A microscopical evaluation of 24 retrieved failed hollow implants

Twenty-four hollow ITI implants (four screws, and 20 cylinders) were retrieved because of failure, and evaluated in our laboratory, in a eight-year period (1989-1996), to see if a common cause could be observed in this implant design. No selection of these implants was carried out, and they represented the total number of implants of this type received in the above-mentioned time frame. The implants had been inserted by several different clinicians and were received from four universities and a private practice. The implants had been removed for mobility, pain, and presence of a vertical bone loss. About two-thirds of the implants were unstable in the jaw at the time of retrieval. Twenty implants had been used as single implants restoration and four in bridge reconstructions. Most of our specimens showed that the inflammatory process had reached the hollow portion of the implants. The following microscopical features were present in almost all our specimens: calculus and plaque on the coronal portion of the implant surface, presence of proliferating epithelium and of bone sequestra, and presence of bone apically to the inflammatory process. Perhaps, when the inflammatory process reaches the implant hollow portion, the infection runs a more rapid course due to the scarce vascularity of the bone inside this part.

Distinct and combined vascular effects of ACE blockade and HMG-CoA reductase inhibition in hypertensive subjects

Hypercholesterolemia and hypertension are frequently associated with elevated sympathetic activity. Both are independent cardiovascular risk factors and both affect endothelium-mediated vasodilation. To identify the effects of cholesterol-lowering and antihypertensive treatments on vascular reactivity and vasodilative capacity, we studied 30 hypercholesterolemic hypertensive subjects. They received placebo for 4 weeks, either enalapril or simvastatin for 14 weeks, and, finally, both medications for an additional 14 weeks. Postischemic forearm blood flow (MFBF) and minimal vascular resistance (mFVR) were used as indices of vasodilative capacity and structural vascular damage, respectively. Total (resting-stress-recovery phases) cardiovascular (blood pressure [BP] and heart rate [HR]) and regional hemodynamic (FBF and FVR) reactivity to stressful stimuli were calculated as area-under-the-curve (auc) (valuextime). Compared with baseline levels, simvastatin reduced total (TOT-C) and LDL cholesterol (LDL-C) (1.27 mmol/L, P<0.001 and 1.33 mmol/L, P<0.001, respectively). Enalapril also reduced TOT-C and LDL-C (0.6 mmol/L, P<0.001 and 0.58 mmol/L, P<0.05, respectively). MFBF was increased substantially by both treatments (P<0.001). Enalapril had a greater effect (-1.7 arbitrary units (AU), P<0.001) than simvastatin (-0.6 AU, P<0.05) on mFVR. During stress, FBF increased more with enalapril (4.4 FBFxminutes, P<0.001) than with simvastatin (1.8 FBFxminutes, P<0.01). Conversely, FVR stress response was reduced more with enalapril (9.1 FVRxminutes, P<0.001) than with simvastatin (2.9 FVRxminutes, P<0.01). During combination treatment, a significant (0.001>P<0.05) additive effect on hypercholesterolemia, structural vascular damage, BP, and FVR was shown. The findings suggest that angiotensin-converting enzyme (ACE) inhibition induces a larger reduction than HMG-CoA reductase blockade in vascular reactivity and structural damage in hypercholesterolemic hypertensive subjects.

Histologic and histomorphometric analysis of the bone response to machined and sandblasted titanium implants: an experimental study in rabbits

The aim of this study was to make a comparative analysis between the bone response to machined and sandblasted implants. The sandblasting was done with 150-microns aluminum oxide particles. Under scanning electron microscopic examination, the machined implants presented typical machining grooves, while a very rough, highly irregular surface with depressions and indentations was present on the sandblasted implants. Light microscopy showed a different bone growth pattern on machined (implantopetal growth) and sandblasted (implantofugal growth) implants. No negative effects on the rate of bone growth were observed in spite of the presence of aluminum ions. The histomorphometric analysis showed that sandblasted implants presented, from the third week onwards, a significantly higher contact percentage (P < .0001). These values could point to higher osteoconductivity as a result of the higher surface roughness of sandblasted surfaces.

Molar root furcation: morphometric and morphologic analysis

The objective of the present study was a morphometric and morphologic analysis of maxillary and mandibular first and second molars using three different techniques. Measurements of 207 maxillary molars (105 first and 102 second molars) and 207 mandibular molars (110 first and 97 second molars) were measured; root length, radicular trunk length (RTL), mesiodistal and buccolingual diameters (BLD) at the cementoenamel junction, inter-radicular angle (IRA) width, and furcal roof area (FRA) were recorded. No significant statistical correlations were found for most of these measurements, the only exception being the relationship between IRA/FRA, IRA/BLD in maxillary molars, and IRA/RTL in the maxillary first molar. Morphologic examination was carried out by stereo microscopy, light microscopy of undecalcified sections, and scanning electron microscopy. All of these techniques showed the complexity of the furcation area with a large number of anatomic irregularities and plaque-retentive structures that could hamper adequate cleaning during periodontal treatment.

Clinical and histologic evaluation of an active "implant periapical lesion": a case report

A new entity called "implant periapical lesion" has recently been described. This lesion could be the result of, for example, bone overheating, implant overloading, presence of a preexisting infection or residual root fragments and foreign bodies in the bone, contamination of the implant, or implant placement in an infected maxillary sinus. This case report describes a titanium implant that was placed in the maxillary premolar region. A fenestration involving the middle portion of the implant was present. After 7 months, the apical portion of the implant showed radiolucency. This lesion rapidly increased in size and a vestibular fistula appeared. A systemic course of antibiotics was not successful, and the implant was then removed. The histologic examination showed the presence of necrotic bone inside the antirotational hole of the implant. The etiology of the implant failure in this instance could possibly be related to bone overheating associated with an excessive tightening of the implant and compression of the bone chips inside the apical hole, producing subsequent necrosis.

