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Meisterhans M, Dimitriou D, Fasser MR, Hoch A, Jud L, Zingg PO. Influence of offset on osseointegration in cementless total hip arthroplasty: A finite element study. J Orthop Res 2024. [PMID: 38376065 DOI: 10.1002/jor.25808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024]
Abstract
Early aseptic loosening is caused by deficient osteointegration of the femoral stem due to increased micromotions and represents a common mode of failure in uncemented total hip arthroplasty (THA). This study hypothesized that a higher femoral offset, a smaller stem size and obesity increase femoral micromotion, potentially resulting in early aseptic loosening. A finite element analysis was conducted based on computed tomography segmented model of four patients who received a THA with a triple-tapered straight stem (Size 1, 3, 6). The influence of femoral stem offset (short neck, standard, lateral), head length (S to XXL), femoral anteversion and obesity during daily activities of fast walking and stair climbing was analyzed. The micromotions for the femoral stem zones were compared to a threshold representing a value above which only partial osseointegration is expected. The minimum femoral offset configuration compared to the maximum offset configuration (short neck stem, S head vs. lateral stem, XXL head) leads to a relative mean micromotion increase of 24% for the upper stem zone. Increasing the body weight (body mass index 30-35 kg/m2 ) increases the micromotion by 20% for all stem zones. The obese population recorded threshold-exceeding micromotions for stem sizes 1 and 3 for all offset configurations during stair climbing. Higher femoral offset, a smaller stem size, and higher loading due to obesity lead to an increase in micromotion between the prosthesis and proximal femur and represent a risk configuration for impaired osseointegration of a triple-tapered straight stem, especially when these three factors are present simultaneously.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Possebon APDR, Schuster AJ, Chagas-Júnior OL, Pinto LDR, Faot F. Immediate versus conventional loading of mandibular implant-retained overdentures: a 3-year follow-up of a randomized controlled trial. Clin Oral Investig 2023; 27:5935-5946. [PMID: 37612525 DOI: 10.1007/s00784-023-05205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES There is a scarcity of randomized clinical trials (RCT) that report medium- and long-term results and a lack of consensus in the literature on the predictability of immediately loaded unsplinted narrow diameter implants supporting mandibular overdentures. This RCT compared the performance of conventional (CL) and immediate loading (IL) of mandibular overdentures retained by two narrow-diameter implants for 3 years. MATERIALS AND METHODS Patients from an RCT treated with CL or IL were invited to attend to 2- and 3-year follow-ups. Clinical, radiographic, functional, and oral health-related quality of life parameters were evaluated. Prosthetic maintenance events, biological complications, and success and survival rates were also recorded. The data were tested by multilevel mixed-effects linear regression analysis and chi-squared tests. RESULTS The 1-year survival rates of 90% in the CL group and 85% in the IL group were maintained as no implants were lost between 1 and 3 years. The marginal bone loss (MBL) in the IL group was significantly lower after year 3 (-0.04; p < 0.01). Significant changes were found only for the intra-group comparisons in the third year of function: (i) CL and IL presented similar progression of implant stability, MBL, and posterior bone area resorption; (ii) while CL started deteriorating of masticatory function, IL still exhibited functional evolution and (iii) oral comfort domain in the CL and pain domain in the IL were improved. CONCLUSION Although IL experienced the lowest MBL after 3 years, the outcomes showed that both loading protocols result in predictable medium-term rehabilitation when monitored annually. CLINICAL RELEVANCE It can be expected that in the third year of function, patients with immediate loading may present more complaints related to general performance even with acceptable masticatory function and self-reported improvements in oral comfort.
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Affiliation(s)
- Anna Paula da Rosa Possebon
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Alessandra Julie Schuster
- School of Dentistry, Federal University of Pelotas, Gonçalves Chaves Street 457, Pelotas, RS, 96015-560, Brazil
| | - Otacílio Luiz Chagas-Júnior
- Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthodontics, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Luciana de Rezende Pinto
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Fernanda Faot
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.
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Kanaizumi A, Suzuki D, Nagoya S, Teramoto A, Yamashita T. Patient-specific three-dimensional evaluation of interface micromotion in two different short stem designs in cementless total hip arthroplasty: a finite element analysis. J Orthop Surg Res 2022; 17:437. [PMID: 36175915 PMCID: PMC9524017 DOI: 10.1186/s13018-022-03329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evaluation of micromotion in various activities in daily life is essential to the assessment of the initial fixation of cementless short stems in total hip arthroplasty. This study sought to evaluate three-dimensionally the micromotion of two types of cementless short stems. Methods Two types of stems were used: the Fitmore stem with a rectangular cross-section (rectangular stem) and the octagonal-oval GTS stem with fins (finned stem). Finite element analysis was used to calculate the micromotion of two activities that place a heavy load on the stem (single-leg stance and stair climbing). Three values were measured: the magnitude of micromotion (mean and 95th percentile), the location of micromotion above the 95th percentile value, and the directions of the micromotion vector. Results 1. There was no significant difference in the magnitude of the micromotion between the rectangular stem and finned stem groups for single-leg stance or stair climbing. 2. In both groups, the micromotion was greatest at the proximal and distal ends. 3. The direction of the micromotion was similar in both groups; internal rotation occurred from the distal to the middle of the stem during stair climbing. Conclusions The rectangular stem had comparable initial fixation to that of the finned stem. In both models, the micromotion was greater at the proximal and distal ends. The direction of the micromotion was not dependent on the stem shape but on the direction of the load on the artificial femoral head. These results will be important for stem selection and future stem development. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03329-5.
