Osseointegration of short titan implants: A pilot study in pigs

The minipig intraoral dental implant model: A systematic review and meta-analysis

OBJECTIVES

The objective of this report was to provide a review of the minipig intraoral dental implant model including a meta-analysis to estimate osseointegration and crestal bone remodeling.

METHODS

A systematic review including PubMed and EMBASE databases through June 2021 was conducted. Two independent examiners screened titles/abstracts and selected full-text articles. Studies evaluating titanium dental implant osseointegration in native alveolar bone were included. A quality assessment of reporting was performed. Random-effects meta-analyses and meta-regressions were produced for bone-implant contact (BIC), first BIC, and crestal bone level.

RESULTS

125 out of 249 full-text articles were reviewed, 55 original studies were included. Quality of reporting was generally low, omissions included animal characteristics, examiner masking/calibration, and sample size calculation. The typical minipig model protocol included surgical extraction of the mandibular premolars and first molar, 12±4 wks post-extraction healing, placement of three narrow regular length dental implants per jaw quadrant, submerged implant healing and 8 wks of osseointegration. Approximately 90% of studies reported undecalcified incandescent light microscopy histometrics. Overall, mean BIC was 59.88% (95%CI: 57.43-62.33). BIC increased significantly over time (p<0.001): 40.93 (95%CI: 34.95-46.90) at 2 wks, 58.37% (95%CI: 54.38-62.36) at 4 wks, and 66.33% (95%CI: 63.45-69.21) beyond 4 wks. Variability among studies was mainly explained by differences in observation interval post-extraction and post-implant placement, and implant surface. Heterogeneity was high for all studies (I2 > 90%, p<0.001).

CONCLUSIONS

The minipig intraoral dental implant model appears to effectively demonstrate osseointegration and alveolar bone remodeling similar to that observed in humans and canine models.

Correlation between two-dimensional micro-CT and histomorphometry for assessment of the implant osseointegration in rabbit tibia model

BACKGROUND

Histology is considered as a gold standard for analyzing bone architecture. However, histomorphometry is a destructive method and only offers the bone information of a limited location. Micro-computed tomography (μCT) is a non-destructive technology and provides a slice at any site. The aim of this study was to compare the correlation of the Bone-to-Implant Contact ratio (BIC) between 2D micro-CT (μCT) and histomorphometry and to investigate a method for assessing the osseointegration of the implant by 2D μCT.

METHODS

A total of 18 implants were divided into three groups (6 implants per group), and inserted into the rabbit tibia defects as follow: implant only (Implant group), implant with β-TCP/hydrogel (TCP group), implant with rhBMP-2 loaded β-TCP/hydrogel composite (BMP-2 group). After 4 weeks of implantation, the specimens were collected to take the micro-CT scan with an aluminum filter and performed H&E staining on the undecalcified sections. The 2D μCT slices were chosen at an angle of 0°, 45°, 90° and 135° with the representative histological section to measure BIC. And the correlations between BICs of 2D μCT and BICs of histology were evaluated.

RESULTS

In each group, BICs at the same sites measured by histomorphometry and corresponding 2D μCT presented the same trend and shown no significant difference between the two methods (P > 0.05). BICs of histological sections and BICs of corresponding 2D μCT slices presented a strong correlation in the implant group (γ = 0.74, P = 0.09), a moderate correlation in the TCP group (γ = 0.46, P = 0.35), a weak correlation in the BMP-2 group (γ = 0.30, P = 0.56). In the implant group, the relationship between BIC-Mean-μCTs and BICs-Histology has presented a significant linear correlation (γ = 0.84, P = 0.04).

CONCLUSIONS

Integrating bone information of several 2D μCT slices in different sites to measure BIC is a feasible method for assessing the implant osseointegration.