Rigid fixation by means of titanium mesh in edentulous ridge expansion for horizontal ridge augmentation in the maxilla

The edentulous ridge expansion has been introduced in recent years to reestablish an appropriate alveolar ridge width. This technique consists of the placement of implants in the space formed after the dislocation of the buccal plate in a labial direction. In guided bone regeneration, the quantity of bone regenerated under the membranes has been demonstrated to be directly related to the amount of the space under the membranes. This space can diminish as a result of membrane collapse. To avoid this problem, a new technique of edentulous ridge expansion, which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, was used in association with autologous bone in 25 patients. At second-stage surgery in all patients, it was possible to see tissue, under the mesh, that had the macroscopic characteristics of mature bone and was superficially covered by a thin soft tissue layer. The microscopic examination showed that all autologous bone particles were embedded in newly formed bone. The use of a rigid mesh can assist bone regeneration in non-space-making defects, since it probably does not interfere with the blood flow to the underlying tissues because of the presence of microholes within the mesh.

Microscopic and histochemical evaluation of demineralized freeze-dried bone allograft in association with implant placement: a case report

A case report is presented in which a titanium implant was placed into a defect resulting from the extraction of an impacted tooth; the defect was filled with demineralized freeze-dried bone allograft particles without a membrane barrier. After a 6-month healing period the bone defect had completely healed and the tissue present had macroscopic features similar to mature bone. Histologic examination of this tissue showed that, in all demineralized freeze-dried bone allograft particles, mineralization nodules were scattered inside the demineralized bone; in the areas where the mineralization nodules were present, osteocyte lacunae could be observed. In the case presented, significant new vital bone formation was observed 6 months after placement of a demineralized freeze-dried bone allograft.

Light and scanning electron microscopic report of four fractured implants

Although they are fortunately rare, implant fractures can cause significant problems for both clinicians and patients. The authors present a light and scanning electron microscopic study of four fractured implants in two patients. Both patients had parafunctional habits (bruxism), hypertrophic masticatory muscles, and wear of occlusal surfaces. The scanning electron microscopic study of the fractured surfaces of all four implants showed the presence of fatigue striations. Bending overload was probably created by a combination of parafunctional forces, bone resorption, posterior location of the implants, and implant diameter.

Early tissue reactions to polylactic acid resorbable membranes: a histological and histochemical study in rabbit

The aim of this study, in rabbit tibia, was an evaluation of the early reactions of the tissues to the insertion of polylactic membranes, used in connection with titanium implants. The specimens were retrieved after 1-4 weeks, and a histological analysis was performed. It was possible to see that, in the early implantation phases, no degradation of the macrostructure of the membrane was present. On the outer portion of the membrane many multinucleated giant cells (MGC) were present and membrane fragments were present inside the cytoplasm of these cells. These cells could explain the inflammatory processes reported, in some reports, with the use of materials made by polylactic and polyglycolic acid. We did not observe detrimental effects in the bone tissue around the membrane, and the membrane appeared to have a mechanical stability for the time necessary for bone regeneration.

Benign cementoblastoma associated with an unerupted third molar

Benign cementoblastoma is a rare lesion representing less than 1% of all odontogenic tumours. It usually affects young people and is located in the posterior jaw. In almost all cases the tumour tends to be associated with an erupted permanent tooth, most often the first molar: only rarely has an association with an impacted or deciduous tooth been reported. The authors present a case of a cementoblastoma involving an impacted third molar.

A histologic evaluation of eight cases of failed dental implants: is bone overheating the most probable cause?

Biomechanical overloading has been stated to be, overall, the major cause of implant failures. Very important can be, however, in the etiopathogenesis of early implant failure, the overheating of the surgical site. The authors present eight cases of implant loss most probably due to bone overheating, even if other causes cannot be excluded. The microscopical picture, in all cases, was composed by the same features: (1) presence of bone sequestra; (2) no regeneration of the peri-implant bone; (3) presence of an inflammatory infiltrate in the gap between bone and implant; (4) no organization of the peri-implant bone clot; (5) presence of a compact and mature bone around the implant; (6) presence of bacteria around the implant and the necrotic bone.

Microscopical features in retrieved human Branemark implants: a report of 19 cases

The authors present a histologic analysis of 19 Branemark titanium implants retrieved for different causes: four implants were removed for abutment fracture, one for dental nerve dysesthesia, two for bone overheating, two for peri-implantitis, nine for mobility, one for unknown causes. In the implants removed for fracture a high bone-implant contact percentage was present (71.83 +/- 4.96%) with compact, mature bone at the interface. The picture of the failure due to bone overheating was characteristic with the presence of bone sequestra and of a gap between implant and bone filled by lymphocytes and plasma cells: many bacteria surrounded the necrotic bone and no newly regenerated bone was present. In peri-implantitis an inflammatory infiltrate was observed in the peri-implant tissues: a dense fibrous connective tissue was present around implants failed for mobility. The microscopical picture is certainly extremely important in identifying the causal determinants of an implant failure.