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Affiliation(s)
- Arata Kanaizumi
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, 291, Minami 1 Jo Nishi 16 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Daisuke Suzuki
- Faculty of Health Science, Hokkaido Chitose College of Rehabilitation, 2-10-10 Satomi, Chitose, Hokkaido, 066-0055, Japan
| | - Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Minami 1 Jo Nishi 17 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, 291, Minami 1 Jo Nishi 16 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, 291, Minami 1 Jo Nishi 16 Chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Micro/nanostructural properties of peri-implant jaw bones: a human cadaver study. Int J Implant Dent 2022; 8:17. [PMID: 35411479 PMCID: PMC9001759 DOI: 10.1186/s40729-022-00417-3] [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: 11/25/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Many points concerning the structure of osseointegration and the surrounding jaw bone remain unclear, and its optimal histological form has yet to be identified. The aim of this study was to clarify the structural characteristics of peri-implant jaw bone on the micro- and nano-scales by quantitatively evaluating bone quality. METHODS Five samples of human mandibular bone containing dental implants and one dentate sample that had been in place for some years while the donors were still alive were collected. Bulk staining was performed, and 100-μm-thick polished specimens were prepared. The osteon distributions in peri-implant bone and mandibular cortical bone were measured, after which alignment analysis of biological apatite (BAp) crystallites and anisotropy analysis of collagen fiber orientation using second-harmonic generation imaging were carried out. RESULTS Osteons in the vicinity of the implant body ran parallel to it. In the cortical bone at the base of the mandible, however, most osteons were oriented mesiodistally. The preferential alignment of BAp crystallites was generally consistent with osteon orientation. The orientation of collagen fibers in peri-implant jaw bone resembled the concentric rings seen in normal cortical bone, but there were also fibers that ran orthogonally across these concentric fibers. CONCLUSIONS These results suggest that the mechanical strain imposed by implants causes the growth of cortical bone-like bone in areas that would normally consist of cancellous bone around the implants, and that its structural characteristics are optimized for the load environment of the peri-implant jaw bone.
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Otsu Y, Matsunaga S, Furukawa T, Kitamura K, Kasahara M, Abe S, Nakano T, Ishimoto T, Yajima Y. Structural characteristics of the bone surrounding dental implants placed into the tail-suspended mice. Int J Implant Dent 2021; 7:89. [PMID: 34467429 PMCID: PMC8408301 DOI: 10.1186/s40729-021-00374-3] [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: 04/22/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many unclear points regarding local structural characteristics of the bone surrounding the implant reflecting the mechanical environment. PURPOSE The purpose of this study is to quantitatively evaluate bone quality surrounding implants placed into the femurs of mice in an unloading model, and to determine the influence of the mechanical environment on bone quality. METHODS Twenty 12-week-old male C57BL6/NcL mice (n = 5/group) were used as experimental animals. The mice were divided into two groups: the experimental group (n = 10) which were reared by tail suspension, and the control group (n = 10) which were reared normally. An implant was placed into the femur of a tail-suspended mouse, and after the healing period, they were sacrificed and the femur was removed. After micro-CT imaging, Villanueva osteochrome bone stain was performed. It was embedded in unsaturated polyester resin. The polymerized block was sliced passing through the center of the implant body. Next, 100-μm-thick polished specimens were prepared with water-resistant abrasive paper. In addition to histological observation, morphometric evaluation of cancellous bone was performed, and the anisotropy of collagen fibers and biological apatite (BAp) crystals was analyzed. RESULTS As a result, the femoral cortical bone thickness and new peri-implant bone mass showed low values in the tail suspension group. The uniaxial preferential orientation of BAp c-axis in the femoral long axis direction in the non-implant groups, but biaxial preferential orientation of BAp c-axis along the long axis of implant and femoral long axis direction were confirmed in new bone reconstructed by implant placement. Collagen fiber running anisotropy and orientation of BAp c-axis in the bone surrounding the implant were not significantly different due to tail suspension. CONCLUSIONS From the above results, it was clarified that bone formation occurs surrounding the implant even under extremely low load conditions, and bone microstructure and bone quality adapted to the new mechanical environment are acquired.
