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Mafra IJ, Bordin D, Siroma RS, Moraschini V, Faverani LP, Souza JG, Mourão CF, Shibli JA. Additive Manufacturing Titanium Dental Implants Placed in Sinuses Grafted with 70HA:30-TCP: A One-Year Retrospective Study for Evaluation of Survival Rate. Dent J (Basel) 2024; 12:181. [PMID: 38920882 PMCID: PMC11202463 DOI: 10.3390/dj12060181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
The present short-term retrospective study evaluated the implant survival rate and peri-implant bone loss around additive-manufactured titanium implants placed in sinuses grafted with Plenum Osshp (Plenum Bioengenharia, Jundia, SP, Brazil) (70HA:30β-TCP) material. A total of 39 implants were inserted after 23 sinus floor elevation procedures in 16 consecutive patients. Prosthetic rehabilitation included fixed partial prostheses (three units), single crowns (eleven units), and fixed full arches (three units). Clinical and radiographic parameters of implant-supported restorations were evaluated after at least one year of occlusal loading. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility, an average distance between the implant shoulder and the first visible bone contact (DIB) < 1.0 mm from the initial surgery, and the absence of prosthetic complications at the implant-abutment interface. The overall cumulative implant survival rate was 97.43%. No prosthetic complications at the implant-abutment interface were reported. After one year, the mean DIB was 0.23 mm ± 0.14. Within the limits of this retrospective study, it can be concluded that 70 HA:30 β-TCP allowed stable and reliable bone support to maintain healthy conditions around titanium dental implants produced by additive manufacturing.
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Affiliation(s)
- Ilton José Mafra
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Dimorvan Bordin
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Rafael S. Siroma
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rua Ibituruna, 108, Maracanã, Rio de Janeiro 20271-020, RJ, Brazil;
| | - Leonardo P. Faverani
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University (UNESP), R. José Bonifácio, 1193—V. Mendonca, Araçatuba 16015-050, SP, Brazil;
| | - João Gabriel Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
| | - Carlos Fernando Mourão
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Jamil Awad Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (I.J.M.); (D.B.); (R.S.S.); (J.G.S.)
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Iezzi G, Zavan B, Petrini M, Ferroni L, Pierfelice TV, D'Amora U, Ronca A, D'Amico E, Mangano C. 3D printed dental implants with a porous structure: The in vitro response of osteoblasts, fibroblasts, mesenchymal stem cells, and monocytes. J Dent 2024; 140:104778. [PMID: 37951493 DOI: 10.1016/j.jdent.2023.104778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
AIMS The first aim of this study was to characterize the surface topography of a novel 3D-printed dental implant at the micro- and macro-level. Its second aim was to evaluate the osteogenic, angiogenic, and immunogenic responses of human oral osteoblasts (hOBs), gingival fibroblasts (hGFs), mesenchymal stem cells (hAD-MSCs), and monocytes to this novel implant surface. METHODS A 3D-printed Ti-6Al-4 V implant was produced by selective laser melting and subjected to organic acid etching (TEST). It was then compared to a machined surface (CTRL). Its biological properties were evaluated via cell proliferation assays, morphological observations, gene expression analyses, mineralization assessments, and collagen quantifications. RESULTS Scanning electron microscopy analysis showed that the TEST group was characterized by a highly interconnected porous architecture and a roughed surface. The morphological observations showed good adhesion of cells cultured on the TEST surface, with a significant increase in hOB growth. Similarly, the gene expression analysis showed significantly higher levels of osseointegration biomarkers. Picrosirius staining showed a slight increase in collagen production in the TEST group compared to the CTRL group. hAD-MSCs showed an increase in endothelial and osteogenic commitment-related markers. Monocytes showed increased mRNA synthesis related to the M2 (anti-inflammatory) macrophagic phenotype. CONCLUSIONS Considering the higher interaction with hOBs, hGFs, hAD-MSCs, and monocytes, the prepared 3D-printed implant could be used for future clinical applications. CLINICAL RELEVANCE This study demonstrated the excellent biological response of various cells to the porous surface of the novel 3D-printed implant.
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Affiliation(s)
- Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, Chieti 66100, Italy
| | - Barbara Zavan
- Translational Medicine Department, University of Ferrara, Ferrara 44121, Italy
| | - Morena Petrini
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, Chieti 66100, Italy
| | - Letizia Ferroni
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna 48033, Italy
| | - Tania Vanessa Pierfelice
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, Chieti 66100, Italy
| | - Ugo D'Amora
- Institute of Polymers, Composites and Biomaterials National Research Council (IPCB-CNR), Naples 80125, Italy
| | - Alfredo Ronca
- Institute of Polymers, Composites and Biomaterials National Research Council (IPCB-CNR), Naples 80125, Italy
| | - Emira D'Amico
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, 31, Chieti 66100, Italy.
