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Bergamo ET, de Oliveira PG, Campos TMB, Bonfante EA, Tovar N, Boczar D, Nayak VV, Coelho PG, Witek L. Osseointegration of implant surfaces in metabolic syndrome and type-2 diabetes mellitus. J Biomed Mater Res B Appl Biomater 2024; 112:e35382. [PMID: 38355936 PMCID: PMC10883641 DOI: 10.1002/jbm.b.35382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/20/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
This in vivo study evaluated the bone healing response around endosteal implants with varying surface topography/chemistry in a preclinical, large transitional model induced with metabolic syndrome (MS) and type-2 diabetes mellitus (T2DM). Fifteen Göttingen minipigs were randomly distributed into two groups: (i) control (normal diet, n = 5) and (ii) O/MS (cafeteria diet for obesity induction, n = 10). Following obesity induction, five minipigs from the obese/metabolic syndrome (O/MS) group were further allocated, randomly, into the third experimental group: (iii) T2DM (cafeteria diet + streptozotocin). Implants with different surface topography/chemistry: (i) dual acid-etched (DAE) and (ii) nano-hydroxyapatite coating over the DAE surface (NANO), were placed into the right ilium of the subjects and allowed to heal for 4 weeks. Histomorphometric evaluation of bone-to-implant contact (%BIC) and bone area fraction occupancy (%BAFO) within implant threads were performed using histomicrographs. Implants with NANO surface presented significantly higher %BIC (~26%) and %BAFO (~35%) relative to implants with DAE surface (%BIC = ~14% and %BAFO = ~28%, p < .025). Data as a function of systemic condition presented significantly higher %BIC (~28%) and %BAFO (~42%) in the control group compared with the metabolically compromised groups (O/MS: %BIC = 14.35% and %BAFO = 26.24%, p < .021; T2DM: %BIC = 17.91% and %BAFO = 26.12%, p < .021) with no significant difference between O/MS and T2DM (p > .05). Statistical evaluation considering both factors demonstrated significantly higher %BIC and %BAFO for the NANO surface relative to DAE implant, independent of systemic condition (p < .05). The gain increase of %BIC and %BAFO for the NANO compared with DAE was more pronounced in O/MS and T2DM subjects. Osseointegration parameters were significantly reduced in metabolically compromised subjects compared with healthy subjects. Nanostructured hydroxyapatite-coated surfaces improved osseointegration relative to DAE, regardless of systemic condition.
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Affiliation(s)
- Edmara T.P. Bergamo
- Biomaterials Division, Department of Molecular Pathobiology New York University College of Dentistry, New York, NY, USA
- Department of Prosthodontics, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Paula G.F.P. de Oliveira
- Biomaterials Division, Department of Molecular Pathobiology New York University College of Dentistry, New York, NY, USA
- CESUPA, Department of Periodontology, University Center of State of Para, Belem, PA, Brazil
| | - Tiago M B Campos
- Biomaterials Division, Department of Molecular Pathobiology New York University College of Dentistry, New York, NY, USA
- Department of Physics, Technological Institute of Aeronautics, São José dos Campos, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Nick Tovar
- Biomaterials Division, Department of Molecular Pathobiology New York University College of Dentistry, New York, NY, USA
- Department of Oral and Maxillofacial Surgery, NYU Langone Medical Center and Bellevue, Hospital Center, New York, NY, USA
| | - Daniel Boczar
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Vasudev Vivekanand Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paulo G. Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lukasz Witek
- Biomaterials Division, Department of Molecular Pathobiology New York University College of Dentistry, New York, NY, USA
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Samara W, Moztarzadeh O, Hauer L, Babuska V. Dental Implant Placement in Medically Compromised Patients: A Literature Review. Cureus 2024; 16:e54199. [PMID: 38496195 PMCID: PMC10942790 DOI: 10.7759/cureus.54199] [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] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
As a discipline of dentistry, oral implantology deals with the diagnosis, design, insertion, restoration, and/or management of alloplastic or autogenous oral structures for the purpose of regaining contour, function, aesthetics, and speech in a partially or completely edentulous patient. The present review aims to provide the currently available knowledge about the impact of certain systemic disorders and the usage of some medications on the survival rate of dental implant therapy and to highlight the importance of patient management under these conditions. Diabetes, osteoporosis, cardiovascular diseases, and the intake of some medications can increase the risk of the failure of a dental implant. Even though there are relatively few medical contraindications to dental implant treatment, certain conditions may increase the risk of failure or complications.