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Affiliation(s)
- Yuto Otsu
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan. .,Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
| | - Satoru Matsunaga
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Takehiro Furukawa
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Kei Kitamura
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Department of Histology and Developmental Biology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Masaaki Kasahara
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Department of Dental Materials Science, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Shinichi Abe
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Ishimoto
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yasutomo Yajima
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.,Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
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The limit of tolerable micromotion for implant osseointegration: a systematic review. Sci Rep 2021; 11:10797. [PMID: 34031476 PMCID: PMC8144379 DOI: 10.1038/s41598-021-90142-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/04/2021] [Indexed: 02/04/2023] Open
Abstract
Much research effort is being invested into the development of porous biomaterials that enhance implant osseointegration. Large micromotions at the bone-implant interface impair this osseointegration process, resulting in fibrous capsule formation and implant loosening. This systematic review compiled all the in vivo evidence available to establish if there is a universal limit of tolerable micromotion for implant osseointegration. The protocol was registered with the International Prospective Register for Systematic Reviews (ID: CRD42020196686). Pubmed, Scopus and Web of Knowledge databases were searched for studies containing terms relating to micromotion and osseointegration. The mean value of micromotion for implants that osseointegrated was 32% of the mean value for those that did not (112 ± 176 µm versus 349 ± 231 µm, p < 0.001). However, there was a large overlap in the data ranges with no universal limit apparent. Rather, many factors were found to combine to affect the overall outcome including loading time, the type of implant and the material being used. The tables provided in this review summarise these factors and will aid investigators in identifying the most relevant micromotion values for their biomaterial and implant development research.
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Liu W, Cai H, Zhang J, Wang J, Sui L. Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis. BMC Oral Health 2021; 21:122. [PMID: 33731092 PMCID: PMC7968211 DOI: 10.1186/s12903-021-01486-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures. METHODS Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. "Grey" literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration's tool, the Newcastle-Ottawa scale, and Egger's test. RESULTS Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI - 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total. CONCLUSIONS For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.
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Affiliation(s)
- Wei Liu
- Department of Prosthodontics, School & Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - He Cai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China
| | - Junjiang Zhang
- Department of Prosthodontics, School & Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Jian Wang
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China
| | - Lei Sui
- Department of Prosthodontics, School & Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China.
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Salman A, Thacker S, Rubin S, Dhingra A, Ioannidou E, Schincaglia GP. Immediate versus delayed loading of mandibular implant-retained overdentures: A 60-month follow-up of a randomized clinical trial. J Clin Periodontol 2019; 46:863-871. [PMID: 31141198 DOI: 10.1111/jcpe.13153] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this observational, post-trial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial that compared immediately and delayed loaded two unsplinted implants, supporting a locator-retained mandibular overdenture. MATERIALS AND METHODS Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a locator-retained mandibular overdenture, were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded. RESULTS Twenty three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60 months was 0.89 mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups, respectively. A statistically significant difference was observed at 60 months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60 months. At 60 months, per-protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups. CONCLUSION Both immediately and delayed loaded implants supporting a locator-retained mandibular overdenture showed similar clinical outcomes.
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Affiliation(s)
- Arif Salman
- Department of Periodontology, West Virginia University School of Dentistry, Morgantown, West Virginia
| | - Sejal Thacker
- Division of Periodontology, UConn Health, Farmington, Connecticut
| | - Satoko Rubin
- Division of Periodontology, UConn Health, Farmington, Connecticut
| | - Ajay Dhingra
- Division of Prosthodontics, UConn Health, Farmington, Connecticut
| | - Effie Ioannidou
- Division of Periodontology, UConn Health, Farmington, Connecticut
| | - Gian Pietro Schincaglia
- Department of Periodontology, West Virginia University School of Dentistry, Morgantown, West Virginia
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de Barros E Lima Bueno R, Dias AP, Ponce KJ, Brunski JB, Nanci A. System for application of controlled forces on dental implants in rat maxillae: Influence of the number of load cycles on bone healing. J Biomed Mater Res B Appl Biomater 2019; 108:965-975. [PMID: 31368244 PMCID: PMC7078813 DOI: 10.1002/jbm.b.34449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 12/26/2022]
Abstract
Experimental studies on the effect of micromotion on bone healing around implants are frequently conducted in long bones. In order to more closely reflect the anatomical and clinical environments around dental implants, and eventually be able to experimentally address load‐management issues, we have developed a system that allows initial stabilization, protection from external forces, and controlled axial loading of implants. Screw‐shaped implants were placed on the edentulous ridge in rat maxillae. Three loading regimens were applied to validate the system; case A no loading (unloaded implant) for 14 days, case B no loading in the first 7 days followed by 7 days of a single, daily loading session (60 cycles of an axial force of 1.5 N/cycle), and case C no loading in the first 7 days followed by 7 days of two such daily loading sessions. Finite element modeling of the peri‐implant compressive and tensile strains plus histological and immunohistochemical analyses revealed that in case B any tissue damage resulting from the applied force (and related interfacial strains) did not per se disturb bone healing, however, in case C, the accumulation of damage resulting from the doubling of loading sessions severely disrupted the process. These proof‐of‐principle results validate the applicability of our system for controlled loading, and provide new evidence on the importance of the number of load cycles applied on healing of maxillary bone.
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Affiliation(s)
- Renan de Barros E Lima Bueno
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Ana P Dias
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Katia J Ponce
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - John B Brunski
- Department of Surgery, School of Medicine, Stanford University, Stanford, California
| | - Antonio Nanci
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
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Orentlicher G, Horowitz A, Kobren L. Computer-Guided Dental Implant Treatment of Complete Arch Restoration of Edentulous and Terminal Dentition Patients. Oral Maxillofac Surg Clin North Am 2019; 31:399-426. [PMID: 31253346 DOI: 10.1016/j.coms.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The treatment of completely edentulous or soon-to-be completely edentulous dental arches with complete-arch fixed denture restorations, supported by dental implants, are some of the more complicated patient cases in oral and maxillofacial surgery and prosthodontics. This article discusses the use of digital technologies, computerized tomographic (CT) guided planning software applications, and surgical guides in treating these complex dental implant patient cases. A discussion of the nuances and workflows of different types of treatments are provided. The importance of experience and a multi-disciplinary team approach is emphasized.