Evaluation of the Surrounding Ring of Two Different Extra-Short Implant Designs in Crestal Bone Maintanence: A Histologic Study in Dogs

The aim of this study was to compare the implant stability and bone resorption and formation of two different extra-short implant designs with different diameter rings placed in a dog´s maxilla. Thirty-six extra-short, 5 mm diameter × 4 mm length (Short DM^®, Bioner Sistemas Implantológicos, Barcelona, Spain), delayed implants were placed in each hemimaxilla of six dogs at the bone crest level. Eighteen implants of each design (wide and narrow ring) were installed. After 8 and 12 weeks of healing, histomorphometric analyses of the specimens were carried out to measure the crestal bone level values and the tissue thickness around the wide and narrow ring implant designs. In the microscopic analysis, less buccal bone resorption was observed in the narrow ring implants with a statistical significance (p < 0.001). For the peri-implant tissue thickness, the distance from the implant shoulder to the external portion of the epithelium was significantly higher for the implants installed with a wide ring with statistical significance (p < 0.001). Our findings suggest that the amount of peri-implant tissues (crestal bone loss) after remodeling over a period of 12 weeks was smaller in the narrow ring extra-short implant installed in the healed maxilla, compared with the wide ring extra-short implants.

Short Implants and Conventional Implants in The Residual Maxillary Alveolar Ridge: A 36-Month Follow-Up Observation

BACKGROUND Short dental implants are considered an alternative method of treatment to the maxillary sinus elevation and bone augmentation procedure at the sites of a reduced alveolar ridge height. The aim of the study was to determine the most effective therapeutic approach for a single tooth replacement in a reduced maxillary alveolar crest. MATERIAL AND METHODS We enrolled 30 partially edentulous patients having a residual crestal height of 6 mm and a minimal width of the alveolar ridge of 6-7 mm: 15 patients received regular dental implants (OsseoSpeed™ L11 Ø4 mm and L13 Ø4 mm) and the implantation was preceded by the sinus lift procedure from a lateral window approach with the application of a xenogeneic bone graft, whereas the remaining 15 patients received short implants (OsseoSpeed™ L6 mm Ø4 mm) without the sinus lift and augmentation procedure. All implants were loaded with single non-splinted crowns. Radiological examination (CBCT, RVG) was performed before the surgery and after 36 months. Primary and secondary stabilization with Osstell ISQ® and Periotest® were assessed. RESULTS Good results in primary and secondary stability were achieved in both systems. The marginal bone level (MBL) loss was low (0.22±0.46 mm and 0.34±0.24 mm, for short and conventional implants, respectively). No significant difference in MBL between groups was found. CONCLUSIONS Short implants can be successfully used to support single crowns in the lateral part of the maxilla.

Comparison of ground sections, paraffin sections and micro-CT imaging of bone from the epiphysis of the porcine femur for morphometric evaluation

The aim of this study was to compare data on the volume fraction of bone and the thickness of the cortical compact bone acquired during microcomputed tomography (micro-CT) analysis with data acquired from identical samples using stereological analysis of either decalcified paraffin sections or ground sections. Additionally, we aimed to compare adjacent tissue samples taken from the major trochanter of the porcine femur to map the basic biological variability of trabecular bone. Fifteen pairs of adjacent tissue blocks were removed from the major trochanter of the proximal epiphyses of porcine femurs (female pigs aged 24-39 months, weight=59.16±8.15kg). In each sample, the volume of the cortical compact bone, the volume of the trabecular bone, and the thickness of the cortical compact bone was assessed using micro-CT. Afterwards, half of the samples were decalcified and processed using paraffin histological sections. Another half was processed into ground sections. The volume and thickness of bone was assessed in histological sections using stereological techniques. There were no significant differences in the bone volumes and thicknesses measured by micro-CT and the corresponding values quantified in decalcified sections. Similarly, there were no differences between the results from micro-CT and the analysis of the corresponding ground sections. Histomorphometric studies based on relatively low numbers of undecalcified ground sections or demineralized paraffin sections of bone yield data on bone volume and the thickness of cortical compact bone that is comparable with three-dimensional micro-CT examination. The pilot data on the variability of cortical compact bone and trabecular bone volumes in the porcine major trochanter provided in this study aim for planning experiments in the field of bone healing and implantology.

Comparative Study on Osseointegration of Implants After Flap and Flapless Surgery in the Mandible of Dogs

PURPOSE

The objective of this study was to compare the implant stability and osseointegration of implants using a flap or flapless technique.

MATERIAL AND METHODS

Mandibular premolars and molars were extracted from both sides in 6 dogs. After 8 weeks, 4 fixtures were implanted using either a flap or flapless technique. Implant stability quotient was measured on insertion and at 2, 4, and 8 weeks later. The animals were killed while the tissues were histologically analyzed.