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Exploring the Importance of Corticalization Occurring in Alveolar Bone Surrounding a Dental Implant. J Clin Med 2022; 11:jcm11237189. [PMID: 36498764 PMCID: PMC9738071 DOI: 10.3390/jcm11237189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Several measures describing the transformation of trabecular bone to cortical bone on the basis of analysis of intraoral radiographs are known (including bone index or corticalization index, CI). At the same time, it has been noted that after functional loading of dental implants such transformations occur in the bone directly adjacent to the fixture. Intuitively, it seems that this is a process conducive to the long-term maintenance of dental implants and certainly necessary when immediate loading is applied. The authors examined the relationship of implant design features to marginal bone loss (MBL) and the intensity of corticalization over a 10-year period of functional loading. This study is a general description of the phenomenon of peri-implant bone corticalization and an attempt to interpret this phenomenon to achieve success of implant treatment in the long term. Corticalization significantly increased over the first 5-year functional loading (CI from 200 ± 146 initially to 282 ± 182, p < 0.001) and maintained a high level (CI = 261 ± 168) in the 10-year study relative to the reference bone (149 ± 178). MBL significantly increased throughout the follow-up period—5 years: 0.83 ± 1.26 mm (p < 0.001), 10 years: 1.48 ± 2.01 mm (p < 0.001). MBL and radiographic bone structure (CI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. In the scope of the study, it can be concluded that the phenomenon of peri-implant jawbone corticalization seems an unfavorable condition for the future fate of bone-anchored implants, but it requires further research to fully explain the significance of this phenomenon.
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Roth LA, Bastos MF, Melo MA, Barão VAR, Costa RC, Giro G, Souza JGS, Grzech-Leśniak K, Shibli JA. The Potential Role of a Surface-Modified Additive-Manufactured Healing Abutment on the Expression of Integrins α2, β1, αv, and β6 in the Peri-Implant Mucosa: A Preliminary Human Study. Life (Basel) 2022; 12:life12070937. [PMID: 35888027 PMCID: PMC9316083 DOI: 10.3390/life12070937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
The stability of peri-implant soft tissues is essential for long-term success. Integrins play a vital role in biological processes through developing and maintaining cell interactions; however, few studies have evaluated the effects of modifications to abutment surfaces on cell adhesion across integrin expression. Therefore, this pilot study assessed the influence of different surface topographies of titanium healing abutments prepared by additive manufacturing (AM) on the gene expression levels of the integrin subunits α2, β1, αv, and β6 in the human peri-implant mucosa. Thirteen healthy adults were included. Depending on the number of required implants, the subjects were distributed in different groups as a function of healing abutment topography: group 1 (fully rough surface); group 2 (upper machined + lower rough); group 3 (rough upper surface + lower machined); group 4 (fully machined). A total of 40 samples (n = 10/group) of the peri-implant mucosa around the abutments were collected 30 days after implant placement, and subsequently, the gene expression levels were evaluated using real-time PCR. The levels of gene expression of β1-subunit integrin were upregulated for individuals receiving fully rough surface abutments compared with the other surface topographies (p < 0.05). However, the healing abutment topography did not affect the gene expression levels of the α2, αv, and β6 integrin subunits in the human peri-implant mucosa (p > 0.05). This preliminary study suggested that controlled modifications of the surface topography of titanium healing abutments produced by AM may influence the quality of the peri-implant mucosa in the early stages of the soft tissue healing process.
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Affiliation(s)
- Leandro Amadeu Roth
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
| | - Marta Ferreira Bastos
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, Rua. Taquari, 546, São Paulo 03166-000, SP, Brazil;
| | - Marcelo A. Melo
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
| | - Valentim A. R. Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba 13414-903, SP, Brazil; (V.A.R.B.); (R.C.C.)
| | - Raphael C. Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba 13414-903, SP, Brazil; (V.A.R.B.); (R.C.C.)
| | - Gabriela Giro
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
| | - João Gabriel Silva Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
- Dental Science School (Faculdade de Ciências Odontológicas—FCO), Av. Waldomiro Marcondes Oliveira, 20-Ibituruna, Montes Claros 39401-303, MG, Brazil
| | - Kinga Grzech-Leśniak
- Department of Oral Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
- Correspondence:
| | - Jamil Awad Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-070, SP, Brazil; (L.A.R.); (M.A.M.); (G.G.); (J.G.S.S.); or (J.A.S.)