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Affiliation(s)
- Gary Orentlicher
- Private Practice, New York Oral, Maxillofacial, and Implant Surgery, 495 Central Park Avenue, Scarsdale, NY 10583, USA; Oral and Maxillofacial Surgery, White Plains Hospital, White Plains, NY, USA.
| | - Andrew Horowitz
- Private Practice, New York Oral, Maxillofacial, and Implant Surgery, 495 Central Park Avenue, Scarsdale, NY 10583, USA; Oral and Maxillofacial Surgery, White Plains Hospital, White Plains, NY, USA
| | - Leonard Kobren
- Private Practice, Westchester Prosthodontics, 12 Old Mamaroneck Road, White Plains, NY 10605, USA
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Calvo-Guirado JL, López-López PJ, Pérez-Albacete Martínez C, Javed F, Granero-Marín JM, Maté Sánchez de Val JE, Ramírez Fernández MP. Peri-implant bone loss clinical and radiographic evaluation around rough neck and microthread implants: a 5-year study. Clin Oral Implants Res 2018; 29:635-643. [PMID: 26744262 DOI: 10.1111/clr.12775] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate marginal bone loss over 5 years around microthreaded implants placed in the maxillary anterior/esthetic zone and immediate restored with non-occlusal loading. MATERIALS AND METHODS Seventy-one implants (with microthreads up to the platform-rough surface body and neck, internal connection and platform switching) were placed in healed bone in the maxillary arches of 30 men and 23 women (mean age 37.85 ± 7.09 years, range 27-60). All subjects had at least 3 mm of soft tissue to allow the establishment of adequate biologic width and to reduce bone resorption. Each patient received a provisional restoration immediately after implant placement with slight occlusal contact. Mesial and distal bone height was evaluated using digital radiography on the day following implant placement (baseline) and after 1, 2, 3, 4 and 5 years. Primary stability was measured with resonance frequency analysis. RESULTS No implants failed, resulting in a cumulative survival rate of 100% after 3 years. Marginal bone loss from implant collar to bone crest measured at baseline (peri-implant bone defect at the fresh extraction socket) and after 5 years was 0.90 mm ± 0.26 mm. Mesial and distal site crestal bone loss ranged from 3.42 ± 1.2 mm at baseline to 3.51 ± 1.5 mm after 5 years and from 3.38 ± 0.9 mm at baseline to 3.49 ± 0.9 mm after 5 years, respectively (P = 0.086). CONCLUSIONS The results of this study showed limited implant crestal bone loss 0.90 mm ± 0.26 mm and 100% of implant survival rate at 5-year follow-up of immediate restored implants with rough surface neck and microthreads.
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Affiliation(s)
- José Luis Calvo-Guirado
- International Dentistry Research Cathedra, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | - Patricia J López-López
- International Dentistry Research Cathedra, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | | | - Fawad Javed
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - José Manuel Granero-Marín
- International Dentistry Research Cathedra, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
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de Barros E Lima Bueno R, Dias AP, Ponce KJ, Wazen R, Brunski JB, Nanci A. Bone healing response in cyclically loaded implants: Comparing zero, one, and two loading sessions per day. J Mech Behav Biomed Mater 2018; 85:152-161. [PMID: 29894930 PMCID: PMC6035061 DOI: 10.1016/j.jmbbm.2018.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/16/2018] [Accepted: 05/30/2018] [Indexed: 01/15/2023]
Abstract
When bone implants are loaded, they are inevitably subjected to displacement relative to bone. Such micro-motion generates stress/strain states at the interface that can cause beneficial or detrimental sequels. The objective of this study is to better understand the mechanobiology of bone healing at the tissue-implant interface during repeated loading. Machined screw shaped Ti implants were placed in rat tibiae in a hole slightly bigger than the implant diameter. Implants were held stable by a specially-designed bone plate that permits controlled loading. Three loading regimens were applied, (a) zero loading, (b) one daily loading session of 60 cycles with an axial force of 1.5 N/cycle for 7 days, and (c) two such daily sessions with the same axial force also for 7 days. Finite element analysis was used to characterize the mechanobiological conditions produced by the loading sessions. After 7 days, the implants with surrounding interfacial tissue were harvested and processed for histological, histomorphometric and DNA microarray analyses. Histomorphometric analyses revealed that the group subjected to repeated loading sessions exhibited a significant decrease in bone-implant contact and increase in bone-implant distance, as compared to unloaded implants and those subjected to only one loading session. Gene expression profiles differed during osseointegration between all groups mainly with respect to inflammatory and unidentified gene categories. The results indicate that increasing the daily cyclic loading of implants induces deleterious changes in the bone healing response, most likely due to the accumulation of tissue damage and associated inflammatory reaction at the bone-implant interface.
