Periodontal implications of the surface characteristics of dental implants in the area of the gingival junction

Implants in relation to natural teeth

Osseointegrated implants are now an accepted part of the prosthetic treatment of edentulous patients. More recently, osseointegrated implants have been advocated in the treatment of partially dentate patients. The implants can be used in conjunction with natural teeth for the support of rigid prostheses. The natural tooth is supported in bone by a periodontal ligament, whereas the implant may be described as having a more intimate or ankylotic connection with the supporting bone. Different attachment mechanisms may lead to differential rates of destruction in both situations, particularly if teeth and implants are splinted together by a rigid prosthetic appliance. Also noteworthy are the possible differential rates of marginal tissue breakdown as a result of the influence of bacteria. Results of a pilot study in which marginal breakdown was induced around implants and natural teeth in beagle dogs suggest that the process of destruction proceeds more slowly in the case of implants. However, the disease process around implants may be more difficult to arrest due to conjectural problems in treating the surface of the implant using conventional techniques of periodontal treatment. From the limited data available so far, it would appear that osseointegrated implants can be used as predictably in partially dentate as in totally edentulous mouths. More research should be initiated on the potential for tissue-breakdown, and long-term maintenance of the marginal tissues around implants.

Some advances in endosseous implants

A major advance in endosseous implantology hinges on the coating of titanium implants by porous biodegradable, bioreactive tricalcium phosphate ceramic. When implanted into alveolar bone by a careful technique, the ceramic is resorbed to be replaced by bone. As a result, the endosseous implant becomes ankylosed to the bone. This represents a stable implant/bone interface as opposed to the unstable connective tissue interface that encapsulates many other implant devices.

Wound healing of endosteal vitreous carbon implants in dogs

Endosteal vitreous carbon implants are biocompatible and were well-tolerated by the alveolar process of dogs but were not accepted by the gingival margin and the mucosa. A continuous gingival recession with 2 to 3 mm sulcus depth was not similar to that around adjacent natural teeth. There was no epithelial attachment around the neck of vitreous carbon implants, and there was very little or no resistance to probing. The feasibility of using vitreous carbon as it presently exists for the maintenance and preservation of alveolar bone is unfavorable and should be revised. Endosteal vitreous carbon implants require more intense laboratory and clinical studies. Therefore, the practical value of the vitreous carbon implant is questionable, and further investigations are needed before vitreous carbon can be declared acceptable in clinical dental practice.

The use of blade implants in a selected population of partially edentulous adults. A five-year report

Based on the findings observed after the insertion of 33 blade implants in 23 patients, ages 31 to 74, for periods up to 60 months, the following conclusions can be made: (1) The blade implant is a technically feasible procedure which can be maintained in the mouth for period up to 5 years, although some degree of bony breakdown will be seen in a majority of the patients at this time; (2) The degree of breakdown around blade implants is almost exclusively located to the locus of the neck of the implant and is most likely due to the lack of attachment at the epithelial-implant interface.