Implant periapical lesions: clinical, histologic, and histochemical aspects. A case report

A new entity, the "implant periapical lesion," has recently been described. The etiology of this condition could be attributed to overheating of the bone, overloading of the implant, presence of a pre-existing infection or of residual root particles and foreign bodies in the bone, implant contamination during production or during insertion, or placement of the implant in an infected maxillary sinus. In this report, a titanium plasma-sprayed implant had been inserted into the mandible of a 53-year-old patient; after 5 months a fistula developed and periapical radiography showed a large radiolucent image around the apical portion of the implant. The implant was removed, and histologic examination showed necrotic bone and an inflammatory infiltrate inside the hollow portion of the implant. The etiology of the implant failure in this instance could be related to a fracture and vascular impairment of the bone inside the implant during insertion, to external contamination of the implant, or to the poor bone quality of the implant site.

Immediate loading of titanium plasma-sprayed implants: an histologic analysis in monkeys

Aim of this study was to evaluate peri-implant tissue reactions to immediately loaded titanium plasma-sprayed implants in Macaca fascicularis monkeys. A total of 48 titanium plasma-sprayed implants were inserted (24 in the posterior maxilla and 24 in the posterior mandible). A metal superstructure was cemented 3 days after implant insertion on 24 implants (12 in the maxilla and 12 in the mandible) (test implants). The remaining 24 implants (12 in the maxilla and 12 in the mandible) were left unloaded (control implants). Nine months after implant placement a block section was carried out, the defect filled with non-resorbable hydroxyapatite, and all 48 implants retrieved. The implants were treated to obtain thin ground sections. Three slides were cut for each implant and examined under normal and polarized light and a morphometrical analysis done. All implants were covered by bone under light microscopy. The histomorphometrical analysis demonstrated that in test implants, the bone-implant contact percentage was 67.3% (+/-7.6%) in the maxilla, and 73.2% (+/-5.9%) in the mandible; in control implants the percentages were, respectively, 54.5% (+/-3.3%) and 55.8% (+/-6.5%). In the test implants the bone around the implants tended to have a more compact appearance. In conclusion, our study demonstrated that in test implants the bone-implant contact percentage was significantly greater than in the controls (P < 0.01) and no fibrous connective tissue was present at the interface.

Clinical and histologic features of a nonaxial load on the osseointegration of a posterior mandibular implant: report of a case

The authors report on the clinical and histologic features of a single implant replacing a mandibular molar, which fractured after a 1-year loading period. Because of anatomic factors, the implant had been placed in an angulated position. The histologic examination showed a very high percentage of bone-implant contact. The bone located at the interface with the implant was mature, compact, and had few marrow spaces. No resorption areas were present, and no connective tissue was seen at the interface. Most likely, the lateral nonaxial forces exerted on the implant created very high bending moments. These forces produced a fracture of the implant, although no loss of osseointegration was observed at the interface.

Histologic observations on 230 retrieved dental implants: 8 years' experience (1989-1996)

The histologic examination of dental implants retrieved from humans is important to establish the causal determinants of implant failure, and to compare and validate the results obtained from animal studies. This study presents a retrospective review of the histologic features of 230 implants retrieved in an 8-year period (1989-1996). All the implants were treated to obtain thin (20 to 30 microm) ground sections. The majority of implants were retrieved because of mobility (n=56), peri-implantitis (n=54), or fractures (n=90). Peri-implantitis occurred more frequently before (n=44) than after (n=10) abutment connection. A dense fibrous connective tissue with no inflammatory cells was present at the interface in the implants retrieved for mobility; bone was found only in the most apical part. In many of these implants epithelial cells were present. The main histologic features of peri-implantitis consisted of the presence of a bone sequestrum near the implant, many bacteria present on the implant surface, and an inflammatory infiltrate (macrophages, lymphocytes, and plasma-cells) nearby. Histology showed that in the implants removed for fracture, there was a very high percentage (80 to 100%) of peri-implant bone.

Vertical ridge augmentation around dental implants using a membrane technique and autogenous bone or allografts in humans

This study investigated the effect on vertical bone regeneration of the addition of demineralized freeze-dried bone allograft or autogenous bone chips to a membrane technique. Twenty partially edentulous patients with vertical jawbone deficiencies were selected for this study. The patients were divided into two groups of 10 individuals. The 10 patients of Group A received 26 Brånemark implants in 10 surgical sites. The 10 patients of Group B received 32 implants in 12 surgical sites. Fifty-two out of 58 implants (22 in Group A and 30 in Group B) extended 1.5 to 7.5 mm superior to the bone crest. Titanium-reinforced expanded polytetrafluoroethylene membranes were used to cover the implants and, before complete membrane fixation, demineralized freeze-dried bone allograft particles were condensed under the membrane in Group A, and autogenous bone chips were used in Group B. At the reentry after 7 to 11 months the membranes were removed and a small biopsy was collected from 11 sites comprehending the miniscrews. The clinical measurements from Group A demonstrated a mean vertical bone gain of 3.1 mm (SD = 0.9 mm, range 1 to 5 mm) with a mean percentage of bone gain of 124% (SD = 46.6%). The measurements from Group B showed a mean vertical bone gain of 5.02 mm (SD = 2.3 mm, range 1 to 8.5 mm) with a mean percentage of bone gain of 95% (SD = 26.8%). Histomorphometric analysis of the present study clearly demonstrated a direct correlation between the density of the pre-existing bone and the density of the regenerated bone. The mean percentage of new bone-titanium contact was from 39.1% to 63.2%, depending on the quality of the pre-existing bone. Both the clinical and histologic results indicate a beneficial effect of the addition of demineralized freeze-dried bone allograft or autogenous bone particles to vertical ridge augmentation procedures in humans.

