Effect of Photobiomodulation Therapy on Peri-Implant Bone Healing in Extra-Short Implants in a Rabbit Model: A Pilot Study

Objective: To evaluate the effects of photobiomodulation therapy (PBMT) at distinct energy levels on peri-implant bone healing in extra-short implants in a experimental rabbit model. Background: The effect of PBMT on peri-implant bone healing in short implants remains unclear. This explored the effect of PBMT on extra-short implants in terms of bone-implant contact (BIC) length and rate, and implant stability quotient (ISQ). Methods: Fifteen white New Zealand rabbits were randomly divided into five groups. In all groups, extra-short implants (3.5 × 4 mm; Nucleoss T6, İzmir/Turkey) were placed in both tibias of the rabbits. PBMT was performed in four groups (group 1, 5 J/cm2; group 2, 10 J/cm2; group 3, 20 J/cm2; and group 4, 25 J/cm2); no PBMT was performed in the control group. On the 30th day, the rabbits were sacrificed and peri-implant tissue samples were obtained to determine the BIC length and BIC rate. Implant stability levels were measured by resonance frequency analysis using the Osstell penguin device and were determined as ISQ values on the 1st and 30th days of the study. Results: PBMT significantly increased the BIC length and BIC rate in groups 3 and 4 (p < 0.001). For the ISQ values, there were significant differences between the 1st and 30th day (p < 0.001). On the 30th day, the ISQ values were significantly higher in groups 3 and 4 compared with the remaining groups (p < 0.001). Conclusions: In this study, PBMT improved peri-implant bone healing through increase in BIC length, BIC rate, and ISQ parameter values in extra-short implants.

The relative contribution of bone microarchitecture and matrix composition to implant fixation strength in rats

Bone microarchitectural parameters significantly contribute to implant fixation strength but the role of bone matrix composition is not well understood. To determine the relative contribution of microarchitecture and bone matrix composition to implant fixation strength, we placed titanium implants in 12-week-old intact Sprague-Dawley rats, ovariectomized-Sprague-Dawley rats, and Zucker diabetic fatty rats. We assessed bone microarchitecture by microcomputed tomography, bone matrix composition by Raman spectroscopy, and implant fixation strength at 2, 6, and 10 weeks postimplantation. A stepwise linear regression model accounted for 83.3% of the variance in implant fixation strength with osteointegration volume/total volume (50.4%), peri-implant trabecular bone volume fraction (14.2%), cortical thickness (9.3%), peri-implant trabecular crystallinity (6.7%), and cortical area (2.8%) as the independent variables. Group comparisons indicated that osseointegration volume/total volume was significantly reduced in the ovariectomy group at Week 2 (~28%) and Week 10 (~21%) as well as in the diabetic group at Week 10 (~34%) as compared with the age matched Sprague-Dawley group. The crystallinity of the trabecular bone was significantly elevated in the ovariectomy group at Week 2 (~4%) but decreased in the diabetic group at Week 10 (~3%) with respect to the Sprague-Dawley group. Our study is the first to show that bone microarchitecture explains most of the variance in implant fixation strength, but that matrix composition is also a contributing factor. Therefore, treatment strategies aimed at improving bone-implant contact and peri-implant bone volume without compromising matrix quality should be prioritized.

Osseointegration Pharmacology: A Systematic Mapping Using Artificial Intelligence

Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.

Does high fat diet effect the bone-implant connection?

OBJECTIVE

Obesity induced by a high fat diet is associated with chronic up-regulation of inflammatory cytokines which stimulate osteoclast activity and bone resorption. However, the role of high-fat diet on bone-implant connectivity has not been studied in detail. In this study, we investigated whether a high-fat diet (HFD) affects bone implant connection (BIC) in periimplant bone.

METHODS

Twenty female Sprague Dawley rats were divided in two groups: 1) Control rats were fed with normal chow and titanium implants were integrated into tibial bones at the end of 3rd month and no treatment was applied 2) HFD group; rats were fed a high-fat diet (42 % of calories as fat), then the titanium implants were integrated into tibial bones at the end 3rd month. Following surgical integration of the implants, the rats were fed with control and HFD diets for 3 months. After the 6 months experimental period all rats were sacrificed and the implants and surrounded bone tissues were collected and the BIC was assessed histomorphometrically after the non-decalcifiing histological methods. Bone implant connection was detected with the ratio of the implant surface directly connected with the peri-implant bone tissues to the total implant surface length.