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Contemporary Approach to the Porosity of Dental Materials and Methods of Its Measurement. Int J Mol Sci 2021; 22:ijms22168903. [PMID: 34445606 PMCID: PMC8396236 DOI: 10.3390/ijms22168903] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 01/05/2023] Open
Abstract
Porosity is an important parameter for characterizing the microstructure of solids that corresponds to the volume of the void space, which may contain fluid or air, over the total volume of the material. Many materials of natural and technically manufactured origin have a large number of voids in their internal structure, relatively small in size, compared to the characteristic dimensions of the body itself. Thus, porosity is an important feature of industrial materials, but also of biological ones. The porous structure affects a number of material properties, such as sorption capacity, as well as mechanical, thermal, and electrical properties. Porosity of materials is an important factor in research on biomaterials. The most popular materials used to rebuild damaged tooth tissues are composites and ceramics, whilst titanium alloys are used in the production of implants that replace the tooth root. Research indicates that the most comprehensive approach to examining such materials should involve an analysis using several complementary methods covering the widest possible range of pore sizes. In addition to the constantly observed increase in the resolution capabilities of devices, the development of computational models and algorithms improving the quality of the measurement signal remains a big challenge.
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Lateral static overload on immediately restored implants decreases the osteocyte index in peri-implant bone: a secondary analysis of a pre-clinical study in dogs. Clin Oral Investig 2020; 25:3297-3303. [PMID: 33150510 DOI: 10.1007/s00784-020-03662-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This animal study was conducted to evaluate the osteocyte index in the peri-implant bone around immediately restored implants under static lateral overload. MATERIAL AND METHODS Seven mongrel dogs received three implants on each side of the mandible. Forty-two implants were distributed into three groups (14 implants per group); each animal received two implants connected to a 4.5-mm opened expansion device (experimental group); in the other mandible side, two implants were connected into an expansion device without activation (control group); one implant each side of the mandible was left submerged (unload group). After 4 months under daily mechanical and chemical plaque control, the animals were euthanized; dental implants and surrounding bone were removed and processed to obtain thin ground sections. Histomorphometry was used to evaluate the osteocyte index in the peri-implant bone contact to implant. RESULTS A higher, statistically significant mean number of osteocytes × 10-5 μm2 (54.74 ± 23.91) was found in the control group compared with the test group (22.57 ± 22.55) (p = 0.0221). The correlation between percentage of bone-implant contact and osteocyte index for submerged implants was not statistically significant (p = 0.2667), whereas the value for immediately loaded implants was statistically significant (p = 0.0480). CONCLUSION The lower number of osteocytes in the peri-implant bone around overloaded implants could be related to the need for functional adaptation of the bone tissue to overloading and to the hypothesized involvement of the osteocytes in the maintenance of the bone matrix in the control group. CLINICAL RELEVANCE Osteocytes play a pivotal role in bone adaptation to mechanical loading, and the osteocyte network has been regarded as being the main mechanosensory mechanism.
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Cumulative Inaccuracies in Implementation of Additive Manufacturing Through Medical Imaging, 3D Thresholding, and 3D Modeling: A Case Study for an End-Use Implant. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In craniomaxillofacial surgical procedures, an emerging practice adopts the preoperative virtual planning that uses medical imaging (computed tomography), 3D thresholding (segmentation), 3D modeling (digital design), and additive manufacturing (3D printing) for the procurement of an end-use implant. The objective of this case study was to evaluate the cumulative spatial inaccuracies arising from each step of the process chain when various computed tomography protocols and thresholding values were independently changed. A custom-made quality assurance instrument (Phantom) was used to evaluate the medical imaging error. A sus domesticus (domestic pig) head was analyzed to determine the 3D thresholding error. The 3D modeling error was estimated from the computer-aided design software. Finally, the end-use implant was used to evaluate the additive manufacturing error. The results were verified using accurate measurement instruments and techniques. A worst-case cumulative error of 1.7 mm (3.0%) was estimated for one boundary condition and 2.3 mm (4.1%) for two boundary conditions considering the maximum length (56.9 mm) of the end-use implant. Uncertainty from the clinical imaging to the end-use implant was 0.8 mm (1.4%). This study helps practitioners establish and corroborate surgical practices that are within the bounds of an appropriate accuracy for clinical treatment and restoration.
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Tumedei M, Piattelli A, Degidi M, Mangano C, Iezzi G. A Narrative Review of the Histological and Histomorphometrical Evaluation of the Peri-Implant Bone in Loaded and Unloaded Dental Implants. A 30-Year Experience (1988-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062088. [PMID: 32245226 PMCID: PMC7143607 DOI: 10.3390/ijerph17062088] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 11/16/2022]
Abstract
Background: The aim of the present review was to assess the histological and histomorphometrical data from the paper published by our Laboratory on peri-implant bone in dental implants in different loading conditions. Methods: The papers published in different implant loading conditions, in dental implants retrieved from humans, and in the Hard Tissues Research Center of the University of Chieti-Pescara, Italy, were screened on MEDLINE/PubMed, Embase, Scopus, and other electronic databases until 31 December 2018. Only articles that reported the histological and histomorphometrical values of the Bone-Implant Contact (BIC) were selected. Results: The system selection provided a total of 155 papers. The manuscripts included for the narrative review were 57. These papers provided histological and histomorphometrical data. Conclusions: The bone remodeling around dental implants was found to be a dynamic process; loading changed the microstructure of the peri-implant bone; and implants were found to provide a successful function, over several decades, with different range of degrees of BIC in vivo (varying from a little more than 30% to a little more than 90%). Loaded implants presented a 10%-12% higher BIC values when compared to submerged, unloaded implants, and rougher surfaces had, on average, about a 10% higher BIC than machined surfaces.
