgia on the disease activity and treatment of patients with axial spondyloarthritis

Objectives:To investigate whether patients with radiologically positive spondyloarthritis (SpA), suffer from comorbid fibromyalgia (FM), and to explore the impact of FM on the clinical manifestations and blood test results of patients with ankylosing spondylitis (AS).Methods:121 patients with spondyloarthritis (SpA) were enrolled in the study. The body function of the patients was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI); the mental health was evaluated using the Hospital Anxiety and Depression Scale (HADS).Results:Out of 121 patients with SpA, 111 patients were with axial spondyloarthritis (axSpA) and 11 patients with FM; 10 patients with peripheral SpA and 1 patient with FM. In axSpA, 107 were radiologically positive axSpA patients, 11 were complicated by FM, and 4 were radiologically negative axSpA (nr-axSpA). Among radiologically positive axSpA, the proportion of female patients in the FM group was higher (63.6%, P<0.05). The ASDAS-C-reactive protein (CRP), ASDAS-erythrocyte sedimentation rate (ESR), BASDAI, BASFI, and HADS-anxiety score, and HADS-depression score of the FM group were all significantly higher than those of the non-FM group.Conclusions:When determining the treatment plan for SpA, the possibility of coexistence of FM should be considered, and adjuvant treatment should be given when necessary.     

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.     

A repeated sampling bone chamber methodology for the evaluation of tissue differentiation and bone adaptation around titanium implants under controlled mechanical conditions

A repeated sampling bone chamber methodology was developed for the study of the influence of the mechanical environment on skeletal tissue differentiation and bone adaptation around titanium implants. Via perforations, bone grows into the implanted outer bone chamber, containing an inner bone chamber with a central test implant. An actuator—easily mounted on the outer bone chamber—allows a controlled mechanical stimulation of the test implant. After each experiment, the inner bone chamber—with its content—can be harvested and analysed. A new inner bone chamber with a central implant can be inserted consecutively in the outer bone chamber and a new experiment can start. Pilot studies led to a reliable surgical protocol and showed the applicability of the methodology, offering the possibility to study skeletal tissue differentiation and adaptation around implants under well-controlled mechanical conditions, and this protected from external loading. Repeated sampling of the bone chamber allows conducting several experiments within the same animal at the same site, thereby excluding subject- and site-dependent variability and reducing the amount of experimental animals.     

Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea

Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twenty‐five patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea‐hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4–6 weeks, 6 months, and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by 10 patients. Dental complications were observed in two patients. Sixty‐four per cent of the patients were still using the MAD at the 1‐year follow‐up. Conclusions: Both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.     

Manganese (III) cyclam complexes with aqua, iodo, nitrito, perchlorato and acetic acid/acetato axial ligands

The syntheses, structures and magnetic properties of five new manganese (III) cyclam complexes, trans-[Mn(cyclam)(OH₂)₂](CF₃SO₃)₃ · H₂O, trans-[Mn(cyclam)I₂]I, trans-[Mn(cyclam)(ONO)₂]ClO₄, trans-[Mn(cyclam)(OClO₃)₂]ClO₄ and trans-[Mn(cyclam)(CH₃COO)(CH₃COOH)](ClO₄)₂, are reported. Cyclam is the tetradentate amine ligand 1,4,8,11-tetraazacyclotetradecane. The complexes all exhibit pronounced tetragonal elongation of the coordination octahedron with the four cyclam nitrogens occupying the four equatorial positions. The magnetic properties are consistent with the formulation of the complexes as high-spin d⁴ systems. trans-[Mn(cyclam)(OH₂)₂](CF₃SO₃)₃ · H₂O is shown to be a convenient starting material for the syntheses of trans cyclam complexes. [Mn(cyclam)(CH₃COO)(CH₃COOH)](ClO₄)₂ exhibits extremely short intermolecular hydrogen bonds resulting in a pseudo-chain structure. The tilt of the axial ligands with respect to the equatorial plane containing the manganese and the cyclam nitrogen atoms is discussed.     