RESULTS

Histologic analysis showed that HFD was not impaired BIC (p>0.05).

CONCLUSION

In conclusion, within the limitation of this research, HFD did not effect the BIC rat tibias (Tab. 2, Fig. 2, Ref. 26). Text in PDF www.elis.sk.

Implant surface alters compartmental-specific contributions to fixation strength in rats

Mechanical fixation of the implant to host bone is an important contributor to orthopedic implant survivorship. The relative importance of bone-implant contact, trabecular bone architecture, and cortical bone geometry to implant fixation strength has never been directly tested, especially in the settings of differential implant surface properties. Thus, using a rat model where titanium rods were placed into the intramedullary canal of the distal femur, we determined the relative contribution of bone-implant contact and peri-implant bone architecture to the fixation strength in implants with different surface roughness: highly polished and smooth (as-received) and dual acid-etched (DAE) implants. Using a training set that maximized variance in implant fixation strength, we initially examined correlation between implant fixation strength and outcome parameters from microcomputed tomography and found that osseointegration volume per total volume (OV/TV), trabecular bone volume per total volume (BV/TV), and cortical thickness (Ct.Th) were the single best compartment-specific predictors of fixation strength. We defined separate regression models to predict implant fixation strength for as-received and DAE implants. When the training set models were applied to independent validation sets, we found strong correlations between predicted and experimentally measured implant fixation strength, with r²  = .843 in as received and r²  = .825 in DAE implants. Interestingly, for as-received implants, OV/TV explained more of the total variance in implant fixation strength than the other variables, whereas in DAE implants, Ct.Th had the most explanatory power, suggesting that surface topography of implants affects which bone compartment is most important in providing implant fixation strength.

Bone-implant-contact and new bone formation around implants placed in FDB blocks compared to placement at the adjunction of particulate FDB

BACKGROUND

The efficacy of human freeze-dried bone (h-FDB) as particulate vs block forms as a proper onlay augmented bone graft material to accommodate implants is undetermined.

PURPOSE

To evaluate osseointegration and new bone formation at implants placed in FDB blocks (BL group) and those at the adjunction of particulate FDB (PR group).

MATERIALS AND METHODS

Twelve pairs of h-FDB blocks were stabilized bilaterally to the calvaria of 12 rabbits. Twenty-four SLA implants were placed at the remodeled grafted blocks, 4 months later. A circumferential gap was created around one implant in each pair and packed with particulate h-FDB. Section biopsies were obtained at 2-month post implant placement (6 months post-block grafting). Bone-to-implant contact (BIC) and bone-area fraction (BAF) were histomorphometrically calculated.

RESULTS

The mean BIC was 34.4% and 33.5% for the BL and PR groups, respectively. The mean BAF was 23.9% and 26.4% for the corresponding groups, respectively. Osseointegration and newly formed bone were evident mostly between the threaded portions of the implants in proximity to the host rabbit calvaria compared to its cervical neck.

CONCLUSION

The particulate and the cancellous block h-FDB forms yielded similar BIC and BAF outcome. Full revascularization/revitalization is questioned.

Effect of cavity preparation and bone mineral density on bone-interface densification and bone-implant contact during press-fit implantation of hip stems

Implant loosening and periprosthetic fracture are two major revision causes for uncemented hip stems. The chosen method of cavity preparation could play a key role for both failure mechanisms. The aim of this study was to determine the dependence of the broach type as well as patient bone mineral density (BMD) on densification and contact conditions at the bone-implant interface. Hip stems were implanted into cadaveric femora using compaction, blunt extraction or sharp extraction broaches with computed tomography scans performed prior to broaching, after broaching and after stem implantation. Proximal periprosthetic bone densification as well as press-fit, contact area and stem seating relative to the last broach were determined. Median bone densification was higher with the compaction and blunt extraction broaches compared to sharp extraction broaches (181% and 177%, respectively, p = 0.002). The bone densification of femora prepared with compaction broaching increased with higher BMD (R²  = 0.183, p = 0.037), while stem seating decreased with higher BMD for all broach types (R²  = 0.259, p = 0.001). Incomplete seated prostheses were associated with smaller press-fit and bone-implant contact area (R²  = 0.249, p = 0.001; R²  = 0.287, p < 0.001). Clinical Significance: The results suggest that compaction broaching maximizes bone densification in patients with higher bone density. However, there appears to be an increased risk of insufficient stem seating in high-density bone that could limit the benefits for primary stability. For lower quality bone, the broach type appears to play a lesser role, but care must be taken to limit extensive stem seating which might increase periprosthetic fracture risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1580-1589, 2019.

