1,720,975 research outputs found
Surgical Strategies in Elderly Implant Patients
No full textThe mean age of candidates for implant surgery as well as dental patients is generally increasing due to the growing life expectancy worldwide. While being older per se is no contraindication for implant therapy, it often implies medical conditions and more medication (polypharmacy). These aspects often reduce the resilience of patients and lead to increased risk of complications after implant surgery.
The present review first describes typical dental and medical conditions of the elderly and their relevance to implant surgery. The main focus is subsequently set on surgical strategies in elderly patients to minimize the related morbidity without compromising the treatment outcome. Whenever possible, a standard implant placement without simultaneous bone grafting is preferred to offer a low-morbidity procedure. The use of short implants as well as narrow diameter implants is important to avoid bone grafting procedures. In addition, the frequency of flapless implant placement using computer-assisted implant surgery (CAIS) has increased considerably over the past 5 years and has become a highly attractive surgical approach in terms of minimal invasiveness
Osseointegration of Zirconia Dental Implants: A Review of Preclincal Data
No full textABSTRACT
Background: Due to its advantageous physical, biological, and esthetic properties as well as its resistance to corrosion, zirconia as a biomaterial to replace missing tooth roots has been the focus of great interest and may become a reliable alternative to titanium implants.
Aim: To present and discuss the preclini- cal data available on osseointegration of zirconia implants placed in the jawbone.
Results: A great number of preclinical studies on zirconia implants with histologic and histomorphometric data are available. Zirconia implants were tested with different implant dimensions and designs, different surface treatments (e.g. machined, sandblasted, acid-etched, alkaline-etched, fusion-sputtered, selective infiltration-etched, powder injection molding, laser-treated, plasma-treated, microgrooved), in different species (i.e., rabbit, monkey, sheep, miniature pig, rat, dog) and different anatomical locations (i.e. tibia, femur, pelvis, maxilla, mandible), under different loading conditions, and with different observation periods (i.e. 1–56 weeks). Taken together, the boneto-implant (BIC) values reported in the literature for zirconia implants placed in the jawbone range from 18% to 89% with many values in the order of 50%–75%. All in all, most preclinical studies and reviews concluded that the BIC values did not reveal statistically significant differences between zirconia and titanium implants. Furthermore, most studies and most reviews come to the conclusion that modified zirconia surfaces have higher BIC values than machined ones.
Conclusions: Most preclinical studies and reviews conclude that zirconia and titanium implants have similar BIC values. Nevertheless, the survival and success rates of zirconia implants documented in clinical studies are dependent on the implant type/system and somewhat inferior to those of titanium implants. More solid, long-term clinical data on zirconia implants are needed and differences between implant systems and surgical procedures need to be evaluated.
Keywords: Zirconia, dental implant, osseointegration, bone-to-implant contac
In Vitro Impact of Conditioned Medium From Demineralized Freeze-Dried Bone on Human Umbilical Endothelial Cells.