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Affiliation(s)
- Renan de Barros E Lima Bueno
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Ana Paula Dias
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Katia J Ponce
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Rima Wazen
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - John B Brunski
- Department of Surgery, School of Medicine, Stanford University, Stanford, CA, United States
| | - Antonio Nanci
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada.
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13
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Jariwala SH, Wee H, Roush EP, Whitcomb TL, Murter C, Kozlansky G, Lakhtakia A, Kunselman AR, Donahue HJ, Armstrong AD, Lewis GS. Time course of peri-implant bone regeneration around loaded and unloaded implants in a rat model. J Orthop Res 2017; 35:997-1006. [PMID: 27381807 PMCID: PMC5800527 DOI: 10.1002/jor.23360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
The time-course of cancellous bone regeneration surrounding mechanically loaded implants affects implant fixation, and is relevant to determining optimal rehabilitation protocols following orthopaedic surgeries. We investigated the influence of controlled mechanical loading of titanium-coated polyether-ether ketone (PEEK) implants on osseointegration using time-lapsed, non-invasive, in vivo micro-computed tomography (micro-CT) scans. Implants were inserted into proximal tibial metaphyses of both limbs of eight female Sprague-Dawley rats. External cyclic loading (60 or 100 μm displacement, 1 Hz, 60 s) was applied every other day for 14 days to one implant in each rat, while implants in contralateral limbs served as the unloaded controls. Hind limbs were imaged with high-resolution micro-CT (12.5 μm voxel size) at 2, 5, 9, and 12 days post-surgery. Trabecular changes over time were detected by 3D image registration allowing for measurements of bone-formation rate (BFR) and bone-resorption rate (BRR). At day 9, mean %BV/TV for loaded and unloaded limbs were 35.5 ± 10.0% and 37.2 ± 10.0%, respectively, and demonstrated significant increases in bone volume compared to day 2. BRR increased significantly after day 9. No significant differences between bone volumes, BFR, and BRR were detected due to implant loading. Although not reaching significance (p = 0.16), an average 119% increase in pull-out strength was measured in the loaded implants. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:997-1006, 2017.
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Affiliation(s)
- Shailly H. Jariwala
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Hwabok Wee
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Evan P. Roush
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Tiffany L. Whitcomb
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Christopher Murter
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gery Kozlansky
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Akhlesh Lakhtakia
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802-6812
| | - Allen R. Kunselman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Henry J. Donahue
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284
| | - April D. Armstrong
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gregory S. Lewis
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
- Author to whom all correspondence should be addressed: Gregory S. Lewis, Ph.D*, Pennsylvania State University College of Medicine, 500 University Drive, Mailbox – H089, Hershey, PA-17033, Phone: (717) 531-5244, Fax no.: (717) 531-7583,
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A Patient Specific Biomechanical Analysis of Custom Root Analogue Implant Designs on Alveolar Bone Stress: A Finite Element Study. Int J Dent 2016; 2016:8242535. [PMID: 27274727 PMCID: PMC4870362 DOI: 10.1155/2016/8242535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives. The aim of this study was to analyse by means of FEA the influence of 5 custom RAI designs on stress distribution of peri-implant bone and to evaluate the impact on microdisplacement for a specific patient case. Materials and Methods. A 3D surface model of a RAI for the upper right canine was constructed from the cone beam computed tomography data of one patient. Subsequently, five (targeted) press-fit design modification FE models with five congruent bone models were designed: “Standard,” “Prism,” “Fins,” “Plug,” and “Bulbs,” respectively. Preprocessor software was applied to mesh the models. Two loads were applied: an oblique force (300 N) and a vertical force (150 N). Analysis was performed to evaluate stress distributions and deformed contact separation at the peri-implant region. Results. The lowest von Mises stress levels were numerically observed for the Plug design. The lowest levels of contact separation were measured in the Fins model followed by the Bulbs design. Conclusions. Within the limitations of the applied methodology, adding targeted press-fit geometry to the RAI standard design will have a positive effect on stress distribution, lower concentration of bone stress, and will provide a better primary stability for this patient specific case.
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15
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Duyck J, Vandamme K. The effect of loading on peri-implant bone: a critical review of the literature. J Oral Rehabil 2014; 41:783-94. [DOI: 10.1111/joor.12195] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 12/22/2022]
Affiliation(s)
- J. Duyck
- BIOMAT Research Group; Department of Oral Health Sciences; KU Leuven; Leuven Belgium
| | - K. Vandamme
- BIOMAT Research Group; Department of Oral Health Sciences; KU Leuven; Leuven Belgium
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16
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Mendonça JA, Francischone CE, Senna PM, Matos de Oliveira AE, Sotto-Maior BS. A Retrospective Evaluation of the Survival Rates of Splinted and Non-Splinted Short Dental Implants in Posterior Partially Edentulous Jaws. J Periodontol 2014; 85:787-94. [DOI: 10.1902/jop.2013.130193] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Han J, Hou J, Zhou G, Wang C, Fan Y. A histological and biomechanical study of bone stress and bone remodeling around immediately loaded implants. SCIENCE CHINA-LIFE SCIENCES 2014; 57:618-26. [PMID: 24824585 DOI: 10.1007/s11427-014-4657-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Immediate loading (IL) increases the risk of marginal bone loss. The present study investigated the biomechanical response of peri-implant bone in rabbits after IL, aiming at optimizing load management. Ninety-six implants were installed bilaterally into femurs of 48 rabbits. Test implants on the left side created the maximal initial stress of 6.9 and 13.4 MPa in peri-implant bone and unloaded implants on the contralateral side were controls. Bone morphology and bone-implant interface strength were measured with histological examination and push-out testing during a 12-week observation period. Additionally, the animal data were incorporated into finite element (FE) models to calculate the bone stress distribution at different levels of osseointegration. Results showed that the stress was concentrated in the bone margin and the bone stress gradually decreased as osseointegration proceeded. A stress of about 2.0 MPa in peri-implant bone had a positive effect on new bone formation, osseointegration and bone-implant interface strength. Bone loss was observed in some specimens with stress exceeding 4.0 MPa. Data indicate that IL significantly increases bone stress during the early postoperative period, but the load-bearing capacity of peri-implant bone increases rapidly with an increase of bone-implant contact. Favorable bone responses may be continually promoted when the stress in peri-implant bone is maintained at a definite level. Accordingly, the progressive loading mode is recommended for IL implants.