Influence of mini-screw diameter and loading conditions on static and dynamic assessments of bone-implant contact: An animal study

OBJECTIVES

The goal was to compare static versus dynamic bone-implant interface histology of mini-screws and to evaluate its relation to diameter and load.

SETTING AND SAMPLE POPULATION

Canine animal model.

MATERIAL AND METHODS

Custom-machined, titanium alloy (Ti6AI4V) mini-screws (n = 70) of 1.60, 2.00, 3.00 and 3.75 mm diameter were placed into edentulous sites in five skeletally mature beagle dogs. Using a split-mouth design, no load (NL) was applied to one side while a 2N load (L) was applied by calibrated coil springs on the other side. Intravenous bone labels were administered 21 and 7 days prior to sacrifice. Dogs were euthanized 90 days after screw placement. Bone sections were analysed under bright-field and epifluorescent light. The region of interest was defined as the bone within the threads of the screws. The following parameters were quantified: (a) Static-bone volume/tissue volume (BV/TV %) and bone-implant contact (BIC, %); (b) Dynamic-labelled bone/bone volume (LB/BV, %), and dynamic BIC (DBIC, %).

RESULTS

BV/TV ranged from 71.2% to 85.0% of the screw surface. BIC ranged from 45.7% to 55.4% of the screw surface and was not affected by diameter (P = 0.66). In contrast, the percentage of DBIC did not vary with the applied load (P = 0.41); however, it correlated significantly with the diameter of the screw (P = 0.001).

CONCLUSION

The percentage of DBIC that is actively remodelling increases with increasing diameter of the screw. Dynamic histomorphometry is more sensitive to detecting changes in bone-implant contact when compared to static measurements.

Optimizing a micro-computed tomography-based surrogate measurement of bone-implant contact

Histology and backscatter scanning electron microscopy (bSEM) are the current gold standard methods for quantifying bone-implant contact (BIC), but are inherently destructive. Microcomputed tomography (μCT) is a non-destructive alternative, but attempts to validate μCT-based assessment of BIC in animal models have produced conflicting results. We previously showed in a rat model using a 1.5 mm diameter titanium implant that the extent of the metal-induced artefact precluded accurate measurement of bone sufficiently close to the interface to assess BIC. Recently introduced commercial laboratory μCT scanners have smaller voxels and improved imaging capabilities, possibly overcoming this limitation. The goals of the present study were to establish an approach for optimizing μCT imaging parameters and to validate μCT-based assessment of BIC. In an empirical parametric study using a 1.5 mm diameter titanium implant, we determined 90 kVp, 88 µA, 1.5 μm isotropic voxel size, 1600 projections/180°, and 750 ms integration time to be optimal. Using specimens from an in vivo rat experiment, we found significant correlations between bSEM and μCT for BIC with the manufacturer's automated analysis routine (r = 0.716, p = 0.003) or a line-intercept method (r = 0.797, p = 0.010). Thus, this newer generation scanner's improved imaging capability reduced the extent of the metal-induced artefact zone enough to permit assessment of BIC. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:979-986, 2018.

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Influence of platelet-derived growth factor on osseous remodeling properties of a variable-thread tapered dental implant in vivo

OBJECTIVES

To evaluate the effect of platelet-derived growth factor (rhPDGF-BB) on the promotion of osteogenesis around variable-thread tapered implants in an animal model.

MATERIAL AND METHODS

Twenty-four variable-thread tapered implants were inserted in the tibia of 12 rabbits. Twelve sites received additional rhPDGF-BB released from a presoaked xenogenic bone block that was fixed supracrestally. Primary outcomes were bone-to-implant contact (BIC; in % ± SD) and percentage of medullary bone fill around the implants (PMF; in % ± SD) after 3 weeks (PDGF n = 6, no PDGF n = 6) and 6 weeks (PDGF n = 6, no PDGF n = 6).