Hollow implants retrieved for fracture: a light and scanning electron microscope analysis of 4 cases

One of the possible complications of implant treatment is the occurrence of an implant fracture. Metal fatigue and biomechanical overload seem to be the most common causes of fractured implants. This study evaluated 4 implants (3 hollow cylinders and 1 hollow screw) which fractured after a mean loading period of 2.8 years. All implants had a 4 mm diameter and had been inserted in a posterior location. In 3 cases parafunctional habits were present. In all cases a vertical resorption of the peri-implant bone was present. The endosseous portion of the implant presented always a very high bone-implant contact percentage. Scanning electron microscopic examination showed that at least one of the implant holes was involved in the fracture line; no porosities or material defects were observed on the fractured surface of the implant. In hollow implants the holes could represent a site of less resistance.

Histologic analysis of the interface of a titanium implant retrieved from a nonvascularized mandibular block graft after a 10-month loading period

The combined use of bone grafts and osseointegrated implants appears to improve the long-term prognosis of transplanted bone. One question pertaining to the use of grafted bone is whether the biologic reaction to implants placed in grafted bone is the same as that seen under nongrafted conditions. A mandibular discontinuity defect in a 63-year-old female patient was repaired with a nonvascularized block graft into which 3 titanium implants were placed. After a 10-month loading period, one of the implants was retrieved and treated to obtain thin ground sections. The histologic examination showed mature bone in close contact with the implant surface; no gaps, fibrous tissue, or inflammatory cells were seen at the interface. No resorption phenomena were present. The bone at the interface was highly mineralized. The features of the regenerated bone and the bone-implant interface in grafted bone were similar to those seen in nongrafted situations; no differences were found with results presented in the literature concerned with retrieved implants placed into vascularized grafts.

Ameloblastic fibro-odontoma: report of two cases

Ameloblastic fibro-odontoma is a rare odontogenic tumour. It affects young people and is usually located in the posterior jaws. Two cases of this tumour are presented: both lesions had produced an asymptomatic swelling. The histology showed the presence of an odontogenic epithelium immersed in a fibrous mesenchyme; dental hard tissues were also present. No recurrences were found after 12 and 4 years from the surgical enucleation of the tumour.

Squamous odontogenic tumour: report of two cases

Squamous odontogenic tumour is a benign odontogenic tumour composed of a well-differentiated squamous epithelium immersed in a fibrous connective tissue stroma. It is a rare tumour and a recent literature review yielded only 36 cases. Two cases of squamous odontogenic tumour are presented, 1 located in the maxilla and the other in the mandible: 1 of these cases showed a periodontal involvement. The radiographic picture was fairly characteristic in 1 case, with a radiolucent lesion between the roots of the second mandibular premolar and the first molar, while, in the other case, it was possible to observe the presence of a lesion located at the apex of a molar. The tumours were enucleated, and no recurrences were observed after 5 years.

Histological and histochemical analyses of acid and alkaline phosphatases around hydroxyapatite-coated implants: a time course study in rabbit

One of the concerns pertaining to hydroxyapatite (HA)-coated dental implants is their possible dissolution over time, with ultimate loss of the implant. HA-coated dental implants were inserted medially into rabbit femoral articular knee joints. The implants were retrieved after 1 week, 1 month, 3 months and 6 months. At 1 week, many alkaline phosphatase (ALP)-positive osteoblasts were observed near the implant surface. No signs of degradation of the coating were present. At 1 month, only few ALP-positive osteoblasts were present in the marrow spaces at the interface with the coating. Many acid phosphatase (ACP)-positive cells were observed near the coating. In many marrow spaces the HA coating was reduced in thickness. At 3 months, a further reduction of the thickness of the coating, in the areas in contact with marrow spaces, was seen. Many ACP-positive cells were present in tight contact with the coating. Few ALP-positive osteoblasts were present. At 6 months, in many areas in contact with marrow spaces, the HA coating was completely resorbed. The histological and histochemical results seem to point to the existence of two types of ACP-positive cells: multinuclear, often in the process of phagocytosing HA particles, and mononuclear, with a morphology similar to osteoclasts.

Histologic aspects of the bone and soft tissues surrounding three titanium non-submerged plasma-sprayed implants retrieved at autopsy: a case report

The authors report the histological features found around three non-submerged titanium plasma-sprayed implants retrieved, after a 10-month loading period, from an autopsy case. At the time of implant insertion, the clinician had noted a wide vestibular dehiscence of the central implant, and it was decided to use a bioabsorbable membrane for guided bone regeneration in this area. After specimen processing, it was possible at low magnification to observe that in the most vestibular slides, the central implant was almost completely surrounded by connective tissue, while in the most lingual slides, the quantity of bone around the implant tended to increase. The other two implants had a bone-implant contact percentage of about 60%. Only in a few areas was mineralized bone in direct contact with the metal surface, while around the major portion of the implant perimeter a layer of unmineralized, red-stained, osteoid material was present. No inflammatory infiltrate was present in the epithelium and in the supracrestal connective tissues. The fibers of this tissue had a different orientation: in the most coronal portion of the implants (smooth surface), they tended to run parallel implant's surface, while in the most apical region (plasma-sprayed surface), they tended to be arranged in a perpendicular fashion. These results, in man, were strikingly similar to those previously reported in dogs and monkeys.