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Affiliation(s)
- JingYun Han
- Key Lab for Biomechanics and Mechanobiology of Ministry of Education, School of Biological and Medical Engineering, Beihang University, Beijing, 100191, China
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18
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Al Maaitah EF, Safi AA, Abdelhafez RS. Alveolar bone density changes around miniscrews: A prospective clinical study. Am J Orthod Dentofacial Orthop 2012. [DOI: 10.1016/j.ajodo.2012.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Prokharau PA, Vermolen FJ, García-Aznar JM. A mathematical model for cell differentiation, as an evolutionary and regulated process. Comput Methods Biomech Biomed Engin 2012; 17:1051-70. [PMID: 23113617 DOI: 10.1080/10255842.2012.736503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We introduce an approach which allows one to introduce the concept of cell plasticity into models for tissue regeneration. In contrast to most of the recent models for tissue regeneration, cell differentiation is considered a gradual process, which evolves in time and which is regulated by an arbitrary number of parameters. In the current approach, cell differentiation is modelled by means of a differentiation state variable. Cells are assumed to differentiate into an arbitrary number of cell types. The differentiation path is considered as reversible, unless differentiation has fully completed. Cell differentiation is incorporated into the partial differential equations (PDEs), which model the tissue regeneration process, by means of an advection term in the differentiation state space. This allows one to consider the differentiation path of cells, which is not possible if a reaction-like term is used for differentiation. The boundary conditions, which should be specified for the general PDEs, are derived from the flux of the fully non-differentiated cells and from the irreversibility of the fully completed differentiation process. An application of the proposed model for peri-implant osseointegration is considered. Numerical results are compared with experimental data. Potential lines of further development of the present approach are proposed.
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Affiliation(s)
- Pavel A Prokharau
- a Delft Institute of Applied Mathematics, Delft University of Technology , HB 07.290, Mekelweg 4, 2628 CD , Delft , The Netherlands
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20
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Prokharau PA, Vermolen FJ, García-Aznar JM. Model for direct bone apposition on pre-existing surfaces, during peri-implant osseointegration. J Theor Biol 2012; 304:131-42. [DOI: 10.1016/j.jtbi.2012.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 01/12/2012] [Accepted: 03/19/2012] [Indexed: 01/10/2023]
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21
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Prokharau P, Vermolen F. Stability analysis for a peri-implant osseointegration model. J Math Biol 2012; 66:351-82. [PMID: 22327881 DOI: 10.1007/s00285-012-0513-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/28/2010] [Indexed: 11/26/2022]
Abstract
We investigate stability of the solution of a set of partial differential equations, which is used to model a peri-implant osseointegration process. For certain parameter values, the solution has a 'wave-like' profile, which appears in the distribution of osteogenic cells, osteoblasts, growth factor and bone matrix. This 'wave-like' profile contradicts experimental observations. In our study we investigate the conditions, under which such profile appears in the solution. Those conditions are determined in terms of model parameters, by means of linear stability analysis, carried out at one of the constant solutions of the simplified system. The stability analysis was carried out for the reduced system of PDE's, of which we prove, that it is equivalent to the original system of equations, with respect to the stability properties of constant solutions. The conclusions, derived from the linear stability analysis, are extended for the case of large perturbations. If the constant solution is unstable, then the solution of the system never converges to this constant solution. The analytical results are validated with finite element simulations. The simulations show, that stability of the constant solution could determine the behavior of the solution of the whole system, if certain initial conditions are considered.
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Affiliation(s)
- Pavel Prokharau
- Delft Institute of Applied Mathematics, Delft University of Technology, Mekelweg 4, 2628 CD, Delft, The Netherlands.