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Affiliation(s)
- Margherita Tumedei
- Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (A.P.); (G.I.)
- Correspondence: ; Tel.: +39-0871-3554083
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (A.P.); (G.I.)
- Biomaterials Engineering, Catholic University of San Antonio de Murcia (UCAM), Av. de los Jerónimos, Guadalupe, 135 30107 Murcia, Spain
- Fondazione Villaserena per la Ricerca, 65121 Città Sant’Angelo (Pescara), Italy
| | | | | | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (A.P.); (G.I.)
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Mangano C, Bianchi A, Mangano FG, Dana J, Colombo M, Solop I, Admakin O. Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series. 3D Print Med 2020; 6:1. [PMID: 31915946 PMCID: PMC6950914 DOI: 10.1186/s41205-019-0055-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To present the application of custom-made 3D-printed subperiosteal implants for fixed prosthetic restoration of the atrophic posterior mandible of elderly patients. Methods Between January 2017 and June 2018, all partially edentulous patients aged over 65 years, with two or more missing teeth in the posterior atrophic mandible, and who did not want to undergo bone regenerative procedures, were included in this study. These patients were rehabilitated with custom-made subperiosteal implants, designed from cone beam computed tomography (CBCT) and fabricated in titanium by means of direct metal laser sintering (DMLS). The outcome measures were fit and stability of the implants at placement, duration of the intervention, implant survival, and early and late complications. All patients were followed for 1 year after surgery. Results Ten patients (four males, six females; mean age 69.6, SD ± 2.8, median 69, 95% CI 67.9–71.6) were included in the study. The fit of the implants was satisfactory, with a mean rating of 7 out of 10 (SD ± 1.6, median 7, 95% CI 6–8). Only two implants had insufficient fit, because of the presence of scattering in the CBCT; however, they were adapted to the sites during the interventions. The mean duration of the intervention was 44.3 min (SD ± 19.4, median 37, 95% CI 32.3–56.3). At the one-year follow-up, no implants were lost (survival rate 100%). One implant presented immediate postoperative complications with pain, discomfort and swelling, and two patients experienced late complications, having their provisional restorations fractured during the temporisation phase. All these complications were minor in nature, but the final complication rate amounted to 30% (three of ten patients). Conclusions Although this study has limits (small patient sample and short follow-up), DMLS has proven to be an effective method for fabricating accurate subperiosteal implants, with high survival rates. This may represent an alternative treatment procedure in elderly patients with a severely atrophic posterior mandible, since it allows avoidance of regenerative bone therapies. Further studies are needed to confirm these outcomes.
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Affiliation(s)
- Carlo Mangano
- Department of Dental Sciences, University Vita Salute S. Raffaele, 20132, Milan, Italy
| | - Andrea Bianchi
- Department of Periodontology and Implantology, Istituto Stomatologico Italiano, 20122, Milan, Italy
| | - Francesco Guido Mangano
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119991, Moscow, Russia.
| | | | | | - Ivan Solop
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Oleg Admakin
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
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Pan S, Liu B. [Research progress on 3D printing metal powders used in cranio-maxillofacial prosthesis]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:438-442. [PMID: 31512841 DOI: 10.7518/hxkq.2019.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With the rapid development of 3D printing, it is widely used in the field of cranio-maxillofacial surgery. Through the individualized production of 3D printing, the backward mode of traditional production relying on manual shaping has been changed to meet the needs of different patients. However, as no clear specification exists for the performance requirements of 3D printing metal powder for cranio-maxillofacial surgery, its long-term development is not feasible. In this paper, the preparation technologies of 3D printing metal powder for cranio-maxillofacial prostheses (i.e., gas atomization, rotating electrode atomization, and radio frequency plasma spheroidization) and 3D printing forming technologies (i.e., selective laser melting, electron beam selective melting, and laser-engineered net shaping) are introduced. The performance requirements of 3D printing metal powder for cranio-maxillofacial prostheses are then summarized according to the characteristics of the preparation and forming technologies described.