Immediate loading of titanium plasma-sprayed screw-shaped implants in man: a clinical and histological report of two cases

THIS STUDY REPORTS ON THE histological findings of two immediately loaded titanium plasma-sprayed (TPS) implants, retrieved for a fracture of the abutment and for psychological reasons, after 8 and 9 months of loading, respectively. The microscopical analysis showed that mature, compact, cortical bone was present around both implants, with the bone implant contact percentage about 60 to 70%. No fibrous tissue or gaps were present at the interface. No resorption was present in the peri-implant bone. On both implants a few osteoblasts were found positive at the interface for alkaline phosphatase (ALP); while no cells positive for acid phosphatase (ACP) were present. Immediate loading can, perhaps, be used in very selected cases of good bone quality, with implants that have certain macro- (screw shape) and micro-interlocks (titanium plasma-sprayed surface) characteristics. Good results have been reported also for non-TPS surface (e.g., machined surface). More data about different designs (e.g., cylinders) or coatings (e.g., hydroxyapatite) are needed before any firm conclusions about immediate loading can be reached.

Clinical and histological results in alveolar ridge enlargement using coralline calcium carbonate

A very important parameter during the insertion of dental implants is the amount of bone present in a site. A regenerative procedure to increase the width and the height of bone is proposed with the use of occlusive barrier membranes and biomaterials. The authors used, in six patients with deficient alveolar ridges, prior to implant insertion, Biocoral gel particles in connection with expanded polytetrafluoroethylene membranes. After 6 months it was observed that a tissue similar to mature bone had regenerated under the membrane and microscopically it was observed that the Biocoral particles were still present and almost all were completely surrounded by mature bone.

High-precision, cost-effective cutting system for producing thin sections of oral tissues containing dental implants

A new high-precision, cost-effective cutting system, able to produce thin (20-30 microns) sections of oral tissues, containing dental implants, is presented. With this system the authors have been able to obtain, in a reproducible and consistent way, thin slides containing biomaterials and biological tissues. Very high cellular detail was possible, even at high magnifications (x 1200). Histochemical reactions (e.g. acid and alkaline phosphatases) have also been obtained in a reproducible way, without sputter ground staining. The time involved in specimen cutting was significantly reduced, and about five slides per specimen were obtained with minimal loss of tissue. In almost all cases it has been possible to eliminate the grinding process with its inherent problems, such as formation of ledging at the bone-titanium interface. With this system it was also possible to obtain thin slides of soft tissue lesions (i.e. benign mucous membrane pemphigoid).

Resorption of composite polymer-hydroxyapatite membranes: a time-course study in rabbit

The histological findings in rabbit, concerning the resorption of a new composite hydroxyapatite-polymer membrane used in guided tissue regeneration are reported. The polymer appeared to be completely resorbed in about 4-6 months, while the inorganic component, hydroxyapatite, appeared to begin to resorb after the tenth month. The integrity of the membrane appeared to be unchanged after a 10-month period. No inflammatory cell infiltrate was present. This new type of membrane appeared to be relatively well tolerated by the host, had no significant adverse soft and hard tissue reaction, appeared to be easy to handle and had good space-maintaining capabilities. More research is certainly needed before clinical use in man.

Simultaneous demonstration of alkaline and acid phosphatase activity in bone, at bone-implant interfaces and at the epiphyseal growth plate in plastic-embedded undemineralized tissues

The aim of the present study was to determine if it was possible to detect in bone, at the epiphyseal growth plate and at the bone-implant interface, the presence of alkaline and acid phosphatases using Technovit 7200 VLC resin. In the plastic-embedded specimens it was possible to observe the simultaneous presence of acid and alkaline phosphatases at the epiphyseal growth plate in the presence of intra-articular implants. The morphology of the cells positive for the phosphatases was very clear, with no apparent diffusion of the reaction product and no sputter ground staining.

Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants: a pilot study in monkeys

This pilot study analyzed the bone reactions to early loaded titanium plasma-sprayed implants. A total of 24 titanium plasma-sprayed implants (12 in the maxilla and 12 in the mandible) (Primary Healing Implant, Legnano) were inserted into four Macaca fascicularis monkeys with instruments specially designed to obtain a precise fit of the implant in the bone socket. A metal superstructure was cemented into 10 mandibular and 10 maxillary implants 15 days after implant insertion. The four remaining implants were used as controls. Eight months after implant placement, a block section was carried out, the defect was filled with nonresorbable hydroxyapatite, and all 24 implants were retrieved. The implants were treated to obtain thin ground sections that were examined under normal and polarized light. Histologic analysis showed that bone was observed around the implant surface in all implants. Morphometric analysis demonstrated that bone lined 67.2% (SD = 3.1%) of the maxillary implant surface, and 80.71% (SD = 4.6%) of the mandibular implant surface. No differences were found in the percentage of bone-implant contact in the control implants. In the loaded implants, however, the bone around the implants had a more compact appearance. The study demonstrated that it is possible to obtain a high percentage of bone-implant contact in early loaded titanium plasma-sprayed implants.

Bacterial penetration through Resolut resorbable membrane in vitro. An histological and scanning electron microscopic study