Growth-related changes in prehistoric Jomon and modern Japanese mandibles with emphasis on cortical bone distribution

Cortical bone distribution of the anthropoid mandibular symphysis has been addressed in relation to mechanical stress generated by mastication. To examine whether or not bone mass and distribution patterns of the human mandibular symphysis could be interpreted as an example of functional adaptation, we compared the skeletal growth series of two populations, prehistoric Jomon, considered to represent a "robust" mandibular morphology associated with a presumed heavier masticatory load, and modern Japanese. Results showed that the adult Jomon symphysis possessed significantly greater bone mass and thicker cortical bone compared to the modern Japanese condition. However, the second moments of area did not differ significantly between the two, indicating comparable rigidity against bending. Furthermore, the Jomon mandibles of the infant to juvenile stages exhibited most of the adult characteristics, in both bone mass/distribution of the symphysis and in mandibular corpus/ramus morphologies. The present study also demonstrated the presence of a growth pattern of symphyseal cortical thickness, common to both the Jomon and the modern Japanese series. In both populations, subsequent to deciduous molar occlusion, cortical bone tends to be thickest at the inferolingual symphysis, at the location where the highest tensile stresses presumably occur during mastication. These findings suggest that the "robust" characteristics of the Jomon mandible are initially manifested early in development, and that the effect of mechanical stimulus to bone mass formation in the human symphysis is largely confined to a regulatory role during growth modeling.     

Evaluation of bone remodeling around single dental implants of different lengths: a mechanobiological numerical simulation and validation using clinical data

Algorithmic models have been proposed to explain adaptive behavior of bone to loading; however, these models have not been applied to explain the biomechanics of short dental implants. Purpose of present study was to simulate bone remodeling around single implants of different lengths using mechanoregulatory tissue differentiation model derived from the Stanford theory, using finite elements analysis (FEA) and to validate the theoretical prediction with the clinical findings of crestal bone loss. Loading cycles were applied on 7-, 10-, or 13-mm-long dental implants to simulate daily mastication and bone remodeling was assessed by changes in the strain energy density of bone after a 3, 6, and 12 months of function. Moreover, clinical findings of marginal bone loss in 45 patients rehabilitated with same implant designs used in the simulation (n = 15) were computed to validate the theoretical results. FEA analysis showed that although the bone density values reduced over time in the cortical bone for all groups, bone remodeling was independent of implant length. Clinical data showed a similar pattern of bone resorption compared with the data generated from mathematical analyses, independent of implant length. The results of this study showed that the mechanoregulatory tissue model could be employed in monitoring the morphological changes in bone that is subjected to biomechanical loads. In addition, the implant length did not influence the bone remodeling around single dental implants during the first year of loading.     

Resorption of mandibular alveolar bone following loss of molar teeth and its relationship to age at death in a human skeletal population

Estimating adult age at death in skeletal remains is problematic, particularly in older adults. Molar wear is arguably the most reliable ageing technique for palaeopopulations, but many older adult skeletons have lost their molar teeth ante mortem, precluding its application. Resorption of the alveolar process occurs following tooth loss, and this appears to continue for a prolonged period. The current work investigates the relationship of this process to individual age in a nineteenth century AD European archaeological skeletal series of known age at death (N = 92 individuals), and discusses its potential as an age indicator. Mandibular corpus height was measured at the different molar positions. In females, reduction of corpus height with age was found at molar positions showing ante mortem loss. In both sexes, a relationship was found between age and a simple composite measure of corpus height in the molar region in those showing ante mortem loss of one or more mandibular molars. The correlation was stronger in females (r = ?0.74) than in males (r = ?0.49), appeared approximately linear, and continued into the ninth decade, the oldest age group in the study material. The results suggest that investigation of height of the posterior part of the mandibular corpus as a skeletal age indicator for individuals that have lost one or more molar teeth is merited in other palaeopopulations. Am J Phys Anthropol 153:643–652, 2014. © 2014 Wiley Periodicals, Inc.