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Affiliation(s)
- Shuo Pan
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Bin Liu
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
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Mangano F, Raspanti M, Maghaireh H, Mangano C. Scanning Electron Microscope (SEM) Evaluation of the Interface between a Nanostructured Calcium-Incorporated Dental Implant Surface and the Human Bone. MATERIALS 2017; 10:ma10121438. [PMID: 29258208 PMCID: PMC5744373 DOI: 10.3390/ma10121438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/26/2022]
Abstract
Purpose. The aim of this scanning electron microscope (SEM) study was to investigate the interface between the bone and a novel nanostructured calcium-incorporated dental implant surface in humans. Methods. A dental implant (Anyridge®, Megagen Implant Co., Gyeongbuk, South Korea) with a nanostructured calcium-incorporated surface (Xpeed®, Megagen Implant Co., Gyeongbuk, South Korea), which had been placed a month earlier in a fully healed site of the posterior maxilla (#14) of a 48-year-old female patient, and which had been subjected to immediate functional loading, was removed after a traumatic injury. Despite the violent trauma that caused mobilization of the fixture, its surface appeared to be covered by a firmly attached, intact tissue; therefore, it was subjected to SEM examination. The implant surface of an unused nanostructured calcium-incorporated implant was also observed under SEM, as control. Results. The surface of the unused implant showed a highly-structured texture, carved by irregular, multi-scale hollows reminiscent of a fractal structure. It appeared perfectly clean and devoid of any contamination. The human specimen showed trabecular bone firmly anchored to the implant surface, bridging the screw threads and filling the spaces among them. Conclusions. Within the limits of this human histological report, the sample analyzed showed that the nanostructured calcium-incorporated surface was covered by new bone, one month after placement in the posterior maxilla, under an immediate functional loading protocol.
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Affiliation(s)
- Francesco Mangano
- Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy.
| | - Mario Raspanti
- Department of Medicine and Surgery, University of Insubria, Varese 21100, Italy.
| | | | - Carlo Mangano
- Department of Dental Sciences, University Vita Salute S. Raffaele, Milan 20132, Italy.
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Histological Evidence of the Osseointegration of Fractured Direct Metal Laser Sintering Implants Retrieved after 5 Years of Function. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9732136. [PMID: 28929117 PMCID: PMC5592009 DOI: 10.1155/2017/9732136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/30/2017] [Indexed: 11/17/2022]
Abstract
Background Direct metal laser sintering (DMLS) is an additive manufacturing technique that allows the fabrication of dental implants layer by layer through the laser fusion of titanium microparticles. The surface of DMLS implants is characterized by a high open porosity with interconnected pores of different sizes; therefore, it has the potential to enhance and accelerate bone healing. To date, however, there are no histologic/histomorphometric studies in the literature evaluating the interface between bone and DMLS implants in the long-term. Purpose To evaluate the interface between bone and DMLS implants retrieved after 5 years of functional loading. Methods Two fractured DMLS implants were retrieved from the human jaws, using a 5 mm trephine bur. Both the implants were clinically stable and functioned regularly before fracture. The specimens were processed for histologic/histomorphometric evaluation; the bone-to-implant contact (BIC%) was calculated. Results Compact, mature lamellar bone was found over most of the DMLS implants in close contact with the implant surface; the histomorphometric evaluation showed a mean BIC% of 66.1% (±4.5%). Conclusions The present histologic/histomorphometric study showed that DMLS implants were well integrated in bone, after 5 years of loading, with the peri-implant bone undergoing continuous remodeling at the interface.
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Tan N, Liu X, Cai Y, Zhang S, Jian B, Zhou Y, Xu X, Ren S, Wei H, Song Y. The influence of direct laser metal sintering implants on the early stages of osseointegration in diabetic mini-pigs. Int J Nanomedicine 2017; 12:5433-5442. [PMID: 28814861 PMCID: PMC5546787 DOI: 10.2147/ijn.s138615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background High failure rates of oral implants have been reported in diabetic patients due to the disruption of osseointegration. The aim of this study was to investigate whether direct laser metal sintering (DLMS) could improve osseointegration in diabetic animal models. Methods Surface characterizations were carried out on two types of implants. Cell morphology and the osteogenic-related gene expression of MG63 cells were observed under conditions of DLMS and microarc oxidation (MAO). A diabetes model in mini-pigs was established by intravenous injection of streptozotocin (150 mg/kg), and a total of 36 implants were inserted into the mandibular region. Micro-computed tomography (micro-CT) and histologic evaluations were performed 3 and 6 months after implantation. Results The Ra (the average of the absolute height of all points) of MAO surface was 2.3±0.3 µm while the DLMS surface showed the Ra of 27.4±1.1 µm. The cells on DLMS implants spread out more podia than those on MAO implants through cell morphology analysis. Osteogenic-related gene expression was also dramatically increased in the DLMS group. Obvious improvement was observed in the micro-CT and Van Gieson staining analyses of DLMS implants compared with MAO at 3 months, although this difference disappeared by 6 months. DLMS implants showed a higher bone–implant contact percentage (33.2%±11.2%) at 3 months compared with MAO group (18.9%±7.3%) while similar results were showed at 6 months between DLMS group (42.8%±10.1%) and MAO group (38.3%±10.8%). Conclusion The three-dimensional environment of implant surfaces with highly porous and fully interconnected channel and pore architectures can improve cell spreading and accelerate the progress of osseointegration in diabetic mini-pigs.