The aim of this study was to evaluate the characteristics of resorption and the pattern of bacterial collonisation of polyglycolic and polylactic resorbable membranes under controlled experimental conditions. A removable cobalt-chromium device was applied to the lower jaw of 5 students for a period of 4 weeks. 8 composite resin chambers were glued to the device, 4 on each side of the mouth. A small piece of PLA/PGA membrane separated the composite chambers into 2 parts. The subjects wore the devices 24 h a day, except for the time necessary for oral hygiene procedures, during which time, the structure was submerged in a 0.2% chlorexidine solution. Every week, 2 of the chambers were removed; one was processed for scanning electron microscopy, to be observed both on the external and internal surface, and the other one for light microscopy examination. Both the electron microscopic and histologic observations showed a progressive increase in the plaque layer on the external surface of the membrane during the period of observation. The light microscopy showed an early invasion of the membrane, starting about 1 week after the exposure. On all the 3- and 4-week specimens, a complete bacterial invasion over the whole thickness of the membrane was visible. After 3 weeks of plaque accumulation, bacterial colonisation of the inner portion of the membrane was detectable in all the specimens. At 3-weeks, we observed in the light microscopy group in 4 out of 5 specimens, a large reduction of the thickness of the material and small voids in the membrane structure. In 1 specimen, the membrane was no more detectable. Only in 5 specimens of the 4-week group was the membrane still recognizable, though reduced to fragments. In conclusion, once exposed to the oral cavity, the PLA/PGA membranes start to resorb in the early stages: this process concludes itself between the 3rd and 4th weeks of exposure. However, the particular conditions of the experimental design nevertheless classify this study as an in vitro, more than as an in vivo experimentation.

Histological evaluation of freeze-dried dura mater (FDDMA) used in guided bone regeneration (GBR): a time course study in man

In 26 patients freeze-dried dura mater (FDDMA) membranes were used in fenestrations and dehiscences around dental implants, in implants inserted into postextraction sockets, in vertical ridge augmentation and in sinus lifting procedures. A re-entry procedure was carried out after 6, 9 and 12 months. In all patients a small portion of the membrane was removed and examined. No inflammatory infiltrate was present in the tissues around the membranes. No cells were present inside the membranes and only in the most peripheral portions was it possible to observe a few cells positive to acid phosphatase. The FDDMA membranes appeared to resorb slowly, did not seem to elicit an inflammatory reaction, and at 12 months they still appeared to play a role in cell occlusion.

Histological evaluation of the peri-implant bone around plasma-sprayed non-submerged titanium implants retrieved from man: a report of two cases

Two cases of non-submerged implants are reported: one was removed, unloaded, after 1 year, for psychiatric reasons, and the other, after a loading period of 4 years, for a fracture of the implant. The implants and surrounding tissues were processed to obtain thin ground sections. In the first case compact lamellar bone was observed in close contact with the titanium all around the implant perimeter. No connective tissue or empty spaces were found at the bone-implant interface. Histochemical staining with von Kossa demonstrated that all the bone around the implant was highly mineralized. No areas of osteoid tissue were found at the bone-implant interface. In the implant retrieved due to fracture it was possible to observe a very high percentage of bone-implant contact.

Guided bone regeneration using resorbable and nonresorbable membranes: a comparative histologic study in humans

Resorbable membranes of poly(lactic acid) and poly(glycolic acid) (PLA/PGA) were compared to nonresorbable expanded polytetrafluoroethylene (e-PTFE) membranes in the treatment of defects around titanium dental implants placed in postextraction sockets. Two partially edentulous and three completely edentulous patients requiring implant-supported restorations participated. Sixteen Brånemark implants were placed into extraction sockets and covered with modified titanium cover screws, called harvest cover screws, which allow tissue biopsy at second-stage implant surgery. Seven defects were treated with PLA/PGA membranes, five were treated with e-PTFE membranes, and four were left untreated (control sites). After 6 months of healing, the harvest cover screws were retrieved and processed for light microscopy examination together with the regenerated tissues. Very little or no bone formation was detected in control specimens. The e-PTFE membranes were found to be the most effective barrier material, in that denser and a greater amount of regenerated bone was found. The PLA/PGA membranes produced some bone regeneration when compared to control sites, but to a lesser extent compared to e-PTFE sites.

Presence of multinucleated giant cells around machined, sandblasted and plasma-sprayed titanium implants: a histological and histochemical time-course study in rabbit

A histological and histochemical evaluation was conducted in rabbit to study the presence of multinucleated giant cells (MGCs) at the interface with machined, sandblasted and plasma-sprayed titanium implants. No MGCs were observed, at any of the experimental times, around machined and sandblasted titanium surfaces. MGCs were, on the contrary, present at the interface with titanium plasma-sprayed implants at two weeks and at two months. At two weeks these cells were numerous, and in some areas, particularly around the spires, tended to line almost all the implant perimeter surface. MGCs were present in large numbers where bone was present at the interface, while, on the contrary, where there was no newly formed bone, they tended to be fewer in number and smaller in diameter. At four and eight weeks these cells tended to decrease in number. The histochemical staining for acid phosphatase (ACP) and alkaline phosphatase (ALP) showed that MGCs were negative to ACP, while many ALP-positive osteoblasts, actively secreting osteoid matrix, were in close and tight contact with the MGCs. In no case was an inflammatory infiltrate present in connection with the MGCs. The precise nature of MGCs is still not clear, but our histological and histochemical results could point to a priming effect on the activity of the osteoblasts in a similar way to the supposed role of the osteoclasts.

Bone formation inside the material interstices of e-PTFE membranes: a light microscopical and histochemical study in man

Membranes used in guided bone regeneration (GBR) should possibly achieve a good degree of tissue integration with neighbouring connective tissues in order to obtain a mechanically stable environment necessary for successful bone and soft tissue healing. The authors observed, in a histological study of e-PTFE membranes used for GBR and retrieved from 10 patients, inside the material interstices of the membranes, in many cases the presence of connective tissue cells and collagen fibres, and in two cases the presence of bone. The presence, inside the membrane, of connective tissue and bone could help toward a tight integration between the membrane and neighbouring tissues, with the production of a biological seal.