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22
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Immediate postextraction implant placement with immediate loading for maxillary full-arch rehabilitation. J Am Dent Assoc 2012; 143:124-33. [DOI: 10.14219/jada.archive.2012.0122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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23
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Geris L, Vandamme K, Naert I, Sloten JV, Van Oosterwyck H, Duyck J. Mechanical Loading Affects Angiogenesis and Osteogenesis in an In Vivo Bone Chamber: A Modeling Study. Tissue Eng Part A 2010; 16:3353-61. [DOI: 10.1089/ten.tea.2010.0130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Liesbet Geris
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U.Leuven, Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, K.U.Leuven, Leuven, Belgium
- Biomechanics Research Unit, Aerospace and Mechanical Engineering Department U.Liège, Liège, Belgium
| | - Katleen Vandamme
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, Faculty of Medicine, School of Dentistry, Oral Pathology, and Maxillofacial Surgery, K.U.Leuven, Leuven, Belgium
| | - Ignace Naert
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, Faculty of Medicine, School of Dentistry, Oral Pathology, and Maxillofacial Surgery, K.U.Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U.Leuven, Leuven, Belgium
| | - Hans Van Oosterwyck
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U.Leuven, Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, K.U.Leuven, Leuven, Belgium
| | - Joke Duyck
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, Faculty of Medicine, School of Dentistry, Oral Pathology, and Maxillofacial Surgery, K.U.Leuven, Leuven, Belgium
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24
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Villa R, Polimeni G, Wikesjö UM. Implant osseointegration in the absence of primary bone anchorage: A clinical report. J Prosthet Dent 2010; 104:282-7. [DOI: 10.1016/s0022-3913(10)00146-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Willie BM, Yang X, Kelly NH, Han J, Nair T, Wright TM, van der Meulen MCH, Bostrom MPG. Cancellous bone osseointegration is enhanced by in vivo loading. Tissue Eng Part C Methods 2010; 16:1399-406. [PMID: 20367497 DOI: 10.1089/ten.tec.2009.0776] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Biophysical stimuli may be an effective therapy to counteract age-related changes in bone structure that affect the primary stability of implants used in joint replacement or fracture fixation. The influence of controlled mechanical loading on osseointegration was investigated using an in vivo device implanted in the distal lateral femur of 12 male rabbits. Compressive loads (1 MPa, 1 Hz, 50 cycles/day, 4 weeks) were applied to a porous titanium foam implant and the underlying cancellous bone. The contralateral limbs served as nonloaded controls. Backscattered electron imaging indicated that the amount of bone ingrowth was significantly greater in the loaded limb than in the nonloaded control limb, whereas the amount of underlying cancellous periprosthetic bone was similar. No significant difference in the mineral apposition rate of the bone ingrowth or periprosthetic bone was measured in the loaded compared to the control limb. Histological analysis demonstrated newly formed woven bone in direct apposition to the implant coating, with a lack of fibrous tissue at the implant-periprosthetic bone interface in both loaded and nonloaded implants. The lack of fibrous tissue demonstrates that mechanical stimulation using this model significantly enhanced cancellous bone ingrowth without the detrimental effects of micromotion. These results suggest that biophysical therapy should be further investigated to augment current treatments to enhance long-term fixation of orthopedic devices. Additionally, this novel in vivo loading model can be used to further investigate the influence of biophysical stimulation on other tissue engineering approaches requiring bone ingrowth into both metallic and nonmetallic cell-seeded scaffolds.
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26
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Ogawa T, Dhaliwal S, Naert I, Mine A, Kronstrom M, Sasaki K, Duyck J. Impact of implant number, distribution and prosthesis material on loading on implants supporting fixed prostheses. J Oral Rehabil 2010; 37:525-31. [PMID: 20236236 DOI: 10.1111/j.1365-2842.2010.02076.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to evaluate axial forces and bending moments (BMs) on implants supporting a complete arch fixed implant supported prosthesis with respect to number and distribution of the implants and type of prosthesis material. Seven oral Brånemark implants with a diameter of 3.75 mm and a length of 13 and 7 mm (short distal implant) were placed in an edentulous composite mandible used as the experimental model. One all-acrylic, one fibre-reinforced acrylic, and one milled titanium framework prosthesis were made. A 50 N vertical load was applied on the extension 10 mm distal from the most posterior implant. Axial forces and BMs were measured by calculating signals from three strain gauges attached to each of the abutments. The load was measured using three different models with varying numbers of supporting implants (3, 4 and 5), three models with different implant distribution conditions (small, medium and large) and three models with different prosthesis materials (titanium, acrylic and fibre-reinforced acrylic). Maximum BMs were highest when prostheses were supported by three implants compared to four and five implants (P < 0.001). The BMs were significantly influenced by the implant distribution, in that the smallest distribution induced the highest BMs (P < 0.001). Maximum BMs were lowest with the titanium prosthesis (P < 0.01). The resultant forces on implants were significantly associated with the implant number and distribution and the prosthesis material.