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Affiliation(s)
- Naiwen Tan
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China.,Department of Stomatology, Hospital 463 of PLA, Xi'an, Shaanxi, China
| | - Xiangwei Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanhui Cai
- Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Sijia Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bo Jian
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yuchao Zhou
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoru Xu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shuai Ren
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongbo Wei
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yingliang Song
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Xi'an, Shaanxi, China.,Department of Implant Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
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Early Bone Formation around Immediately Loaded Transitional Implants Inserted in the Human Posterior Maxilla: The Effects of Fixture Design and Surface. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4152506. [PMID: 28280731 PMCID: PMC5322419 DOI: 10.1155/2017/4152506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/18/2017] [Indexed: 11/17/2022]
Abstract
Aim. To evaluate the effects of fixture design and surface on the early bone formation around immediately loaded implants inserted in the human posterior maxilla. Materials and Methods. Ten totally edentulous subjects received two transitional implants: one tapered implant with knife-edge threads/nanostructured calcium-incorporated surface (test: Anyridge®, Megagen, Gyeongbuk, South Korea) and one cylindrical implant with self-tapping threads/sandblasted surface (control: EZPlus®, Megagen). The implants were placed according to a split-mouth design and immediately loaded to support an interim complete denture; after 8 weeks, they were removed for histologic/histomorphometric analysis. The bone-to-implant contact (BIC%) and the bone density (BD%) were calculated. The Wilcoxon test was used to evaluate the differences. Results. With test implants, a mean BIC% and BD% of 35.9 (±9.1) and 31.8 (±7.5) were found. With control implants, a mean BIC% and BD% of 29.9 (±7.6) and 32.5 (±3.9) were found. The mean BIC% was higher with test implants, but this difference was not significant (p = 0.16). Similar BD% were found in the two groups (p = 0.9). Conclusions. In the posterior maxilla, under immediate loading conditions, implants with a knife-edge thread design/nanostructured calcium-incorporated surface seem to increase the peri-implant endosseous healing properties, when compared to implants with self-tapping thread design/sandblasted surface.
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Sun Q, Yang Y, Luo W, Zhao J, Zhou Y. The Influence of Electrolytic Concentration on the Electrochemical Deposition of Calcium Phosphate Coating on a Direct Laser Metal Forming Surface. Int J Anal Chem 2017; 2017:8610858. [PMID: 28250771 PMCID: PMC5303588 DOI: 10.1155/2017/8610858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/31/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023] Open
Abstract
A calcium phosphate (CaP) coating on titanium surface enhances its biocompatibility, thus facilitating osteoconduction and osteoinduction with the inorganic phase of the human bone. Electrochemical deposition has been suggested as an effective means of fabricating CaP coatings on porous surface. The purpose of this study was to develop CaP coatings on a direct laser metal forming implant using electrochemical deposition and to investigate the effect of electrolytic concentration on the coating's morphology and structure by X-ray diffraction, scanning electron microscopy, water contact angle analysis, and Fourier transform infrared spectroscopy. In group 10-2, coatings were rich in dicalcium phosphate, characterized to be thick, layered, and disordered plates. In contrast, in groups 10-3 and 10-4, the relatively thin and well-ordered coatings predominantly consisted of granular hydroxyapatite. Further, the hydrophilicity and cell affinity were improved as electrolytic concentration increased. In particular, the cells cultured in group 10-3 appeared to have spindle morphology with thick pseudopodia on CaP coatings; these spindles and pseudopodia strongly adhered to the rough and porous surface. By analyzing and evaluating the surface properties, we provided further knowledge on the electrolytic concentration effect, which will be critical for improving CaP coated Ti implants in the future.