Clinical and histologic aspects of biphasic calcium phosphate ceramic (BCP) used in connection with implant placement

A granulate of biphasic calcium phosphate ceramic (BCP), composed of 50% hydroxyapatite and 50% beta-tricalcium phosphate, was used, in man, to fill defects resulting from cyst enucleation. The defects were covered with e-PTFE membranes, and at the re-entry procedure after six months, it was possible to see that the defects were filled by a newly formed tissue with the macroscopic features of mature bone. Smooth titanium implants were inserted in the newly regenerated tissue. Histological examination of this tissue showed that most of the particles were lined by newly formed bone. Some particles were undergoing resorption processes and were being gradually substituted by newly formed bone. No inflammatory infiltrate was present. Our results point, in conclusion, to a good biocompatibility and osteoconductivity of this material.

Microscopical observations of the osseous responses in early loaded human titanium implants: a report of two cases

The authors present the histological picture of the surrounding tissues of two screw-shaped titanium plasma-sprayed implants retrieved for a fracture of the abutment after 18 and 42 months, respectively. These two implants were loaded after two months. The microscopical examination showed that both implants were covered in a large part of the implant surface by compact, mature lamellar bone with the presence of many Haversian systems and osteons. With von Kossa staining it was possible to see that the bone at the interface with the implant was highly mineralised. No connective tissue or inflammatory cells were present at the interface.

Effects of alkaline phosphatase on bone healing around plasma-sprayed titanium implants: a pilot study in rabbits

Alkaline phosphatase (ALP) is an enzyme thought to be important in the process of biomineralization. ALP promotes hydrolysis of phosphate containing substrates, produces orthophosphate and increases the uptake of calcium. ALP has been demonstrated recently to induce mineralization of collagen sheets in the animal body. Many factors are being investigated to try to increase the quantity of bone around dental implants. The aim of this study was an evaluation of the bone formation around dental implants used in conjunction with ALP extracted from calf intestine. Titanium plasma-sprayed implants were put for 30 min in glasses containing 500 micrograms of ALP, and then inserted into the femoral articular surface of the knee joint. The implants were retrieved after 2, 3, 4 and 8 weeks, and treated to obtain thin ground sections. The histological examination showed a higher quantity of bone trabeculae, and at 2 and 3 weeks, the presence of plump, elongated, highly stained, very active ALP-positive osteoblasts around the treated specimens. ALP seems, in the experimental conditions of this pilot study, to have a positive effect on bone formation around titanium plasma-sprayed implants.

Cellular colonization and bone formation into expanded polytetrafluoroethylene membranes: a light microscopical and histochemical time course study in the rabbit

We report on a time course study of cellular colonization of expanded polytetrafluoroethylene (ePTFE) membranes in rabbits. Bone defects (8 mm) were prepared with low speed burs in rabbit tibial metaphyses and covered with ePTFE membranes. The membranes were retrieved after 3, 6, 9, and 12 weeks. At 3 weeks, all membranes were filled by cells and osteoid tissue: no mineralized tissue was found. Osteoblasts positive for alkaline phosphatase (ALP) were observed on the outer surface and inside the material interstices of the membrane. At 6 weeks, it was possible to observe an increase of the quantity of the osteoid material inside the membranes. At 9 weeks, bone tissue was present and it usually originated from the most external part of the membrane, and spread to the central part of the membrane. Only the central portion of this bone appeared to be completely mineralized. A sharp decrease in the number of ALP-positive osteoblasts was observed. At 12 weeks, the quantity of bone present appeared to be substantially increased. Only a small percentage of the bone inside the membrane appeared to be completely mineralized. No cells positive to acid phosphatase were observed. These histological results confirm the high biocompatibility of ePTFE membranes and the bone formation inside the ePTFE interconnected nodes could, probably, help in achieving a good biomaterial-tissue integration with predictable results in bone regeneration.

Microscopical aspects of failure in osseointegrated dental implants: a report of five cases

Implant failures can be due for the most part to infections or to trauma. Different clinical pictures and microbiological findings have been reported for these two different aetiologies. The authors report the histological findings of five osseointegrated implants, removed for failure, in four patients. In some of the implants a fibrous connective tissue was present, interposed between the implant and the bone: in this tissue it was possible to find epithelial cells, even in the most apical part of the implant. These features seem to be the hallmark of the implants which failed due to surgical trauma or insertion in sites ill-fitted for such treatment. In one case a gap between the prosthetic restoration and the abutment was present, and this fact could have contributed to the implant failure. In some cases recognition of the exact aetiological factors of the failures is not possible, and, moreover, an association between the two types, infective and traumatic, is possible.

Comparison of bone regeneration with the use of mineralized and demineralized freeze-dried bone allografts: a histological and histochemical study in man

Mineralized (FDBA) and demineralized freeze-dried bone allografts (DFDBA) have been proposed as substitutes for autologous bone in oral surgery. The demineralization process has been shown, in rodents, to determine osteoinduction in tissues other than bone. Other investigators have reported poor clinical results, in man, with the use of DFDBA. The aim of the present study was a comparative light microscopical and histochemical analysis of bone regeneration processes, in man, with the use of FDBA and DFDBA. Our histological results showed that in DFDBA only the particles near the host bone were involved in the mineralization processes, while in FDBA even the particles that were farthest from the host bone were lined by osteoblasts, actively secreting osteoid matrix and newly formed bone. These results probably point to a more osteoconductive effect of FDBA. No osteoinduction was observed with FDBA or DFDBA.