No full textAngiogenesis is essential for the consolidation of bone allografts. The underlying molecular mechanism, however, remains unclear. Soluble factors released from demineralized freeze-dried bone target mesenchymal cells; however, their effect on endothelial cells has not been investigated so far. The aim of the present study was therefore to examine the effect of conditioned medium from demineralized freeze-dried bone on human umbilical endothelial cells in vitro. Conditioned medium was first prepared from demineralized freeze-dried bone following 24 hours incubation at room temperature to produce demineralized bone conditioned media. Thereafter, conditioned medium was used to stimulate human umbilical vein endothelial cells in vitro by determining the cell response based on viability, proliferation, expression of apoptotic genes, a Boyden chamber to determine cell migration, and the formation of branches. The authors report here that conditioned medium decreased viability and proliferation of endothelial cells. Neither of the apoptotic marker genes was significantly altered when endothelial cells were exposed to conditioned medium. The Boyden chamber revealed that endothelial cells migrate toward conditioned medium. Moreover, conditioned medium moderately stimulated the formation of branches. These findings support the concept that conditioned medium from demineralized freeze-dried bone targets endothelial cells by decreasing their proliferation and enhancing their motility under these in vitro conditions
Der CO2-Laser in der Stomatologie. Teil 2
No full textThe second part of this review presents and discusses evidence in the recent literature for the application of the CO2 laser for the therapy of stomatologic lesions. Clinical outcomes and complications for the use of the CO2 laser are presented for the following stomatological conditions: leukoplakia, lichen planus, benign soft-tissue and salivary gland tumors, reactive soft tissue changes (i.e., fibroepithelial polyps), recurrent aphthous stomatitis, drug-induced gingival hyperplasia, mucous extravasation and mucous retention cysts, herpes simplex virus-induced lesions, maxillary midline frenum, and ankyloglossia (tongue-tie). This review outlines indications in which the CO2 laser is the treatment method of choice and in which situations the laser has still to be applied with caution.Im zweiten Teil der vorliegenden Übersichtsarbeit wird der Einsatz des CO2-Lasers bei stomatologischen Läsionen anhand der aktuellen Literatur besprochen und dargelegt, wo sich dieser als Therapiemittel eignet und bei welchen Veränderungen seine Anwendung
weiterhin kritisch betrachtet werden sollte. Im Speziellen wird dabei auf die klinischen Resultate und allfälligen Komplikationen des Lasereinsatzes bei der oralen Leukoplakie, dem oralen Lichen planus (OLP), benignen Weichgewebeund Speicheldrüsentumoren,
reizbedingten Gewebemehrbildungen, rezidivierenden aphthösen Läsionen, medikamentös bedingten Gingivahyperplasien, Speichelretentions- und Extravasationszysten, Herpes-simplex-Virus (HSV)-Läsionen sowie Lippen- und Zungenbändchen eingegangen
Der CO2-Laser in der Stomatologie. Teil 1
No full textSince its development in the early 60s of the last century, the CO2 laser has been rapidly introduced into medical research and almost every surgical specialty in medicine and dentistry. In dental surgery it is mainly used for oral soft tissue applications. For the treatment of some stomatologic lesions the CO2 laser is looked upon as the treatment method of choice, while for other lesions the evidence for its use is still not sufficient. The first part of this review discusses the typical aspects of wound healing in oral soft tissues following the application of a CO2 laser and will focus on histopathological issues of biopsies taken with a CO2 laser as compared to conventionally performed biopsies. The second part will review indications for the use of the CO2 laser for the therapy of stomatologic lesions.Seit seiner Entwicklung in den 60er Jahren des letzten Jahrhunderts hielt der CO2-Laser schnell Einzug in die medizinische Forschung und fast alle operativen Gebiete der Medizin und der Zahnmedizin. In der zahnärztlichen Chirurgie wird er heutzutage vor allem zur Bearbeitung der oralen Weichgewebe eingesetzt. In der Behandlung von Mundschleimhauterkrankungen gilt der CO2-Laser bei bestimmten Läsionen mittlerweile als Therapie der Wahl, bei anderen wird sein Einsatz weiterhin eher kritisch bewertet. Im vorliegenden ersten Teil einer zweiteiligen Übersichtsarbeit soll zunächst auf die Eigenarten der Wundheilung der Mundschleimhaut nach CO2-Laser-Gebrauch im Vergleich zur Skalpellanwendung und auf die histopathologische Beurteilbarkeit von mit dem CO2-Laser entnommenen Biopsien anhand aktueller Literatur eingegangen werden. Im zweiten Teil werden dann die einzelnen Indikationen zum CO2-Laser-Einsatz in der Stomatologie eingehend besprochen
Early Implant Placement Following Single Tooth Extraction in the Esthetic Zone with Contour Augmentation - Selection Criteria, Surgical Procesures and Long-Term Results