RESULTS

Implant stability increased for 8 weeks, and no statistically significant differences were observed between the surgical protocols. Bone-implant contact showed 60.27% ± 30.99% for flapless surgery and 59.73% ± 17.12% for flap surgery. And the results of new bone formation area from total area showed 56.07% ± 27.78% for flapless surgery and 57.00% ± 14.66% for flap surgery. There were no statistically significant differences.

CONCLUSION

This study showed no significant difference in implant stability as well as osseointegration regardless of flap or flapless technique.

Comparative evaluation of the effectiveness of the implantation in the lateral part of the mandible between short tissue level (TE) and bone level (BL) implant systems

Short dental implants can be an alternative method of treatment to a vertical bone augmentation procedure at sites of reduced alveolar height. However, for successful treatment, an implant system that causes a minimal marginal bone loss (MBL) should be taken into consideration. The aim of the study has been to evaluate implantation effectiveness for bone level and tissue level short implants provided in lateral aspects of partially edentulous mandible and limited alveolar ridge height. The MBL and primary as well as secondary implant stability were determined in the study. Patients were randomly divided into two groups according to the method of treatment provided. Sixteen short Bone Level Implants (OsseoSpeed TX, Astra tech) and 16 short Tissue Level Implants (RN SLActive^®, Straumann) were successfully placed in the edentulous part of the mandible. The determination of the marginal bone level was based on radiographic evaluation after 12 and 36 weeks. Implant stability was measured immediately after insertion and after 12 weeks. The marginal bone level of Bone Level Implants was significantly lower compared to Tissue Level Implants. Furthermore, the Bone Level Implants had greater primary and secondary stability in comparison with Tissue Level Implants (Primary: 77.8 ISQ versus 66.5 ISQ; Secondary: 78.9 ISQ versus 73.9 ISQ, respectively). Since short Bone Level Implants showed a significantly decreased MBL 12 and 36 weeks after implantation as well as better results for the primary stability compared to Tissue Level Implants, they should preferentially be used for this mentioned indication.

Evaluating the osseointegration of nanostructured titanium implants in animal models: Current experimental methods and perspectives (Review)

The aim of this paper is to review the experimental methods currently being used to evaluate the osseointegration of nanostructured titanium implants using animal models. The material modifications are linked to the biocompatibility of various types of oral implants, such as laser-treated, acid-etched, plasma-coated, and sand-blasted surface modifications. The types of implants are reviewed according to their implantation site (endoosseous, subperiosteal, and transosseous implants). The animal species and target bones used in experimental implantology are carefully compared in terms of the ratio of compact to spongy bone. The surgical technique in animal experiments is briefly described, and all phases of the histological evaluation of osseointegration are described in detail, including harvesting tissue samples, processing undemineralized ground sections, and qualitative and quantitative histological assessment of the bone-implant interface. The results of histological staining methods used in implantology are illustrated and compared. A standardized and reproducible technique for stereological quantification of bone-implant contact is proposed and demonstrated. In conclusion, histological evaluation of the experimental osseointegration of dental implants requires careful selection of the experimental animals, bones, and implantation sites. It is also advisable to use larger animal models and older animals with a slower growth rate rather than small or growing experimental animals. Bones with a similar ratio of compact to spongy bone, such as the human maxilla and mandible, are preferred. A number of practical recommendations for the experimental procedures, harvesting of samples, tissue processing, and quantitative histological evaluations are provided.

Osseointegration behavior of novel Ti-Nb-Zr-Ta-Si alloy for dental implants: an in vivo study