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Affiliation(s)
- Qianyue Sun
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Yuhui Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130033, China
| | - Wenjing Luo
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
| | - Jinghui Zhao
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
| | - Yanmin Zhou
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
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Bowers M, Yoo D, Marin C, Gil L, Shabaka N, Goldstein M, Janal M, Tovar N, Hirata R, Bonfante E, Coelho P. Surface characterization and in vivo evaluation of laser sintered and machined implants followed by resorbable-blasting media process: A study in sheep. Med Oral Patol Oral Cir Bucal 2016; 21:e206-13. [PMID: 26827064 PMCID: PMC4788801 DOI: 10.4317/medoral.20946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/17/2015] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to compare the histomorphometric and histological bone response to laser-sintered implants followed by resorbable-blasting media (RBM) process relative to standard machined/RBM surface treated implants. Material and Methods Six male sheep (n=6) received 2 Ti-6Al-4V implants (1 per surface) in each side of the mandible for 6 weeks in vivo. The histomorphometric parameters bone-implant contact (BIC) and bone area fraction occupancy (BAFO) were evaluated. Results Optical interferometry revealed higher Sa and Sq values for the laser-sintered/RBM surface in relation to standard/RBM implants. No significant differences in BIC were observed between the two groups (p>0.2), but significantly higher BAFO was observed for standard/RBM implants (p<0.01). Conclusions The present study demonstrated that both surfaces were biocompatible and osseoconductive, and the combination of laser sintering and RBM has no advantage over the standard machined implants with subsequent RBM. Key words:Dental implants, osseointegration, resorbable- blasting media, sheep, in vivo.
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Affiliation(s)
- Michelle Bowers
- 345 E 24th Street, 10010, Biomaterials and Biomimetics, New York University, New York, NY, USA, rh1694@@nyu.edu
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Maxillary overdentures supported by four splinted direct metal laser sintering implants: a 3-year prospective clinical study. Int J Dent 2014; 2014:252343. [PMID: 25580124 PMCID: PMC4279819 DOI: 10.1155/2014/252343] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose. Nowadays, the advancements in direct metal laser sintering (DMLS) technology allow the fabrication of titanium dental implants. The aim of this study was to evaluate implant survival, complications, and peri-implant marginal bone loss of DMLS implants used to support bar-retained maxillary overdentures. Materials and Methods. Over a 2-year period, 120 implants were placed in the maxilla of 30 patients (18 males, 12 females) to support bar-retained maxillary overdentures (ODs). Each OD was supported by 4 implants splinted by a rigid cobalt-chrome bar. At each annual follow-up session, clinical and radiographic parameters were assessed. The outcome measures were implant failure, biological and prosthetic complications, and peri-implant marginal bone loss (distance between the implant shoulder and the first visible bone-to-implant contact, DIB). Results. The 3-year implant survival rate was 97.4% (implant-based) and 92.9% (patient-based). Three implants failed. The incidence of biological complication was 3.5% (implant-based) and 7.1% (patient-based). The incidence of prosthetic complication was 17.8% (patient-based). No detrimental effects on marginal bone level were evidenced. Conclusions. The use of 4 DMLS titanium implants to support bar-retained maxillary ODs seems to represent a safe and successful procedure. Long-term clinical studies on a larger sample of patients are needed to confirm these results.
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Direct metal laser sintering titanium dental implants: a review of the current literature. Int J Biomater 2014; 2014:461534. [PMID: 25525434 PMCID: PMC4267165 DOI: 10.1155/2014/461534] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/16/2014] [Accepted: 11/06/2014] [Indexed: 12/14/2022] Open
Abstract
Statement of Problem. Direct metal laser sintering (DMLS) is a technology that allows fabrication of complex-shaped objects from powder-based materials, according to a three-dimensional (3D) computer model. With DMLS, it is possible to fabricate titanium dental implants with an inherently porous surface, a key property required of implantation devices. Objective. The aim of this review was to evaluate the evidence for the reliability of DMLS titanium dental implants and their clinical and histologic/histomorphometric outcomes, as well as their mechanical properties. Materials and Methods. Electronic database searches were performed. Inclusion criteria were clinical and radiographic studies, histologic/histomorphometric studies in humans and animals, mechanical evaluations, and in vitro cell culture studies on DMLS titanium implants. Meta-analysis could be performed only for randomized controlled trials (RCTs); to evaluate the methodological quality of observational human studies, the Newcastle-Ottawa scale (NOS) was used. Results. Twenty-seven studies were included in this review. No RCTs were found, and meta-analysis could not be performed. The outcomes of observational human studies were assessed using the NOS: these studies showed medium methodological quality. Conclusions. Several studies have demonstrated the potential for the use of DMLS titanium implants. However, further studies that demonstrate the benefits of DMLS implants over conventional implants are needed.