Direct bone formation on sand-blasted titanium implants: an experimental study

Surface modifications of an implant have been demonstrated to be important in influencing the tissue reactions around the implant. Recently, osteoblasts have been shown to be capable of laying down a mineralized matrix in direct contact with the titanium surface. The aim of the present study was to analyse the early bone responses to titanium implants with an aluminium dioxide sand-blasted surface. Microscopical analysis showed that in the first week it was possible to observe the presence of mineralized bone in direct contact with the metal surface, while in other portions of the interface, osteoblasts were seen at the implant surface. These results were confirmed in the 2 and 4 wk observations. Our results could help to explain the increased removal torque forces reported in the literature concerning sand-blasted implants.

Histological evaluation of bone reactions to aluminium oxide dental implants in man: a case report

Alumina implants have been shown to possess high biocompatibility. The authors present the case of an aluminium oxide ceramic implant removed because of fracture of the abutment after a 30-month loading period. It was possible to observe microscopically that the implant was covered by highly mineralized mature compact lamellar bone; no connective tissue or inflammatory cells were present at the interface. Osteocytes were observed very close to the bone-implant interface. These features indicate the good biocompatibility of the implant.

A histologic study of nonsubmerged titanium plasma-sprayed screw implants retrieved from a patient: a case report

The authors report on the microscopic findings in two plasma-sprayed nonsubmerged implants retrieved from a patient 6 months after placement. One of the implants had been loaded for 3 months, while the other was left unloaded. Clinically, the peri-implant gingival tissues were in good health. The implants were sectioned according to the cutting-grinding system. Bone lined the titanium surface almost completely with 77.3% +/- 5.1% of contact in the unloaded implant and 86.5% +/- 3.3% of contact in the loaded implant. Signs of bone resorption with many macrophages and osteoclasts were present in the loaded implant, while in the unloaded implant only osteoclast resorption activity was demonstrable.

Evaluation of guided bone regeneration in rabbit tibia using bioresorbable and non-resorbable membranes

The aim of this study was an evaluation of the possibility of bone regeneration in connection with implant placement, using a new bioresorbable membrane (Guidor Matrix Barrier) used previously in periodontal tissues regeneration. The study compared the bone regeneration obtained around Bonefit-ITI implants inserted in rabbit tibia using Guidor membranes, Gore-Tex membranes and in control sites. Microscopic analysis was performed after 6, 9 and 12 weeks. It was possible to see that the amount of bone around implants covered by Guidor and Gore-Tex membranes was roughly equivalent in all experimental sites at the 6-, 9- and 12-week time intervals. Also, all control sites healed completely. It could be concluded from this study that: (1) rabbit tibia cannot be recommended in research connected with guided bone regeneration, as all control sites healed in the same way as the test sites; (2) in no case did the presence or the degradation of the resorbable membrane prevent the formation of new bone; (3) no inflammatory reaction was present around the bioresorbable and the non-resorbable membranes; (4) bone formed in all cases on the outer surface of the non-resorbable membranes; (5) large Guidor membrane fragments were present in the 6-week specimens, while in the 12-week specimens only small fragments were recognizable; (6) Guidor membranes can be used in guided bone regeneration.

Juvenile hyaline fibromatosis of gingiva: a case report

Juvenile hyaline fibromatosis is an extremely rare inherited condition, probably resulting from an inborn error of metabolism. It is characterized by cutaneous nodules, gingival hypertrophy and joint contractions. It affects children but usually it is not present at birth, and is microscopically characterized by a conspicuous hyalinization of the connective tissue.

Vertical ridge augmentation using a resorbable membrane: a case report

The vertical dimension may be very important clinically where anatomic structures may limit the bone height available for implant insertion. Moreover, lack of bone tissue may result in exposure of implant threads, soft tissue recession, less-than-optimal implant stability, and esthetic problems in the prosthetic reconstruction. Attempts have been made to increase the bone height with the placement of autografts and allografts on top of the ridge, but long-term results have been unsatisfactory. Recently an increase of bone in a vertical direction has been obtained in rats, rabbits, and man using expanded polytetrafluoroethylene (ePTFE) membranes. The authors present a case in which an increase of the vertical dimension of the alveolar ridge was obtained using a resorbable freeze-dried dura mater membrane in association with demineralized freeze-dried bone. After a 6-month uneventful healing period the space under the membrane was filled by a tissue with the macroscopic features of bone, and the two implants were almost covered by the newly-formed tissue. An histological examination of a retrieved sample of the newly formed tissue demonstrated the presence of mature bone. It can be concluded that a localized vertical increase of the alveolar ridge may be obtained with the use of a resorbable freeze-dried dura mater membrane.

Detection of alkaline and acid phosphatases around titanium implants: a light microscopical and histochemical study in rabbits

Alkaline phosphatase (ALP) may play a very important role in the mineralization process of bone, while acid phosphatase (ACP) is implicated in bone resorption. The aim of the present study was a histochemical characterization of ALP and ACP at the bone-implant interface after the insertion of smooth screw-shaped threaded titanium implants in rabbit tibia. In the first 3 weeks it was possible to observe a very strong positivity in the cytoplasm of osteoblasts near the implant surface. These osteoblasts surrounded islands of soft tissue or trabeculated woven bone. In the first 4 weeks a large quantity of newly formed bone originating from the periosteal and endosteal surfaces was observed; a remodeling of the cortical bone was also present. A sharp decrease of the ALP activity was observed from the third week onwards, and at 2 months it was possible to observe that the ALP and ACP activities were similar, possibly in relation to the remodelling of bone. From 2 to 6 months there were no morphological differences in the microscopical appearance of the bone around the implants. The bone was mature, compact and the new bone had staining features similar to pre-existing bone.