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Affiliation(s)
- Walla Samara
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
| | - Omid Moztarzadeh
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
- Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
| | - Lukas Hauer
- Department of Stomatology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
| | - Vaclav Babuska
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine in Pilsen, Charles University, Czech Republic, Pilsen, CZE
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Bergamo ET, Witek L, Ramalho I, Lopes ACO, Vivekanand Nayak V, Bonfante EA, Tovar N, Torroni A, Coelho PG. Bone healing around implants placed in subjects with metabolically compromised systemic conditions. J Biomed Mater Res B Appl Biomater 2023; 111:1664-1671. [PMID: 37184298 PMCID: PMC10330391 DOI: 10.1002/jbm.b.35264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
The aim of this study was to evaluate the bone healing of tight-fit implants placed in the maxilla and mandible of subjects compromised with metabolic syndrome (MS) and type-2 Diabetes Mellitus (T2DM). Eighteen Göttingen minipigs were randomly distributed into three groups: (i) control (normal diet), (ii) MS (cafeteria diet for obesity induction), (iii) T2DM (cafeteria diet for obesity induction + Streptozotocin for T2DM induction). Maxillary and mandibular premolars and molar were extracted. After 8 weeks of healing, implants with progressive small buttress threads were placed, and allowed to integrate for 6 weeks after which the implant/bone blocks were retrieved for histological processing. Qualitative and quantitative histomorphometric analyses (percentage of bone-to-implant contact, %BIC, and bone area fraction occupancy within implant threads, %BAFO) were performed. The bone healing process around the implant occurred predominantly through interfacial remodeling with subsequent bone apposition. Data as a function of systemic condition yielded significantly higher %BIC and %BAFO values for healthy and MS relative to T2DM. Data as a function of maxilla and mandible did not yield significant differences for either %BIC and %BAFO. When considering both factors, healthy and MS subjects had %BIC and %BAFO trend towards higher values in the mandible relative to maxilla, whereas T2DM yielded higher %BIC and %BAFO in the maxilla relative to mandible. All systemic conditions presented comparable levels of %BIC and %BAFO in the maxilla; healthy and MS presented significantly higher %BIC and %BAFO relative to T2DM in the mandible. T2DM presented lower amounts of bone formation around implants relative to MS and healthy. Implants placed in the maxilla and in the mandible showed comparable amounts of bone in proximity to implants.