RESULTS

Considerable crestal and medullary bone remodeling could be found around all implants. After 3 weeks, both BIC and PMF values were higher in the no PDGF group (BIC: 63% ± 10 with PDGF vs. 85% ± 5 with no PDGF; PMF: 57% ± 10 with PDGF vs. 74% ± 4 with no PDGF). After 6 weeks, the BIC difference between the two groups was less distinct (BIC: 78% ± 17 with PDGF vs. 72% ± 25 with no PDGF), whereas the PDGF group showed higher PMF values (PMF: 77% ± 5 with PDGF vs. 56% ± 10 with no PDGF).

CONCLUSIONS

The addition of rhPDGF-BB decreases early osseous crestal and medullar healing properties around dental implants. In a later phase, an increase in the cortical area as well as an increased medullar bone formation was seen. This response is likely to provide stronger secondary stability and stability in suboptimal situations involving poor-quality bone.

Bone reactions around dental implants subjected to progressive static load: an experimental study in dogs

OBJECTIVE

To evaluate histologically and histomorphometrically, the peri-implant bone reaction around implants subjected to controlled progressive orthodontic loading.

MATERIALS AND METHODS

In three beagle dogs, bilateral edentulous flat alveolar ridges were created in the maxillary area posterior to the canines. After 8 weeks of healing, 24 implants (Biomet 3i) were inserted in the edentulous sites. Two experimental groups were created. Progressive loading group: Twelve implants were left to heal for 8 weeks uncovered, and abutments were adapted and connected by pairs with Ni-Ti orthodontic springs. A gradual static force of 100, 200 and 300 g was applied for a 3-week period each. Thus, a total progressive loading period of 9 weeks was exercised. Unloaded control group: Twelve implants were left to heal undisturbed. At the end of the experimental period, all implants of both groups were removed with the surrounding bone. Histologic and histomorphometric analyses were performed, and the following parameters were measured: bone-to-implant contact, bone density 1 and 2 mm distant to the implant threads and crestal bone resorption. Median regression models are used for statistical analysis.

RESULTS

Implants of the progressive loading group exhibited significantly higher percentage of bone-to-implant contact compared to the unloaded control implants (P = 0.018). Bone density 1 and 2 mm distant to the threads was found to be the same between the two groups (P = 0.734 and P = 0.961, respectively). Crestal bone resorption did not differ between loaded and unloaded implants (P = 0.813).

CONCLUSION

The application of progressive loading by controlled orthodontic force on osseointegrated implants provoked significant increase in the percentage of bone-to-implant contact of the low-density bone of the dog maxilla.

The effect of vitamin D supplementation on bone formation around titanium implants in diabetic rats

BACKGROUND

Diabetes has become the next most widespread disease after cancer. Recent studies have found that diabetes and moderate to severe vitamin D deficiency are associated with reduced bone mineral content; therefore administration of vitamin D may correct these conditions. The purpose of this research is to compare the effect of vitamin D administration on bone to implant contact in diabetic rats with control group.

MATERIALS AND METHODS

In this randomized placebo-controlled trial, 48 Wistar rats were rendered diabetic (130≤ blood sugar ≤200 mg/dl) by IV injection of 35 mg/kg Alloxan. Implants were inserted in tibial bone; Then rats were divided into study and control groups and received oral vitamin D3 (160 IU) or placebo respectively for one week. Bone to implant contact value was measured under light microscope at 3 and 6 weeks.

RESULTS

Analysis of data indicated that vitamin D had no significant effect on bone to implant contact (BIC). At 3 weeks, the control group (n = 5) reported BIC level at 44 ± 19 and study group (n = 7) at 57 ± 20. At 6 weeks, the control group (n = 5) reported BIC level at 70 ± 29, and study group (n = 10) at 65 ± 22. Twenty one samples were missed because of death or incorrect lab processes.

CONCLUSION

It seems that vitamin D supplement has no significant effect on BIC in 130 mg/dL ≤ blood sugar ≤200 mg/dL (P = 0.703) andwas also not time dependent (P = 0.074).