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Affiliation(s)
- T Ogawa
- Department of Prosthetic Dentistry, BIOMAT Research Group, Catholic University of Leuven, K.U.Leuven, Leuven, Belgium
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27
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Zhou W, Han C, Yunming L, Li D, Song Y, Zhao Y. Is the osseointegration of immediately and delayed loaded implants the same?���comparison of the implant stability during a 3-month healing period in a prospective study. Clin Oral Implants Res 2009; 20:1360-6. [DOI: 10.1111/j.1600-0501.2009.01757.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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28
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Geris L, Vandamme K, Naert I, Sloten JV, Duyck J, Van Oosterwyck H. Numerical Simulation of Bone Regeneration in a Bone Chamber. J Dent Res 2009; 88:158-63. [DOI: 10.1177/0022034508329603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While mathematical models are able to capture essential aspects of biological processes like fracture healing and distraction osteogenesis, their predictive capacity in peri-implant osteogenesis remains uninvestigated. We tested the hypothesis that a mechano-regulatory model has the potential to predict bone regeneration around implants. In an in vivo bone chamber set-up allowing for controlled implant loading (up to 90 μ m axial displacement), bone tissue formation was simulated and compared qualitatively and quantitatively with histology. Furthermore, the model was applied to simulate excessive loading conditions. Corresponding to literature data, implant displacement magnitudes larger than 90 μ m predicted the formation of fibrous tissue encapsulation of the implant. In contradiction to findings in orthopedic implant osseointegration, implant displacement frequencies higher than 1 Hz did not favor the formation of peri-implant bone in the chamber. Additional bone chamber experiments are needed to test these numerical predictions.
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Affiliation(s)
- L. Geris
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C—PB 2419, 3001 Leuven, Belgium; and
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, K.U. Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - K. Vandamme
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C—PB 2419, 3001 Leuven, Belgium; and
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, K.U. Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - I. Naert
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C—PB 2419, 3001 Leuven, Belgium; and
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, K.U. Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - J. Vander Sloten
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C—PB 2419, 3001 Leuven, Belgium; and
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, K.U. Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - J. Duyck
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C—PB 2419, 3001 Leuven, Belgium; and
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, K.U. Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
| | - H. Van Oosterwyck
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C—PB 2419, 3001 Leuven, Belgium; and
- Department of Prosthetic Dentistry/BIOMAT Research Cluster, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, K.U. Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium
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29
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Barros RR, Degidi M, Novaes AB, Piattelli A, Shibli JA, Iezzi G. Osteocyte Density in the Peri-Implant Bone of Immediately Loaded and Submerged Dental Implants. J Periodontol 2009; 80:499-504. [DOI: 10.1902/jop.2009.080484] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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30
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Slaets E, Naert I, Carmeliet G, Duyck J. Early cortical bone healing around loaded titanium implants: a histological study in the rabbit. Clin Oral Implants Res 2009; 20:126-34. [DOI: 10.1111/j.1600-0501.2008.01623.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Bogaerde LV, Pedretti G, Sennerby L, Meredith N. Immediate/Early Function of Neoss Implants Placed in Maxillas and Posterior Mandibles: An 18-Month Prospective Case Series Study. Clin Implant Dent Relat Res 2008; 12 Suppl 1:e83-94. [DOI: 10.1111/j.1708-8208.2008.00135.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vandamme K, Naert I, Vander Sloten J, Puers R, Duyck J. Effect of Implant Surface Roughness and Loading on Peri-Implant Bone Formation. J Periodontol 2008; 79:150-7. [DOI: 10.1902/jop.2008.060413] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Duyck J, Slaets E, Sasaguri K, Vandamme K, Naert I. Effect of intermittent loading and surface roughness on peri-implant bone formation in a bone chamber model. J Clin Periodontol 2007; 34:998-1006. [PMID: 17935504 DOI: 10.1111/j.1600-051x.2007.01135.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joke Duyck
- Department of Prosthetic Dentistry/BIOMAT Research Group, Faculty of Medicine, K.U. Leuven, Leuven, Belgium.
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Geris L, Vandamme K, Naert I, Vander Sloten J, Duyck J, Van Oosterwyck H. Application of mechanoregulatory models to simulate peri-implant tissue formation in an in vivo bone chamber. J Biomech 2007; 41:145-54. [PMID: 17706229 DOI: 10.1016/j.jbiomech.2007.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 07/04/2007] [Accepted: 07/04/2007] [Indexed: 01/23/2023]
Abstract
Several mechanoregulatory tissue differentiation models have been proposed over the last decade. Corroboration of these models by comparison with experimental data is necessary to determine their predictive power. So far, models have been applied with various success rates to different experimental set-ups investigating mainly secondary fracture healing. In this study, the mechanoregulatory models are applied to simulate the implant osseointegration process in a repeated sampling in vivo bone chamber, placed in a rabbit tibia. This bone chamber provides a mechanically isolated environment to study tissue differentiation around titanium implants loaded in a controlled manner. For the purpose of this study, bone formation around loaded cylindrical and screw-shaped implants was investigated. Histologically, no differences were found between the two implant geometries for the global amount of bone formation in the entire chamber. However, a significantly larger amount of bone-to-implant contact was observed for the screw-shaped implant compared to the cylindrical implant. In the simulations, a larger amount of bone was also predicted to be in contact with the screw-shaped implant. However, other experimental observations could not be predicted. The simulation results showed a distribution of cartilage, fibrous tissue and (im)mature bone, depending on the mechanoregulatory model that was applied. In reality, no cartilage was observed. Adaptations to the differentiation models did not lead to a better correlation between experimentally observed and numerically predicted tissue distribution patterns. The hypothesis that the existing mechanoregulatory models were able to predict the patterns of tissue formation in the in vivo bone chamber could not be fully sustained.
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Affiliation(s)
- Liesbet Geris
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, K.U. Leuven, Celestijnenlaan 300C, PB 2419, 3001 Leuven, Belgium.
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