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Affiliation(s)
- Edmara T.P. Bergamo
- Biomaterials Division - Department of Molecular Pathobiology NYU Dentistry, New York, NY USA
- Department of Prosthodontics, University of Sao Paulo, School of Dentistry, Sao Paulo, SP, Brazil
| | - Lukasz Witek
- Biomaterials Division - Department of Molecular Pathobiology NYU Dentistry, New York, NY USA
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY USA
| | - Ilana Ramalho
- Department of Prosthodontics, University of Sao Paulo, School of Dentistry, Sao Paulo, SP, Brazil
| | - Adolfo CO Lopes
- Department of Prosthodontics, University of Sao Paulo, School of Dentistry, Sao Paulo, SP, Brazil
| | - Vasudev Vivekanand Nayak
- Biomaterials Division - Department of Molecular Pathobiology NYU Dentistry, New York, NY USA
- Department of Mechanical and Aerospace Engineering, Tandon School of Engineering, Brooklyn, NY USA
| | - Estevam A Bonfante
- Department of Prosthodontics, University of Sao Paulo, School of Dentistry, Sao Paulo, SP, Brazil
| | - Nick Tovar
- Biomaterials Division - Department of Molecular Pathobiology NYU Dentistry, New York, NY USA
- Department of Oral and Maxillofacial Surgery, NYU Langone Medical Center and Bellevue, Hospital Center, New York, NY USA
| | - Andrea Torroni
- Hansjörg Wyss Department of Plastic Surgery, Grossman School of Medicine, New York University, New York, NY USA
| | - Paulo G. Coelho
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Wood PF, da Costa Fernandes CJ, de Almeida GS, Suter LC, de Lima Parra JPRL, Bezerra FJ, Zambuzzi WF. The Action of Angiocrine Molecules Sourced from Mechanotransduction-Related Endothelial Cell Partially Explain the Successful of Titanium in Osseointegration. J Funct Biomater 2023; 14:415. [PMID: 37623660 PMCID: PMC10455987 DOI: 10.3390/jfb14080415] [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: 03/17/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
Since Branemark's findings, titanium-based alloys have been widely used in implantology. However, their success in dental implants is not known when considering the heterogenicity of housing cells surrounding the peri-implant microenvironment. Additionally, they are expected to recapitulate the physiological coupling between endothelial cells and osteoblasts during appositional bone growth during osseointegration. To investigate whether this crosstalk was happening in this context, we considered the mechanotransduction-related endothelial cell signaling underlying laminar shear stress (up to 3 days), and this angiocrine factor-enriched medium was harvested further to use exposing pre-osteoblasts (pOb) for up to 7 days in vitro. Two titanium surfaces were considered, as follows: double acid etching treatment (w_DAE) and machined surfaces (wo_DAE). These surfaces were used to conditionate the cell culture medium as recommended by ISO10993-5:2016, and this titanium-enriched medium was later used to expose ECs. First, our data showed that there is a difference between the surfaces in releasing Ti molecules to the medium, providing very dynamic surfaces, where the w_DAE was around 25% higher (4 ng/mL) in comparison to the wo_DAE (3 ng/mL). Importantly, the ECs took up some of this titanium content for up to 3 days in culture. However, when this conditioned medium was used to expose pOb for up to 7 days, considering the angiocrine factors released from ECs, the concentration of Ti was lesser than previously reported, reaching around 1 ng/mL and 2 ng/mL, respectively. Thereafter, pOb exposed to this angiocrine factor-enriched medium presented a significant difference when considering the mechanosignaling subjected to the ECs. Shear-stressed ECs showed adequate crosstalk with osteoblasts, stimulating the higher expression of the Runx2 gene and driving higher expressions of Alkaline phosphatase (ALP), bone sialoprotein (BSP), and osteocalcin. Mechanotransduction-related endothelial cell signaling as a source of angiocrine molecules also stimulated the higher expression of the Col3A1 gene in osteoblasts, which suggests it is a relevant protagonist during trabecular bone growth. In fact, we investigated ECM remodeling by first evaluating the expression of genes related to it, and our data showed a higher expression of matrix metalloproteinase (MMP) 2 and MMP9 in response to mechanosignaling-based angiocrine molecules, independent of considering w_DAE or the wo_DAE, and this profile reflected on the MMP2 and MMP9 activities evaluated via gelatin-based zymography. Complimentarily, the ECM remodeling seemed to be a very regulated mechanism in mature osteoblasts during the mineralization process once both TIMP metallopeptidase inhibitor 1 and 2 (TIMP1 and TIMP2, respectively) genes were significantly higher in response to mechanotransduction-related endothelial cell signaling as a source of angiocrine molecules. Altogether, our data show the relevance of mechanosignaling in favoring ECs' release of bioactive factors peri-implant, which is responsible for creating an osteogenic microenvironment able to drive osteoblast differentiation and modulate ECM remodeling. Taking this into account, it seems that mechanotransduction-based angiocrine molecules explain the successful use of titanium during osseointegration.