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Biological width around one- and two-piece implants retrieved from human jaws. BIOMED RESEARCH INTERNATIONAL 2014; 2014:850120. [PMID: 25050375 PMCID: PMC4094864 DOI: 10.1155/2014/850120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/02/2014] [Indexed: 11/25/2022]
Abstract
Several histologic studies regarding peri-implant soft tissues and biological width around dental implants have been done in animals. However, these findings in human peri-implant soft tissues are very scarce. Therefore, the aim of this case series was to compare the biological width around unloaded one- and two-piece implants retrieved from human jaws. Eight partially edentulous patients received 2 test implants in the posterior mandible: one-piece (solid implants that comprise implant and abutment in one piece) and two-piece (external hexagon with a healing abutment) implants. After 4 months of healing, the implants and surrounding tissue were removed for histologic analysis. The retrieved implants showed healthy peri-implant bone and exhibited early stages of maturation. Marginal bone loss, gaps, and fibrous tissue were not present around retrieved specimens. The biologic width dimension ranged between 2.55 ± 0.16 and 3.26 ± 0.15 to one- and two-piece implants, respectively (P < 0.05). This difference was influenced by the connective tissue attachment, while sulcus depth and epithelial junction presented the same dimension for both groups (P > 0.05). Within the limits of this study, it could be shown that two-piece implants resulted in the thickening of the connective tissue attachment, resulting in the increase of the biological width, when compared to one-piece implants.
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Mangano FG, De Franco M, Caprioglio A, Macchi A, Piattelli A, Mangano C. Immediate, non-submerged, root-analogue direct laser metal sintering (DLMS) implants: a 1-year prospective study on 15 patients. Lasers Med Sci 2013; 29:1321-8. [PMID: 23494103 DOI: 10.1007/s10103-013-1299-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/01/2013] [Indexed: 11/29/2022]
Abstract
This study evaluated the 1-year survival and success rate of root-analogue direct laser metal sintering (DLMS) implants, placed into the extraction sockets of 15 patients. DLMS is a technology which allows solids with complex geometry to be fabricated by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model; the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer-by-layer, the desired object. Cone-beam computed tomography (CBCT) acquisition and 3D image conversion, combined with the DLMS process, allow the fabrication of custom-made, root-analogue implants (RAIs). CBCT images of 15 non-restorable premolars (eight maxilla; seven mandible) were acquired and transformed into 3D models: from these, custom-made, root-analogue DLMS implants with integral abutment were fabricated. Immediately after tooth extraction, the RAIs were placed in the sockets and restored with a single crown. One year after implant placement, clinical and radiographic parameters were assessed: success criteria included absence of pain, suppuration, and exudation; absence of implant mobility and absence of continuous peri-implant radiolucency; distance between the implant shoulder and the first visible bone-to-implant contact <1.5 mm from initial surgery; and absence of prosthetic complications. At the 1-year follow-up, no implants were lost, for a survival rate of 100 %. All implants were stable, with no signs of infection. The good conditions of the peri-implant tissues were confirmed by the radiographic examination, with a mean DIB of 0.7 mm (±0.2). The possibility of fabricating custom-made, RAI DLMS implants opens new interesting horizons for immediate placement of dental implants.
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Affiliation(s)
- Francesco Guido Mangano
- Department of Surgical and Morphological Science, Dental School, University of Varese, Varese, Italy,
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Mangano F, Bazzoli M, Tettamanti L, Farronato D, Maineri M, Macchi A, Mangano C. Custom-made, selective laser sintering (SLS) blade implants as a non-conventional solution for the prosthetic rehabilitation of extremely atrophied posterior mandible. Lasers Med Sci 2012; 28:1241-7. [PMID: 22976817 DOI: 10.1007/s10103-012-1205-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/03/2012] [Indexed: 11/28/2022]
Abstract
The treatment of severely atrophied posterior mandibles with standard-diameter root-form implants may present a challenge. Bone reconstructive surgery represents the treatment of choice; however, it may not be accepted by some patients for economic reasons or due to higher morbidity. Computer-aided design/computer-aided manufacturing (CAD/CAM) technologies have recently opened new frontiers in biomedical applications. Selective laser sintering (SLS) is a CAD/CAM technique that allows the fabrication of complex three-dimensional (3D) structures created by computer-generated image-based design techniques. The aim of this study is to present a protocol for the manufacture and clinical use of custom-made SLS titanium blade implants as a non-conventional therapeutic treatment for the prosthetic rehabilitation of extremely atrophied posterior mandibles. Computed tomography datasets of five patients were transferred to a specific reconstruction software, where a 3D projection of the atrophied mandible was obtained, and custom-made endosseous blade implants were designed. The custom-made implants were fabricated with SLS technique, placed in the extremely atrophied posterior (<4 mm width) mandible, and immediately restored with fixed partial restorations. After 2 years of loading, all implants were in function, showing a good esthetic integration. Blade implants can be fabricated on an individual basis as a custom-designed device. This non-conventional approach may represent an option for restoring the atrophied posterior mandible of elderly patients.
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Affiliation(s)
- F Mangano
- Dental School, Oral Surgery Unit, University of Varese, Piazza Trento 4, 22015, Gravedona, Como, Italy.
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