This study aimed to evaluate the effects of Ti-Nb-Zr-Ta-Si alloy implants on mineral apposition rate and new BIC contact in rabbits. Twelve Ti-Nb-Zr-Ta-Si alloy implants were fabricated and placed into the right femur sites in six rabbits, and commercially pure titanium implants were used as controls in the left femur. Tetracycline and alizarin red were administered 3 weeks and 1 week before euthanization, respectively. At 4 weeks and 8 weeks after implantation, animals were euthanized, respectively. Surface characterization and implant-bone contact surface analysis were performed by using a scanning electron microscope and an energy dispersive X-ray detector. Mineral apposition rate was evaluated using a confocal laser scanning microscope. Toluidine blue staining was performed on undecalcified sections for histology and histomorphology evaluation. Scanning electron microscope and histomorphology observation revealed a direct contact between implants and bone of all groups. After a healing period of 4 weeks, Ti-Nb-Zr-Ta-Si alloy implants showed significantly higher mineral apposition rate compared to commercially pure titanium implants (P < 0.05), whereas there was no significant difference between Ti-Nb-Zr-Ta-Si alloy implants and commercially pure titanium implants (P > 0.05) at 8 weeks. No significant difference of bone-to-implant contact was observed between Ti-Nb-Zr-Ta-Si alloy implants and commercially pure titanium implants implants after a healing period of 4 weeks and 8 weeks. This study showed that Ti-Nb-Zr-Ta-Si alloy implants could establish a close direct contact comparedto commercially pure titanium implants implants, improved mineral matrix apposition rate, and may someday be an alternative as a material for dental implants.

Effects on the osseointegration of titanium implants incorporating calcium-magnesium: a resonance frequency and histomorphometric analysis in rabbit tibia

OBJECTIVE

This study assessed the bone formation around titanium surface incorporating the calcium-magnesium (CaMg) deposited by blasted in rabbit tibia bone to determine whether this surface would further enhance bone healing compared with commercially available implant surface.

MATERIAL AND METHODS

The deposition of CaMg on the titanium SLA surface were obtained by blasting formed the experimental group (EX group), while implants with traditional SLA surface were used as control group (CO group), in this study. Fifty cylindrical threaded implants with a length of 8 mm were used (P = 25 per group). Five implants of each group were used to surface characterization by scanning electron microscopy, energy dispersive spectrometry, and optical profilometry. Ten New Zealand white rabbits received 40 implants (n = 20 per group). Resonance frequency analysis was performed three times (0, 4, and 6 weeks). Histomorphometric analysis was performed 4 and 6 weeks after implantation. Statistical significance was set at P < 0.05.

RESULTS

Blasted CaMg deposition on SLA implant surface displayed almost identical surface morphologies and R(a) values at the micron scale. In comparing the implant stability quotient at the three time points, highly significant statistic differences were found (P < 0.001). Histomorphological analysis showed higher degrees of bone organization in the samples of test implant surfaces at both implantation times.

CONCLUSION

Within the limitations of this study, the results indicate that the deposition of CaMg on the SLA titanium surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact.

Evaluation of extrashort 4-mm implants in mandibular edentulous patients with reduced bone height in comparison with standard implants: a 12-month results

OBJECTIVE

The aim of this research was to evaluate the primary stability, the marginal bone loss, the survival, and the success criteria, of 4-mm-length implants compared with implants of conventional length supporting fixed prostheses.

MATERIALS AND METHODS

Ten patients were selected for treatment of their atrophic edentulous jaws. Each patient received the following treatment: six dental implants were inserted, two anterior implants of conventional length (10-mm) in the interforaminal area and four posterior short implants of 4-mm length (Standard Plus, Roxolid, SLActive, Institut Straumann AG). The implants supported screw-retained fixed complete dentures. Examinations were conducted at day 0, three, six, and twelve months after surgery for the evaluation of the implant primary stability, secondary stability, crestal bone loss and survival by clinical evaluations, insertion torque values, resonance frequency analysis (RFA), and periapical radiography, respectively.

RESULTS

Sixty implants were inserted in ten patients. Mean insertion torque was slightly lower for 4-mm implants than 10-mm implants (38.1 Ncm vs. 42.2 Ncm) but without statistically significant difference. Implant stability was similar for extrashort and conventional implants. Marginal bone loss was similar for both groups for all the time periods. One short implant was lost before loading. The survival rates twelve months after implant placement were of 97.5% and 100% for short and conventional implants, respectively. Similarly, implant stability as measured by RFA was nonsignificantly lower for the 4-mm implants compared to the 10-mm implants. The marginal bone loss was lower for short implants three, six, and twelve months after the surgery without statistical significant difference.

CONCLUSIONS

Within the limitations of this study, we conclude that short dental implants (8 mm or less in length) supporting single crowns or fixed bridges are a feasible treatment option with radiographic and clinical success rates similar to longer implants for patients with compromised ridges. Long-term data with larger number of implants and subjects are needed to confirm these preliminary results.