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Affiliation(s)
| | | | | | | | | | | | - Willian Fernando Zambuzzi
- Department of Chemical and Biological Sciences, Institute of Biosciences, UNESP—Universidade Estadual Paulista, Botucatu 18618-970, Brazil
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Kim SH, Oh NS, Kim HJ. Survival Rates and Clinical Outcomes of Implant Overdentures in Old and Medically Compromised Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11571. [PMID: 36141841 PMCID: PMC9517507 DOI: 10.3390/ijerph191811571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Studies on the survival rate of implant overdentures in medically compromised patients are limited because most studies exclude patients with systemic diseases affecting implant prognosis. This retrospective study aimed to evaluate the survival rate and clinical outcomes of dental implants used for overdentures in medically compromised patients. A total of 20 patients (9 men, 11 women; mean age: 67.55 ± 6.84 years, range: 53-81 years) were included. Fourteen patients had more than two systemic diseases, and nine patients had more than three systemic diseases. The mean follow-up period was 39.05 months. Of the 60 implants, 2 failed, resulting in an implant survival rate of 96.6%. No statistical differences were found in implant survival rates according to sex, age, implant diameter, restored arch, or opposing dentition (p > 0.05). A significant difference in mean marginal bone loss (MBL) was noted for restoring the arch (p = 0.022) and opposing dentition (p = 0.036). Implants placed in the mandible and with opposing removable partial dentures and complete dentures showed lower mean MBL. No significant differences in implant MBL were observed in terms of age, sex, or implant diameter (p > 0.05). Favorable clinical outcomes can be expected from implant overdentures using two or four implants in edentulous patients with systemic diseases by ensuring that the patients have a sufficient healing period and regular checkups.
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Affiliation(s)
- So-Hyun Kim
- Department of Dentistry, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea
| | - Nam-Sik Oh
- Department of Dentistry, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea
| | - Hyo-Jung Kim
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunwhando-ro, Dong-gu, Ulsan 44033, Korea
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Matheus HR, Ervolino E, Gusman DJR, Forin LG, Piovezan BR, de Almeida JM. The influence of antineoplastic agents on the peri-implant bone around osseointegrated titanium implants: an in vivo histomorphometric and immunohistochemical study. Clin Oral Investig 2022; 26:2681-2692. [PMID: 34686918 DOI: 10.1007/s00784-021-04239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The interaction between antineoplastic drugs used for treating cancer and non-affected tissues remains poorly assessed and may be critical for maintaining the quality of life for patients during and after treatment. This pre-clinical study evaluated the effects of cisplatin (CIS) and 5-fluorouracil (5-FU) on the peri-implant repair process around osseointegrated titanium implants installed in the tibiae of rats. MATERIAL AND METHODS Were used 90 male rats, randomly divided into three groups (n = 30): physiological saline solution (PSS), CIS, and 5-FU. Titanium implants (4.0 × 2.2 mm) were inserted in both tibiae of all animals at day 0. The animals received either PSS, CIS, or 5-FU at 35 and 37 days. Euthanasia was performed at 50, 65, and 95 days after surgery. Histometric (bone/implant contact [BIC]) and bone area fraction occupancy (% BAFO), histological, and immunohistochemical (for bone morphogenetic protein 2/4 [BMP2/4], Runt-related transcription factor 2 [RUNX2], osteocalcin [OCN], and tartrate-resistant acid phosphatase [TRAP]) analyses were performed. Data were statistically analyzed. RESULTS Groups CIS and 5-FU presented lower BIC and lower BAFO as compared with PSS in all time points. The imbalance in bone turnover was observed by the lower number of BMP2/4-, RUNX2-, and OCN-positive cells/mm2 and the higher number of TRAP-positive cells/mm in groups CIS and 5-FU as compared with PSS in all time points. Persistent and exacerbated inflammation was observed in groups CIS and 5-FU. CONCLUSIONS Both antineoplastic agents interfered negatively in the bone turnover around osseointegrated titanium implants. CLINICAL RELEVANCE Closer and more careful follow-up of patients with osseointegrated implants that will undergo chemotherapy with either CIS or 5-FU shall be performed.