No full textImplant placement post single tooth extraction in the esthetic zone is an important and frequent indication for implant therapy. Today, the clinician can choose from four different treatment approcaches for the timing of implant placement. The decision for the most appropriate treatment plan should be based on a thorough clinical and radiographic examination and well-defined selection criteria. Early implant placement after soft tissue healing is one of the treatment options available. This approach is applied by our team in the case of a thin bone wall phenotype (<1mm) or a missing facial bone wall at the extraction site, and sufficient bone volume available in the palato-apical area to allow good primary stability of the implant. The surgical procedures include a flapless thooth extraction, a 4-to-8 week soft tissue healing period, implant placement in the in the correct 3-dimensional position, a simultaneaous contour agmentation on the facial aspect with the GBR technique using a 2-layer composite graft with locally harvested aoutologous bone chips and a low-substitution bone filler, application of a double-layer collagen membran, and a tension-free primary wound closure. Following 8 weeks of healing, the implant site is reopened with a punch technique, and the implant can be resored with a screw-retained single crown. The rationale for this surgical approach is presented including inclusion criteria, surgical procedures, case reports and long-term documentation
Modern implant dentistry based on osseointegration : 50 years of progress, current trends and open questions
No full textIn the 1960s and 1970s, implant-supported prostheses based on subperiosteal or blade implants had a poor reputation because of questionable clinical outcomes and lack of scientific documentation. The change to a scientifically sound discipline was initiated by the two scientific pioneers of modern implant dentistry, Professor P. I. Brånemark from the University of Gothenburg in Sweden and Professor André Schroeder from the University of Bern in Switzerland. Together with their teams, and independently of each other, they laid the foundation for the most significant development and paradigm shift in dental medicine. The present volume of Periodontology 2000 celebrates 50 years of osseointegration. It reviews the progress of implant therapy over the past 50 years, including the basics of implant surgery required to achieve osseointegration on a predictable basis and evolving innovations. The development of bone-augmentation techniques, such as guided bone regeneration and sinus floor elevation, to correct local bone defects at potential implant sites has increased the indications for implant therapy. The paradigm shift to moderately rough implant surfaces resulted in faster and enhanced bone integration and led to improvements in various treatment protocols, such as immediate and early implant placement in postextraction sites, and made various loading protocols possible, including immediate and early implant loading. In the past 15 years, preoperative analysis and presurgical planning improved as a result of the introduction of three-dimensional imaging techniques. Hereby, cone-beam computed tomography offers better image quality with reduced radiation exposure, when compared with dental computed tomography. This opened the door for digital planning and surgical modifications. Over the last 50 years this evolution has facilitated tremendous progress in esthetic outcomes with implant-supported prostheses and improved patient-centered outcomes. This volume of Periodontology 2000 also discusses the current trends and open questions of implant dentistry, such as the potential of digital implant dentistry in the surgical and prosthetic field, the trend for an increasing average age of implant patients and the related adaptations of treatment protocols, and the second attempt to establish ceramic implants using, this time, zirconia as the implant material. Finally, some of the hottest controversies are discussed, such as recent suggestions on bone integration being a potential foreign-body reaction and the evidence-based appraisal of the peri-implantitis debate
Implants for elderly patients.
No full textIn the developed world, the large birth cohorts of the so-called baby boomer generation have arrived in medical and dental practices. Often, elderly patients are 'young-old' baby boomers in whom partial edentulism is the predominant indication for implant therapy. However, the generation 85+ years of age represents a new challenge for the dental profession, as their lives are frequently dominated by dependency, multimorbidity and frailty. In geriatric implant dentistry, treatment planning is highly individualized, as interindividual differences become more pronounced with age. Nevertheless, there are four typical indications for implant therapy: (i) avoidance of removable partial prostheses; (ii) preservation of existing removable partial prostheses; (iii) stabilization of Kennedy Class I removable partial prostheses; and (iv) stabilization of complete prostheses. From a surgical point of view, two very important aspects must be considered when planning implant surgery in elderly patients: first, the consistent strive to minimize morbidity; and, second, the fact that coexisting medical risk factors are significantly more common in elderly patients. Modern three-dimensional cone beam computed tomography imaging is often indicated in order to plan minimally invasive implant surgery. Computer-assisted implant surgery might allow flapless implant surgery, which offers a low level of postoperative morbidity and a minimal risk of postsurgical bleeding. Short and reduced-diameter implants are now utilized much more often than a decade ago. Two-stage surgical procedures should be avoided in elderly patients. Implant restorations for elderly patients should be designed so that they can be modified to become low-maintenance prostheses, or even be removed, as a strategy to facilitate oral hygiene and comfort in the final stage of life
- …