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Affiliation(s)
- Henrique Rinaldi Matheus
- Department of Diagnosis and Surgery-Periodontics Division, São Paulo State University (Unesp), St. José Bonifácio 1193 - Vila Mendonça, Araçatuba, SP, 16015-050, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - Edilson Ervolino
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
- Department of Basic Science, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - David Jonathan Rodrigues Gusman
- Department of Diagnosis and Surgery-Periodontics Division, São Paulo State University (Unesp), St. José Bonifácio 1193 - Vila Mendonça, Araçatuba, SP, 16015-050, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - Luiz Guilherme Forin
- Department of Diagnosis and Surgery-Periodontics Division, São Paulo State University (Unesp), St. José Bonifácio 1193 - Vila Mendonça, Araçatuba, SP, 16015-050, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - Bianca Rafaeli Piovezan
- Department of Diagnosis and Surgery-Periodontics Division, São Paulo State University (Unesp), St. José Bonifácio 1193 - Vila Mendonça, Araçatuba, SP, 16015-050, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil
| | - Juliano Milanezi de Almeida
- Department of Diagnosis and Surgery-Periodontics Division, São Paulo State University (Unesp), St. José Bonifácio 1193 - Vila Mendonça, Araçatuba, SP, 16015-050, Brazil.
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP, Brazil.
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Ryan LL, Kohles SS. A temporospatial histomorphometric analysis of bone density adjacent to acid-etched self-tapping dental implants with an external hexagon connection in the female baboon. Clin Oral Investig 2022; 26:2143-2154. [PMID: 34585261 DOI: 10.1007/s00784-021-04195-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize osseointegration as the percent of bone-implant contact (%BIC) along the surface (0.0 mm) as well as at surface profiles 0.5 mm and 1.0 mm lateral to the implant, determining any differences between early occlusally loaded and non-loaded implants. MATERIAL AND METHODS In ten adult female baboons, 120 dental implants were randomly placed in opposing mandibular and maxillary locations. Eighty sites had two groups of healing (no load) of either 1 (n = 40) or 2 (n = 40) months leading to 3 months of functional loading. These sites received full acid-etched surface implants. The 40 control implants represented healing only periods (no load) for 1 (n = 10), 2 (n = 10), 4 (n = 10), and 5 (n = 10) months. These implants were of a vertically split surface texture design (acid-etched and machined). Block sections and photomicrographs were obtained. Blinded histometric analyses determined the %BIC via a superimposed template. RESULTS The unloaded groups (1, 2, and 4 months) had higher %BIC compared to the 5-month group (p < 0.0001). The loaded groups exhibited mean bone densities of 59.2% and 55.5% (1-month healing at 0.5 mm and 1.0 mm, respectively) and 61.0% and 57.1% (2-month healing at 0.5 mm and 1.0 mm, respectively) with no significant difference between healing time (p = 0.4118). CONCLUSION There was a lateral increase in %BIC in the loaded compared to unloaded groups. CLINICAL RELEVANCE The decrease in bone densities at the 5-month unloaded group suggests that there is a critical earlier time period when dental implants should be placed into functional load.
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Affiliation(s)
- Lara L Ryan
- Johnson County Periodontics, Dental Implants, and Laser Surgery, Overland Park, KS, USA
| | - Sean S Kohles
- Kohles Bioengineering, 1731 SE 37th Avenue, Portland, OR, 97214-5135, USA.
- Division of Biomaterials & Biomechanics, School of Dentistry, and Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Department of Human Physiology, University of Oregon, Eugene, OR, USA.
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